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SIGNpost 00695

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *

Post00695 Nigeria Tanzania + Course + Job + Abstracts + News  24 April 2013

CONTENTS
1. Assessment of Injection Safety in Selected Local Government Areas in
Five States in Nigeria: 2012 Follow-up Report
2. Safe injections require Excellence in “Stock Management of Medicines and
Supplies”
3. Abstract: Improving waste segregation while reducing costs in a
tertiary-care hospital in a lower-middle-income country in Central
America
4. Abstract: Knowledge, attitude and practice of hospital staff management
5. Abstract: Knowledge and Attitudes of Health Care Workers from the
Primary Health Centre in Indija, Serbia on Professional Exposures to
Blood-borne Infections
6. Abstract: The hidden epidemic of hepatitis C virus infection in the
United States: occult transmission and burden of disease
7. Abstract: Scale-up of a comprehensive harm reduction programme for
people injecting opioids: lessons from north-eastern India
8. Abstract: High coverage needle/syringe programs for people who inject
drugs in low and middle income countries: a systematic review
9. Abstract: A connectivity model for assessment of HIV transmission risk
in injection drug users (IDUs)
10. Abstract: Mujer Mas Segura (Safer Women): a combination prevention
intervention to reduce sexual and injection risks among female sex
workers who inject drugs
11. Abstract: Efficacy and safety over 26 weeks of an oral treatment
strategy including sitagliptin compared with an injectable treatment
strategy with liraglutide in patients with type 2 diabetes mellitus
inadequately controlled on metformin: a randomised clinical trial
12. Abstract: Chinese medicine injection shuanghuanglian for treatment of
acute upper respiratory tract infection: a systematic review of
randomized controlled trials
13. Abstract: Hand hygiene practices and resources in a teaching hospital
in Ghana
14. Abstract: The Feedback Intervention Trial (FIT)–improving hand-hygiene
compliance in UK healthcare workers: a stepped wedge cluster randomised
controlled trial
15. Abstract: Efficacy and safety of a single intra-articular injection of
2% hyaluronic acid plus mannitol in knee osteoarthritis over a 6-month
period
16. Abstract: Safety and Efficacy Findings from a Non-interventional Study
of a New Hyaluronic Acid/Sorbitol Formulation (GO-ON® Matrix) for
Intra-articular Injection to Relieve Pain and Disability in
Osteoarthritis Patients
17. Abstract: Autologous fat grafting and injectable dermal fillers for
human immunodeficiency virus-associated facial lipodystrophy: a
comparison of safety, efficacy, and long-term treatment outcomes
18. No Abstract: Immunosuppressive biological mechanisms support
reassessment of use of the injectable contraceptive medroxyprogesterone
acetate
19. Stanford Online Course Starts 29 April: Mobile Health Without Borders
20. WHO Vacancy Notice: Regional Advisor, Essential Medicines and
Pharmaceutical Policies, Brazzaville, Congo
21. News
– USA: Another Compounding Company Recalls All Sterile Product
– In Tanzania, Iramba Health Supply Chain Goes from Failing to Model
System
– Oklahoma USA: 60 Hepatitis Cases Confirmed Among Tulsa Dentist’s
Patients
– USA: Dozens of Oklahoma Dentist’s Patients Test Positive for Hepatitis
– Global: Major price cut for five-in-one vaccine
– Nevada USA: Nev Jury Orders HMO to Pay $500M in Hepatitis Case
– Arizona USA: Testing advised for patients of defunct clinic

The web edition of SIGNpost is online at:
http://signpostonline.info/archives/1442

More information follows at the end of this SIGNpost!

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__________________________________________________________________
________________________________*_________________________________

1. Assessment of Injection Safety in Selected Local Government Areas in
Five States in Nigeria: 2012 Follow-up Report

The executive summary, table of contents and download links follow.
__________________________________________________________________
Assessment of Injection Safety in Selected Local Government Areas in Five
States in Nigeria: 2012 Follow-up Report

Continuing work from the Making Medical Injections Safer project,
USAID/Nigeria asked AIDSTAR-One to provide injection safety technical
assistance to the government of Nigeria and PEPFAR implementing partners.

AIDSTAR-One conducted this follow-up assessment of injection safety in five
USAID priority states: Bauchi, Benue, Cross River, Lagos, and Sokoto. Using
an adaptation of the Revised Injection Safety Assessment Tool (Tool C-
Revised) developed by the World Health Organization, AIDSTAR-One’s
assessment covered all injection and blood-drawing procedures in 80 public
sector health care settings and laboratories.

Findings from this study will be used to set priorities for project
interventions in public sector health care settings and laboratories across
the five states.

Access this report on the AIDSTAR-One website at:
http://tinyurl.com/ckv4v85

http://aidstarone.com/focus_areas/prevention/resources/reports/injection_sa
fety_assessment_nigeria_followup

Download the Assessment of Injection Safety in Selected Local Government
Areas in Five States in Nigeria: 2012 Follow-up Report (PDF, 1.4 MB)
http://tinyurl.com/c8tnbry
__________________________________________________________________
EXECUTIVE SUMMARY

This follow-up assessment of injection safety in Nigeria was conducted in
five states designated as priorities by the U.S. Agency for International
Development (USAID): Bauchi, Benue, Cross River, Lagos, and Sokoto. The
assessment used an adaptation of the Revised Injection Safety Assessment
Tool (Tool C-Revised) developed by the World Health Organization and
covered all injection and blood drawing procedures in 80 public sector
health care settings and laboratories.

Between baseline and follow-up, AIDSTAR-One Nigeria organized advocacy
visits to policy makers at all levels, organized a training of trainers at
the state level, as well as facility based trainings of different cadres of
healthcare workers and waste handlers. AIDSTAR-One Nigeria also provided
seed stock of safe injection commodities to health facilities on completion
of trainings. Supportive supervision then followed with state desk
officers, and any challenges that arose were discussed with management for
continuous quality improvement.

The assessment, which entailed interviews, observations, and stock
assessments in 21 hospitals and 59 lower-level facilities where AIDSTAR-One
is working, found significant improvements in injection safety practices at
follow-up, however, some challenges still remain.

RISKS TO THE PATIENT
At baseline, loose used sharps waste was identified as a major risk. Though
a statistically significant increase in the number of facilities with
properly contained infectious waste (non-sharps) was observed at follow-up,
disposal of used sharps continues to be a challenge. Statistically
significant increases in health facilities with running water and soap for
washing hands, as well as facilities with alcohol-based hand sanitizer for
cleansing hands, were observed, however, the overall proportions of
available hand washing options were still low. After the intervention, the
majority of the injections were prepared on a clean work table or tray, a
statistically significant increase compared to baseline; however, there was
no change in the proportion of intravenous procedures that were prepared on
work table or trays with proper hygienic conditions. Across all types of
injection equipment, fewer stockouts were reported at follow-up compared to
baseline. However, nearly half of facilities did not have a procedure in
place for placing emergency orders for injection devices when stockouts do
occur.

RISKS TO THE PROVIDER
At follow-up, most facilities had both injection safety and waste
management policies in place, and a majority was able to show copies of the
policy and guidelines. This was a statistically significant improvement
from baseline.

Statistically significant increases were seen in the number of health care
facilities with at least one puncture-resistant and leakproof sharps
container in all areas where injections and intravenous procedures are
performed as well as the number of health care facilities with one or more
punctureresistant sharps container “in stock.” Compared to baseline,
significantly more injection providers at viii follow-up used a barrier to
protect their fingers when breaking glass ampoules; however, a majority
still did not.

The results at follow-up show more providers use best practices for
recapping compared to results from baseline. At follow-up, the majority of
providers did not re-cap1 syringes prior to disposal, which reduces their
risk of exposure to blood-borne pathogens, and the difference compared to
baseline was found to be significant. Very few providers (4.3 percent)
reported experiencing accidental needle-stick injuries in the six months
before the follow-up survey.

However, despite the constant risk of possible injury, only 14.6 percent of
providers reported that guidelines for post-exposure prophylaxis (PEP) were
available. And similar to baseline, one third of providers mentioned that
PEP was provided for high-risk exposures. Hepatitis B vaccination did not
improve compared to baseline, with still only half of the providers
receiving the complete course of three or more doses. However, a majority
of injection providers received training on injection safety in the two
years prior to the follow-up survey, and communications materials such as
job aids were posted in almost all facilities at follow-up, both
significant increases from baseline.

RISKS TO THE WASTE HANDLER
A significantly higher proportion of waste handlers were trained on safer
ways of handling and disposing of waste at follow-up. Nearly all waste
handlers reported that at least one type of equipment was available to
protect them from injuries at their workplace; the most common personal
protective equipment available was goggles, heavy-duty gloves, latex gloves
(which do not offer much protection), and aprons. Needle-stick injuries
were rare among waste handlers (3.8 percent), a statistically significant
improvement. However, although waste handlers face constant risk of
exposure to blood-borne pathogens, less than half of all waste handlers
were vaccinated against hepatitis B, and only 32 percent received the full
course of three or more doses.

RISKS TO THE COMMUNITY
Better waste management practices at facilities were observed at follow-up
compared to baseline. A statistically significant increase in health
facilities, in which there were no sharps in an open container in any area
of the facility, was observed; however, few facilities made sure that full
containers awaiting final destruction were fully closed and stored in a
locked area away from public access. One-third of facilities also had used
sharps lying around on their grounds, where community members could easily
come into contact with them.

This study provides follow-up results for injection safety interventions in
new local government areas in five states where project activities were not
previously implemented prior to baseline. These results will be used by the
Federal Ministry of Health, the five states and focal local government
areas, and the

AIDSTAR-One project as evaluation materials to gauge the effectiveness of
project interventions.

The primary recommendations are as follows:
• The Federal Ministry of Health should ensure that sufficient quantities
of national guidelines and other essential policy documents are available
in all health facilities.
• Proper personal protective equipment and job aids should be made
available, and PEP should be routinely provided in the event of accidental
needle-sticks.
• All facilities should continue supportive monitoring of procedures for
sharps waste management.
• Advocacy for the safety of health workers, including waste handlers,
should be continued through the newly drafted infection prevention and
control (IPC) Policy.
• The national and healthcare worker (HCW) hand washing promotion campaign
should be encouraged.
• Government at all levels and hospital management should ensure continuous
supplies of safe injection commodities to promote best practices.
• Continuous injection safety education should be institutionalized to
ensure training and retraining as necessary.

Specific sub-recommendations pertaining to particular elements of injection
procedures are includedin the full document.

Note (1) The practice of replacing a protective sheath on a needle. Two-
handed re-capping increases the risk of needle-stick injuries and is not
recommended. However, where such action is unavoidable, the one-hand scoop
technique is an acceptable alternative in phlebotomy
practices.
__________________________________________________________________
CONTENTS

Acronyms v
Executive Summary vii
Risks to the Patient vii
Risks to the Provider vii
Risks to the Waste Handler viii
Risks to the Community viii
Introduction 1
Results 9
Conclusion 51
Recommendations 55
References 59
Appendix 1: Proposed and Actual Sampling of the Facilities 61
Appendix 2: AIDSTAR-One 2011 Baseline Health Facility List 63
Appendix 3: List of Replacement Facilities Used in the Survey 67
Appendix 4: World Health Organization Tool C Revised 69
__________________________________________________________________
________________________________*_________________________________

2. Safe injections require Excellence in “Stock Management of Medicines and
Supplies”

A story of change form Tanzania..

Many SIGNpost readers are familiar with the classic photo of 34 needles and
4 syringes in a pot of water from Tanzania in 2000. The photo is the cover
photo at http://facebook.com/SIGN.Moderator
__________________________________________________________________
Anne Marie Hvid <anne_marie_hvid@jsi.com>
Apr 20 (4 days ago)

In 2009, key staff at Tanzania’s Ministry of Health and Social Welfare
(MOHSW) and Medical Stores Department (MSD) declared the council health
management team (CHMT) of the Iramba district to be one of the poorest
performing teams in the country in the stock management of medicines and
supplies. Today, Iramba has been named a center of excellence for health
commodity management by the USAID | DELIVER PROJECT and the Supply Chain
Management System project.

Read the full story: http://j.mp/13mKApS

Anne Marie Hvid, PMP

Knowledge Management Advisor

USAID | DELIVER PROJECT
John Snow, Inc.

1616 Fort Myer Drive, 15th floor
Arlington, VA 22209 USA
Phone: +1.703.310.5256

email: ahvid@jsi.com
http://deliver.jsi.com/
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Improving waste segregation while reducing costs in a
tertiary-care hospital in a lower-middle-income country in Central
America
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23592758

Waste Manag Res. 2013 Apr 16.

Improving waste segregation while reducing costs in a tertiary-care
hospital in a lower-middle-income country in Central America.

Johnson KM, Gonzalez ML, Dueñas L, Gamero M, Relyea G, Luque LE, Caniza MA.

Department of Infectious Diseases, St. Jude Children’s Research Hospital,
Memphis, USA.

Healthcare waste (HCW) management and segregation are essential to ensure
safety, environmental protection and cost control. Poor HCW management
increase risks and costs for healthcare institutions. On-going surveillance
and training are important to maintain good HCW practices. Our objectives
were to evaluate and improve HCW practices at Hospital Bloom, San Salvador,
El Salvador.

We studied HCW disposal practices by observing waste containers, re-
segregating waste placed in biohazardous waste bags, and administering a
seven-itemsknowledge survey before and after training in waste management
at Hospital Bloom. The training was based on national and international
standards.

We followed total biohazardous waste production before and after the
training.

The hospital staff was knowledgeable about waste segregation practices, but
had poor compliance with national policies. Re-segregating waste in
biohazardous waste bags showed that 61% of this waste was common waste,
suggesting that the staff was possibly unaware of the cost of mis-
segregating healthcare waste. After staff training in HCW management, the
correct responses increased by 44% and biohazardous waste disposal at the
hospital reduced by 48%.

Better segregation of biohazardous waste and important savings can be
obtained by HCW management education of hospital staff. Hospitals can
benefit from maximising the use of available resources by sustaining best
practices of HCW, especially those in hospitals in lower-middle-income
countries.
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Knowledge, attitude and practice of hospital staff management
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23585502

Waste Manag Res. 2013 Apr 18.

Knowledge, attitude and practice of hospital staff management.

Lakbala P, Lakbala M.

Medical Record & Health Information Technology, Hormozgan University of
Medical Science, Bandar Abbas, Iran.

The proper handling and disposal of biomedical waste (BMW) is very
imperative. There is a defined set of rules for handling BMW worldwide.
Unfortunately, laxity and lack of adequate training and awareness in the
execution of these rules leads to staid health and environment
apprehension.

The objective of the study was to assess the knowledge and attitude of
hospital staff to BMW management. The cross-sectional study was conducted
on 261 healthcare workers from 9 hospitals, which were randomized from 32
hospitals.

The most important finding was a significant (P < 0.05) relationship
between the level of education attainments and training in BMW management.
Twenty-nine (19.9%) members of government hospital staff and 37 (32.2%)
members of staff from the private sector agreed that BMW management is not
just the government’s responsibility, but one that every member of
personnel should share.

This finding will help to address the issue more appropriately, and plan
for better training programs and monitoring of BMW management systems in
hospitals.
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Knowledge and Attitudes of Health Care Workers from the
Primary Health Centre in Indija, Serbia on Professional Exposures to
Blood-borne Infections
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23585167

Arh Hig Rada Toksikol. 2013 Mar 1;64(1):145-51.

Knowledge and Attitudes of Health Care Workers from the Primary Health
Centre in Indija, Serbia on Professional Exposures to Blood-borne
Infections.

Gajic Z, Rajcevic S, Duric P, Ilic S, Dugandžija T.

Exposure to blood-borne infections (HIV, hepatitis B, hepatitis C) poses a
serious risk to health care workers (HCWs). The aim of this cross-sectional
study was to determine the level of knowledge and attitudes on occupational
exposure in primary health care.

In 2009, a total of 100 health care workers from the Primary Health Care
Centre in Indija, Autonomous Province of Vojvodina, Serbia were included in
the study.

The results suggested that the health care workers who participated in the
survey possess basic knowledge about blood-borne virus transmission routes.

Most incorrect answers were related to the transmission of blood-borne
viruses by tears, saliva, urine and stool. This study also demonstrated
that health workers tend to unrealistically estimate the risk of HIV
infections.

As for the level of education about the prevention and control of blood-
borne infections, 49 % of the participants had never had any education on
this topic, while 22 % had been educated during the last five years.

Around 75 % consider education on blood-borne infection and protective
measures at work unnecessary.
__________________________________________________________________
________________________________*_________________________________

6. Abstract: The hidden epidemic of hepatitis C virus infection in the
United States: occult transmission and burden of disease
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23596274

Top Antivir Med. 2013 Feb-Mar;21(1):15-9.

The hidden epidemic of hepatitis C virus infection in the United States:
occult transmission and burden of disease.

Ward JW.

Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Society faces an immense burden of hepatitis C virus (HCV) infection-
related morbidity and mortality. Transmission of HCV is ongoing, and the
incidence of HCV infection has been increasing in recent years. New
therapies for treating HCV infection hold considerable promise for
increasing cure rates and thus reducing HCV transmission. However, many
persons with HCV infection in the United States are unaware of their
infection status.

The Centers for Disease Control and Prevention (CDC) recently expanded its
HCV testing recommendations to include 1-time HCV testing for individuals
born between 1945 and 1965, a population with a 3% prevalence of infection.
Linkage to care and treatment for those identified with infection through
testing would have a profound impact in reducing HCV disease burden.

Coordinated efforts by public health agencies, clinical care providers,
laboratories, and payers are necessary to improve primary and secondary
prevention of HCV disease.

This article summarizes a presentation by John W. Ward, MD, at the IAS-USA
live continuing medical education program held in Atlanta, Georgia, in
October 2012.

Free full text http://www.iasusa.org/sites/default/files/tam/21-1-15.pdf
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Scale-up of a comprehensive harm reduction programme for
people injecting opioids: lessons from north-eastern India
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23599555

Bull World Health Organ. 2013 Apr 1;91(4):306-12.

Scale-up of a comprehensive harm reduction programme for people injecting
opioids: lessons from north-eastern India.

Lalmuanpuii M, Biangtung L, Mishra RK, Reeve MJ, Tzudier S, Singh AL,
Sinate R, Sgaier SK.

Project ORCHID, Emmanuel Hospital Association, Guwahati, India .

PROBLEM: Harm reduction packages for people who inject illicit drugs,
including those infected with human immunodeficiency virus (HIV), are cost-
effective but have not been scaled up globally. In the north-eastern Indian
states of Manipur and Nagaland, the epidemic of HIV infection is driven by
the injection of illicit drugs, especially opioids. These states needed to
scale up harm reduction programmes but faced difficulty doing so.

APPROACH: In 2004, the Bill & Melinda Gates Foundation funded Project
ORCHID to scale up a harm reduction programme in Manipur and Nagaland.

LOCAL SETTING: In 2003, an estimated 10?000 and 16?000 people were
injecting drugs in Manipur and Nagaland, respectively. The prevalence of
HIV infection among people injecting drugs was 24.5% in Manipur and 8.4% in
Nagaland.

RELEVANT CHANGES: By 2012, the harm reduction programme had been scaled up
to an average of 9011 monthly contacts outside clinics (80% of target); an
average of 1709 monthly clinic visits (15% of target, well above the 5%
monthly goal) and an average monthly distribution of needles and syringes
of 16 each per programme participant. Opioid agonist maintenance treatment
coverage was 13.7% and retention 6 months after enrolment was 63%.
Antiretroviral treatment coverage for HIV-positive participants was 81%.

LESSONS LEARNT: A harm reduction model consisting of community-owned,
locally relevant innovations and business approaches can result in good
harm reduction programme scale-up and influence harm reduction policy.
Project ORCHID has influenced national harm reduction policy in India and
contributed to the development of harm reduction guidelines.

Free full text http://www.who.int/bulletin/volumes/91/4/12-108274.pdf
__________________________________________________________________
________________________________*_________________________________

8. Abstract: High coverage needle/syringe programs for people who inject
drugs in low and middle income countries: a systematic review
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23332005

BMC Public Health. 2013 Jan 19;13:53.

High coverage needle/syringe programs for people who inject drugs in low
and middle income countries: a systematic review.

Des Jarlais DC, Feelemyer JP, Modi SN, Abdul-Quader A, Hagan H.

The Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel
Medical Center, New York City, USA. ddesjarlais@chpnet.org

BACKGROUND: Persons who inject drugs (PWID) are at an elevated risk for
human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection.
In many high-income countries, needle and syringe exchange programs (NSP)
have been associated with reductions in blood-borne infections. However, we
do not have a good understanding of the effectiveness of NSP in low/middle-
income and transitional-economy countries.

METHODS: A systematic literature review based on PRISMA guidelines was
utilized to collect primary study data on coverage of NSP programs and
changes in HIV and HCV infection over time among PWID in low-and middle-
income and transitional countries (LMICs). Included studies reported
laboratory measures of either HIV or HCV and at least 50% coverage of the
local injecting population (through direct use or through secondary
exchange). We also included national reports on newly reported HIV cases
for countries that had national level data for PWID in conjunction with NSP
scale-up and implementation.

RESULTS: Studies of 11 NSPs with high-coverage from Bangladesh, Brazil,
China, Estonia, Iran, Lithuania, Taiwan, Thailand and Vietnam were included
in the review. In five studies HIV prevalence decreased (range -3% to -15%)
and in three studies HCV prevalence decreased (range -4.2% to -10.2%). In
two studies HIV prevalence increased (range +5.6% to +14.8%). HCV incidence
remained stable in one study. Of the four national reports of newly
reported HIV cases, three reported decreases during NSP expansion, ranging
from -30% to -93.3%, while one national report documented an increase in
cases (+37.6%). Estimated incidence among new injectors decreased in three
studies, with reductions ranging from -11/100 person years at risk to
-16/100 person years at risk.

CONCLUSIONS: While not fully consistent, the data generally support the
effectiveness of NSP in reducing HIV and HCV infection in low/middle-income
and transitional-economy countries. If high coverage is achieved, NSP
appear to be as effective in LMICs as in high-income countries. Additional
monitoring and evaluation research is needed for NSPs where reductions in
HIV/HCV infection among PWID are not occurring in order to identify and
correct contributing problems.

Free Article http://www.biomedcentral.com/1471-2458/13/53
__________________________________________________________________
________________________________*_________________________________

9. Abstract: A connectivity model for assessment of HIV transmission risk
in injection drug users (IDUs)
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23584136

Eval Program Plann. 2013 Mar 18;39C:23-27.

A connectivity model for assessment of HIV transmission risk in injection
drug users (IDUs).

Flaer PJ, Cistone PJ, Younis MZ, Parkash J.

Diagnosis and Treatment Planning Section, AEGD Residency Program of
“Community Smiles”, Dade County Dental Research Clinic, Miami, FL, USA.

The purpose of this study was to produce models composed of mapping of
connectivity networks of HIV transmission risk in injection drug users
(IDUs).

This methodology provided a novel approach and diagnostic tool for
understanding HIV infection transmission risk and drug use in the typical
niche of IDUs, i.e., a “shooting gallery” (a gathering site for injection
drug activity). Furthermore, component IDUs may have memberships in
multiple “shooting galleries” revealing subsequent interconnectivities.

Charting of IDU connectivity diagrams illustrated the relationships of
peripheral sites to the critical central core of high HIV transmission
risk. Members of this highly interlinked and infectious central core of
IDUs had high HIV transmission risk and severe drug use-producing high
morbidity and mortality that resulted in great public health concern. In
addition, connectivity diagrams reveal very high HIV transmission risk in
component IDUs in “dual memberships”, i.e., membership in more than one
central core (with the highest number of partners). Therefore, IDUs with
“dual memberships” were the most infectious members of the “shooting
gallery”.

In summation, network mapping of HIV transmission risk in IDUs allows for
subsequent socio-behavioral analysis and the development of focused
individual and programmatic interventions.

Copyright © 2013 Elsevier Ltd. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Mujer Mas Segura (Safer Women): a combination prevention
intervention to reduce sexual and injection risks among female sex
workers who inject drugs
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22891807

BMC Public Health. 2012 Aug 14;12:653.

Mujer Mas Segura (Safer Women): a combination prevention intervention to
reduce sexual and injection risks among female sex workers who inject
drugs.

Vera A, Abramovitz D, Lozada R, Martinez G, Rangel MG, Staines H, Patterson
TL, Strathdee SA.

Department of Medicine, University of California, San Diego, 9500 Gilman
Drive # 0507, La Jolla, CA 92093-0507, USA.

BACKGROUND: Female sex workers who inject drugs (FSW-IDUs) are at risk of
acquiring HIV, sexually transmitted infections (STI) and blood-borne
infections through unprotected sex and sharing injection equipment. We
conducted a 2×2 factorial randomized controlled trial to evaluate
combination interventions to simultaneously reduce sexual and injection
risks among FSW-IDUs in Tijuana and Ciudad Juarez, Mexico.

METHODS/DESIGN: FSW-IDUs =18 years reporting sharing injection equipment
and unprotected sex with clients within the last month were randomized to
one of four conditions based on an a priori randomization schedule,
blinding interviewer/counselors to assignment. Due to the extreme
vulnerability of this population, we did not include a control group that
would deny some women access to preventive information. All women received
similar information regardless of group allocation; the difference was in
the way the information was delivered and the extent to which women had an
interactive role. Each condition was a single 60-minute session, including
either an interactive or didactic version of an injection risk intervention
and sexual risk intervention. Women underwent interviewer-administered
surveys and testing for HIV, syphilis, gonorrhea, Chlamydia, and
Trichomonas at baseline and quarterly for 12 months.

Combined HIV/STI incidence will be the primary outcome. Secondary outcomes
are proportionate reductions in sharing of injection equipment and
unprotected sex with clients.

DISCUSSION: Of 1,132 women, 548 (48.4%) were excluded (88.9% were
ineligible; 11.1% refused to participate or did not return); 584 eligible
women enrolled (284 in Tijuana; 300 in Ciudad Juarez). All 584 participants
completed the baseline interview, provided biological samples and were
randomized to one of the four groups. During follow-up, 17 participants
(2.9%) were lost to follow-up, of whom 10 (58.8%) had died, leaving 567
participants for analysis.

This study appears to be the first intervention to attempt to
simultaneously reduce injection and sexual risk behaviors among FSW-IDUs.

The factorial design will permit analysis to determine whether the
combination of the two interactive interventions and/or its respective
components are effective in reducing injection and/or sexual risks, which
will have direct, tangible policy implications for Mexico and potentially
other resource-poor countries.

TRIAL REGISTRATION: NCT00840658.

Free PMC Article
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3490986/
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Efficacy and safety over 26 weeks of an oral treatment
strategy including sitagliptin compared with an injectable treatment
strategy with liraglutide in patients with type 2 diabetes mellitus
inadequately controlled on metformin: a randomised clinical trial
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23604551

Diabetologia. 2013 Apr 19.

Efficacy and safety over 26 weeks of an oral treatment strategy including
sitagliptin compared with an injectable treatment strategy with liraglutide
in patients with type 2 diabetes mellitus inadequately controlled on
metformin: a randomised clinical trial.

Charbonnel B, Steinberg H, Eymard E, Xu L, Thakkar P, Prabhu V, Davies MJ,
Engel SS.

University of Nantes, Nantes, France.

AIMS/HYPOTHESIS: The aim of this work was to compare treatment
intensification strategies based on orally administered vs injectable
incretin-based antihyperglycaemic agents in patients with type 2 diabetes
mellitus on metformin monotherapy.

METHODS: In a 26 week, open-label study, 653 patients (baseline
HbA1c?=?8.2% [66 mmol/mol]) were randomised at 111 sites in 21 countries in
a 1:1 ratio to a strategy using oral agents (starting with sitagliptin 100
mg/day) or a strategy using the injectable drug liraglutide starting at a
dose of 0.6 mg/day, up-titrated to 1.2 mg/day after 1 week. The following
patients with type 2 diabetes mellitus were recruited for the study: those
aged 18-79 years, on a stable dose of metformin monotherapy =1,500 mg/day
for =12 weeks, with an HbA1c =7.0% (53 mmol/mol) and =11.0% (97 mmol/mol)
and a fasting fingerstick glucose (FFG) <15 mmol/l (<270 mg/dl) at the
randomisation visit, deemed capable by the investigator of using a Victoza
pen injection device (containing 6 mg/ml liraglutide; Novo Nordisk,
Bagsværd, Denmark). Women taking part in the study agreed to remain
abstinent or use an acceptable method of birth control during the study.
Randomisation was performed via a computer-generated allocation schedule
using an interactive voice response system. After 12 weeks, patients on
sitagliptin with HbA1c ?=?7.0% (53 mmol/mol) and fasting glucose >6.1
mmol/l had their treatment intensified with glimepiride; patients on
liraglutide with HbA1c ?=?7.0% (53 mmol/mol) had the dose up-titrated to
1.8 mg/day. The primary analysis assessed whether the strategy using oral
drugs was non-inferior to that using an injectable drug regarding HbA1c
change from baseline at week 26 using a per-protocol (PP) population and a
non-inferiority margin of 0.4%.

RESULTS: In the PP population (522 patients included: oral strategy,
n?=?269; injectable strategy, n?=?253) antihyperglycaemic therapy was
intensified at week 12 in 50.2% and 28.5%, respectively. HbA1c decreased
over 26 weeks in both treatment strategy groups, with a larger initial
reduction at week 12 in the injectable strategy group. The LS mean change
in HbA1c at week 26 was -1.3% (95% CI -1.4, -1.2) in the oral strategy
group and -1.4% (95% CI -1.5, -1.3) in the injectable strategy group; the
study met the non- inferiority criterion. Both treatment regimens were
generally well tolerated; hypoglycaemia was reported more often with the
oral strategy, while nausea, vomiting, diarrhoea and abdominal pain were
reported more often with the injectable strategy.

CONCLUSIONS/INTERPRETATION: An oral, incretin-based treatment strategy with
sitagliptin and, if needed, glimepiride may be a good approach in many
patients with type 2 diabetes mellitus for managing inadequate glycaemic
control on metformin monotherapy, as compared with an injectable treatment
strategy with liraglutide. The oral and injectable strategies had similar
effects on HbA1c and had good overall tolerability.

Trial registration: ClinicalTrials.gov NCT01296412

Funding: The study was sponsored by Merck
Sharp & Dohme Corp., a subsidiary of Merck and Co., Inc., Whitehouse
Station, NJ, USA.
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Chinese medicine injection shuanghuanglian for treatment of
acute upper respiratory tract infection: a systematic review of
randomized controlled trials
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23606893

Evid Based Complement Alternat Med. 2013;2013:987326.

Chinese medicine injection shuanghuanglian for treatment of acute upper
respiratory tract infection: a systematic review of randomized controlled
trials.

Zhang H, Chen Q, Zhou W, Gao S, Lin H, Ye S, Xu Y, Cai J.

School of Chinese Medicine, Faculty of Science, The Chinese University of
Hong Kong, Shatin, New Territories, Hong Kong.

Acute upper respiratory tract infections (AURTIs) are the illnesses caused
by an acute infection with various viruses and bacteria involving the upper
respiratory tract. Shuanghuanglian (SHL) injection, a Chinese medicine
intravenous preparation extracted from honeysuckle, Scutellaria
baicalensis, and fructus forsythiae, is commonly used to treat AURTIs.

* Although it is used largely in Chinese hospitals, there is no substantial
evidence to demonstrate its clinical effect on AURTIs.

We conducted a systematic review to evaluate the effectiveness and safety
of Shuanghuanglian injection for the treatment of acute upper respiratory
tract infections.
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Hand hygiene practices and resources in a teaching hospital
in Ghana
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23592644

J Infect Dev Ctries. 2013 Apr 17;7(4):338-47.

Hand hygiene practices and resources in a teaching hospital in Ghana.

Yawson AE, Hesse AA.

Korle-Bu Teaching Hospital, Korle-Bu, Accra, Ghana. aeyawson@yahoo.com.

INTRODUCTION: Nosocomial infections have long been neglected in Sub-Saharan
Africa, and hand hygiene (HH) is usually neglected in hospital settings.
This study aimed to provide baseline data on HH compliance among health
workers and HH resources in a large West African teaching hospital.

METHODOLOGY: A cross-sectional, unobtrusive observational study assessed
personal and care-related HH compliance among doctors and nurses and HH
resources in 15 service provision centres of the Korle-Bu Teaching Hospital
(KBTH), Ghana, in 2011. Data was collected with an infection prevention
checklist and health worker HH compliance form, based on World Health
Organization guidelines.

RESULTS: Care-related HH compliance of doctors and nurses was low and basic
HH resources were deficient in all 15 service centres. Care-related HH
compliance among doctors ranged from 9.2% to 57% and 9.6% to 54% among
nurses. HH compliance was higher when risk was perceived to be higher
(i.e., in the emergency and wound dressing/treatment rooms and labour
wards). The neonatal intensive care unit (NICU) showed the highest level of
compliance among health workers. Facilities for HH, particularly alcohol
hand rub and liquid soap dispensers were shown to be deficient.

CONCLUSIONS: Care-related HH compliance among doctors and nurses in this
large West African hospital is low; however, the NICU, which had
implemented HH interventions, had better HH compliance. HH intervention
programs should be designed and promoted in all service centres. Also, the
introduction of alcohol-based hand rubs as an accessible and effective HH
alternative in Korle-Bu Teaching Hospital is recommended.

Free full text
http://www.jidc.org/index.php/journal/article/view/23592644/863
__________________________________________________________________
________________________________*_________________________________

14. Abstract: The Feedback Intervention Trial (FIT)–improving hand-hygiene
compliance in UK healthcare workers: a stepped wedge cluster randomised
controlled trial
__________________________________________________________________
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0041617

PLoS One. 2012;7(10):e41617.

The Feedback Intervention Trial (FIT)–improving hand-hygiene compliance in
UK healthcare workers: a stepped wedge cluster randomised controlled trial.

Fuller C, Michie S, Savage J, McAteer J, Besser S, Charlett A, Hayward A,
Cookson BD, Cooper BS, Duckworth G, Jeanes A, Roberts J, Teare L, Stone S.

Royal Free Campus, University College London Medical School, University
College, London, United Kingdom.

INTRODUCTION: Achieving a sustained improvement in hand-hygiene compliance
is the WHO’s first global patient safety challenge. There is no RCT
evidence showing how to do this. Systematic reviews suggest feedback is
most effective and call for long term well designed RCTs, applying
behavioural theory to intervention design to optimise effectiveness.

METHODS: Three year stepped wedge cluster RCT of a feedback intervention
testing hypothesis that the intervention was more effective than routine
practice in 16 English/Welsh Hospitals (16 Intensive Therapy Units [ITU];
44 Acute Care of the Elderly [ACE] wards) routinely implementing a national
cleanyourhands campaign). Intervention-based on Goal & Control theories.
Repeating 4 week cycle (20 mins/week) of observation, feedback and
personalised action planning, recorded on forms. Computer-generated
stepwise entry of all hospitals to intervention. Hospitals aware only of
own allocation. Primary outcome: direct blinded hand hygiene compliance
(%).

RESULTS: All 16 trusts (60 wards) randomised, 33 wards implemented
intervention (11 ITU, 22 ACE). Mixed effects regression analysis (all
wards) accounting for confounders, temporal trends, ward type and fidelity
to intervention (forms/month used). INTENTION TO TREAT ANALYSIS: Estimated
odds ratio (OR) for hand hygiene compliance rose post randomisation (1.44;
95% CI 1.18, 1.76;p<0.001) in ITUs but not ACE wards, equivalent to 7-9%
absolute increase in compliance. PER-PROTOCOL ANALYSIS FOR IMPLEMENTING
WARDS: OR for compliance rose for both ACE (1.67 [1.28-2.22]; p<0.001) &
ITUs (2.09 [1.55-2.81]; p<0.001) equating to absolute increases of 10-13%
and 13-18% respectively. Fidelity to intervention closely related to
compliance on ITUs (OR 1.12 [1.04, 1.20]; p?=?0.003 per completed form) but
not ACE wards.

CONCLUSION: Despite difficulties in implementation, intention-to-treat,
per-protocol and fidelity to intervention, analyses showed an intervention
coupling feedback to personalised action planning produced moderate but
significant sustained improvements in hand-hygiene compliance, in wards
implementing a national hand-hygiene campaign. Further implementation
studies are needed to maximise the intervention’s effect in different
settings.

TRIAL REGISTRATION: Controlled-Trials.com ISRCTN65246961.

Free Article
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0041617
__________________________________________________________________
________________________________*_________________________________

15. Abstract: Efficacy and safety of a single intra-articular injection of
2% hyaluronic acid plus mannitol in knee osteoarthritis over a 6-month
period
__________________________________________________________________

Rev Esp Cir Ortop Traumatol. 2012 Jul-Aug;56(4):274-80.

[Efficacy and safety of a single intra-articular injection of 2% hyaluronic
acid plus mannitol in knee osteoarthritis over a 6-month period].
[Article in Spanish]

Borrás-Verdera A, Calcedo-Bernal V, Ojeda-Levenfeld J, Clavel-Sainz C.

Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario
Virgen Macarena, Sevilla. España.

OBJECTIVE: To evaluate the safety and efficacy of a single intra-articular
injection of 2% hyaluronic acid (HA)+mannitol in symptomatic knee
osteoarthritis (KOA).

MATERIAL AND METHODS: Pilot, multicentre, open, non-comparative study
performed in eighty patients with painful KOA, of whom 79 completed the
study. They received one injection of 2ml of 2% HA+0.5% mannitol (Day 0)
and were followed-up for 6 months. On Days 0, 15, 30, 60, 90, 120, 150 and
180, pain and joint function were assessed using a visual analogue scale
(VAS) and WOMAC index. Efficacy and safety by investigator and patient, and
rescue medication, as an indirect measure of pain, were also recorded.

RESULTS: A significant reduction in joint pain, stiffness and functional
disability compared with baseline was observed at every follow-up visit
(P<.001). Joint function improved by 38.7% on Day 30, reaching 47.5% on Day
180. Rescue medication use decreased from 58.2% at baseline to 2.5% on Day
90, increasing in the last visits. Efficacy and safety were positively
evaluated by investigators and patients. No serious adverse events were
observed. Mild side effects were reported in 4 patients (local pain and
swelling in the infiltration area).

DISCUSSION: There is evidence that repeated intra-articular injections of
HA improve symptoms in KOA. However, studies with a single injection of HA
have shown mixed results. This study demonstrates that one single intra-
articular injection of non-cross-linked HA reduces joint pain and increases
function in patients with KOA over a period of at least 6 months.

Copyright © 2011 SECOT. Published by Elsevier Espana. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

16. Abstract: Safety and Efficacy Findings from a Non-interventional Study
of a New Hyaluronic Acid/Sorbitol Formulation (GO-ON® Matrix) for
Intra-articular Injection to Relieve Pain and Disability in
Osteoarthritis Patients
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23599036

Drug Res (Stuttg). 2013 Apr 18.

Safety and Efficacy Findings from a Non-interventional Study of a New
Hyaluronic Acid/Sorbitol Formulation (GO-ON® Matrix) for Intra-articular
Injection to Relieve Pain and Disability in Osteoarthritis Patients.

Heisel J, Kipshoven C.

m&i-Fachkliniken Hohenurach, Bad Urach, Germany.

This non-interventional study was intended to examine the efficacy and
tolerability of intra-articular injections with the GO-ON® matrix, a new
viscosupplement product made of non-animal sodium hyaluronate combined with
the oxygen free radical scavenger sorbitol, when used in routine clinical
practice.

A total of 1 147 patients (43.5% male, 53,5% female, 3% missing) aged on
average 63.3 years with osteoarthritis were enrolled in 398 centers and
treated with the product. The most commonly treated joint was the knee
(92.9%) with a Kellgren-Lawrence classification of Grade I (6.7%), Grade II
(31.4%), Grade III (48.0%), and Grade IV (13.9%).Most patients (58-66%,
imputing for missing data) received 1 injection, 29-40% received 3
injections.

Using a Likert scale to asses pain, the mean change in pain due to
osteoarthritis was a reduction of 56.5% from baseline (2.61±0.80) to 6
months (1.07±0.86). At baseline, 56.2% of patients reported severe/very
severe pain versus 5.9% after 6 months. Accordingly, 6.8% of patients
reported no pain/mild pain at baseline vs. 67.1% after 6 months. At
baseline, 28.9% reported no pain/mild pain vs. to 66.4% after 6 months. At
baseline, 29.1% of patients reported severe/very severe functional
impairment vs. 3.9% 6 months after the first injection. The 3 and 6 month
results were comparable.

Adverse reactions were rare and confined to musculoskeletal and connective
tissue disorders. No infections were reported in any treated joints.

The results confirm that the GO-ON matrix® treatment is effective and well
tolerated in the treatment of symptoms due to osteoarthritis.

© Georg Thieme Verlag KG Stuttgart · New York.
__________________________________________________________________
________________________________*_________________________________

17. Abstract: Autologous fat grafting and injectable dermal fillers for
human immunodeficiency virus-associated facial lipodystrophy: a
comparison of safety, efficacy, and long-term treatment outcomes
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23142937

Plast Reconstr Surg. 2013 Mar;131(3):499-506.

Autologous fat grafting and injectable dermal fillers for human
immunodeficiency virus-associated facial lipodystrophy: a comparison of
safety, efficacy, and long-term treatment outcomes.

Shuck J, Iorio ML, Hung R, Davison SP.

Department of Plastic Surgery, Georgetown University Hospital, Washington,
DC 20007, USA.

BACKGROUND: Facial lipoatrophy is a common side effect of human
immunodeficiency virus treatment with highly active antiretroviral therapy.
To identify the most clinically durable and efficient way of addressing
facial lipoatrophy, the authors reviewed all available evidence for the use
of injectable dermal fillers and autologous fat transfers as treatment
modalities, focusing on safety, outcomes, and long-term durability.

METHODS: A systematic review of the Cochrane and MEDLINE databases for
autologous fat transfer and injectable dermal fillers for the treatment of
human immunodeficiency virus-associated lipodystrophy was performed. Based
on U.S. Food and Drug Administration approval in human immunodeficiency
virus lipoatrophy, studies were limited to the use of hyaluronic acid
and/or poly-L-lactic acid. Facial volume, subjective patient satisfaction,
standardized outcome scales, reinjection rates, and complications were
recorded.

RESULTS: Nineteen studies were included representing 724 patients, with 549
patients in the hyaluronic acid/poly-L-lactic acid cohort and 175 in the
autologous fat transfer cohort. Improvements in facial volume and
durability of treatment were similar between dermal fillers and fat
transfer, as measured by both objective means and subjective patient
outcomes. However, poly-L- lactic acid was reinjected at a rate three times
that of autologous fat, and was associated with a relatively high rate of
subcutaneous papule formation at 22 percent (range, 3 to 44 percent).

CONCLUSIONS: Dermal fillers and autologous fat transfer are effective
treatment modalities for human immunodeficiency virus-associated facial
lipoatrophy, with high rates of facial volume restoration and patient
satisfaction. Autologous fat transfer may offer similar to superior long-
term durability but with less of a financial burden compared with
injectable fillers.

Comment in:
Plast Reconstr Surg.2013. http://www.ncbi.nlm.nih.gov/pubmed/23446564
Discussion: Autologous fat grafting and injectable dermal fillers for human
immunodeficiency virus-associated facial lipodystrophy: a comparison of
safety, efficacy, and long-term treatment outcomes.
__________________________________________________________________
________________________________*_________________________________

18. No Abstract: Immunosuppressive biological mechanisms support
reassessment of use of the injectable contraceptive medroxyprogesterone
acetate
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23429710

Endocrinology. 2013 Mar;154(3):985-8.

Immunosuppressive biological mechanisms support reassessment of use of the
injectable contraceptive medroxyprogesterone acetate.

Hapgood JP.

Department of Molecular and Cell Biology, University of Cape Town, Private
Bag X1, Rondebosch, 7700, South Africa. Janet.Hapgood@uct.ac.za
__________________________________________________________________
________________________________*_________________________________

19. Stanford Online Course Starts 29 April: Mobile Health Without Borders
__________________________________________________________________
https://venture-lab.org/mhealth

Stanford ONLINE
Stanford University

Online Course: Mobile Health Without Borders

INSTRUCTORS:
Eric Leroux, M.D., M.B.A, Stanford University
Homero Rivas, Assistant Professor of Surgery, Director of Innovative
Surgery, School of Medicine, Stanford University

Starting April 29, 2013

The Course

The course will function like a conference, but it takes place over three
months rather than two days, and encourages the transformation from passive
audience observer to active participant and thought leader. The themes to
be addressed are: 1) Global Health Challenges. 2) Mobile Health
Opportunities. 3) Entrepreneurship in Health Care.

Today, more people have access to a mobile phone than to clean drinking
water. At the same time, health systems around the world struggle to
deliver cost-effective care. For example, where the United States confronts
unsustainably soaring costs and millions of underserved citizens, Sub-
Saharan Africa endeavours to provide medical care in the

context of infrastructural challenges, economic shortfalls, and the highest
disease burden in the world. Throughout India and China, investments in
mobile entrepreneurship are reshaping how health care is delivered to
massive populations. Meanwhile South America is experiencing a surge of
entrepreneurial activity that promises to reshape how its citizens interact
with the health system. To expose you to the breadth of activity and
opportunity, each class will consist of multiple short presentations from
renowned experts. Each lecture will be streamed live and a recorded copy
will remain available on the course website through the duration of the
course. Class discussions about these presentations will also take place
online.

In the era of expansive and ever-expanding access to mobile technology,
ideas can be more readily shared and solutions can more readily reach
patients in need, wherever they are. We are more connected than ever
before, in many ways: through global dissemination of infectious diseases;
through shared challenges such as chronic disease burden; and of course
through the Internet and telecom networks. Multi disciplinary collaboration
holds the promise to increase the quality, efficiency, access, convenience,
and personalization of health care in developed countries and in emerging
economies.

Mobile Health Without Borders aims to realize that promise by providing a
platform for participants to increase their capacity to have a meaningful
impact on global health. To achieve this, students will work closely with
classmates from around the world on small group assignments. These are to
help you prepare for the Health Innovation Challenge, an opportunity to
work with a global multi-disciplinary team and world-class mentors to
design a solution to a health challenge you care about.
__________________________________________________________________
________________________________*_________________________________

20. WHO Vacancy Notice: Regional Advisor, Essential Medicines and
Pharmaceutical Policies, Brazzaville, Congo

Please visit WHO’s e-Recruitment website at: www.who.int/employment. The
system provides instructions for online application procedures.
__________________________________________________________________

Vacancy Notice No: AFRO/13/FT121

Title: Regional Advisor, Essential Medicines and Pharmaceutical Policies

Grade: P5
Contract type: Fixed-Term Appointment
Duration of contract: Two (02) years
Date: 3 April 2013

Application Deadline: 1 May 2013

Duty Station: Brazzaville, Congo

Organization unit: AFRO Africa Regional Office (AF/RGO) / AF/HSS Health
Systems and Services (AF/HSS) Essential Medicines(EDM)

OBJECTIVES OF THE PROGRAMME : To ensure access to and rational use of safe
and effective essential medicines of acceptable quality at the lowest
possible cost.

-To develop and coordinate technical support to Member States in drug
policy formulation and implementation, improving national capacity in
medicines supply and access, medicines regulation, quality
assurance, rational use and Traditional Medicine.

Description of duties:
The incumbent performs the following duties:-

1. Coordinate the preparation and the implementation of the EDM workplan
and its subsequent regular monitoring and evaluation

2. Coordinate with Essential Medicines and Health Products/HQ. (EMP/HQ)the
development, implementation and monitoring of WHO policy and strategy for
essential medicines in the African Region; develop collaboration and
coordination with bilateral and multi-lateral agencies and NGOs;

3.Provide technical support to countries and Regional projects: Address
essential medicines matters within the global health sector development
agenda. Plan and prioritize technical support at country and regional level
and oversee coordination for implementation and monitoring; ensuring that
integrated WHO technical support is provided to Member States; and
disseminate relevant information on medicines issues to all stakeholders;

4.Provide political and technical expertise: within the health sector
development policy, provide technical input on pharmaceuticals particularly
in the area of Quality Assurance and Medicines Policies and Regulation to
WHO programs at country and regional level; coordinate the development of
operational tools and training in collaboration with EMP/HQ; WHO
Collaborating Centers and relevant professional bodies and institutions.
Represent EDM/AFRO at regional and global meetings in relation with Quality
Assurance and Medicines Policies and Regulation.

5.Contribute to promote and foster WHO partnership in the area of medicines
with Regional and Sub-regional entities such as African Union, and Regional
Economic Communities

6.Contribute to the implementation the regional strategy on traditional
medicine in health systems and related activities in consultation with the
Regional Adviser for Traditional Medicine.

REQUIRED QUALIFICATIONS

Education: Essential: Degree in medicine or pharmacy with Postgraduate
degree in public health and/or management.
Desirable: Specialization in one area of Pharmacy

Skills: An ability to plan, organize, coordinate and implement EDM
programme as relevant responses to country needs in essential medicines;
ability to produce technical reports and documents based on experience
acquired on essential medicines in developing countries, especially
Africa.; ability to assist in resource mobilization for the EDM programme.
Ability to work in a multi-cultural environment and ability to communicate
effectively in one of the official languages used in the African Region.

Experience: Essential: 10 years’ experience in senior technical and/or
managerial positions at national level and some international and/or
regional experience, mostly in developing countries in health sector
development and pharmaceuticals.
Desirable: Experience in policy formulation and medicines regulation.

Languages: Excellent knowledge of English or French with a working
knowledge of the other language.

Annual salary: (Net of tax) US$ 80,734 at single rate; US$ 86,904 with
primary dependants

Post Adjustment: 65.3 % of the above figure(s). This percentage is to be
considered as indicative since variations may occur each month either
upwards or downwards due to currency exchange rate fluctuations or
inflation.

Online applications are strongly encouraged to enable WHO to store your
profile in a permanent database.

Please visit WHO’s e-Recruitment website at: www.who.int/employment. The
system provides instructions for online application procedures.

All applicants are encouraged to apply online as soon as possible after the
vacancy has been posted and well before the deadline stated in the vacancy
announcement.

WHO is committed to workforce diversity.

Any appointment/extension of appointment is subject to WHO Staff
Regulations, Staff Rules and Manual.

Only candidates under serious consideration will be contacted.
WHO has a smoke-free environment and does not recruit smokers or users of
any form of tobacco.
__________________________________________________________________
________________________________*_________________________________

21. News

– USA: Another Compounding Company Recalls All Sterile Product
– In Tanzania, Iramba Health Supply Chain Goes from Failing to Model
System
– Oklahoma USA: 60 Hepatitis Cases Confirmed Among Tulsa Dentist’s
Patients
– USA: Dozens of Oklahoma Dentist’s Patients Test Positive for Hepatitis
– Global: Major price cut for five-in-one vaccine
– Nevada USA: Nev Jury Orders HMO to Pay $500M in Hepatitis Case
– Arizona USA: Testing advised for patients of defunct clinic

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________
http://www.medscape.com/viewarticle/802963

USA: Another Compounding Company Recalls All Sterile Product
Megan Brooks, Medscape Medical News, USA (23.04.13)

Balanced Solutions Compounding Pharmacy LLC, of Lake Mary, Florida, has
voluntarily recalled all lots of sterile products compounded by the
pharmacy that are not expired because of concerns that the products may not
be sterile, the US Food and Drug Administration (FDA) has announced.

The sterile products include all injectables with the Balanced Solutions
Compounding Pharmacy name. A complete list of all 53 recalled products is
available on the company Web site.

“These products were supplied to the offices of licensed medical
professionals and patients. Sterile products included in this withdrawal
were furnished nationwide,” the company notes in a statement also available
on its Web site.

“Poor Practices and Conditions”

According to the FDA, during an inspection of Balanced Solutions,
investigators observed “poor practices and conditions, which may have
exposed the company’s sterile products to microbial contamination.”
Preliminary findings regarding sterile production practices and conditions
at the site “raise concerns about a lack of sterility assurance. This lack
of sterility assurance has been confirmed by further FDA analysis,” the
agency says.

In particular, the FDA sampled chromium chloride injection from Balanced
Solutions and identified gram-negative bacteria in the product. “Gram-
negative bacteria can cause disease and many types of infection, but the
Sphingobacterium thalpophilum bacteria found in the solution does not
usually cause infection in humans,” the agency notes.

Balanced Solutions says it has not received any reports of injury or
illness associated with use of the recalled products to date. “Patient
safety is our highest priority. Out of an abundance of caution, we have
decided to initiate this voluntary recall to include all lots of all
sterile products within expiry,” the company says.

Patients who received any sterile drug products produced and distributed by
Balanced Solutions are being asked to contact their healthcare provider.

The FDA advises that healthcare facilities and healthcare providers that
have received sterile products from Balanced Solutions “immediately check
their medical supplies, quarantine the products, and follow the recall
instructions from Balanced Solutions.”

Balanced Solutions is notifying customers by telephone, fax, and/or mail to
return the products to the pharmacy. Healthcare providers with questions
regarding this recall may contact the company by phone at 1-407-936-2998 or
1-877-306-0008 between the hours of 9:30 am and 6:00 pm Eastern Standard
Time, Monday through Friday or by email at pharmacist@bshrx.com.

The problems and product recall involving Balanced Solutions comes on the
heels of recalls at 3 other compounding pharmacies because of similar
problems and concerns over sterility of products. As previously reported by
Medscape Medical News, those companies are ApothéCure Inc and NuVision and
Green Valley Drugs.

Adverse reactions or quality problems experienced with the use of Balanced
Solution products or other products may be reported to MedWatch, the FDA’s
safety information and adverse event reporting program, by telephone at
1-800-FDA-1088; by fax at 1-800-FDA-0178; online at
https://www.accessdata.fda.gov/scripts/medwatch/medwatch-online.htm; with
postage-paid FDA form 3500, available at
http://www.fda.gov/MedWatch/getforms.htm; or by mail to MedWatch, 5600
Fishers Lane, Rockville, Maryland 20852-9787.
__________________________________________________________________
__________________________________________________________________
In Tanzania, Iramba Health Supply Chain Goes from Failing to Model System
USAID|DELIVER Project (19.04.13)

In 2009, key staff at Tanzania’s Ministry of Health and Social Welfare
(MOHSW) and Medical Stores Department (MSD) declared the council health
management team (CHMT) of the Iramba district to be one of the poorest
performing teams in the country in the stock management of medicines and
supplies. Shortages of supplies occurred in one part of the district and
overstocks and expiries in another.

Reporting of consumption to MSD was well below expectations, and a root
cause analysis showed that the poor reporting was caused, in part, by a
lack of funds. For example, health facility representatives were forced to
use personal monies to send reports to the district. Therefore, facilities
did not send reports and, when they did, the reports were often based on
incoherent data.

As a first step toward improvement, the district medical officer allocated
funds to facilitate reporting in the first quarter. Poor quality reports
were penalized, requiring the responsible official to use his or her own
funds to report. This new process held more staff members accountable and
produced instant results: reporting rates rose from an average of 2 percent
to 100 percent, all 49 facilities reported, and report quality improved.

Having learned to sustain its supply chain improvements, Iramba has been
named a center of excellence for health commodity management by the USAID
|DELIVER PROJECT and the Supply Chain Management System project. The USAID
|DELIVER PROJECT designed Tanzania’s original integrated logistics system
(ILS) for health commodities in Tanzania and continues to work with the
MOHSW to improve and strengthen the ILS through monitoring, supervision,
and assessments.

Read the complete story http://tinyurl.com/bwaqt7s
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http://tinyurl.com/cqfz6zg

Oklahoma USA: 60 Hepatitis Cases Confirmed Among Tulsa Dentist’s Patients
Occupational Health & Safety online, USA (19.04.13)

The Oklahoma State Department of Health and the Tulsa Health Department
announced the first round of results April 18 from testing completed on
3,122 people who had been patients of W. Scott Harrington’s dental surgical
practice.

Completed laboratory tests on 3,122 people who were treated at W. Scott
Harrington’s dental surgical practice have identified 57 individuals who
tested positive for hepatitis C and three individuals who tested positive
for hepatitis B, the Oklahoma State Department of Health and the Tulsa
Health Department announced April 18. “Positive results have been reported
for HIV, but OSDH Data Security Policy regarding HIV disclosure prohibits
public reporting of numbers less than 3,” the two agencies stated in a
statement posted that day.

This confirmation came after the first round of results from the testing.
On March 28, public health officials announced they were notifying current
and former patients of the practice that they may have been exposed to
bloodborne viruses at Harrington’s Tulsa and Owasso offices and urged them
to be tested. The Oklahoma State Department of Health’s Public Health
Laboratory completed the testing for 3,122 people; 3,235 people as of April
18 had visited county health departments to have blood drawn for testing
and an unknown number of others have sought testing through private health
care providers, the statement says. It says based on current Oklahoma
disease prevalence data for hepatitis B and C and HIV, health officials
know some of the positives probably resulted from infection exposure not
related to the Harrington practice. The most recent data available
indicates an estimated 4,944 people are living with HIV/AIDS in Oklahoma
and as many as 68,000 Oklahomans may be infected with hepatitis C.

“We understand these first reported test results may be of concern,” said
THD Director Dr. Bruce Dart. “Thorough investigations are routinely
conducted upon notification of a positive report for these infections. This
response will be handled in the same manner, as disease investigation is a
core public health service and staff are well trained to conduct this type
of response.”

The departments are notifying people who participated in the screening of
their test results; those with positive tests are being personally
contacted and counseled and will be directed to resources for appropriate
care and follow-up. If warranted, testing will be recommended for a spouse
or partner.

“This is a complex investigation,” State Epidemiologist Dr. Kristy Bradley
said. “The next phase will include more in-depth interviews of persons who
test positive to determine the likelihood that their exposure is associated
with their dental surgical procedure at the Harrington practice. We will
certainly continue to keep the public informed as we learn more.”
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USA: Dozens of Oklahoma Dentist’s Patients Test Positive for Hepatitis
By Steve Olafson, Reuters Health Information (18.04.13)

OKLAHOMA CITY (Reuters) Apr 18 – Blood tests conducted on patients treated
at an Oklahoma oral surgery practice that has been closed over health
concerns show that 57 have hepatitis C, three have hepatitis B and as many
as three have HIV, officials said on Thursday.

Health officials said it will take more investigation – including
interviews with each patient and blood tests of the remaining patients –
before they can determine whether the viruses were contracted at the dental
offices, an extremely rare occurrence.

“Now the real disease detective work goes into effect,” state health
department spokeswoman Leslea Bennet-Webb said.

Officials cannot be more specific about the number of patients who tested
positive for HIV because of the state’s confidentiality policy that
restricts public disclosure of HIV cases involving fewer than three people,
Bennet-Webb said.

Health officials so far have screened 3,122 people who underwent oral
surgery procedures at clinics operated by Dr Scott Harrington, a Tulsa oral
surgeon who is accused of using improper sterilization techniques.

Harrington agreed to close his Tulsa practice and a nearby satellite clinic
last month. Health officials want 7,000 of his patients to have their blood
tested.

Harrington’s attorney has said his client has an impeccable record with the
state dentistry board, which has filed a 17-count complaint against the
oral surgeon that accuses him of being a “menace to the public health”
because of his unsanitary procedures.

There are only three known cases in the United States of viruses being
transmitted during dental procedures, according to Centers for Disease
Control and Prevention.
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Global: Major price cut for five-in-one vaccine
IRIN News (18.04.13)

NAIROBI, 18 April 2013 (IRIN) – The cost of vaccinating children with the
pentavalent vaccine – a five-in-one formulation – is set to drop
significantly following a deal between the GAVI Alliance and an Indian drug
manufacturer that is reducing its price by 30 percent.

GAVI will now be able to purchase the pentavalent vaccine – which protects
against diphtheria, tetanus, whooping cough, heptatitis B and Haemophilius
influenzae type b – from Indian firm Biological E for US$1.19 per dose,
down from its current price of $2.17 (and down from $3.56 per dose a decade
ago). Millions of children in 73 GAVI-eligible countries are set to benefit
from the price drop, which will free up an estimated $150 million for GAVI
over the next four years.

“Working to secure price reductions means we are able to make our funding
go further, reaching more children and protecting more lives,” a GAVI
Alliance spokesman told IRIN.

Experts say reductions in the price of vaccines – and the price of
transporting and storing them, which often requires expensive refrigeration
– will be crucial to lowering child mortality and meeting the UN Millennium
Development Goal on child survival.

kr/rz

IRIN is a service of the UN Office for the Coordination of Humanitarian
Affairs
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Nevada USA: Nev Jury Orders HMO to Pay $500M in Hepatitis Case
Las Vegas Sun, Las Vegas Nevada USA (17.04.13)

Three patients who contracted hepatitis at a health care clinic will
receive $500 million in damages from UnitedHealth Group, Inc. as the result
of a successful civil negligence suit. UnitedHealth had received warnings
that a Las Vegas physician cut corners that put patients at risk for
contracting blood-borne diseases at the clinic. However, two subsidiaries
of UnitedHealth—Health Plan of Nevada and Sierra Health Services—contracted
with the physician anyway, according to the plaintiffs’ lawyers in the
suit.

The jury’s award was far less than the $2.5 billion sought by the
plaintiffs. However, Bonnie and Carl Brunson’s attorney, Robert Eglet,
stated that the jury sent a “strong message” to health maintenance
organizations and health insurers that they must establish fair
reimbursement to providers so they can deliver quality health care. The
third plaintiff, Helen Meyer, also indicated her satisfaction with the
jury’s award. Health Plan of Nevada will pay the victims $270 million, and
parent company Sierra Health Services will pay $230 million in damages.

UnitedHealth spokesman Tyler Mason warned that holding insurance companies
liable for the negligent conduct of individual physicians will result in
higher insurance premiums for Nevadans. UnitedHealth will appeal the
decision.
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http://tinyurl.com/c7489mh

Arizona USA: Testing advised for patients of defunct clinic
San Francisco Chronicle (17.04.13)

TUCSON, Ariz. (AP) — Nearly 180 former patients of a now-defunct Marana
dental clinic were being advised Wednesday to be tested for blood-borne
infections such as hepatitis and the virus that causes AIDS because
equipment at the clinic was apparently installed improperly.

The Pima County Health Department announced that it was in the process of
contacting 174 dental patients who were seen at the T Dental Clinic between
January and July of 2010, when the clinic closed.

Health officials said there’s no indication that infections were actually
transmitted to patients, and the recommendation for testing is
precautionary.

“At this time, there is no evidence that patients were exposed,” said Dr.
Francisco Garcia, Pima County’s public health director. “We are trying to
help provide residents with sufficient information so they can take the
appropriate steps to feel secure about their health. The only individuals
at risk for infection are those who were seen at T Dental Clinic during a
very specific period of time.”

The county Health Department has partnered with the Arizona Department of
Health Services to look into the incident and contact patients of the
dental office.

Last month in Oklahoma, health officials urged 7,000 patients of an oral
surgeon to be tested for possible exposure to hepatitis and HIV, the virus
that causes AIDS, after finding unsanitary conditions at his Tulsa and
Owasso clinics.

The transmission of infectious diseases by dentists and oral surgeons is
extremely rare, with only three known cases, according to the Centers for
Disease Control and Prevention.
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