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PubMed2004

Estimating the global burden of HIV/AIDS: what do we really know about the HIV pandemic?

The validity of UNAIDS/WHO estimates of the burden of HIV/AIDS is rightly questioned by politicians, scientists, and activists-especially since the 2003 estimates to be released in July, 2004, will show substantial drops in the burden of HIV/AIDS in several countries, and increases in others. However, the estimates are based on an explicit attempt to meet criteria we believe should guide the generation of international morbidity and mortality figures. These criteria extend beyond the quality of the input data to include features of the estimation process such as transparency and participation. The 2003 estimates now include plausible ranges for estimates rather than a single best estimate. This reduces the chance that insignificant differences in estimates from different sources are given importance. Here, we describe the levels of uncertainty associated with the UNAIDS/WHO estimates of HIV/AIDS. We explain the reason for moving to the use of plausibility bounds, the factors that determine the width of the bounds, and the implications for policy makers and programme managers.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

The effect of tuberculosis control in China.

BACKGROUND: China has 1.4 million new cases of tuberculosis every year, more than any country except India. A new tuberculosis control project based on short-course chemotherapy was introduced in half the country in 1991, after a national survey of tuberculosis prevalence in 1990. Another survey was done in 2000 to re-evaluate the national tuberculosis burden, providing the opportunity to assess the effect of the control project. METHODS: The survey in 2000 identified 375599 eligible individuals at 257 investigation points chosen from all 31 mainland provinces by stratified random sampling. Children (aged 0-14 years) were suspected of having tuberculosis if they had an induration of 10 mm or greater after a tuberculin skin test, and an abnormal fluorograph. Adults were suspected if they had a persistent cough, abnormal fluorograph, or both. Tuberculosis was diagnosed by chest radiograph, sputum-smear microscopy, and culture. FINDINGS: 365097 people were examined (97% of those eligible). Prevalences of pulmonary, culture-positive, and smear-positive tuberculosis in 2000 were 367 (95% CI 340-397), 160 (144-177), and 122 (110-137) per 100000 population, respectively. Between 1990 and 2000, prevalences of these three forms of the disease had fallen, respectively, by 32% (5-68), 37% (7-66), and 32% (9-51) more in areas in which the project was implemented than in non-project areas. For culture-positive disease, a 30% (9-48) reduction was directly attributable to the project. INTERPRETATION: Between 1991 and 2000, prevalence of tuberculosis was reduced significantly in areas of China by use of short-course chemotherapy following WHO guidelines. We estimate that in 2000, in a population of more than half a billion, there were 382000 fewer prevalent culture-positive cases and 280000 fewer prevalent smear-positive cases than there would otherwise have been.

Adolescent↗
PubMedDate not supplied

Overcoming health-systems constraints to achieve the Millennium Development Goals.

Effective interventions exist for many priority health problems in low income countries; prices are falling, and funds are increasing. However, progress towards agreed health goals remains slow. There is increasing consensus that stronger health systems are key to achieving improved health outcomes. There is much less agreement on quite how to strengthen them. Part of the challenge is to get existing and emerging knowledge about more (and less) effective strategies into practice. The evidence base also remains remarkably weak, partly because health-systems research has an image problem. The forthcoming Ministerial Summit on Health Research seeks to help define a learning agenda for health systems, so that by 2015, substantial progress will have been made to reducing the system constraints to achieving the MDGs.

Delivery of Health Care↗