BackgroundIn the Asia-Pacific region, limited systematic assessment has been conducted on HIV service delivery models. Applying an analytical framework of the continuum of prevention and care, this study aimed to assess HIV service deliveries in six Asia and Pacific countries from the perspective of service availability, linking approaches and performance monitoring for maximizing HIV case detection and retention.MethodsEach country formed a review team that provided published and unpublished information from the national HIV program. Four types of continuum were examined: (i) service linkages between key population outreach and HIV diagnosis (vertical-community continuum); (ii) chronic care provision across HIV diagnosis and treatment (chronological continuum); (iii) linkages between HIV and other health services (horizontal continuum); and (iv) comprehensive care sites coordinating care provision (hub and heart of continuum).ResultsRegarding the vertical-community continuum, all districts had voluntary counselling and testing (VCT) in all countries except for Myanmar and Vietnam. In these two countries, limited VCT availability was a constraint for referring key populations reached. All countries monitored HIV testing coverage among key populations.Concerning the chronological continuum, the proportion of districts/townships having antiretroviral treatment (ART) was less than 70% except in Thailand, posing a barrier for accessing pre-ART/ART care. Mechanisms for providing chronic care and monitoring retention were less developed for VCT/pre-ART process compared to ART process in all countries.On the horizontal continuum, the availability of HIV testing for tuberculosis patients and pregnant women was limited and there were sub-optimal linkages between tuberculosis, antenatal care and HIV services except for Cambodia and Thailand. These two countries indicated higher HIV testing coverage than other countries.Regarding hub and heart of continuum, all countries had comprehensive care sites with different degrees of community involvement.ConclusionsThe analytical framework was useful to identify similarities and considerable variations in service availability and linking approaches across the countries. The study findings would help each country critically adapt and adopt global recommendations on HIV service decentralization, linkages and integration. Especially, the findings would inform cross-fertilization among the countries and national HIV program reviews to determine county-specific measures for maximizing HIV case detection and retention.

Concern about a possibly increasing prevalence of bottle-feeding led in 1995 to an Infant Feeding Survey of 1822 mothers attending urban health facilities. Infant feeding practices including feeding of colostrum, exclusive breastfeeding, weaning practices and bottle-feeding were assessed. This revealed that 28.8% of mothers had not given colostrum to their babies, that 43.5% of 3-month-old babies were exclusively breastfed, and that solids were introduced before 4 months of age in over half of the study population. Bottle-feeding was used by 20% of the study population. Feeding practices differed in women of Highlands and of Coastal origin. The findings emphasize the need to strengthen health education programmes which take into account the mothers' different cultural backgrounds. The issue of breast-feeding by mothers in paid employment needs to be addressed.

Objectives Papua New Guinea (PNG) has among the highest rates of sexually transmitted infections (STIs) globally and is committed to reducing their incidence. The Syphilis Interventions Towards Elimination (SITE) model was used to explore the expected impact and cost of alternative syphilis intervention scale-up scenarios. Methods SITE is a dynamical model of syphilis transmission among adults 15–49 years. Individuals are divided into nine groups based on sexual behaviour and into six stages of infection. The model was calibrated to PNG using data from routine surveillance, bio-behavioural surveys, research studies and program records. Inputs included syphilis prevalence, risk behaviours, intervention coverage and service delivery unit costs. Scenarios compared different interventions (clinical treatment, contact tracing, syphilis screening, and condom promotion) for incidence and cost per infection averted over 2021–2030. Results Increasing treatment coverage of symptomatic primary/secondary-stage syphilis cases from 25–35% in 2020 to 60% from 2023 onwards reduced estimated incidence over 2021–2030 by 55%, compared to a scenario assuming constant coverage at 2019–2020 levels. The introduction of contact tracing in 2020, assuming 0.4 contacts per symptomatic person treated, reduced incidence over 2021–2030 by 10%. Increasing screening coverage by 20–30 percentage points from the 2019–2020 level reduced incidence over 2021–2030 by 3–16% depending on the target population. Scaling-up clinical, symptom-driven treatment and contact tracing had the lowest cost per infection averted, followed by condom promotion and periodic screening of female sex workers and men who have sex with men. Conclusions PNG could considerably reduce its syphilis burden by scaling-up clinical treatment and contact tracing alongside targeted behavioural risk reduction interventions. SITE is a useful tool countries can apply to inform national STI programming and resource allocation.

Purpose: As elderly population is increasing, prediction and prevention of functional decline in the elderly are of great concern. This study aimed to evaluate whether poor self-reported health status (SRHS) could predict functional decline after two years in the elderly population.Methods: Data from the KLoSA panel, a national representative sample of the aging Koreans, were used. Subjects of investigation were the elderly population aged 65 or more without disability in carrying out activities of daily living (ADL) at baseline. The survey asked respondents about their subjective health status. Setting the respondents who stated their health status 'very good' or 'good' as the reference group, multivariable logistic regression analysis was performed to compare functional decline according to the baseline SRHS.Results: A total of 2,824 subjects were included in the analysis. Among them, 138 (4.9 %) reported functional decline of at least one of the 7 ADL components after two years. In multivariable logistic regression analysis, SRHS was significantly associated with subsequent functional decline in respondents who chose 'Bad' (odds ratio (OR), 3.32; 95 % confidence interval (CI), 1.71 -6.44) or 'Very bad' (OR, 4.75; 95 % CI, 2.12 -10.66). Moreover, poorer SRHS was significantly associated with subsequent impairment in each ADL components. Also, SRHS predicted overall subsequent impairment in the instrumental ADL.Conclusions: SRHS predicted functional decline after two years in the elderly without baseline disabilities. SRHS can be a good predictor of future functional decline in the elderly population. Objectives: To describe the changes in activities of daily living (ADL) function occurring before, after hospital admission and discharge in inpatients elderly with medical illness and to assess the effect of frailty on loss of ADL function. LOSS OF INDEPENDENCE IN ACTIVITIES OF DAILY LIVING IN OLDER ADULTS HOSPITALIZEDDesign: Prospective observational study. Setting: Brazilian university hospital. Participants: One-hundred ninety-five patients (mean age 74 years, 59% men).Measurements: At the time of hospital admission, patients were interviewed about their independence in ADLs (Katz index) 2 weeks before admission (M0), at admission (M1), discharge (M2) and 15 days after discharge (M3) and about frailty (M0) (Cardiovascular Health Study index). Outcome measures included functional decline between M0-M1, between M0-M2, between M0-M3 and between M2-M3.Results: Eighteen percent of patients were dependent (Katz index < 3) and 38.4% were frailty in M0. The ADL function of 31% of the patients did not decline between M0-M2. Thirty-five percent declined between M0-M3. This included the 17.1% of patients who declined between M0-M1 and failed to recover to baseline function. Fifty-nine percent declined between M1-M2. Twenty -four percent recovered between M2-M3. Several studies report that basic motor abilities, including muscular strength and static and dynamic balance influence the risk of falls in elderly people. Howev...

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