It is imperative to prove efficacy of tailored interventions and translate the efficacious ones into clinical strategies for achieving good ART adherence. ART adherence among registered HIV/AIDS cases at HIV treatment centre, Pakistan Institute of Medical Sciences, Islamabad was assessed through RCT. Study duration was 10 weeks; eligible subjects (N = 76) were randomly halved; Intervention Group (IG) received trial interventions i.e. subject involvement, weekly phone reminders in addition to routine counselling, while Comparison group received routine counselling only. Self-reported adherence (SRA) questionnaire and pill identification test (PIT) conducted at both baseline and follow-up in addition to CD4 count and viral load. ITT using ANOVA; McNemar's test for variables with before-after assessments within a group. Results showed significant differences in ≥95% SRA, ≥95% Adherence on PIT, Viral load test of <50 copies per cubic mm. These interventions should be included in the overall treatment strategy for HIV/AIDS in Pakistan.

Background Pakistan is among a number of countries facing protracted challenges in addressing maternal mortality with a concomitant weak healthcare system complexed with inequities. Sexual and reproductive health and rights (SRHR) self-care interventions offer the best solution for improving access to quality healthcare services with efficiency and economy. This manuscript documents country experience in introducing and scaling up two selected SRHR self-care interventions. A prospective qualitative study design was used and a semi-structured questionnaire was shared with identified SRHR private sector partners selected through convenience and purposive sampling. The two interventions include the use of misoprostol for postpartum hemorrhage and the use of subcutaneous depomedroxyprogesterone acetate (DMPA) as injectable contraceptive method. Data collection was done through emails and telephone follow-up calls. Results Nine of the 13 partners consulted for the study responded. The two selected self-care interventions are mainly supported by private sector partners (national and international nongovernmental organizations) having national or subnational existence. Their mandates include all relevant areas, such as policy advocacy, field implementation, trainings, supervision and monitoring. A majority of partners reported experience related to the use of misoprostol; it was introduced more than a decade ago, is registered and is procured by both public and private sectors. Subcutaneous DMPA is a new intervention, having been introduced only recently, and commodity availability remains a challenge. It is being delivered through health workers/providers and is not promoted as a self-administered contraceptive. Community engagement and awareness raising is reported as an essential element of successful field implementation; however, no beneficiary data was collected for the study. Training approaches differ considerably, are standalone or integrated with SRHR topics and their duration varies between 1 and 5 days, covering a range of cadres. Conclusion Pubic sector ownership and patronage is essential for introducing and scaling up self-care interventions as a measure to support the healthcare system in delivering quality sexual and reproductive health services. Supervision, monitoring and reporting are areas requiring further support, as well as the leadership and governance role of the public sector. Standardization of trainings, community awareness, supervision, monitoring and reporting are required together with integration of self-care in routine capacity building activities (pre- and in-service) on sexual and reproductive health in the country.

Pakistan is the sixth most populous country in the world & is ranked 53 rd in the list of countries contributing towards high maternal mortality ratios. According to a recent maternal mortality survey, the current maternal mortality ratio of Pakistan is 186 per 100,000 live births with high disparities among provinces; Balochistan being the highest contributor with MMR of 298 per 100,000 live births. This study specifically focuses on the causes & contributory factors of high maternal deaths in Balochistan based on the evidence generated by the Maternal and Perinatal Death Surveillance & Response system. MPDSR provides the decision maker with reliable and timely data to take required action and to reduce the preventable maternal deaths. Maternal mortality data was collected from the three pilot tertiary health care facilities and data was analyzed using Statistical Package for Social Sciences version (20.0). Out of 40 notified maternal deaths in the period January 2020 till July 2020 around 39 deaths were reviewed & analyzed. This study found out that of these 39 maternal deaths around 32% were attributed to hemorrhage, and around 15% & 12% resulted from eclampsia and sepsis respectively. Other major causes of maternal deaths included obstructed labour (10%), embolism (10%) and anesthesia complications (2%) respectively. Nonmedical causes of these maternal deaths included shortage of human resource (7.7%), lack of medical equipment (7.7%) and failure to recognize the danger signs earlier (5.1%). The major underlying factors of these maternal deaths included low antenatal visits, underutilization of family planning services, poor referral system and delays at all levels in the three delay model. The study concluded that almost all of these maternal deaths can be avoided by undertaking appropriate measures & timely actions.

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With the COVID-19 pandemic spreading across the world, its disruptive effect on the provision and utilization of non- COVID related health services have become well-documented. As countries developed mitigation strategies to help continue the delivery of essential health services through the pandemic, they needed to carefully weigh the benefits and risks of pursuing these strategies. In an attempt to assist countries in their mitigation efforts, a Benefit-Risk model was designed to provide guidance on how to compare the health benefits of sustained essential reproductive, maternal, newborn and child (RMNCH) services against the risk of SARS-CoV-2 infections incurred by the countries’ populations when accessing these services. This article describes how two existing models were combined to create this model, the field-testing process carried out from November 2020 through March 2021 in six countries and the findings. The overall Benefit-Risk Ratio in the 6 countries analyzed was found to be between 13.7 and 79.2, which means that for every 13.7 to 79.2 lives gained due to increased RMNCH service coverage, there was one loss of a life related to COVID-19. In all cases and for all services, the benefit of maintaining essential health services far exceeded the risks associated with additional COVID-19 infections and deaths. This modelling process illustrated how essential health services can continue to operate during a pandemic and how mitigation measures can reduce COVID-19 infections and restore or increase coverage of essential health services. Overall, this Benefit-Risk analysis underscored the importance and value of maintaining coverage of essential health services even during public health emergencies, including the recent COVID-19 pandemic