Global MCH and HIV Insights

| http://online.mcphs.edu
Week 9
Chapter 16
Instructor: Gina Crosley-Corcoran, MPH
PBH 805 – Maternal & Child Health

Defining Global Health
Currently defined as “health problems, issues, and
concerns that transcend national boundaries, and
may be best addressed by cooperative actions”
There are concerns with this definition – there is
a need to emphasize that global actions are
needed to guarantee the well-being of all.
For example, the COVID-19 global pandemic has
modeled how countries must work together to
protect all populations from infectious disease.

Transitions Defined
Demographic
transition
• refers to the shift
from high mortality
and fertility to low
mortality and
fertility, where
mortality declines
and fertility
remains high.
Epidemiologic
transition
• describes the shift
from
communicable
diseases to
noncommunicable
diseases, with both
coexisting as major
health issues.
Nutrition
transition
• refers to the
coexistence of
malnutrition and
obesity.
Obstetric
transition
• describes a gradual
secular shift from a
pattern of high
maternal mortality
to low maternal
mortality.

Persistent Inequalities and Disparities
Generally linked to racial disparities, which reflects the impacts of
racism
Ethnic disparities should also be considered, although difficult to
compare
Other examples
• Gender inequalities
• Socioeconomic factors
• Educational opportunities
• Access to health care
• Housing assets

International Organizations
•Created in the aftermath of World War II for peace and conflict
resolution
United Nations (UN)
•Established to promote and protect the health of all people
World Health Organization
(WHO)
•Created to assist orphans and abandoned children after the war
•Focuses on improving health and well-being for all children
United Nations
International Children’s
Emergency Fund (UNICEF)
•Focuses on improving health and development around the
world
U.S. Agency for
International Development
(USAID)

Sustainable Development Goals
 Refers to a set of commitments that the United
Nations members agreed upon
 Based on 17 global priorities that include 160
associated measurable targets
 (see next slide)

Sustainable Development Goals
<Insert Figure 16-3>

Measuring Maternal and Child Health
Monitoring health indicators allows for identifying
priorities for action
Utilization of various data sources
• Perinatal Information System
• Demographic and Health Surveys
• Health and Demographic Surveillance Systems
• Institute for Health Metrics
• County-specific survey data

Examples of Key Measurements
 Maternal mortality
 Blood loss
 Birth weight
 Gestational age
 Child growth
 Rapid diagnostic tests
 HIV/AIDS monitoring
<Insert Figure 16-4>

Evaluating MCH Interventions
 A large portion is based on empirical evidence instead of
rigorous research.
 This trend began to change with the “evidence-based medicine” movement.
 Soon after, Cochrane Collaboration was created.
 Today, complex interventions targeting maternal and child
health populations are systematically evaluated through
randomized studies at the “cluster” level.
 International organizations, such as WHO, base their
recommendations on these systematic reviews of
randomized controlled trials and other studies.

Implementation Trials
Major challenge in global
health is finding effective ways
to implement interventions
that have shown to be
effective under ideal
conditions.
Implementation trials use
rigorous study designs in
implementation science,
which is the study of barriers
to implementation and ways to
overcome barriers.
Trials are often cluster
randomized controlled trials
where groups are randomized,
which allows for the evaluation
of interventions in health
facilities.
All trials should be preceded
by formative research with full
engagement from experts in
the country of focus as well as
the people for whom the
intervention is intended.

Global Collaborations
 Should be both respectful and bidirectional
 Communities should be involved in the collection,
analysis, and dissemination of results.
 Examples include studies on Zika virus and pregnancy in South America.
 Universities and research centers that have
developed a strong capacity to conduct research and
evaluate health programs should be sustained.
 Offer new opportunities to learn and exchange ideas
 Contribute to local priorities and sustainability efforts

Global MCH Conclusion
Low and middle-income countries face past and present health challenges.
New technologies have created opportunities for global connection.
Inequalities still persist and many approaches remain non-evidence based.
Success in global health can only be attained if all nations are full
participants in sustainability efforts and join forces to solve health issues
together.

HIV
In the United States and Globally

HIV in the United States
Fully review the latest United States data at: https://www.kff.org/hivaids/fact-sheet/the-hivaids-
epidemic-in-the-united-states-the-basics/
Latest Estimates from KFF:
• The first cases of what would later become known as AIDS were reported in the United States (U.S.) in June of 1981.1 Today,
there are more than 1.2 million people living with HIV in the U.S. and there are more than 35,000 new infections each year.
people with AIDS have died since the beginning of the epidemic.2 More than 700,000 people in the U.S., have died from HIV-
related illness.
• HIV continues to have a disproportionate impact on certain populations, particularly racial and ethnic minorities, gay and
bisexual men and other men who have sex with men and transgender women.3,4,5
• HIV testing is important for both treatment and prevention efforts. Yet, 13% of those with HIV are unaware they are
infected.6
• Antiretroviral therapy (ART) has substantially reduced HIV-related morbidity and mortality, improved long-term outcomes for
people with HIV and plays a key role in HIV prevention. Treatment guidelines recommend initiating treatment as soon as one
is diagnosed with HIV.7 When an individual with HIV is on antiretroviral therapy and the level of HIV in their body is
undetectable, there is “effectively no risk” of sexual transmission.8 Still, many people with HIV are not in care, on treatment,
or virally suppressed.9
• Numerous federal and local government departments and agencies are involved in the domestic HIV/AIDS response, which
together provide disease surveillance, prevention, care, support services, and health insurance coverage. Additionally, the
private sector and community-based organizations, provide services for people with HIV and those at risk for HIV.

HIV in the United States

HIV Globally
Fully review the latest Global data at: https://www.kff.org/global-health-policy/fact-
sheet/the-global-hivaids-epidemic/
Latest Estimates from KFF:
• Global prevalence among adults (the percent of people ages 15-49 who are infected) has leveled since 2001 and
was 0.7% in 2019 (see Figure 1).
• There were 38 million people living with HIV in 2019 (see Table 1), up from 30.7 million in 2010, the result of
continuing new infections and people living longer with HIV. Of the people living with HIV in 2018, 36.2 million
were adults and 1.8 million were children under age 15.
• Although HIV testing capacity has increased over time, enabling more people to learn their HIV status, about one in
five people with HIV (19%) are still unaware they are infected.
• Although there have been significant declines in new infections since the mid-1990s, there were still about 1.7
million new infections in 2019, or about 5,000 new infections per day. Recent data show that while progress has
been made, that progress is unequal within and between countries.8 Furthermore, the pace of decline varies by
age group, sex, and region.
• HIV remains a leading cause of death worldwide and the leading cause of death globally among women of
reproductive age.9 However, AIDS-related deaths have declined, due in part to antiretroviral treatment (ART) scale-
up. 690,000 people died of AIDS in 2019, a 37% decrease from 1.1 million in 2010 and a 59% decrease from the
peak of 1.7 million in 2004.
UNAIDS. 2020 Global AIDS Update: Seizing the Moment; July 2020. UNAIDS.
AIDSinfo website; accessed July 2020, http://aidsinfo.unaids.org/. UNAIDS.
Core Epidemiology Slides; July 2020. UNAIDS. Global HIV & AIDS statistics –
2020 fact sheet; July 2020; UNAIDS. UNAIDS data 2020, July 2020.

HIV Globally

HIV and Prenatal Care
 Routine screening for HIV/AIDS is now a central
component of prenatal care
 This routine screening is providing data that can also
be used to monitor HIV/AIDS prevalence
 Blood routinely collected during prenatal care (e.g.,
for syphilis screening) can be used to perform
unlinked anonymous screening for HIV/AIDS

PEPFAR
 Created in 2003, PEPFAR stands for U.S. President's
Emergency Plan for AIDS Relief
 Represents the largest commitment by any nation to
address a single disease in history
 In fiscal year 2020, provided HIV testing services for
nearly 50 million people
 As of September 30, 2020, supported lifesaving ART
for nearly 18.2 million men, women, and children.

Week 9 Assignments
Discussion Board
Post
Quiz on Chapter

Global MCH and HIV Insights

Recommended

Recommended

More Related Content

Similar to Global MCH and HIV Insights

Similar to Global MCH and HIV Insights (20)

More from Gina Crosley-Corcoran

More from Gina Crosley-Corcoran (20)

Recently uploaded

Recently uploaded (20)

Global MCH and HIV Insights