Nursing: Combat of HIV/AIDS, Malaria and TB

Combat of HIV/AIDS, Malaria and TB

Student’s Name

Institution

Course

Instructor’s Name

Date

Combat of HIV/AIDS, Malaria and TB

Assignment 1: Non-governmental Agencies Involved in Global Issues

Introduction

 The development of every nation and the world at large depends on the nature of labor and the health of its citizens. It is thus the primary obligation of the society to ensure that the members of the community are taken care of in all ways possible in terms of health provision and maintenance. These responsibilities of public health maintenance and improvement lie squarely to all sectors of society. In the guest of ensuring the health population by the society, there have been deliberate efforts from the basic personal care and the public health systems as a larger group. The major concern of the personal health system through private as well as the government health care organizations, institutions, or any providers aims at providing curative services. In terms of financing these services, the common terms are that payments are made by the patients, the government, or the health insurance companies.

             To enhance public health, some programs are needed which both the hand of government, the public health sector, and the non-governmental sector ought to provide. Amongst these required services are population-based promotions which focus on the prevention of services and interventions that aim at protecting from illnesses, injuries, and diseases. Across the world, some epidemics require international responses and help especially in developing countries. Such epidemics are the spread of HIV/AIDs which does not only affect the health of the populace but influence the growth of the economy (Poku, 2017). In the past, there has been a great disparity in the way nations respond to these epidemics. Poor government policies and the bad economy have contributed to the scaling spread of these diseases. Attracting the attention of the international public health organizations on the need for their services to address those kinds of disparities. This paper addresses the influence of government and non-governmental public health agencies on global health disparities.

            The difference between Public Health NGOs from Government Public Health organizations

By definition, Non-governmental organizations are usually international organizations that are not profit-oriented, although some local agencies refer to their organizations as nongovernmental organizations. These organizations commonly referred to as NGOs have their structure and framework, they are independent of any government influence but often are funded by the government (Edwards, 2014).  Their main activities are in humanitarian areas such as responding to HIV/AIDS epidemics in the world and many others as per their deemed objectives. Non-governmental organizations in contrast to government organizations are that they carry out several positive activities being cost-conscious but are not limited by profit motives.

            Governmental public health organizations, on the other hand, are government-based bodies from which their directives on effecting responsibilities are derived from the local or national government authorities. These authorities are derived from the locals or the citizens in a community or the nation at large. These authorities are constituted in the local or state laws, the principal aim of the public health organization is to ensure the good health of the citizens under its jurisdictions through preventive or curing measures as deemed necessary. These government organizations in the world differ greatly among nations.

Selected Organization.

The nature and the intensity of disparities in global health challenges warrant a coalescing of efforts by nations and other organizations to achieve a positive impact on these challenges, as there is no single country that can be able to handle these issues singlehandedly. These complex areas require multiple approaches by organizations, institutions, and governments through their agencies in coming up with policies, soliciting funds, and implementing and evaluating the programs adopted (Walsch, 2015). A case example in the response to the global problem of HIV/AIDs across the world and mostly in developing countries, several non-governmental organizations have been in haste to help, but one example, The Global Fund organization is featured here as a representative of how the other organization functions.

History of The Global Fund Organization

In the 21st century, the common epidemics across the world were AIDS, tuberculosis, and malaria. As a response to these epidemics, a partnership organization by the name of The Global Fund was developed to manage and bring to an end the spread of these epidemics. The Global Fund a Non-governmental organization of partnership between governments, the private sector, and civil society, therefore, was formed in the year 2002 (Heymann, 2015). This organization contributes to programs that aim to mitigate the epidemics at an estimated US$4 billion every other year. These programs are placed in countries where they are most affected and run by local experts.

The structure and partnership format of the global fund through the local programs have managed to save millions of people from the jaws of these deadly diseases across the globe. The major activities have been the provision of facilitation, prevention, care services, and treatments.  The economies of these affected areas have since registered improvement upon the entry of the Global Fund into their region and local health systems, and a large number of people who are in the hundreds of millions have since been impacted positively.

In many countries, there were a lot of cries and desperation as a result of the fast spread of AIDS, children, and pregnant mothers, while TB has been in the millennial-afflicted poor, this was in the year 2000. The epidemic appeared unstoppable and determined to devastate the entire population. As a result, there was a collective fight by different sectors ranging from civil societies, private sectors, and government agencies as well, in fighting these menaces. The Global Fund, in particular, fought back relentlessly through a pooling of world resources and investing in programs that had the same intentions of fighting the spread and development of these endemics (Mander, 2014).

The model of The Global Fund organization is designed in such a way that it promotes innovative thinking and appreciates efforts to mitigate the challenges that face global health at large.  In most cases the global fund organizations chip into where the countries have identified where and how to respond to the impacts of TB, AIDS, and malaria by giving the best alternatives, harnessing the best convenient practices by utilizing the experiences and the best insights and innovative nature it has harnessed over time to utilize the least input and ensure resilient, sustainable outputs on health systems.

The Financial Health of the Organization.

The Global Fund connects countries with diverse partners – private sector investors, philanthropists, civil society organizations, and multilateral donors – to develop and implement practical, innovative finance mechanisms to increase the impact against the three diseases. These solutions complement government spending and amplify domestic health financing. The Global Fund has a replenishment three-year cycle mode of raising money. Raises funds in three-year cycles known as Replenishments. The majority of the funds collected at about 95 percent come from the donor governments. The private foundations, the initiates strategies developed by the organization, and the private sector contribute the remaining 5 percent. The strong advocacy that exists between the partners of the global fund, more so the civil society from the endemic countries and the  G20 countries has seen it rise in global contributions from 2002 the year it was established.

The 2016 contribution income of the global fund includes:

•  USD 4,871 million from public donors;

•  USD 289 million from private foundations;

•  USD 35 million from Product (RED);

•  USD 36 million from private corporations (financial sector) and international not-for-profit organizations.

Fund Allocation

            The Global Fund has a way of allocating its funds to eligible and desiring countries in support of malaria, HIV/AIDS, and TB programs. The funding is made at the beginning of the new cycle which is once every three years, this funding intends to create an environment with healthy citizens, and sustainable and resilient health systems (Bediang, 2014). The collection after the three-year cycle represents the total amount of money available to be allocated. Where allocations are made to qualified individual countries, the qualifications are arrived at, through a developed formula that bases its calculations on the degree of disease prevalence and economic capacity and then refined to an account for qualitative and transparent adjustments process that checks in relevant contextual factors.

            Every organization at the end of the day has to know whether the investments in society are impacting positively or not, thus there are several ways to which measurements can be attributed, one common and relevant way the Global Fund is measuring its investments is the number of lives saved. At the end of the 2017 fiscal year, the programs that the global fund had hand on had saved 27 million lives (Stenberg, 2017). Another measure of success is the reduction of malaria, aids, and TB victims by a third since 2002, in countries where the global fund had invested. All these achievements and credit do not only go to    The Global Fund but to all her partners, policymakers, community health, scientists, drug makers, and donors. The achievement is no mean feat, as the epidemic was once considered impossible.

Impacts of the Organization on the Health Initiative.

The highest number of aids related deaths was at a peak in 2005 at 1.8 million, but due to interventions taken to Improve the sector, through making HIV treatment accessible, the number of AIDs related deaths has then reduced to under 1 million in 2017. Regarding TB there has been a drop by 37 percent in related deaths since 2000, this insinuates positive progress that is being made. Of all the international funds on TB, the Global Funds contributes more than 65 percent. Malaria was the worst of the epidemic in the early years of the 21st century, but the spirited and concerted effort of all the organizations and government agencies contributed to the success of controlling the same (Agbedra, 2018). there has been a drop of 50 percent in death rates since 2000 meaning a lot of lives have been saved.

There has been registered progress in the goals of the Global Fund, and each of these foundation goals has led to the development of the others. Global health at the same time shares the responsibility and goals of universal health care coverage. Thus, helps in preventing and reducing millions of potential deaths that are caused by communicable and infectious diseases.

Application to Organization Assistance

The organization has a way of selecting its beneficiaries, through a competent and need-based formula, where the low-income countries are the majority of the participants. Not every organization can be accepted by the global community to register as an NGO and be given the priority to steer the efforts of curbing global issues. The sincerity and status of the organization have to be relooked before receiving funds and donations from the volunteers.

Many countries feel like they deserve to be considered in the lists of the beneficiaries going to this, almost every other country would have been claiming a portion in donation since the majority of the countries have differing problems. Therefore, there is a form to fill out if a country wants to be considered for donations. Some statistics are taken which will be used to calculate which countries deserve the interventions the most.

Countries where the Organization has a Presence.

            The Global Fund organization has a presence in many countries across the world. It is present in all the continents and mostly in African and Asian continents. Non-governmental organizations have a quick response and easy structure in responding to a crisis that government organizations do. As long as the need to be helped has been ascertained the response is quick. However, the structure of government follows strict guidelines. The countries with more severe burdens of the epidemics are prioritized by the Global Fund in terms of funding. The sub-Saharan Africa tops in HIV, and multi-drug resistant tuberculosis and the top 15 countries leading with malarial infection rates, that is Nigeria leading with (25%) of the total malaria incidence, the Democratic Republic of the Congo follows with (11%), Mozambique comes on third with (5%), India fourth at (4%) and Uganda (4%) respectively.

References

Agbedra, S. Y. (2018). Spatial Distribution of AIDS Cases and Accessibility to Treatment      Centers in Sunyani Municipality (Doctoral dissertation, University of Ghana).

Bediang, G., Stoll, B., Elia, N., Abena, J. L., Nolna, D., Chastonay, P., & Geissbuhler, A.              (2014). SMS reminders to improve the tuberculosis cure rate in developing countries           (TB-SMS Cameroon): a protocol of a randomized control study. Trials, 15(1), 35.

Edwards, M., & Hulme, D. (2014). Non-governmental Organisations-Performance and         Accountability: Beyond the magic bullet. Routledge.

Heymann, D. L., Chen, L., Takemi, K., Fidler, D. P., Tappero, J. W., Thomas, M. J., ... &    Kalache, A. (2015). Global health security: the wider lessons from the West African Ebola virus disease epidemic. The Lancet, 385(9980), 1884-1901.

Mander, J. (Ed.). (2014). The case against the global economy: and for a turn towards localization. Routledge.

Poku, N. K. (2017). The political economy of AIDS in Africa. Routledge.

            Stenberg, K., Hanssen, O., Edejer, T. T. T., Bertram, M., Brindley, C., Meshreky, A.,    ... & Soucat, A. (2017). Financing transformative health systems towards achievement of the health Sustainable Development Goals: a model for projected resource needs in 67 low-income and middle-income countries. The Lancet Global             Health, 5(9), e875- e887.

Walsh, F. (2015). Strengthening family resilience. Guilford Publications.

Assignment 2: Global Issue Problem Description

            Health threats in the world today are complex and erratic, some new, seasonal, and deadly diseases that develop once in a season emerge on media and take attention as global health threats, such as Ebola in West Africa for instance. Such threats require immediate attention but the global community at the same time must not forget about their continued priorities in the fight against the persistent epidemics they have been fighting against for a decade, (HIV/AIDS) human immunodeficiency virus/acquired immunodeficiency syndrome, tuberculosis (TB), and malaria. According to the UNAIDS report, in 2002, HIV and aids were the world's leading cause of death among people of 15-59 bracket of age. At the same time also more than 3 million people were infected. For a long time, AIDS has been seen as a death sentence, once you contract it start counting your days, this is not the case as of now, though no cure yet, the disease can be maintained through the use of antiretroviral drugs which keeps one fit. AIDS still is a chronic disease with no cure since as of the year 2015, there were a related 1.1 million deaths, new infections 2 million, and a total of 36.7 million people living with the virus (Case, 2015). These figures call for heightened attention and research on the cure for the treatment. TB is another serious epidemic but it is often overlooked. The worldwide reports in 2015 show deaths of up to 1.4 million and 10.4 new reported cases. These figures are threatening and should be looked into with the same seriousness they manifest. The common problem with TB is that these viruses have developed resistance to some of the drugs, thus proving difficult to control also there are few developments of new drugs to counter their resistance. Malaria finally, is another deadly disease, but the good it can be controlled if some serious interventions are affected, as per 2015 WHO statistics, there was a reported new case of 212 million infections, globally amounting to 429,000 deaths. These diseases are common in woodland and habitats around lakes and marshy areas, and vulnerable communities without the strength to adopt control measures since the transmissions are affected by female Anopheles mosquitoes which survive best in wet areas making it difficult for the struggling economies to grow lacking behind the societies. The paper analyses the impacts of HIV/AIDS, malaria, and Tuberculosis in the world.

HIV/AIDS

            As early as 2000 there was a great deal of information spreading about the HIV/AIDS pandemic, these threats to global health attracted enormous funding from NGOs, government agencies, and some volunteers on the path to finding drugs and research on the same threat. This research on treatments aimed at providing those infected with the virus lead a quality life despite their status. 16 years later, after the continued concerted efforts from the global community, the results show a great stride in the positive direction in that 18.2 million people had access to antiretroviral therapy, in contrast with just a million people able to access the same 16 years down the line. This number was a set target to be achieved in 2015, but nine months to the time the goal was achieved, it was not that a low goal was set but the power of collective efforts in responding to the crisis (Foster, 2002). For every affected effort, there has to result whether positive or negative depending on the nature of interventions invoked, as per the interventions on the HIV crisis, as a result of these efforts, there was a 35 percent decrease in new infections and a 42 percent decrease in aids related deaths as between 2000 and 2015 (Basin, 2015). This is a no-mean-feat achievement in such a sector with a determined virus to spread and infrequent funds, the success of these interventions goes to the donors and health agencies to ensure sustainable funding.

AIDS Prevalence

            Despite the told stories on the success of taming the spread and availing antiretroviral drugs across the globe, there are places and regions within the continent where the story is different, the mention of this viral disease is enough to scare, it is pervasive and its impacts are widely felt, the continent with such disparity is Sub-Saharan Africa. In 2015, the region was leading in the number of registered deaths related to these infections, with the highest number of people registered to be living with HIV, the figure standing at 69.5 percent, there was also a burden of 65.2 percent new occurrence of infections in the region (Day, 2018). Furthermore, there is a slower response to progress on the vulnerable group in sub-Saharan Africa, having young women and adolescent girls predisposed to higher risks than in any other place in the world. AIDS is a dreaded disease having women of reproductive age leading to several deaths related to the disease. Though a lot of awareness of the importance of testing oneself to know the health status, there is still a gap in this area where 60 percent of the population worldwide knows their status, the remaining 40 percent still have not willingly or inconvenient of the accessibility to the testing services. This state of the situation is a risk in terms of curbing the spread of the virus. In Africa people below the age of 25 are the larger lot who do not know their HIV status, the unfortunate case is that the age bracket, of 15-24 constitutes a total of 200 million in the population presenting a possibility of causing a surge in the HIV/AIDS pandemic once again.

The AIDS Scope and Nations Most Impacted

Sub-Saharan countries, especially in the East and Southern Africa, are the hardest hit region by the HIV endemic. It has a significant number of people in the world population which stands at an approximately 6.2% of the total world's populace. Unfortunately, almost half of this population is infected with HIV which is an estimated figure of 19.4 million people. The new infection registered in 2016 alone was 790,000 which is 43% of the global population. South Africa although well off in terms of development than most of its African counterparts still has a sizeable number of infections which accounts for a third of the region's infections. The other 50 percent of infections are accounted for by only eight countries which are Mozambique, Malawi, Uganda, Zambia, Tanzania, Zimbabwe, Ethiopia, and Kenya (Granich, 2015).

In 2016, there was a high number of AIDS-related illnesses, having 42000 people accounted to have died, the figure however large it is, depicts progress since the number was almost clocking to a million in 2010, standing at 760,000 deaths. The strides made all point to the kinds of strategies developed as such the UNAIDS 90-90-90 targets.

There has been a collective effort from the global community and nations through their health agencies to create a target to end these pandemics. To this effect, there was a joint effort by the United Nations programs on taming the AIDS pandemic. This adopted global strategy goes by the 90-90-90 agenda of which the program aims to have 90 percent of the population aware of their HIV status, 90 percent of the population diagnosed as having the infection able to receive antiretroviral drugs, and the other 90 percent of the total people receiving antiretroviral medications being able to do viral suppression by 2020 (Dutta, 2015). In strategizing how to maximize the impact the world community decided to support some organizations such as the Global Fund in fighting AIDS, malaria, and tuberculosis in specific, by finding a diverse approach that fits the structure and nature of different countries. The global fund strategy 2017-2022 aims to end the pandemics by adopting appropriate, alignment specific to the contextual countries and providing sustainable programs in tackling the diseases.

In terms of the monetary value that global funding contributes to the HIV/AIDS programs, it stands to an estimated value of $19 billion annually. Which is the highest value in comparison to funding made to any other single disease? The sources of these funds are majorly from the countries and some from donors. 57 percent of the total money raised in 2015 was money collected from in countries and the rest is from donors which are contributed in many ways, mostly in sub-Sahara Africa and developing countries that majorly depend on donor funds in responding to such endemics. In 2014 for instance, 44 countries had a dependency on donor funds to curb HIV/AIDS to a total of 75 percent or even more (Granich, 2015).

Social and Economic Status Impacts

The fight to tame HIV/AIDS has since registered some success in terms of reduction in the spread, availability of retroviral drugs, and awareness on methods of spread to the communities, these, alone cannot make to achieving complete goals without making an effort to an understanding on the social and economic vulnerabilities of the societies involved. This broadening view not only facilitates health outcomes but education and better livelihood as well. Field staff respondents have demonstrated the necessity to treat patients most humanely and professionally as possible. This is best served when understanding the social life of the community in question is well-researched, for instance, some cultures of people perpetuate the spread of the AIDS virus. In Africa for instance, there is the adoption of someone's life if one dies, a belief that a brother should inherit the property and wife of the disease, if in case the disease was as a result of this endemic disease then the spread will surely continue. Some other cultures practice communal circumcision of their sons, where they believe in the use of one sharpened blade, such crude and stereotypical social cultures heightened the spread of HIV/AIDS.

Another aspect to consider is the economic condition of the region where intended services are to be affected. This consideration might have no direct effect on the objectives of the Global Fund in meeting a reduced spread of aids by 2022 but still will have some impacts. For instance, a person using antiretroviral drugs cannot maintain consistency in a place where the economy is tough that is when even getting enough food is a challenge. Research shows that people living with aids and in malnourished environments have a higher affinity to die within the first six months of treatment than patients who have enough food. So it is advisable that in the continued fight against AIDS poverty and stereotyped ways of life perceived as a culture should be done away with the same energy.

The mere fact that depending on the way through which the social, economic, cultural, organizational, policy, and legal factors can affect impacts either positively or negatively on HIV, has led to critical structure designing of approaches to preventing spread. The structural interventions aim to establish an environment that promotes an individual's resilience and reduces vulnerability and risk. These interventions adopt policies or programs that change the political or social setup, in that they change the way the community responds to day to day-to-day issues or on a specific level twist the way people live. These changes in structural programs with the intent of reducing and preventing HIV will not achieve their goals effectively if other prevention programming structures are not complemented to bring about consistent reduction and vulnerability in HIV risks.

Examples of the structural initiatives that can be affected to impact on HIV prevalence and control are:

1. Coming up with legal policies that encourage a favorable environment to exchange programs in needles as well as the creation of consumption sites.
2. Creation of legal laws that punish those who discriminate the HIV patients and vulnerable groups to gather for anti-stigma measures.
3. Creation of policies that give a favorable environment to all genders regardless of sex, such as initiatives such as the fight against sexual violence and economic independence to all and sundry.
4. Creating policies that favor injection drug users on stable housing programs.
5. Advocating for funding and encouraging an enabling environment to fight the endemic through allowing the affected communities to participate in promotions and prevention programs for HIV.

            Considering applying the structural intervention in a certain community, for it to be effective some factors need to be considered first and they are the social, cultural economic, and environmental contribution and potential risks within those contexts to which HIV risks can be affected.  After which the successful existing programs that have borne fruits elsewhere should then be considered for implementation in the interested community.

            It is often common knowledge that structural features that HIV vulnerability is so deeply dependent on are entrenched in the political economic and social drapery of society. This means changes to the structural features are long-term and capital-intensive. There has been limited information on the effectiveness of the structural changes to the impacts of HIV risks, prevalence, and prevention due to its large-scale setup which cannot be done so easily.

Leveraging Partnerships

            Local funds, for instance, have had informal in the past the strategist the global health community has been using has done a lot in the contribution of the development the sector has so far had, but going forward, there have been growing complexities, in the health sector in terms of endemics and nature of responses required. As such there is a need to revise ways and methods of approaching the problem of AIDS, one such example is integrating the power of partnership towards solving a common problem. The Global Fund organization for instance, in the past, has, with the host country had an informal partnership. The best approach to tapping the maximum potential in between these relations and ensuring self-sufficiency as well as sustainability working together as partners are the only choice. The partnership will then engage stakeholders who are governments and civil society groups to relook at the planning process before execution until it is agreed that the plan is all-inclusive and sound at the time.

A Continued Focus on Data and Metrics

            The progress made in addressing the HIV/AIDS pandemic warrants a recognition, that there are serious barriers that prevent closing up the matter, and the data present that 50 percent of those people having the virus are unaware. Thus, the a need to address the importance of testing one’s health status every 3 months or as regularly as possible to help in strategizing and closing up the testing gap. This unawareness is attributed to rising HIV treatment. But it also presents continuing challenges in keeping the epidemic under control if those who are infected are unaware. The increase in data collection on the health impact assessment down to the last household helps in measuring the prevalence, mortality rate, and incidence hence providing technical support. There is still a higher number of infections than those on treatments which calls for heightened support on prevention than the treatments (Shisana, 2014).

HIV/TB Coinfection

            In most cases of AIDS-related deaths, the disease responsible for deaths in low resource-based areas is mainly TB. This is an epidemiological challenge to controlling the spread. It is noted that those people with AIDS are more prone to contracting TB 21 to 31 times more than any other person without. In 2015, out of the total AIDS patients, one-third of them had contracted TB. For instance, of the 10.4 million people who had contracted TB 1.2 million of them had already contracted HIV.  TB and HIV coinfection is a dangerous interaction to ever exist. Since the interaction causes less absorption of the TB treatments hence increasing health deterioration of the body as a result of TB, that is why the final death to people with coinfection die faster than those people with AIDS alone. It is then advisable that when devising interventions to gather for co-infected patients, extensive nature of treatment is required and awareness of the health experts on LMICs areas should understand the importance of the need to effectively administer treatments as TB tends to develop resistants should consistency be not observed.

            The complex epidemiology of TB, the ability to co-incur with HIV/AIDS, and the increase in drug-resistant strains have dwarfed the efforts of the social community in controlling their spread. The unfortunate fact is that these co-incurrences happen in the same countries with already enough problems in terms of lifestyle and food problems. These countries which are highly hit, are the same countries that appear top with the incidence of HIV/AIDS.

            The many effects have led to coming up with several strategies that have been put under trial for the same goal of curbing the spread, it is clear that these strategies are not objective enough to release the burden this endemic disease poses. Major treatment strategy being directly observed treatment (DOT) short course which was branded and pushed for adoption in the mid-1990s by WHO. This became a TB control strategy for the better part of the century, the strategy was limited to specific parts of the countries which among the list include, Malawi, Tanzania, and Mozambique. The DOT policy seems to be impacting positively and that is why by the end of 2001, more than 127 countries had emulated the policy.

            From the approaches to which these endemics are attended to it is clear that, for a long-lasting impact on these AIDS endemics, the approach has to be changed from an emergency support style to a more sustained response, having strategic planning and incorporation of patient care (Danieli, 2018). While organizations continue playing the ethical imperative role of saving lives, effective ways of doing it better should be identified and adopted for the benefit of everyone in the equation. This is achieved through leveraging on the existing structures reducing the costs and the need to acquaint oneself with the new environment in the case of foreign or visiting agencies.

The Environmental, Economic and Social Factors that Determine the Health Status

            Many factors determine the health of the individual or citizens of the nation Healthwise, these factors range from the economic, social, and environmental. Depending on the country, as defined by their public health agencies it takes different forms of explanations. But some factors cut across these definitions and are common all through, Among are social environments, income, employment/working conditions, social support networks, literacy, education, physical environments, individual health observes and survival skills, fit child development, biology, and genetic grant, well-being services, gender, and culture.

            The incidence of HIV/AIDS, in terms of social factors, revolves around the self-esteem factor and powerfulness, any factor that hinders them predisposes them to health issues. For instance, when someone is raped, homeless, or lacks choices in life, one tends to get stigmatized, and vulnerable, and thus this could cloud your judgment and hence reduces the ability of one to protect themselves from contracting AIDS (Adams, 2016).

            All of these factors in one way or another have the ability to impact either directly or indirectly the spread of HIV/AIDS. Thus, enforcing policy factors that ensure the safety of her citizens, and developing economically friendly policies that reduce poverty strengthens people's esteem which makes them make tough choices and healthy ones in life reducing the vulnerabilities of the endemics.

TUBERCULOSIS

            Before 1993, the time TB was declared an international emergency, it had been underprioritized for a very long time. The first occurrence of this airborne disease was in the 1970s during the time complacency in public health was at its highest, as a result in the 1980s there was a resurgence of TB, and the world has struggled to reduce the global burden of TB, facing significant challenges in tackling the disease in the world's poorest regions. There is a registered decrease in mortality and incidence of about 1.4 to 2.3 percent annually, between the years 2000 and 2005 which merits applause but the sad thing is that this reduction in mortality is quite slow. AIDS was once a leading cause of death in infectious diseases but it has then been tamed, now TB is leading with a near death of 1.4 million and a new case registered at 1.4 million as per 2015 UNAIDS data. AIDS coming second with 1.1 million deaths (Munro, 2007).

            TB is a global disease and has had some burdening impacts majorly on southeast Asia, the Western Pacific, and Africa. The global community has had to brainstorm ideas on how best to control these neglected but equally dangerous diseases, and the best they could come up with is the then, end TB strategy which is under WHO. The strategy had its main goals aligned with the SDGs. These goals had an objective of reducing TB-related deaths by 95 percent and reducing the disease incidence by 90 percent by 2035. The secondary objectives of these strategies also included making an effort to reduce the percentage of TB-stricken households that have the problem of financing expensive medications to already suffering communities hence scaling up poverty and increasing morbidity in general. To meet these set objectives heightened efforts and soliciting of enough funds to service the drive is a necessity, as of 2016, the estimated budget of $8.3 billion was needed to effectively enroll the required interventions, unfortunately, there has been straining in terms of meeting the necessary global resources. In 2016, the total of collected finances was less than the target by 30 percent, and out of the collective majority of the funds solicited came from the country, that is 84 percent of the $6.6 billion (Abdool, 2011). These effects in low-income countries have adversely affected the rollout of the TB programs, as the effective measure could require at least 90 percent of the foreign assistance which is the least given in these areas.

Epidemiological Complexity of Tuberculosis

            The shunning away and low contribution to curbing the challenge of TB is associated with its epidemiological structure and complexities of the TB infections. This is a real problem in low-income areas, as the populace is left alone to fight these complexities. First, TB is difficult to diagnose, and the resulting inadequate case finding is an obstacle to global TB control.  In the contemporary diagnosis of diseases, it is often fast and easy to diagnose diseases, but in the case of TB, a bacterial infection, it is a little bit different, it has a long growth cycle which the common rapid diagnosis Of a bacterial infection with an especially long growth cycle, TB cannot easily be detected with rapid diagnostic tests which are common to the other global health diseases. In LMIC areas, the principal method utilized in diagnosis is the sputum smear microscopy, it is quick but not efficient as it has limited ability thus detection of pediatric TB, and TB coinfection becomes a challenge. The long growth cycle of TB becomes the next challenge as the patient can take an average of six to nine months under treatments that require the use of multiple drugs, as well as the need to integrate chemotherapy sessions. All of these requirements limit the interventions by potential donors. The control of TB is effective when the correct regiments and environmental conditions are adhered to but the issue comes with the prolonged cycle which reduces the adherence to these cycles. The global success rate is 83 percent which in the real sense should have been 100 percent but the problems associated with the administration of the drug still remain a challenge.

Drug-Resistant Tuberculosis

            When drugs are diagnosed, that very particular pattern should be followed for it to be effective, but when one skips or does not follow the correct guidelines there is a repercussion. Amongst the effects of these effects is the development of resistance by the strain virus being controlled to the drug. This is the case with the TB patients when treatments are made, they adhere not, claiming the prolonged usage of the same. The emergence of drug-resistant TB such as the monoresistant TB, drug-resistant TB (XDR-TB), and multidrug-resistant TB (MDR-TB) has been observed to have emerged as a result. Another big contribution to the emergence of drug-resistant TB is the combination chemotherapy of the mid-1900s (Munro, 2007). people spread the word that chemotherapy was able to cure TB fast and hence the ultimate cure. Then a lot of donations which was being channeled to aid suppress the epidemic were withdrawn by various donors. 

            During the 1970s and 1980s, there was a resurgence of TB across the world, these are attributed to the earlier fake belief that chemotherapy was the ultimate treatment which caused the extraction of the important prevention practices the global community was contributing to. MDR-TB as well as among the outbreak. In 2015 alone as per the WHO statistics, there were 3.9 new cases of TB registered, MDR-TB estimated new cases of 480,000, 9.5 percent XDR-TB cases. These figures might look small but the underlying burden it affects is wider and longer felt. For instance, trying to determine the resistance of the TB strain takes a continuous 6 weeks of intense laboratory services which should be sophisticated hence a challenge in LMICs areas.

References

Adam, B. D. (2016). Neoliberalism, masculinity, and HIV risk. Sexuality Research and          Social Policy, 13(4), 321-329.

Basin, M. (2017). Achillea millefolium: Re‐Exploring Herbal Remedies for Combating        Malaria. A Phytochemical Perspective, 160.

Case, A., & Deaton, A. (2015). Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proceedings of the National   Academy of Sciences, 112(49), 15078-15083.

Day, C., Ndlovu, N., & Gray, A. (2018). Health and Related Indicators 2018. South African          Health Review, 2018(1), 139-250.

Dutta, A., Barker, C., & Kallarakal, A. (2015). The HIV treatment gap: estimates of the financial resources needed versus available for scale-up of antiretroviral therapy in 97          countries from 2015 to 2020. PLoS medicine, 12(11), e1001907.

Shisana, O., Rehle, T., Simbayi, L. C., Zuma, K., Jooste, S., Zungu, N., ... & Onoya, D.      (2014). South African national HIV prevalence, incidence and behavior survey,          2012.

Assignment 3: Intervention and Evaluation Plan

            The study dwells more on the interventions adopted by the non-governmental organizations and the government agencies as well as the evaluation plan they best consider to suit their structure. Bearing in mind the diverse sources from which information can be spread or gathered, the nature of intervention required to be adopted should be based on various aspects such as the social, cultural, and religious aspects of the area. In a span of data collection and evaluation, a framework has to be chosen from which the entire plan should be rolled on to effect maximum results. African governments in the last decade have been on a rushing spree to develop low-cost interventions to arrest the spread of HIV/AIDS, through government agencies, and international, and volunteer private organizations. The interventions have utilized various information transmission gadgets like leaflets, stickers, banners, and other kits. Varied messages are being vented across all the media platforms on education about HIV and AIDS on radio stations, television, billboards, and through local entertainers (Madikizela, 2015). Also, many peer educators are going around the continent visiting common places where people gather in numbers that are hotels, gardens, local bars, etc, teaching basic AIDS prevention education as well as giving out condoms.

            Success measured in terms of preventing the development of new cases of HIV and AIDS has not been easy to quantify and evaluate the effectiveness of these interventions but the trends on the recent decrease in prevalence is a shred of clear evidence that such methods are effective.

The Role of Sport as a Tool to Respond to HIV/AIDS

            Across the world, the common intervention adopted in both the developed and non-developed nations is the sport-based intervention. These interventions are preferred mainly to meeting various social needs because it is the only common binding factor that transverses across all the disparities that exist socially. It is only in sporting activities that you see people of diverse cultures beliefs and characters coming together whenever there is a sporting activity. Utilizing this aspect to achieve the millennium goals especially the MDG 6 which is on HIV/AIDS, TB, and malaria is a step ahead (Marshall, 2015). The strategy is considered relevant and important as it can utilize an already existing framework for the best of the community. In South Africa for instance, some interviews conducted by SDP IWG to find out the best tool that can be used to address the various social challenges reveals that of the 34 members present 18 of them confirm the connection between the sport for development as equally effective when correctly and objectively used.

            The sport utilization as the intervention has varied tools that can be utilized to be effective in reaching the final goals which are spreading awareness on the importance of prevention rather than cure and the importance of keeping healthy among other social intended concerns. These numerous toolkits such as the soccer, rugby, basketball, and handball forums are in most scenarios utilized by the NGOs to pass out the intended message and life skills principally amid adolescence.

            Several activities can be tapped from the sporting tool as an intervention to AIDS control which is very important to youths and even to adults. Such a play as ‘Find the Ball' involves creating two teams with each passing a written ball denoting the symbols of HIV, while this is happening the participants are required to be blindfolded and are expected to tell who has the ball. Such a game, in the end, drives a relevant and permanent message to the participants that it is important to know that you cannot tell if someone has HIV just by looks. At the same time sensitizes the community that those infected are people and should be treated just like any other human being hence reducing the rate of stigma between the HIV stricken people (Thorpe, 2016).

Ball dribbling around cones is another ball intervention strategy that teaches the masses indirectly. The risk field explores risky behaviors through representations such as dribbling the ball around the cones. The act represents the different risky conducts. Several other skills in football are used repeatedly to pass a health message.

            A case example of another intervention that can be utilized to pass the message is the integrated sport. The Magic Bus organization in India developed a curriculum on reproductive and sexual health through this intervention. The intervention did not only come up with the curriculum but also increased the willpower of youths to be part of fighting the death claws of HIV and AIDS.

            Training and coaching are another way through which the young can be attracted to which, lessons on such topics as Kicking AIDS Out are administered.  The sportspersons and coaches can be used as well after training as ambassadors in the promotion of HIV and AIDS control messages. A case example of SCORE organization which trains coaches and uses them to drive HIV and AIDS prevention messages.

            A conducted evaluation among various NGOs revealed that the majority of them though they use other interventions for aid prevention have sports-related activity. The South African government is one of the countries that has realized the benefits of integrating sports into sensitization programs. Through the use of sports in responding and conducting their programs on prevention methods.

Evaluation Plan.

            To find out the effectiveness of sports intervention as a form of awareness of global health issues, especially AIDS and TB. An evaluation program was established based in South Africa and had seven employees all from five different NGOs, evaluation framework aimed at integrating a framework of improving the use of sport-based interventions to increase awareness of the spread of HIV, TB as well as malaria. The evaluation also takes the form of interventions in terms of program design, implementation, and outcomes. These are the stages to which evaluation is based on determining if it was successful or not. The intervention evaluation thus follows a procedure of formative, process, and later the outcome.

The first design is the formative evaluation which examines the structural potential of the method, in this case, the sport intervention. The evaluation involves looking at the ability of the sport intervention masses if the sport has the capacity to attract all genders and sexes and if it cuts across all age groups (Breuer, 2015). Then looks at the policies that provide the peer counselors in such events the freedom to educate people or are restricted. Based on these considerations the sports intervention method has the ability and structure to avail many people as much as possible and to which gender and age cut across all, therefore it can meet its goals based on this evaluation.

The second evaluation is the Process evaluation technique, which entails the counterchecking of the projects as it is rolled out, against short-term goals, whether the goals are being achieved or not, in such a scenario, the sports interventions have such goals as to make people understand the causes of HIV and AIDS, make people know what are preventions methods. Throughout the projects, the measurement of the awareness the sports fans have on the spread and misconceptions surrounding HIV and AIDS was kept updated by asking questions and complemented by questionnaires.

            The last evaluation method is the Outcome evaluation, the most important of all the evaluations. It shows the final impacts of the interventions on the community. Measure up the goals of the interventions. Like, in this case, the sports intervention technique's goal was to make sure people are aware of what causes AIDS, how it is being spread, and what the misconceptions surrounding it are. While the soccer games are going on the recorded audio is played repeatedly creating awareness among the unsuspecting masses. This way by the end of the day people would have enjoyed the fun at the same time enlightened on matters of health. The measure of success is then measured to give information on whether the goals of the sport-adopted intervention were achieved or not.

            The logical program evaluation of these intervention methods is expensive, time-consuming, and laborious, hence to ensure the interventions will yield positive in the end, behavioral observations are encouraged to identify in brief if the procedure will be worth trying hence avoiding wastage of the resources on weak projects with hints of no relevance on the project. The evaluation must be held on for some time to bring out the more pragmatic and valid results, however, the rigorous and difficult the exercises could prove to be.

Data Evaluation

In the phase of data evaluation, there are three subsections involved and are;

(a): document analysis,

(b): one-on-one interviews

(c): focus group interview.

            The first phase of the document analysis majors on analyzing annual reports, the second subsection dwells on sampling type, and the third subsections rotate on indicators of the outcomes, that is what could be the impact of the awareness through the sporting facet to the immediate community (Lindlof, 2017). thematic analyses are then used to measure and analyze data from the focus group.

            Phase 3 included the use of convenience sampling to select six specialists/experts involved in the field of HIV/AIDS to explore what indicators can be used to monitor outcomes of sport-based awareness HIV/AIDS programs. In addition, purposive sampling was used to select one official from SRSA who is involved in monitoring and evaluation. Schedule one-on-one interviews were used.

Results and Discussions

            The data collections use the format of the three phases above, and based on that structure the results will be discussed and presented in that order. These results had a particular effort towards achieving a particular outcome hence a specific focus and outcome will be integrated with the aim of getting a generic result in sport-based HIV/AIDS programs, as per the different NGOs that are selected in South Africa.

Types of Outcome Measures

            In case there is a report of more than one primary HIV/AIDS cognizance outcome reported, studies were included.  Such multiple outcomes could be biological, antiretroviral therapy (ARV). Sexual behavior, knowledge of HIV/AIDS, condom use, and self-efficacy.

Search Strategy

            A search strategy utilized various sources ranging from the manual searches of important references in the university library use of published as well as unpublished studies. Electronic search websites like Google Scholar, and MEDLINE. All of these works are guided by the reference list of the specific journals of relevance.

Data Extraction and Management

            The studies and the report on the program had all of their data extracted from the full report or the abstract. The information about indicators, objectives, and outcomes of the sport-based HIV/AIDS programs. The verification of alignment and relevance is then looked into by the researcher and supervisor as well.

 Key outcomes from included studies

After the data extraction the analysis and classification of data are done based on the context of the HIV/AIDS,  that is all the factors are grouped based on the biological or health of HIV/AIDS, gender norms, communication on HIV/AIDS, sexual and behavioral transmission of HIV/AIDS, gender norms within the context of HIV/AIDS and awareness concerning stigma. These studies were then counted and discussed based on the impacts they bring about as either positive or negative.

Discussions from the Focus Group Interview

            The talk on the results of the focus group hints at what ought to be adjusted to bring a finer result. Such adjustments were given by the employees of a particular NGO, that it is very based on the determinants of HIV/AIDS and the projected outcomes. Through such adjustments, some specific risk behaviors can be identified and associated with a specific source.

Recommendations to be Considered by Selected NGOs

            For any NGOs to run effectively there have to be important determinants that act as a framework for achieving the best of the set objective. Tapping on the same should be the main goal of every serious organization, as such interventions and evaluation plan functions have to be established. Responsibilities the capacities of the organization and the prospects of an organization remaining sustainable should be estimated using the theory of change models should there be a need to do so.

 Conclusion

            Even if the findings of this study show that the sport-based HIV/AIDS effects of awareness are challenging to measure, there is a significant reduction when such interventions are applied in the incidences and deaths as a result of the endemic. The South African government through the national strategic plan 2012-2016 for HIV, STIs, and TB, the responsibilities adopted by the NGOs merge with the government objectives on intentions of reducing the risks and behaviors associated with HIV/AIDS.

References

Breuer, E., Lee, L., De Silva, M., & Lund, C. (2015). Using theory of change to design and evaluate public health interventions: a systematic review. Implementation    Science, 11(1), 63.

Lindlof, T. R., & Taylor, B. C. (2017). Qualitative communication research methods. Sage publications.

Madikizela, N. (2015). Communication tools used to educate High School Learners about            HIV/AIDS in the Mthatha area(Doctoral dissertation).

Marshall, S. K., & Barry, P. (2015). Community sport for development: Perceptions from practice in Southern Africa. Journal of Sport Management, 29(1), 109-121.

Thorpe, H. (2016). Action sports for youth development: Critical insights for the SDP    community. International journal of sport policy and politics, 8(1), 91-116.