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Content strategy sweet spot needs to hit 4 key pillars – NewsDay

Happily, digital technology also provides the tools, data and other information needed to inform newsrooms and help incorporate audience desires into content strategies. Sometimes, this information shows our instincts are wrong.

THE days when news editors relied solely on seat-of-the-pants instincts when choosing what topics and stories to publish are long gone.

That worked in a take-it-or-leave-it, pre-digital media world; the game has changed. More knowledge, more insight and more regard for what the audience need and want is necessary.

Happily, digital technology also provides the tools, data and other information needed to inform newsrooms and help incorporate audience desires into content strategies. Sometimes, this information shows our instincts are wrong.

But data alone is not the answer: Traditional journalistic values must still figure into decisions about content. In addition, it is essential to understand what readers and users want, their desires and ambitions, and, perhaps most importantly, what they are willing to pay for.

Where journalistic mission, audience knowledge and empathy, usage analytics and financial impact meet, you have a “sweet spot” for any content strategy. Stories hit the sweet spot when they fulfil the organisation’s mission, score well with the analytics, satisfy a deep audience information need and get people to pay for more.

But it takes some work to find them.

Market insight

When we talk about market insight, we are not talking about asking audiences what they want. Often, they do not know. Or, they will tell you what they think you want to hear or what provides prestige and hide what actually attracts them.

Market insight means understanding how people think, what they feel, what fears they have, what drives them and what motivates them. With these customer insights, you can deduce what kind of content responds to their needs much more accurately than asking them to rate your stories. For example, if you discover that a significant part of your audience values information about personal health or they are very career driven, then you can offer more stories about these topics.

But field research is often not the best way to determine what, specifically, they want in terms of health and career. You could find out through focus groups, but this is time-consuming, expensive and only considers the views of a small number of people. There is then the need to experiment and test, especially if you move into topics which are not a big part of your current offerings.

This is where digital kicks in.

Analytics

Usage and user behaviour data and analytics have value. This “post-mortem” data, gathered after the story appears, tells you what people looked at, how much they consumed and for how long.

This knowledge can inform your decisions on other stories to publish. This not only tells you which content is popular, but also what you can leave out — the stories that have little or no traffic, have very short reading times, don’t convert, or are not read by many subscribers.

But you cannot rely on this alone: There is always the possibility that you have created a self-fulfilling prophecy. If you offer more of something and place it prominently on the site or in the app, people will consume more simply because it is there. One example is the so-called and often demonised listicles. Listicles are easy-to-read, offer added value and, therefore, popular. But a dangerous reflex would be to overdo it.

Journalistic mission

The third dimension, never to be forgotten or diminished, is your mission and how you define your brand. You do not only provide what you think your audience wants (or needs),  but also what you are convinced is important. These are not only the things that are driven by data or audience research.

Your audience may not necessarily seek them out, so it is important to put it right in front of them, even on page 1, when you are convinced this is very important.

An example: A very popular regional newspaper in Europe once published an eight-page special about a “high-brow” book author of that country. It was quite niche and not really appealing to a majority of the readers, but the editor-in-chief decided it was important for the brand to get it in front of their readers.

These types of stories can surprise people and widen their horizons … if they decide to engage. This is, of course, old school judgment of the newsroom team. This knowledge and experience is a core capability of any good editorial operation.

Paid content potential

The fourth area and in the midst of digital transformation very important, is content that could have a financial impact. That is, stories generating new audiences or engaging existing audiences, who are willing to pay for the privilege of accessing them. Or, stories generating sufficient reach to pay into the digital advertising bucket as well as fill the audience acquisition funnel.

Ideally, these stories emerge from those that satisfy the other three criteria: Stories based on customer insight and journalistic value and that are confirmed as relevant by data and analytics. If that happens, the sweet spot is met.

To find this sweet spot is the goal, but it is not realistic to think every piece of content will fit into it.

Both art and science are involved. You might have stories that are important for the journalistic mission and receive a lot of traffic, but your audience insight would not have predicted or supported it. Or, you might have popular stories that don’t support the journalistic mission.

These are the typical “click-bait” stories. You have to be careful with these, as stories that do not fit the mission (and can be found elsewhere) can dilute your value proposition.

It is not easy to find the sweet spot. But overall, it is always important to seek stories that fulfil those four criteria, or at least two of them. The bigger the overlap, obviously, the better. Thinking about content in this way is likely to produce content that is desired, generates traffic and subscriptions and satisfies readers as well as fulfilling the traditional role of serving your community.

Dietmar Schantin is a digital media strategist and has helped to transform the editorial and commercial operations of media brands around the world.

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Mortality Among Children Aged

Nickolas T. Agathis, MD1; Iyiola Faturiyele, MBChB2; Patricia Agaba, MBBS3,4; Kiva A. Fisher, PhD1; Stephanie Hackett, MPH1; Elfriede Agyemang, MD1; Neha Mehta, MPH1; Gurpreet Kindra, PhD5; Diane F. Morof, MD5; Immaculate Mutisya, MBChB6; Lennah Nyabiage, MBChB6; Katherine A. Battey, MPH7; Ezeomu Olotu, MBBS8; Talent Maphosa, MD9; Catherine Motswere-Chirwa, MPH10; Akeem T. Ketlogetswe, MSc10; Jessica Mafa-Setswalo11; Sikhathele Mazibuko, MBChB12; Maria Ines Tomo de Deus, MD13; Herminio G. Nhaguiombe13; Edward M. Machage, MD14; Bridget Mugisa, MD15; Dolapo T. Ogundehin, PhD16; Carolyn Mbelwa, MD17; Estella Birabwa, MBChB18; Monica Etima, MD18; Yakubu Adamu, MD19; Ismail Lawal, MD19; Jonah Maswai, MBChB20; Dorothy Njeru, MPH20; Janet Mwambona, MD21; Boniface Nguhuni, MD21; Rosemary Mrina, MD3,4; Susan Hrapcak, MD1; George K. Siberry, MD2; Catherine Godfrey, MD22; Hilary T. Wolf, MD22 (View author affiliations)

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Summary

What is already known about this topic?

Globally, children aged <5 years, including children living with HIV who are not receiving antiretroviral treatment (ART), experience disproportionately high mortality.

What is added by this report?

Compared with older persons living with HIV receiving ART served by the U.S. President’s Emergency Plan for AIDS Relief during October 2020–September 2022, a higher proportion of children aged <5 years receiving ART died or had interrupted treatment, and a lower proportion had a suppressed HIV viral load.

What are the implications for public health practice?

Prioritizing and optimizing HIV and general health services for children aged <5 years living with HIV receiving ART, including those recommended in the WHO STOP AIDS Package, might help address these disproportionately poorer outcomes.

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Abstract

Globally, children aged <5 years, including those living with HIV who are not receiving antiretroviral treatment (ART), experience disproportionately high mortality. Global mortality among children living with HIV aged <5 years receiving ART is not well described. This report compares mortality and related clinical measures among infants aged <1 year and children aged 1–4 years living with HIV with those among older persons aged 5–14, 15–49, and ≥50 years living with HIV receiving ART services at all clinical sites supported by the U.S. President’s Emergency Plan for AIDS Relief. During October 2020–September 2022, an average of 11,980 infants aged <1 year and 105,510 children aged 1–4 years were receiving ART each quarter; among these infants and children receiving ART, 586 (4.9%) and 2,684 (2.5%), respectively, were reported to have died annually. These proportions of infants and children who died ranged from four to nine times higher in infants aged <1 year, and two to five times higher in children aged 1–4 years, than the proportions of older persons aged ≥5 years receiving ART. Compared with persons aged ≥5 years living with HIV, the proportions of children aged <5 years living with HIV who experienced interruptions in treatment were also higher, and the proportions who had a documented HIV viral load result or a suppressed viral load were lower. Prioritizing and optimizing HIV and general health services for children aged <5 years living with HIV receiving ART, including those recommended in the WHO STOP AIDS Package, might help address these disproportionately poorer outcomes.

Introduction

Globally, children aged <5 years living with HIV are less likely to receive a diagnosis of HIV and be linked to antiretroviral treatment (ART) than are older persons living with HIV, and are more likely to die, especially those who are not receiving ART (1). Disparities in mortality and other outcomes among children compared with older persons living with HIV after initiating ART are not as well described. Given the relatively high global mortality rates among children aged <5 years in general (2), those living with HIV receiving ART might experience excessively high mortality compared with older persons living with HIV receiving ART. This report compares mortality and other clinical measures among infants aged <1 year and children aged 1–4 years with those among persons aged ≥5 years living with HIV receiving ART services during October 2020–September 2022, at all clinical sites supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).

Methods

PEPFAR Monitoring, Evaluation, and Reporting data collected quarterly from all PEPFAR-supported treatment sites during October 2020–September 2022 were analyzed.* Indicators included the estimated number of persons living with HIV receiving ART, mortality§ (i.e., reported to have died), interruption in treatment (i.e., no clinical encounter during the 28 days after the last scheduled clinical contact), proxy viral load coverage** (i.e., documented viral load result during the previous 12 months among those assumed to be eligible for a viral load test), and viral load suppression†† (i.e., had a suppressed viral load result among those with a viral load result documented within the previous 12 months). Mortality was measured as the annual mean numbers and proportions of reported deaths among those receiving ART, and the other indicators are reported as quarterly mean numbers or proportions among those receiving ART§§; these measures were compared among children aged <5 years living with HIV receiving ART (stratified by age <1 and age 1–4 years to differentiate infants from other children aged <5 years) and older persons aged 5–14, 15–49, and ≥50 years living with HIV receiving ART. Crude mortality ratios (CMRs) were calculated comparing the proportions of reported deaths among these age groups. SAS (version 9.4; SAS Institute) was used to conduct all analyses. This activity was reviewed by CDC, deemed not research, and was conducted consistent with applicable federal law and CDC policy.¶¶

Results

Among all PEPFAR-supported sites, an average of 17.9 million persons living with HIV received ART each quarter, among whom 11,980 were aged <1 year, and 105,510 were aged 1–4 years during the 2-year analysis period. Among these ART recipients, 4.9% of those aged <1 year and 2.5% of those aged 1–4 years were reported to have died annually; among older age groups these prevalences were 0.5% (5–14 years), 0.7% (15–49 years), and 1.4% (≥50 years) (Table 1) (Figure). Proportions of reported deaths among infants aged <1 year were approximately four to nine times those among older age groups: CMR = 9.2, 7.2, and 3.6 among persons living with HIV aged 5–14 years, 15–49 years, and ≥50 years, respectively. Proportions among children aged 1–4 years were approximately two to five times those among older age groups: CMR = 4.8, 3.7, and 1.9 among those aged 5–14 years, 15–49 years, and ≥50 years, respectively (Table 1). Interruptions in treatment were also more prevalent among children aged <5 years living with HIV than among persons within older age groups (<1 year and 1–4 years, 4%; 5–14 years, 2%; 15–49 years, 3%; and ≥50 years, 2%) living with HIV receiving ART; proportions were lower for proxy viral load coverage (<1 year: not reported***; 1–4 years, 66%; 5–14 years, 82%; 15–49 years, 77%; and ≥50 years, 83%), and for viral load suppression (<1 year, 78%; 1–4 years, 73%; 5–14 years, 85%; 15–49 years, 94%; and ≥50 years, 96%) (Table 2).

Discussion

Among approximately 18 million persons living with HIV receiving ART through PEPFAR during October 2020–September 2022, prevalences of reported death were higher among children aged <5 years than among persons in older age groups, consistent with previously published findings (3). The additional finding that interruptions in treatment were also more common among children aged <5 years living with HIV might suggest that mortality is disproportionately underreported in this age group, because patients with interruptions in treatment or who are lost to follow-up might have died (3).

Among persons living with HIV receiving ART, several factors might explain the disparities in mortality among children aged <5 years compared with older persons. First, many children aged <5 years with HIV are severely immunosuppressed and at high risk for poor outcomes when they receive an HIV diagnosis and initiate ART (4). WHO considers all children aged <5 years living with HIV who are not clinically stable receiving ART to have advanced disease (4); in contrast, persons aged ≥5 years living with HIV are considered to have advanced disease only if they have a WHO stage 3 or 4 illness††† or a CD4 count <200 cells/mm3 (4). Second, these findings demonstrate that children aged <5 years receiving ART have lower rates of viral load suppression along with higher rates of mortality, and viral nonsuppression is a well-described risk factor for death among children living with HIV (5). Finally, general mortality for persons aged <5 years, regardless of HIV status, remains high in many low-resource settings, including those where PEPFAR supports HIV programs (2). Factors that influence mortality in all children aged <5 years likely also influence mortality in children aged <5 years living with HIV in these settings. For example, one study from western Kenya identified common and overlapping immediate causes of death among children aged <5 years with HIV and uninfected children, including pneumonia, malnutrition, and malaria (6). Measures to enhance data collected at the individual level and explore causes and circumstances of death among children aged <5 years living with HIV receiving ART might help guide programs and policies aimed at preventing these deaths.

Limitations

The findings in this report are subject to at least three limitations. First, treatment interruption and mortality estimates from PEPFAR Monitoring, Evaluation, and Reporting data are likely underreported, underestimating the actual number of deaths and interruptions in treatment among ART recipients served by PEPFAR. Second, underreporting and inconsistencies in reporting death and treatment interruption between PEPFAR-supported sites vary, which might bias or confound the findings of this analysis (i.e., site-level factors that influence completeness or consistency in reporting might also influence outcomes among children or older persons living with HIV).§§§ Finally, these findings might not be generalizable to children living with HIV served in non–PEPFAR-supported sites.

Implications for Public Health Practice

Prioritizing and optimizing HIV and general health services for children aged <5 years living with HIV receiving ART might help address the disproportionately poorer outcomes they experience. Global efforts to help prevent pediatric HIV infections and optimize the entire pediatric HIV clinical cascade have intensified, including the multilateral Global Alliance to End AIDS in Children by 2030 (7) and the PEPFAR Accelerating Progress in Pediatrics and Prevention of Mother to Child Transmission initiative (8). Strategies aimed at optimizing HIV care for children living with HIV include 1) diagnosing children as early as possible, and linking them to optimized ART (especially dolutegravir-based regimens); 2) ensuring that these children continue in effective HIV care and treatment through family-centered, differentiated service delivery models (9); and 3) comprehensively preventing, identifying, and managing advanced HIV disease and its complications, including tuberculosis and severe acute malnutrition, according to the WHO STOP AIDS Package (4). Ensuring that children aged <5 years living with HIV also receive timely general pediatric services, including immunizations, micronutrient supplementation, and antimalarial treatment can also improve their health and might reduce mortality attributable to common pediatric causes of death. Enrolling children at high risk living with HIV into community-based support programs such as PEPFAR’s Orphan and Vulnerable Children program gives them access to more comprehensive services, including family-based case management and socioeconomic support, additional services that can augment the care these children receive and help them and their caregivers thrive (8,10). These strategies, as highlighted in PEPFAR’s 2023 country and regional operational planning guidance¶¶¶ (8), have the potential to prevent death, reduce the inequities experienced by children aged <5 years living with HIV, and contribute to the global measures to end AIDS among children by 2030.

Acknowledgments

Sarah K. Dastur, Rachel A. Golin, U.S. Agency for International Development; Nicole Flowers, Steve Gutreuter, William Levine, CDC.


1Division of Global HIV and Tuberculosis, Global Health Center, CDC; 2Office of HIV/AIDS, U.S. Agency for International Development, Washington, D.C.; 3Walter Reed Army Institute of Research, U.S. Department of Defense, Bethesda, Maryland; 4Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland; 5Division of Global HIV and Tuberculosis, CDC South Africa; 6Division of Global HIV and Tuberculosis, CDC Kenya; 7Division of Global HIV and Tuberculosis, CDC Namibia; 8Division of Global HIV and Tuberculosis, CDC Nigeria; 9Division of Global HIV and Tuberculosis, CDC Zimbabwe; 10Division of Global HIV and Tuberculosis, CDC Botswana; 11Ministry of Health and Wellness, Gaborone, Botswana; 12Division of Global HIV and Tuberculosis, CDC Eswatini; 13Division of Global HIV and Tuberculosis, CDC Mozambique; 14Division of Global HIV and Tuberculosis, CDC Tanzania; 15U.S. Agency for International Development, South Africa; 16U.S. Agency for International Development, Nigeria; 17U.S. Agency for International Development, Tanzania; 18Walter Reed Army Institute of Research, U.S. Department of Defense, Uganda; 19Walter Reed Army Institute of Research, U.S. Department of Defense, Nigeria; 20Walter Reed Army Institute of Research, U.S. Department of Defense, Kenya; 21Walter Reed Army Institute of Research, U.S. Department of Defense, Tanzania; 22Bureau of Global Health Security and Diplomacy, U.S. Department of State, Washington, D.C.

References

  1. UNAIDS. The path that ends AIDS: UNAIDS global AIDS update 2023. Geneva, Switzerland: Joint United Nations Programme on HIV/AIDS; 2023. https://www.unaids.org/en/resources/documents/2023/global-aids-update-2023
  2. UNICEF. Under-five mortality. New York, NY: UNICEF; 2021. Accessed December 30, 2022. https://data.unicef.org/topic/child-survival/under-five-mortality
  3. Kassanjee R, Johnson LF, Zaniewski E, et al.; International epidemiology Databases to Evaluate AIDS (IeDEA) Collaboration. Global HIV mortality trends among children on antiretroviral treatment corrected for under-reported deaths: an updated analysis of the International epidemiology Databases to Evaluate AIDS collaboration. J Int AIDS Soc 2021;24. (Suppl 5):e25780 https://doi.org/10.1002/jia2.25780 PMID:34546646
  4. World Health Organization. Package of care for children and adolescents with advanced HIV disease: stop AIDS. Technical brief. Geneva, Switzerland: World Health Organization; 2020. https://www.who.int/publications-detail-redirect/9789240008045
  5. Judd A, Chappell E, Turkova A, et al.; European Pregnancy and Paediatric HIV Cohort Collaboration (EPPICC) study group in EuroCoord. Long-term trends in mortality and AIDS-defining events after combination ART initiation among children and adolescents with perinatal HIV infection in 17 middle- and high-income countries in Europe and Thailand: a cohort study. PLoS Med 2018;15:e1002491. https://doi.org/10.1371/journal.pmed.1002491 PMID:29381702
  6. Onyango DO, Akelo V, van der Sande MAB, et al. Causes of death in HIV-infected and HIV-uninfected children aged under-five years in western Kenya. AIDS 2022;36:59–68. https://doi.org/10.1097/QAD.0000000000003086 PMID:34586084
  7. World Health Organization. New global alliance launched to end AIDS in children by 2030 [Press release]. Geneva, Switzerland: Joint United Nations Programme on HIV/AIDS; 2022. https://www.who.int/news/item/02-08-2022-new-global-alliance-launched-to-end-aids-in-children-by-2030
  8. Office of the US Global AIDS Coordinator and Health Diplomacy. US President’s Emergency Plan for AIDS Relief. PEPFAR 2023 country and regional operational plan (COP/ROP) guidance for all PEPFAR-supported countries. Washington, DC: US State Department, Office of the US Global AIDS Coordinator and Health Diplomacy; 2023.
  9. World Health Organization. Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach. Geneva, Switzerland: World Health Organization; 2021. https://www.who.int/publications/i/item/9789240031593
  10. Ferrand RA, Simms V, Dauya E, et al. The effect of community-based support for caregivers on the risk of virological failure in children and adolescents with HIV in Harare, Zimbabwe (ZENITH): an open-label, randomised controlled trial. Lancet Child Adolesc Health 2017;1:175–83. https://doi.org/10.1016/S2352-4642(17)30051-2 PMID:29104904
TABLE 1. Annual proportion of reported deaths and crude mortality ratios among persons living with HIV and receiving antiretroviral treatment — U.S. President’s Emergency Plan for AIDS Relief, 28 supported countries and regions,* 2021–2022Return to your place in the text
Characteristic 2021 2022 2021 and 2022 (annual mean)§
% Died No. died No. receiving ART % Died No. died No. receiving ART % Died No. died No. receiving ART
Age group, yrs
<1 4.4 585 13,223 5.5 587 10,737 4.9 586 11,980
1–4 2.6 2,786 108,325 2.5 2,581 102,695 2.5 2,684 105,510
5–14 0.5 2,943 537,867 0.5 2,772 534,105 0.5 2,858 535,986
15–49 0.7 94,539 13,089,351 0.6 90,672 13,984,027 0.7 92,606 13,536,689
≥50 1.4 50,001 3,488,945 1.3 51,913 3,936,499 1.4 50,957 3,712,722
Total 0.9 150,854 17,237,711 0.8 148,525 18,568,063 0.8 149,691 17,902,887
Crude mortality ratios
<1 vs. 5–14 8.1 10.5 9.2
<1 vs. 15–49 6.1 8.4 7.2
<1 vs. ≥50 3.1 4.1 3.6
1–4 vs. 5–14 4.7 4.8 4.8
1–4 vs. 15–49 3.6 3.9 3.7
1–4 vs. ≥50 1.8 1.9 1.9

Abbreviations: ART = antiretroviral therapy; PEPFAR = U.S. President’s Emergency Plan for AIDS Relief.
* Sites from 25 PEPFAR-supported countries and three PEPFAR-supported regions were included in this analysis. The 25 countries include Angola, Botswana, Burundi, Cameroon, Côte d’Ivoire, Democratic Republic of the Congo, Dominican Republic, Eswatini, Ethiopia, Haiti, Kenya, Lesotho, Malawi, Mozambique, Namibia, Nigeria, Rwanda, South Africa, South Sudan, Tanzania, Uganda, Ukraine, Vietnam, Zambia, and Zimbabwe. The three regions include Asia Region (Burma, India, Indonesia, Kazakhstan, Kyrgyzstan, Laos, Nepal, Papua New Guinea, Philippines, Tajikistan, and Thailand), West Africa Region (Benin, Burkina Faso, Ghana, Liberia, Mali, Senegal, Sierra Leone, and Togo), and Western Hemisphere Region (Barbados, Brazil, Colombia, El Salvador, Guatemala, Guyana, Honduras, Jamaica, Nicaragua, Panama, Peru, and Trinidad and Tobago).
2021–2022 represents fiscal years, which start in the previous October (e.g., October 2021–September 2022 represents 2022).
§ Proportions of reported deaths were calculated for fiscal years 2021 and 2022 by summing the reported number of deaths across the four quarters and dividing by the mean number of persons living with HIV receiving ART estimated from each of the four quarters. The number of persons living with HIV receiving ART estimated from each quarter equals the number of persons reported to be newly initiated on ART in the current quarterly reporting period plus the number reported to be receiving ART at the end of the previous quarterly reporting period.
Crude mortality ratios are ratios of proportions of reported deaths for each age group among persons living with HIV receiving ART who are aged <1 or 1–4 years and those who are aged 5–14, 15–49, and ≥50 years.

Return to your place in the textFIGURE. Annual percentage of reported deaths* among persons living with HIV and receiving antiretroviral treatment — U.S. President’s Emergency Plan for AIDS Relief, 28 supported countries and regions, 2021–2022§
<img class="img-fluid" alt="The figure is a bar chart illustrating reported deaths, annually, among persons living with HIV and receiving antiretroviral treatment in 28 U.S. President’s Emergency Plan for AIDS Relief-supported countries and regions during 2021–2022." title="Mortality Among Children Aged

Abbreviations: ART = antiretroviral therapy; PEPFAR = U.S. President’s Emergency Plan for AIDS Relief.

* Percentage of reported deaths was calculated for fiscal years 2021 and 2022 by summing the reported number of deaths across the four quarters and dividing by the mean number of persons living with HIV receiving ART estimated from each of the four quarters. The number of persons living with HIV receiving ART estimated from each quarter equals the number of persons living with HIV reported to be newly initiated on ART in the current quarterly reporting period plus the number reported to be receiving ART at the end of the previous quarterly reporting period.

Sites from 25 PEPFAR-supported countries and three PEPFAR-supported regions were included in this analysis. The 25 countries include Angola, Botswana, Burundi, Cameroon, Côte d’Ivoire, Democratic Republic of the Congo, Dominican Republic, Eswatini, Ethiopia, Haiti, Kenya, Lesotho, Malawi, Mozambique, Namibia, Nigeria, Rwanda, South Africa, South Sudan, Tanzania, Uganda, Ukraine, Vietnam, Zambia, and Zimbabwe. The three regions include Asia Region (Burma, India, Indonesia, Kazakhstan, Kyrgyzstan, Laos, Nepal, Papua New Guinea, Philippines, Tajikistan, and Thailand), West Africa Region (Benin, Burkina Faso, Ghana, Liberia, Mali, Senegal, Sierra Leone, and Togo), and Western Hemisphere Region (Barbados, Brazil, Colombia, El Salvador, Guatemala, Guyana, Honduras, Jamaica, Nicaragua, Panama, Peru, and Trinidad and Tobago).

§ 2021–2022 represents fiscal years, which start in the previous October (e.g., October 2021–September 2022 represents 2022).

TABLE 2. Interruptions in treatment, proxy viral load coverage, and viral load suppression among persons living with HIV receiving antiretroviral treatment — U.S. President’s Emergency Plan for AIDS Relief, 28 supported countries and regions,* 2021–2022,§Return to your place in the text
Characteristic % Numerator Denominator
Interruptions in treatment
Age group, yrs
<1 4.2 509 11,980
1–4 4.0 4,224 105,510
5–14 2.4 12,735 535,986
15–49 3.0 406,565 13,536,689
≥50 2.0 74,721 3,712,722
Proxy viral load coverage**
Age group, yrs
<1†† NA NA NA
1–4 66.0 65,742 99,639
5–14 81.9 431,988 527,392
15–49 76.7 9,836,384 12,831,401
≥50 82.9 2,940,808 3,546,420
Viral load suppression§§
Age group, yrs
<1 78.4 2,687 3,427
1–4 73.2 48,106 65,742
5–14 85.0 367,312 431,988
15–49 94.3 9,279,763 9,836,384
≥50 96.3 2,830,747 2,940,808

Abbreviations: ART = antiretroviral therapy; NA = not applicable; PEPFAR = U.S. President’s Emergency Plan for AIDS Relief.
* Sites from 25 PEPFAR-supported countries and three PEPFAR-supported regions were included in this analysis. The 25 countries include Angola, Botswana, Burundi, Cameroon, Côte d’Ivoire, Democratic Republic of the Congo, Dominican Republic, Eswatini, Ethiopia, Haiti, Kenya, Lesotho, Malawi, Mozambique, Namibia, Nigeria, Rwanda, South Africa, South Sudan, Tanzania, Uganda, Ukraine, Vietnam, Zambia, and Zimbabwe. The three regions include Asia Region (Burma, India, Indonesia, Kazakhstan, Kyrgyzstan, Laos, Nepal, Papua New Guinea, Philippines, Tajikistan, and Thailand), West Africa Region (Benin, Burkina Faso, Ghana, Liberia, Mali, Senegal, Sierra Leone, and Togo), and Western Hemisphere Region (Barbados, Brazil, Colombia, El Salvador, Guatemala, Guyana, Honduras, Jamaica, Nicaragua, Panama, Peru, and Trinidad and Tobago).
2021–2022 represents fiscal years which start in the previous October (e.g., October 2021–September 2022 represents 2022).
§ The other measures (treatment interruption, proxy viral load coverage, and viral load suppression) could not be summarized as annual estimates because, unlike mortality, treatment could have been interrupted or viral load measures received multiple times during a 1- or 2-year period. Therefore, trying to create annual estimates of these quarterly collected and reported measures would likely lead to overestimates of the actual measures because of duplication.
Interruption in treatment is defined as not having a clinical encounter for 28 days after the last scheduled appointment or expected clinical contact. The proportions with treatment interruptions are calculated as the number of treatment interruptions in the current quarterly reporting period divided by the sum of those already receiving ART in the previous quarterly reporting period and those newly initiated on ART in the current quarterly reporting period.
** Proxy viral load coverage is defined as having a documented viral load result within the previous 12 months among those assumed to be eligible for a viral load in the current quarterly reporting period. For calculating proxy viral load coverage, the numerator is number of persons living with HIV receiving ART in the current quarterly reporting period reported to have a documented viral result during the previous 12 months, and the denominator is the number of persons receiving ART two quarters before the current quarterly reporting period. The term proxy is used because the numerator and denominator are determined from two different populations of persons.
†† PEPFAR Monitoring, Evaluation, and Reporting data underestimate proxy viral load coverage for infants aged <1 year living with HIV, and it has not been included in this analysis. The numerator for proxy viral load coverage in infants aged <1 year only records those with diagnoses and placed on treatment before age 6 months who received a viral load in their first year of life. The numerator excludes infants linked to ART later (aged ≥6 months) who are not eligible for a viral load until their second year of life.
§§ Viral load suppression is defined as having a suppressed viral load result (HIV RNA <1,000 copies/mL) among those with a documented viral load result within the previous 12 months. For calculating the proportion of persons living with HIV receiving ART with suppression, the numerator is the number of persons living with HIV receiving ART in the current quarterly reporting period with a suppressed viral load result documented within the previous 12 months, and the denominator is number of persons receiving ART in the current quarterly reporting period reported to have a documented viral result during the previous 12 months.

Suggested citation for this article: Agathis NT, Faturiyele I, Agaba P, et al. Mortality Among Children Aged <5 Years Living with HIV Who Are Receiving Antiretroviral Treatment — U.S. President’s Emergency Plan for AIDS Relief, 28 Supported Countries and Regions, October 2020–September 2022. MMWR Morb Mortal Wkly Rep 2023;72:1293–1299. DOI: http://dx.doi.org/10.15585/mmwr.mm7248a1.


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Students from Africa have expectations and doubts about COP28 – University World News

AFRICA

During preparatory events ahead of COP28, youth perspectives have been deliberately sought and are expected to be amplified by the 2023 presidency which intends to “centre youth perspectives in international climate policy-making, setting a model for future COPs”, according to YOUNGO, the official children and youth constituency of the United Nations Framework Convention on Climate Change (UNFCCC).

University World News spoke to students who are attending the 2023 United Nations climate change conference, COP28, which is being held in Dubai, United Arab Emirates (UAE), from 30 November to 12 December.

Christabel Mhiribidi, who has just graduated from Zimbabwe’s Midlands State University, is one of them. She studied geography and environmental studies and will pursue a climate-related masters degree in future. She recalls meeting the UN Secretary General Antonio Guterres last year when COP27 took place in Sharm el-Sheikh, Egypt.


Christabel Mhiribidi, Image provided

“l have always read about him and his tireless efforts to create a conducive environment for all. So, getting to see him in person was like a dream come true,” Mhiribidi told University World News.

At COP28 Mhiribidi said she would be representing the voices of children and young people to make sure their perspectives were taken into consideration during decision-making processes.

She was chosen by the UAE-sponsored International Youth Climate Delegate Program that selected 100 young people from an applicant pool of 11,000 from the Least Developed Countries, Small Island Developing States, indigenous peoples and other minority groups to follow climate negotiations and discussions about carbon credits and just transition processes at the conference.

“It is important for university students to attend climate conferences as they will develop an appreciation of global climate issues which informs the action taken thereafter. They will interact with like-minded peers, share climate stories, challenges and collectively offer solutions,” she said.


Nyasha Milanzi, Image provided

Focusing on just energy transition

Another Zimbabwean student, Nyasha Milanzi, who is pursuing a masters degree in sustainable communities at Michigan Technological University in the United States, told University World News she is attending COP28 as a delegate of her university to complete a research paper as well as learn about other climate topics such as environmental justice for indigenous peoples, carbon credits and adaptation.

She will co-moderate a session on 2 December with Emma Loizeaux from the University of Colorado about ‘Fossil Fuel Divestment at University’.

Milanzi said her interdisciplinary research focuses on equitable and just energy transitions in under-served communities in Sub-Saharan Africa and in rural communities.

Milanzi said she will be attending as an observer and will be able to participate in sessions or negotiations with themes related to indigenous communities, carbon financing and adaptation.

She said that, during her first year in Michigan as a graduate student, she got the opportunity to enrol in a climate and energy policy class where students could potentially attend COP28.

She said that, through this course, she learned about many of the complex global climate science, politics, governance, and law issues, which she believes are essential for understanding the gravity of the problem at hand as well as the challenges encountered when trying to solve a global challenge without a ‘world government’.

Milanzi said her initial area of interest in climate advocacy was to work with like-minded individuals and organisations to eradicate energy poverty in Africa, starting in her country, Zimbabwe.

“However, during my undergraduate studies at Ashesi University (Ghana), I learned about the impact of the energy sector on our environment and how that sector, alone, is responsible for close to a third of the greenhouse gases emitted into our atmosphere.

“After that, my approach to the topic of electrification pivoted. I realised that we needed to build more grid systems that emit less greenhouse gases than fossils.

“Most African countries, including Zimbabwe, increasingly need more energy to power their economies. Unfortunately, burning fossil fuels is harmful for our planet and can be dangerous to the communities that live in proximity to these power plants.

“In 2019, air pollutants killed about 1.9 million people in Africa, according to the World Health Organization,” she said.

Milanzi said she is now conducting research and investigating equitable and just pathways for implementing energy transitions to renewable energy sources as they are less detrimental to the environment and they are better for human health.

She said the global effort outlined in the Paris Agreement, aimed at limiting global warming to below 1.5 degrees Celsius by 2030, faces a critical challenge and the current progress is far from where the world needs to be.

What to expect from COP28

But what are her expectations when it comes to COP28?

Milanzi said a key priority for her is the successful implementation of the Loss and Damage Fund at COP28. The fund, established at COP27, aims to provide financial assistance to nations most vulnerable and impacted by the effects of climate change.

She said Africa, in particular, requires substantial financial support to meet the costs associated with adaptation efforts.

Milanzi said that, furthermore, it is critical to address the systemic underrepresentation of indigenous communities and other vulnerable groups in negotiations.

“A poignant example is a community in Kenya that, just a few months ago, was forcibly evicted from their ancestral lands to make way for carbon market forests.

“This situation is regrettable, particularly considering that these communities were not included when the provisions and terms of operation for carbon markets were established in the COPs. Now, they find themselves uprooted from their homes and livelihoods to facilitate their government’s engagement in carbon forest trading.

“The injustice is twofold: not only were they excluded from the initial decision-making processes, but they are also now bearing the brunt of the consequences,” she said.

“To rectify this, it is imperative that the platform instituted for indigenous peoples around the world receives substantial resources. Only through such proactive measures can we hope to correct the historical oversights and ensure that those most affected by climate change have a meaningful and inclusive role in shaping the solutions.”

The Local Communities and Indigenous Peoples’ Platform was set up in 2021.


Wandipa Mualefhe, Image provided

Learning the stories of the most vulnerable

In an interview with University World News, Wandipa Mualefhe, a student from Botswana, who is in the third-year of a PhD study in environmental and energy policy, also at Michigan Technological University, said COP28 will be her first major climate conference.

Mualefhe said that, as an undergraduate, she studied civil and environmental engineering at Stanford University.

She said the environmental aspect of the degree exposed her to climate change and the focus was more on how to adapt to it and how to mitigate the effects.

“Adaptation work is very important. For me, I think, the most important thing in the climate change conversation is finding the most vulnerable people and learning their stories; learning, not just about them, but from them, too,” she said.

Mualefhe said she comes from a privileged background in Botswana where her family is in the middle class, hence she has mostly been cushioned from the effects of climate change.

She has, however, noted that Botswana has a long-running history of droughts that are getting worse and, in recent years, floods have also been experienced.

“The project I’m pursuing for my dissertation is an ethnographic exploration of climate change in Botswana, where I’m from. I’m going to COP28 as a component of one of the classes I took this semester, an international climate policy class.

“I chose it mainly for this opportunity. My research interests are in climate change, climate justice, climate/environmental/energy policy, gendered power, public policy-making, and policy analysis,” she said.

However, with access to the conference, she plans to attend events and discussions relating to adaptation, just transition, capacity-building, gender, and other discussions focusing on Africa and the Global South in general.

But does she think COP28 will achieve much?

“I have felt some disappointment about the UN Climate Change Convention in general and climate conferences, of which COP is the biggest one. I just don’t think enough is happening, considering what is known. I think there is an awful focus on politics at these conferences that takes away some of the work that needs to be done,” said Mualefhe.


Tafadswa Kurotwi, Image provided

Book targets young people

Tafadswa Kurotwi, in her fourth year at the Catholic University of Zimbabwe, attended COP27 and told University World News she is also making her way to COP28.

She said there is a gap in climate education which she has tried to bridge by writing a book targeting young people.

She said the climate change book which she wrote with fellow youths Elizabeth Gulugulu and Priyanka Naik will be launched during COP28. She could not say more about the book until its launch.

“My attendance is to amplify my voice as well as to represent young people from my country and from the Global South, who are being impacted by the climate crisis,” she said.

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Zimbabwe’s Goal to End AIDS Is So Close. Why Are Health Experts … – Global Press Journal

HARARE, ZIMBABWE — Precious rarely takes her medication in public. If she must, she keeps the pills in an unmarked case and discreetly opens it inside her handbag before taking the medication. Even at home in Mabvuku, a suburb east of Harare, Precious makes sure the pills remain in her secret place — the unmarked case. The 31-year-old has her reasons.

In 2004, Precious, who asked to use her middle name for fear of stigma, was diagnosed with HIV. She was put on antiretroviral therapy. Soon after, she moved in with her cousin and divulged her status.

“She then broke the news to her friends. News spread that I was on antiretroviral treatment,” Precious says.

The mother of two was devastated. She felt betrayed. “I thought that she was going to keep the issue a secret when I confided in her,” she says.

Enraged, Precious went home and poured the case of pills into the toilet. For 12 years, she stopped taking medication and resolved to keep her status a secret. Even now, Precious — who is a sex worker — has not shared her HIV status with the men she has been intimate with. (Sex work is no longer a crime in Zimbabwe.)

Precious is one of many Zimbabweans living with HIV in a country that was among the worst affected by the epidemic. The first national estimate, produced in 2003, showed that 24.6% of the country’s adult population (ages 15 to 49) was infected.

But in the last few years, Zimbabwe has managed to reduce its HIV prevalence. By 2022, that HIV prevalence figure dropped to 11%, according to data from the Joint United Nations Programme on HIV/AIDS, known as UNAIDS.

Zimbabwe is also one of the few countries in the world that, according to a July report by UNAIDS, has achieved the 95-95-95 targets at national level. This means that 95% of people living with HIV are aware of their status, 95% of them are on medication, and 95% of those on medication have a suppressed viral load.

Despite these significant strides, there is little cause for celebration in the area of stigma and discrimination, which are on the rise. In a 2022 Stigma Index survey, a tool that measures stigma and discrimination experienced by people living with HIV/AIDS, 69.7% of people living with HIV reported experiencing stigma or discrimination, up from 65.5% in 2014, according to the nonprofit Zimbabwe National Network of People Living with HIV, known as ZNNP+. And according to a UNAIDS update this year, about 30% of men and women aged 15 to 49 in Zimbabwe held discriminatory attitudes toward people living with HIV.

Experts caution that the battle against stigma (negative attitudes and beliefs) and discrimination (actions based on those beliefs) remains vital in Zimbabwe.

Bernard Madzima, CEO at National AIDS Council, worries that the rise in stigma and discrimination could affect Zimbabwe’s chances of attaining the UNAIDS goal to end the HIV/AIDS epidemic by 2030, as well as increase the burden on health services.

“If people are afraid of being stigmatized, they will not present themselves for HIV testing and or will not access treatment services. This means that these people will not have their viral load suppressed and remain capable of infecting anyone that they engage in sex with,” Madzima says.

When they skip medicine, they end up with full-blown AIDS, agrees Tonderai Mwareka, stigma index coordinator at ZNNP+. They are also more vulnerable to opportunistic infections, infections that occur more frequently and are more severe in people with weakened immune systems.

Sex workers, transgender people and people in prison are among those most affected, says Mwareka, as they face double stigma based on both their HIV status and their occupation, sexual orientation or incarceration.

“I make sure that I take my medication in the morning to ensure that even if I bring a client home, they would not know about my status.”

In Precious’ case, when her cousin noticed she was no longer taking medication, she lied. She told her cousin that she had gone for another checkup and was told to stop taking medication because she was negative.

“I said maybe the machine had made an error,” Precious says.

She did not disclose her status to her clients either, as she worried how that might affect her sex work. Although she says she advocated for use of protection, some clients preferred not to.

For the 12 years Precious didn’t take any HIV medication, she struggled with headaches and dizziness and self-medicated with painkillers. In 2015, Precious relocated to another town and temporarily stopped sex work to start a new life with her newfound boyfriend. Because of the dizziness and headaches, a niece who stayed in the same town and was also on HIV treatment encouraged her to get tested.

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Gamuchirai Masiyiwa, GPJ Zimbabwe

Medical supplies at an Opportunistic Infections clinic in Mabvuku, a suburb east of Harare, Zimbabwe.

“I went to a local clinic, got tested and was put on treatment,” she says. She didn’t tell her niece that she’d found out about her status 12 years earlier.

Precious was put on medication again. Since she had not told her boyfriend about her status, she kept the medication at her niece’s place and went there each day for her dose. Whenever she ran out of medication, her niece would collect them on her behalf. But this arrangement only lasted for a year. She says she found out that her niece had been revealing her status, and so she quit taking her medication again, this time for six years.

It was when she moved to Harare to resume sex work in 2022 that things changed. Precious attended an outreach program by New Start Center, an organization that offers HIV testing and counseling services, where she learned about the importance of staying on medication and the risks of reinfection. She then resumed her medication.

Precious believes that her health could have worsened had she not resumed her treatment. But she still opts to keep her status a secret because of stigma. If people found out, the news would spread fast, she says, and she could lose clients.

“I make sure that I take my medication in the morning to ensure that even if I bring a client home, they would not know about my status,” she says. “Even if they sleep over, I always find tricks to take my treatment without them noticing.”

“We will make sure that everyone is reached and no one is left behind.” Ministry of Health and Child Care

The main cause of increased stigma and discrimination, Mwareka says, is lack of knowledge. He says that in the 1990s and early 2000s, there was a lot of investment in HIV messaging in both print and broadcast media.

“Almost every corner you passed had a poster about HIV/AIDS. But this is not the case anymore,” he says. “We relaxed a bit thinking that we had won the war, but the effects are now coming out.”

Owen Mugurungi, who directs the Ministry of Health and Child Care’s AIDS and tuberculosis unit, finds the rise in stigma and discrimination worrying. He blames misconceptions and false information around HIV spreading through social media. The government will ramp up its efforts to address the issue by ensuring proper information is available on all media channels, including social media platforms, he says.

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Gamuchirai Masiyiwa, GPJ Zimbabwe

Precious says she keeps her HIV status a secret to avoid further stigma and possibly lose her sex work clients.

“We want it to be at zero stigma, or less than 5%, and the key drivers for us to do it is through community education,” he adds.

Mwareka would like to see a return to robust HIV awareness campaigns. But while ZNNP+ leads awareness campaigns and HIV disease management programs, he says, they have limited resources and cannot cover the whole country.

ZNNP+ isn’t the only one affected by lack of resources. A fraught economy has caused the Zimbabwe government to invest less in HIV prevention as well, according to 2022 planning documents for the United States President’s Emergency Plan for AIDS Relief program in Zimbabwe, which notes that “declining economic conditions and fiscal space have exacerbated the difficulties in mobilizing domestic resources for health, a plight that has been exaggerated further by the COVID-19 pandemic.”

“The times I went to fetch water at a well in my neighborhood, people would say if I fetched the water, I may cough and the virus will contaminate the water.”

Caroline, who asked to use her first name for fear of stigma, believes that although stigma and discrimination are still rife in Zimbabwe, things have slightly improved. The soft-spoken mother of one says that, when she was diagnosed with HIV in 2008, even her family members were too embarrassed to escort her to the hospital. As a result she missed some appointments. But she was lucky because, at the time, hospital staff would follow up if she missed checkups.

At home, the 39-year-old says she had a designated plate, cup and spoon, and no one wanted to eat from the same plate with her.

“I had a niece that I took care of since she was 3 months. She got used to being around me. We could eat from the same plate. But when I was sick, her mother beat her for eating from my plate, assuming she would get infected,” Caroline says. “It affected me deeply.”

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Gamuchirai Masiyiwa, GPJ Zimbabwe

“Almost every corner you passed had a poster about HIV/AIDS. But this is not the case anymore,” says Tonderai Mwareka, the stigma index coordinator at Zimbabwe National Network of People Living with HIV.

Even when she got better and didn’t appear visibly sick, the stigma did not stop. “The times I went to fetch water at a well in my neighborhood, people would say if I fetched the water, I may cough and the virus will contaminate the water,” she says.

At least people are now more accepting that a person with HIV can live longer, she says, while before, they viewed it as a death sentence.

Despite the prevalence of stigma, Caroline still holds out hope. “We will get to a point where we will be able to eliminate HIV — if people adhere to medication, and if maybe an injection that one may get once a year will help ensure that people adhere to treatment,” she says.

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