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Kumar D, Prinja S. Costing of services under National Tuberculosis Elimination Program at public health facilities of northern India. Indian J Tuberc 2023; 70:232-238. [PMID: 37100581 DOI: 10.1016/j.ijtb.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 05/17/2022] [Accepted: 05/20/2022] [Indexed: 04/28/2023]
Abstract
BACKGROUND Costing of resources helps to measure financial implications and effective utilization of resources of national programs. As there is limited evidence about cost per service, current study was done to assess the cost of services under National Tuberculosis Elimination Program (NTEP) at Community Health Centres (CHCs) and Primary Health Centres (PHCs) of northern state of India. MATERIAL AND METHODS Cross-sectional study carried out in two districts and from each district eight CHCs and PHCs were randomly selected. RESULTS Mean annual cost of providing NTEP services at CHCs and PHCs were US$5243.1 (95%CI: 3008.0-7225.4) and US$1031.9 (95%CI: 669.1-1447.1) respectively. Across both centres human resource contributes to the most (CHC: 72.9%; PHC: 85.9%). One way sensitivity analysis was carried out for all health facilities and observed that human resource cost influences most cost per treated case by providing services under NTEP. Although relatively very less but cost of drugs also influences cost per treatment. CONCLUSION Cost of delivering services was high for CHCs as compared to PHCs. At both types of health facilities, human resource contributes the most to cost of delivering services under the program.
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Affiliation(s)
- Dinesh Kumar
- Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, Himachal Pradesh, 176001, India.
| | - Shankar Prinja
- School of Public Health and Community Medicine, Post Graduate Institute of Medical Education and Research. Chandigarh, 160012, India.
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Ma J, Vongpradith A, Ledesma JR, Novotney A, Yi S, Lim K, Hay SI, Murray CJL, Kyu HH. Progress towards the 2020 milestones of the end TB strategy in Cambodia: estimates of age and sex specific TB incidence and mortality from the Global Burden of Disease Study 2019. BMC Infect Dis 2022; 22:904. [PMID: 36463098 PMCID: PMC9719136 DOI: 10.1186/s12879-022-07891-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 11/21/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Cambodia was recently removed from the World Health Organization's (WHO's) top 30 high tuberculosis (TB) burden countries. However, Cambodia's TB burden remains substantial, and the country is on the WHO's new global TB watchlist. We aimed to examine the levels and trends in the fatal and non-fatal TB burden in Cambodia from 1990 to 2019, assessing progress towards the WHO End TB interim milestones, which aim to reduce TB incidence rate by 20% and TB deaths by 35% from 2015 to 2020. METHODS We leveraged the Global Burden of Disease 2019 (GBD 2019) analytical framework to compute age- and sex-specific TB mortality and incidence by HIV status in Cambodia. We enumerated TB mortality utilizing a Bayesian hierarchical Cause of Death Ensemble modeling platform. We analyzed all available data sources, including prevalence surveys, population-based tuberculin surveys, and TB cause-specific mortality, to produce internally consistent estimates of incidence and mortality using a compartmental meta-regression tool (DisMod-MR 2.1). We further estimated the fraction of tuberculosis mortality among individuals without HIV coinfection attributable to the independent effects of alcohol use, smoking, and diabetes. RESULTS In 2019, there were 6500 (95% uncertainty interval 4830-8680) deaths due to all-form TB and 50.0 (43.8-57.8) thousand all-form TB incident cases in Cambodia. The corresponding age-standardized rates were 53.3 (39.9-69.4) per 100,000 population for mortality and 330.5 (289.0-378.6) per 100,000 population for incidence. From 2015 to 2019, the number of all-form TB deaths decreased by 11.8% (2.3-21.1), while the age-standardized all-form TB incidence rate decreased by 11.1% (6.3-15.6). Among individuals without HIV coinfection in 2019, alcohol use accounted for 28.1% (18.2-37.9) of TB deaths, smoking accounted for 27.0% (20.2-33.3), and diabetes accounted for 12.5% (7.1-19.0). Removing the combined effects of these risk factors would reduce all-form TB deaths by 54.2% (44.2-62.2). DISCUSSION Despite significant progress in reducing TB morbidity and mortality since 1990, Cambodia is not on track to achieve the 2020 WHO End TB interim milestones. Existing programs in Cambodia can benefit from liaising with risk factor control initiatives to accelerate progress toward eliminating TB in Cambodia.
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Affiliation(s)
- Jianing Ma
- grid.34477.330000000122986657Institute for Health Metrics and Evaluation, University of Washington, 3980 15Th Ave. NE, Seattle, WA 98195 USA
| | - Avina Vongpradith
- grid.34477.330000000122986657Institute for Health Metrics and Evaluation, University of Washington, 3980 15Th Ave. NE, Seattle, WA 98195 USA
| | - Jorge R. Ledesma
- grid.34477.330000000122986657Institute for Health Metrics and Evaluation, University of Washington, 3980 15Th Ave. NE, Seattle, WA 98195 USA
| | - Amanda Novotney
- grid.34477.330000000122986657Institute for Health Metrics and Evaluation, University of Washington, 3980 15Th Ave. NE, Seattle, WA 98195 USA
| | - Siyan Yi
- grid.4280.e0000 0001 2180 6431Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore ,grid.513124.00000 0005 0265 4996KHANA Center for Population Health Research, Phnom Penh, Cambodia ,grid.265117.60000 0004 0623 6962Center for Global Health Research, Public Health Program, Touro University California, Vallejo, CA USA
| | - Kruy Lim
- grid.452809.20000 0004 0396 8383Sihanouk Hospital Center of Hope, Phnom Penh, Cambodia
| | - Simon I. Hay
- grid.34477.330000000122986657Institute for Health Metrics and Evaluation, University of Washington, 3980 15Th Ave. NE, Seattle, WA 98195 USA ,grid.34477.330000000122986657Department of Health Metrics Sciences, University of Washington, Seattle, WA USA
| | - Christopher J. L. Murray
- grid.34477.330000000122986657Institute for Health Metrics and Evaluation, University of Washington, 3980 15Th Ave. NE, Seattle, WA 98195 USA ,grid.34477.330000000122986657Department of Health Metrics Sciences, University of Washington, Seattle, WA USA
| | - Hmwe H. Kyu
- grid.34477.330000000122986657Institute for Health Metrics and Evaluation, University of Washington, 3980 15Th Ave. NE, Seattle, WA 98195 USA ,grid.34477.330000000122986657Department of Health Metrics Sciences, University of Washington, Seattle, WA USA
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Differential Impact of the rpoB Mutant on Rifampin and Rifabutin Resistance Signatures of Mycobacterium tuberculosis Is Revealed Using a Whole-Genome Sequencing Assay. Microbiol Spectr 2022; 10:e0075422. [PMID: 35924839 PMCID: PMC9430608 DOI: 10.1128/spectrum.00754-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Drug resistance in Mycobacterium tuberculosis (MTB) has long been a serious health issue worldwide. Most drug-resistant MTB isolates were identified due to treatment failure or in clinical examinations 3~6 months postinfection. In this study, we propose a whole-genome sequencing (WGS) pipeline via the Nanopore MinION platform to facilitate the efficacy of phenotypic identification of clinical isolates. We used the Nanopore MinION platform to perform WGS of clinical MTB isolates, including susceptible (n = 30) and rifampin- (RIF) or rifabutin (RFB)-resistant isolates (n = 20) according to results of a susceptibility test. Nonsynonymous variants within the rpoB gene associated with RIF resistance were identified using the WGS analytical pipeline. In total, 131 variants within the rpoB gene in RIF-resistant isolates were identified. The presence of the emergent Asp531Gly or His445Gln was first identified to be associated with the rifampin and rifabutin resistance signatures of clinical isolates. The results of the minimum inhibitory concentration (MIC) test further indicated that the Ser450Leu or the mutant within the rifampin resistance-determining region (RRDR)-associated rifabutin-resistant signature was diminished in the presence of novel mutants, including Phe669Val, Leu206Ile, or Met148Leu, identified in this study. IMPORTANCE Current approaches to diagnose drug-resistant MTB are time-consuming, consequently leading to inefficient intervention or further disease transmission. In this study, we curated lists of coding variants associated with differential rifampin and rifabutin resistant signatures using a single molecule real-time (SMRT) sequencing platform with a shorter hands-on time. Accordingly, the emerging WGS pipeline constitutes a potential platform for efficacious and accurate diagnosis of drug-resistant MTB isolates.
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Teo AKJ, Prem K, Wang Y, Pande T, Smelyanskaya M, Gerstel L, Chry M, Tuot S, Yi S. Economic Evaluation of Community Tuberculosis Active Case-Finding Approaches in Cambodia: A Quasi-Experimental Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312690. [PMID: 34886416 PMCID: PMC8656683 DOI: 10.3390/ijerph182312690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/17/2021] [Accepted: 11/29/2021] [Indexed: 11/16/2022]
Abstract
This study aimed to estimate the costs and incremental cost-effectiveness of two community-based tuberculosis (TB) active case-finding (ACF) strategies in Cambodia. We also assessed the number needed to screen and test to find one TB case. Program and national TB notification data from a quasi-experimental study of a cohort of people with TB in 12 intervention operational districts (ODs) and 12 control ODs between November 2018 and December 2019 were analyzed. Two ACF interventions (ACF seed-and-recruit (ACF SAR) model and one-off roving (one-off) ACF) were implemented concurrently. The matched control sites included PCF only. We estimated costs using the program and published data in Cambodia. The primary outcome was disability-adjusted life years (DALY) averted over 14 months. We considered the gross domestic product per capita of Cambodia in 2018 as the cost-effectiveness threshold. ACF SAR needed to test 7.7 people with presumptive TB to identify one all-forms TB, while one-off ACF needed to test 22.4. The costs to diagnose one all-forms TB were USD 458 (ACF SAR) and USD 191 (one-off ACF). The incremental cost per DALY averted was USD 257 for ACF SAR and USD 204 for one-off ACF. Community-based ACF interventions that targeted key populations for TB in Cambodia were highly cost-effective.
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Affiliation(s)
- Alvin Kuo Jing Teo
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore 117549, Singapore; (A.K.J.T.); (K.P.); (Y.W.)
| | - Kiesha Prem
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore 117549, Singapore; (A.K.J.T.); (K.P.); (Y.W.)
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Yi Wang
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore 117549, Singapore; (A.K.J.T.); (K.P.); (Y.W.)
| | - Tripti Pande
- McGill International TB Centre, Montreal, QC H4A 3S5, Canada;
| | | | - Lisanne Gerstel
- KIT Royal Tropical Institute, 1092 AD Amsterdam, The Netherlands;
| | - Monyrath Chry
- Cambodia Anti-Tuberculosis Association, Phnom Penh 12303, Cambodia;
| | - Sovannary Tuot
- KHANA Centre for Population Health Research, Phnom Penh 12301, Cambodia;
- Faculty of Social Sciences and Humanity, Royal University of Phnom Penh, Phnom Penh 12150, Cambodia
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore 117549, Singapore; (A.K.J.T.); (K.P.); (Y.W.)
- KHANA Centre for Population Health Research, Phnom Penh 12301, Cambodia;
- Center for Global Health Research, Touro University California, Vallejo, CA 94592, USA
- Correspondence:
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Tucker A, Oyuku D, Nalugwa T, Nantale M, Ferguson O, Farr K, Reza TF, Shete PB, Cattamanchi A, Dowdy DW, Sohn H, Katamba A. Costs along the TB diagnostic pathway in Uganda. Int J Tuberc Lung Dis 2021; 25:61-63. [PMID: 33384046 DOI: 10.5588/ijtld.20.0532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- A Tucker
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - D Oyuku
- Uganda Tuberculosis Implementation Research Consortium (U-TIRC), Kampala, Uganda
| | - T Nalugwa
- Uganda Tuberculosis Implementation Research Consortium (U-TIRC), Kampala, Uganda
| | - M Nantale
- Uganda Tuberculosis Implementation Research Consortium (U-TIRC), Kampala, Uganda
| | - O Ferguson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - K Farr
- Implementation Science Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - T F Reza
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, San Francisco, CA, USA, Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
| | - P B Shete
- Uganda Tuberculosis Implementation Research Consortium (U-TIRC), Kampala, Uganda, Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, San Francisco, CA, USA, Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
| | - A Cattamanchi
- Uganda Tuberculosis Implementation Research Consortium (U-TIRC), Kampala, Uganda, Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, San Francisco, CA, USA, Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
| | - D W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Uganda Tuberculosis Implementation Research Consortium (U-TIRC), Kampala, Uganda
| | - H Sohn
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - A Katamba
- Uganda Tuberculosis Implementation Research Consortium (U-TIRC), Kampala, Uganda, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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Glaeser E, Jacobs B, Appelt B, Engelking E, Por I, Yem K, Flessa S. Costing of Cesarean Sections in a Government and a Non-Governmental Hospital in Cambodia-A Prerequisite for Efficient and Fair Comprehensive Obstetric Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8085. [PMID: 33147862 PMCID: PMC7663741 DOI: 10.3390/ijerph17218085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 11/18/2022]
Abstract
Knowing the cost of health care services is a prerequisite for evidence-based management and decision making. However, only limited costing data is available in many low- and middle-income countries. With a substantially increasing number of facility-based births in Cambodia, costing data for efficient and fair resource allocation is required. This paper evaluates the costs for cesarean section (CS) at a public and a Non-Governmental (NGO) hospital in Cambodia in the year 2018. We performed a full and a marginal cost analysis, i.e., we developed a cost function and calculated the respective unit costs from the provider's perspective. We distinguished fixed, step-fixed, and variable costs and followed an activity-based costing approach. The processes were determined by personal observation of CS-patients and all procedures; the resource consumption was calculated based on the existing accounting documentation, observations, and time-studies. Afterwards, we did a comparative analysis between the two hospitals and performed a sensitivity analysis, i.e., parameters were changed to cater for uncertainty. The public hospital performed 54 monthly CS with an average length of stay (ALOS) of 7.4 days, compared to 18 monthly CS with an ALOS of 3.4 days at the NGO hospital. Staff members at the NGO hospital invest more time per patient. The cost per CS at the current patient numbers is US$470.03 at the public and US$683.23 at the NGO hospital. However, the unit cost at the NGO hospital would be less than at the public hospital if the patient numbers were the same. The study provides detailed costing data to inform decisionmakers and can be seen as a steppingstone for further costing exercises.
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Affiliation(s)
- Eva Glaeser
- Department of General Business Administration and Health Care Management, University of Greifswald, 17489 Greifswald, Germany;
| | - Bart Jacobs
- Social Health Protection Programme, Deutsche Gesellschaft für Internationale Zusammenarbeit (GiZ), Phnom Penh 12302, Cambodia; (B.J.); (B.A.); (E.E.)
| | - Bernd Appelt
- Social Health Protection Programme, Deutsche Gesellschaft für Internationale Zusammenarbeit (GiZ), Phnom Penh 12302, Cambodia; (B.J.); (B.A.); (E.E.)
| | - Elias Engelking
- Social Health Protection Programme, Deutsche Gesellschaft für Internationale Zusammenarbeit (GiZ), Phnom Penh 12302, Cambodia; (B.J.); (B.A.); (E.E.)
| | - Ir Por
- National Institute of Public Health (NIPH), Phnom Penh 12150, Cambodia; (I.P.); (K.Y.)
| | - Kunthea Yem
- National Institute of Public Health (NIPH), Phnom Penh 12150, Cambodia; (I.P.); (K.Y.)
| | - Steffen Flessa
- Department of General Business Administration and Health Care Management, University of Greifswald, 17489 Greifswald, Germany;
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Teo AKJ, Ork C, Eng S, Sok N, Tuot S, Hsu LY, Yi S. Determinants of delayed diagnosis and treatment of tuberculosis in Cambodia: a mixed-methods study. Infect Dis Poverty 2020; 9:49. [PMID: 32381122 PMCID: PMC7203857 DOI: 10.1186/s40249-020-00665-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 04/23/2020] [Indexed: 11/10/2022] Open
Abstract
Background Cambodia is among the 30 countries in the world with the highest burden of tuberculosis (TB), and it is estimated that 40% of people with TB remain undiagnosed. In this study, we aimed to investigate the determinants of delayed diagnosis and treatment of TB in Cambodia. Methods This mixed-method explanatory sequential study was conducted between February and September 2019 in 12 operational districts in Cambodia. It comprised of a retrospective cohort study of 721 people with TB, followed by a series of in-depth interviews. We assessed factors associated with time to TB diagnosis and treatment initiation using Cox proportional hazards model. Subsequently, we conducted in-depth interviews with 31 people with TB purposively selected based on the time taken to reach TB diagnosis, sex, and residence. Transcripts were coded, and thematic analyses were performed. Results The median time from the onset of symptoms to TB diagnosis was 49 days (Interquartile range [IQR]: 21–112). We found that longer time to diagnosis was significantly associated with living in rural area (Adjusted hazards ratio [aHR] = 1.25; 95% confidence interval [CI]: 1.06–1.48); TB symptoms—cough (aHR: 1.52; 95% CI: 1.18–1.94), hemoptysis (aHR 1.32; 95% CI: 1.07–1.63), and night sweats (aHR: 1.24; 95% CI: 1.05–1.46); seeking private health care/self-medication (aHR: 1.23; 95% CI: 1.04–1.45); and higher self-stigma (aHR: 1.02; 95% CI: 1.01–1.03). Participants who received education level above the primary level were inversely associated with longer time to diagnosis (aHR: 0.78; 95% CI: 0.62–0.97). The median time from TB diagnosis to the initiation of treatment was two days (IQR: 1–3). The use of smear microscopy for TB diagnosis (aHR: 1.50; 95% CI: 1.16–1.95) was associated with longer time to treatment initiation. Seeking private health care and self-medication before TB diagnosis, lack of perceived risk, threat, susceptibility, and stigma derived qualitatively further explained the quantitative findings. Conclusions TB diagnostic delay was substantial. Increasing public awareness about TB and consciousness regarding stigma, engaging the private healthcare providers, and tailoring approaches targeting the rural areas could further improve early detection of TB and narrowing the gap of missing cases in Cambodia.
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Affiliation(s)
- Alvin Kuo Jing Teo
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore.
| | - Chetra Ork
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Sothearith Eng
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Ngovlyly Sok
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Li Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore.,KHANA Center for Population Health Research, Phnom Penh, Cambodia.,Center for Global Health Research, Touro University California, Vallejo, USA.,School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
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Jo Y, Mirzoeva F, Chry M, Qin ZZ, Codlin A, Bobokhojaev O, Creswell J, Sohn H. Standardized framework for evaluating costs of active case-finding programs: An analysis of two programs in Cambodia and Tajikistan. PLoS One 2020; 15:e0228216. [PMID: 31986183 PMCID: PMC6984737 DOI: 10.1371/journal.pone.0228216] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/09/2020] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Over the years, technological and process innovations enabled active case finding (ACF) programs to expand their capacities and scope to have evolved to close gaps in missing TB patients globally. However, with increased ACF program's operational complexity and a need for significant resource commitments, a comprehensive, transparent, and standardized approach in evaluating costs of ACF programs is needed to properly determine costs and value of ACF programs. METHODS Based on reviews of program activity and financial reports, multiple interviews with program managers of two TB REACH funded ACF programs deployed in Cambodia and Tajikistan, we first identified common program components, which formed the basis of the cost data collection, analysis, reporting framework. Within each program component and sub-activity group, cost data were collected and organized by relevant resource types (human resource, capital, recurrent, and overhead costs). Total shared, indirect and overhead costs were apportioned into each activity category based on direct human resource contribution (e.g. a number of staff and their relative level of effort dedicated to each program component). Capital assets were assessed specific to program components and were annualized based on their expected useful life and a 3% discount rate. All costs were assessed based on the service provider perspective and expressed in 2015 USD. RESULTS Over the two program years (April 2013 to December 2015), the Cambodia and Tajikistan ACF programs cumulated a total cost of $336,951 and $771,429 to screen 68,846 and 1,980,516 target population, bacteriologically test 4,589 and 19,764 presumptive TB, diagnose 731 and 2,246 TB patients in the respective programs. Recurrent costs were the largest cost components (54% and 34%) of the total costs for the respective programs and Xpert MTB/RIF (Xpert) testing incurred largest program component/activity cost for both programs. Cost per screening was $0.63 and $0.10 and cost per Xpert test was $25 and $18; Cost per TB case detected (Xpert) was $373 and $343 in Cambodia and Tajikistan. CONCLUSIONS Results from two contextually and programmatically different multi-component ACF programs demonstrate that our tool is fully capable of comprehensively and transparently evaluating and comparing costs of various ACF programs.
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Affiliation(s)
- Youngji Jo
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Farangiz Mirzoeva
- Republican Centre of Population Protection from Tuberculosis, Dushanbe, Tajikistan
| | - Monyrath Chry
- Cambodia Anti-Tuberculosis Association, Phnom Penh, Cambodia
| | | | | | - Oktam Bobokhojaev
- Republican Centre of Population Protection from Tuberculosis, Dushanbe, Tajikistan
| | - Jacob Creswell
- Cambodia Anti-Tuberculosis Association, Phnom Penh, Cambodia
| | - Hojoon Sohn
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- * E-mail:
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Malekjahani A, Sindhwani S, Syed AM, Chan WCW. Engineering Steps for Mobile Point-of-Care Diagnostic Devices. Acc Chem Res 2019; 52:2406-2414. [PMID: 31430118 DOI: 10.1021/acs.accounts.9b00200] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Mobile phone technology is a perfect companion for point-of-care diagnostics as they come equipped with advanced processors, high resolution cameras, and network connectivity. Despite several academic pursuits, only a few mobile phone diagnostics have been tested in the field, commercialized or achieved regulatory approval. This review will address the challenges associated with developing mobile diagnostics and suggest strategies to overcome them. We aim to provide a resource for researchers to accelerate the development of new diagnostics. Our Account includes an overview of published mobile phone diagnostics and highlights lessons learned from their approach to diagnostic development. Also, we have included recommendations from regulatory and public health agencies, such as the U.S. Food and Drug Administration and World Health Organization, to further guide researchers. We believe that the development of mobile phone point-of-care diagnostics takes place in four distinct steps: (1) Needs and Value Assessment, (2) Technology Development, (3) Preclinical Verification, and (4) Clinical Validation and Field Trials. During each step, we outline developmental strategies to help researchers avoid potential challenges. (1) Researchers commonly develop devices to maximize technical parameters such as sensitivity and time which do not necessarily translate to increased clinical impact. Researchers must focus on assessing specific diagnostic needs and the value which a potential device would offer. (2) Often, researchers claim they have developed devices for feasible implementation at the point-of-care, yet they rely on laboratory resources. Researchers must develop equipment-free devices which are agnostic to any mobile phone. (3) Another challenge researchers face is decreased performance during field evaluations relative to initial laboratory verification. Researchers must ensure that they simulate the field conditions during laboratory verification to achieve successful translation. (4) Finally, proper field testing of devices must be performed in conditions which match that of the final intended use. The future of mobile phone point-of-care diagnostic devices is bright and has the potential to radically change how patients are diagnosed. Before we reach this point, researchers must take a step backward and focus on the first-principles of basic research. The widespread adoption and rapid scaling of these devices can only be achieved once the fundamentals have been considered. The insights and strategies provided here will help researchers avoid pitfalls, streamline development and make better decisions during the development of new diagnostics. Further, we believe this Account can help push the field of mobile diagnostics toward increased productivity, leading to more approved devices and ultimately helping curb the burden of disease worldwide.
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Affiliation(s)
- Ayden Malekjahani
- Institute of Biomaterials and Biomedical Engineering (IBBME), University of Toronto, 164 College St, Toronto, ON M5S 3G9, Canada
| | - Shrey Sindhwani
- Institute of Biomaterials and Biomedical Engineering (IBBME), University of Toronto, 164 College St, Toronto, ON M5S 3G9, Canada
| | - Abdullah Muhammad Syed
- Institute of Biomaterials and Biomedical Engineering (IBBME), University of Toronto, 164 College St, Toronto, ON M5S 3G9, Canada
| | - Warren C. W. Chan
- Institute of Biomaterials and Biomedical Engineering (IBBME), University of Toronto, 164 College St, Toronto, ON M5S 3G9, Canada
- Chemical Engineering and Applied Chemistry, University of Toronto, 200 College St, Toronto, ON M5S 3E5, Canada
- Department of Chemistry, University of Toronto, 80 St. George, Toronto, ON M5S 3H6, Canada
- Faculty of Applied Science and Engineering, University of Toronto, Toronto, ON M5S 1A4, Canada
- Donnelly Center for Cellular and Biomolecular Research, University of Toronto, 160 College St, Toronto, ON M5S 3E1, Canada
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