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Bari K, Oliver VL, Abbas S, Marthias T, Kane S. The economic consequences of obstetric fistula: A systematic search and narrative review. Int J Gynaecol Obstet 2024; 166:238-249. [PMID: 38243609 DOI: 10.1002/ijgo.15370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 12/18/2023] [Accepted: 01/02/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND Obstetric fistula develops from obstructed labor and is a devastating condition with significant consequences across several domains of a woman's life. This study presents a narrative review of the evidence on the economic consequences of obstetric fistula. METHODS Three databases were searched, and search results were limited to English language papers published after 2003. Search results were reviewed for relevance based on title and abstract followed by full text review using specific inclusion and exclusion criteria. Bibliographies of papers were also scanned to identify relevant papers for inclusion. Data were extracted under three categories (defined a priori): the economic consequences of having the condition, the economic consequences of seeking care, and the macroeconomic impacts. RESULTS The search returned 517 unique papers, 49 of which were included after screening. Main findings identified from the studies include women losing their jobs, becoming dependent on others, and losing financial support when relationships are lost. Seeking care was economically costly for families or unaffordable entirely. There were no studies describing the impact of fistula on national economies. CONCLUSION Economic consequences of obstetric fistula are multifaceted, pervasive, and are intertwined with the physical and psychosocial consequences of the condition. Understanding these consequences can help tailor existing fistula programs to better address the impacts of the condition. Further research to address the dearth of literature describing the macroeconomic impact of obstetric fistula will be critical to enhance the visibility of this condition on the health agendas of countries.
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Affiliation(s)
- Kimiya Bari
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Victoria L Oliver
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Shazra Abbas
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Tiara Marthias
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Sumit Kane
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Liang A, Wilson-Barthes M, Galárraga O. Cost-effectiveness of differentiated care models that incorporate economic strengthening for HIV antiretroviral therapy adherence: a systematic review. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:46. [PMID: 38790050 PMCID: PMC11127452 DOI: 10.1186/s12962-024-00557-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/19/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND There is some evidence that differentiated service delivery (DSD) models, which use a client-centered approach to simplify and increase access to care, improve clinical outcomes among people living with HIV (PLHIV) in high HIV prevalence countries. Integrating economic strengthening tools (e.g., microcredit, cash transfers, food assistance) within DSD models can help address the poverty-related barriers to HIV antiretroviral therapy (ART). Yet there is minimal evidence of the cost-effectiveness of these types of multilevel care delivery models, which potentially prohibits their wider implementation. METHODS Using a qualitative systematic review, this article synthesizes the literature surrounding the cost-effectiveness of differentiated service delivery models that employ economic strengthening initiatives to improve HIV treatment adherence in low- and middle-income countries. We searched three academic databases for randomized controlled trials and observational studies published from January 2000 through March 2024 in Sub-Saharan Africa. The quality of each study was scored using a validated appraisal system. RESULTS Eighty-nine full texts were reviewed and 3 met all eligibility criteria. Two of the three included articles were specific to adolescents living with HIV. Economic strengthening opportunities varied by care model, and included developmental savings accounts, microenterprise workshops, and cash and non-cash conditional incentives. The main drivers of programmatic and per-patient costs were ART medications, CD4 cell count testing, and economic strengthening activities. CONCLUSION All economic evaluations in this review found that including economic strengthening as part of comprehensive differentiated service delivery was cost-effective at a willingness to pay threshold of at least 2 times the national per capita gross domestic product. Two of the three studies in this review focused on adolescents, suggesting that these types of care models may be especially cost-effective for youth entering adulthood. All studies were from the provider perspective, indicating that additional evidence is needed to inform the potential cost-savings of DSD and economic strengthening interventions to patients and society. Randomized trials testing the effectiveness of DSD models that integrate economic strengthening should place greater emphasis on costing these types of programs to inform the potential for bringing these types of multilevel interventions to scale.
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Affiliation(s)
- Annie Liang
- Brown University School of Public Health, Providence, RI, USA
| | - Marta Wilson-Barthes
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Omar Galárraga
- Department of Health Services, Policy and Practice; and International Health Institute, Brown University School of Public Health, 121 South Main Street, Box G-S121-2, Providence, RI, USA.
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3
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Haire S, Lépine A, Effron DA, Treibich C. Can Self-affirmation Encourage HIV-Prevention? Evidence from Female Sex Workers in Senegal. AIDS Behav 2023; 27:3183-3196. [PMID: 37195469 PMCID: PMC10516782 DOI: 10.1007/s10461-023-04039-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 05/18/2023]
Abstract
We test an intervention aiming to increase condom usage and HIV testing in a stigmatized population at high risk of contracting HIV: female sex workers (FSWs) in Senegal. Some sex work is legal in Senegal, and condoms and HIV tests are freely available to registered FSWs-but FSWs may be reluctant to get tested and use condoms, in part because doing so would entail acknowledging their risk of contracting HIV and potentially expose them to stigma. Drawing on self-affirmation theory, we hypothesized that reflecting on a source of personal pride would help participants acknowledge their risk of HIV, intend to use condoms more frequently, and take an HIV test. Prior research suggests that similar self-affirmation interventions can help people acknowledge their health risks and improve their health behavior, especially when paired with information about effectively managing their health (i.e., self-efficacy information). However, such interventions have primarily been tested in the United States and United Kingdom, and their generalizability outside of these contexts is unclear. Our high-powered experiment randomly assigned participants (N = 592 FSWs; N = 563 in the final analysis) to a self-affirmation condition or a control condition and measured their risk perceptions, whether they took condoms offered to them, and whether (after randomly receiving or not receiving self-efficacy information) they took an HIV test. We found no support for any of our hypotheses. We discuss several explanations for these null results based on the stigma attached to sex work and HIV, cross-cultural generalizability of self-affirmation interventions, and robustness of previous findings.
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Affiliation(s)
| | - Aurélia Lépine
- Institute for Global Health, University College London, London, UK
| | | | - Carole Treibich
- Univ. Grenoble Alpes, CNRS, INRAE, Grenoble INP, GAEL, 38000 Grenoble, France
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Brent RJ. Cost-Benefit Analysis versus Cost-Effectiveness Analysis from a Societal Perspective in Healthcare. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4637. [PMID: 36901658 PMCID: PMC10001534 DOI: 10.3390/ijerph20054637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 06/18/2023]
Abstract
Cost-effectiveness analysis (CEA) is the main way that economic evaluations are carried out in the health care field. However, CEA has limited validity in deciding whether any health care evaluation is socially worthwhile and hence justifies funding. Cost-Benefit Analysis (CBA) is the economic evaluation method that should be used to help decide what to invest in when the objective is to record the impact on everyone in society. Cost-utility analysis (CUA), which has its roots in CEA, can be converted into CBA under certain circumstances that are not general. In this article, the strengths and weaknesses of CEA relative to CBA are analyzed in stages, starting in its most classical form and then proceeding via CUA to end up as CBA. The analysis takes place mainly in the context of five actual dementia interventions that have already been found to pass a CBA test. The CBA data is recast into CEA and CUA terms in tabular form in order that the contrast been CEA and CBA is most transparent. We find that how much of the fixed budget that is used up to fund other alternatives determines how much is left over to fund the particular intervention one is evaluating.
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Affiliation(s)
- Robert J Brent
- Department of Economics, Fordham University, Bronx, NY 10458, USA
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5
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Johnson AM. Pandemic HIV and its legacy for medicine and global health. Clin Med (Lond) 2023; 23:106-114. [PMID: 36921987 PMCID: PMC11046497 DOI: 10.7861/clinmed.ed.23.2.harv] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
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The Cost-Effectiveness of HIV/STI Prevention in High-Income Countries with Concentrated Epidemic Settings: A Scoping Review. AIDS Behav 2022; 26:2279-2298. [PMID: 35034238 PMCID: PMC9163023 DOI: 10.1007/s10461-022-03583-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2022] [Indexed: 11/27/2022]
Abstract
The purpose of this scoping review is to establish the state of the art on economic evaluations in the field of HIV/STI prevention in high-income countries with concentrated epidemic settings and to assess what we know about the cost-effectiveness of different measures. We reviewed economic evaluations of HIV/STI prevention measures published in the Web of Science and Cost-Effectiveness Registry databases. We included a total of 157 studies focusing on structural, behavioural, and biomedical interventions, covering a variety of contexts, target populations and approaches. The majority of studies are based on mathematical modelling and demonstrate that the preventive measures under scrutiny are cost-effective. Interventions targeted at high-risk populations yield the most favourable results. The generalisability and transferability of the study results are limited due to the heterogeneity of the populations, settings and methods involved. Furthermore, the results depend heavily on modelling assumptions. Since evidence is unequally distributed, we discuss implications for future research.
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Hausken K, Ncube M. A Game Theoretic Analysis of Competition Between Vaccine and Drug Companies during Disease Contraction and Recovery. Med Decis Making 2021; 42:571-586. [PMID: 34738510 PMCID: PMC9189729 DOI: 10.1177/0272989x211053563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Infectious diseases such as COVID-19 and HIV/AIDS are behaviorally
challenging for persons, vaccine and drug companies, and donors. Methods In 3 linked games in which a disease may or may not be contracted,
N persons choose risky or safe behavior (game 1). Two
vaccine companies (game 2) and 2 drug companies (game 3) choose whether to
develop vaccines and drugs. Each person chooses whether to buy 1 vaccine (if
no disease contraction) or 1 drug (if disease contraction). A donor
subsidizes vaccine and drug developments and purchases. Nature
probabilistically chooses disease contraction, recovery versus death with
and without each drug, and whether vaccines and drugs are developed
successfully. COVID-19 data are used for parameter estimation. Results Each person chooses risky behavior if its utility outweighs safe behavior,
accounting for nature’s probability of disease contraction which depends on
how many are vaccinated. Each person buys a vaccine or drug if the companies
produce them and if their utilities (accounting for side effects and virus
mutation) outweigh the costs, which may be subsidized by a sponsor. Discussion Drug purchases depend on nature’s recovery probability exceeding the
probability in the absence of a drug. Each company develops and produces a
vaccine or drug if nature’s probability of successful development is high,
if sufficiently many persons buy the vaccine or drug at a sales price that
sufficiently exceeds the production price, and if the donor sponsors. Conclusion Accounting for all players’ interlinked decisions allowing 14 outcomes, which
is challenging without a game theoretic analysis, the donor maximizes all
persons’ expected utilities at the societal level to adjust how persons’
purchases and the companies’ development and production are subsidized. Highlights
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Affiliation(s)
- Kjell Hausken
- Faculty of Science and Technology, University of Stavanger, Stavanger, Norway
| | - Mthuli Ncube
- Said Business School, University of Oxford, Oxford, UK
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Hausken K, Ncube M. Decisions of persons, the pharmaceutical industry, and donors in disease contraction and recovery assuming virus mutation. HEALTH ECONOMICS REVIEW 2021; 11:26. [PMID: 34297215 PMCID: PMC8298955 DOI: 10.1186/s13561-021-00320-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/18/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The article develops an eight-period game between N persons and a pharmaceutical company. The choices of a donor and Nature are parametric. METHODS Persons choose between safe and risky behavior, and whether or not to buy drugs. The pharmaceutical company chooses whether or not to develop drugs. The donor chooses parametrically whether to subsidize drug purchases and drug developments. Nature chooses disease contraction, recovery, death, and virus mutation. The game is solved with backward induction. RESULTS The conditions are specified for each of seven outcomes ranging from safe behavior to risky behavior and buying no or one or both drugs. The seven outcomes distribute themselves across three outcomes for the pharmaceutical company, which are to develop no drugs, develop one drug, and develop two drugs if the virus mutates. For these three outcomes the donor's expected utility is specified. CONCLUSION HIV/AIDS data is used to present a procedure for parameter estimation. The players' strategic choices are exemplified. The article shows how strategic interaction between persons and a pharmaceutical company, with parametric choices of a donor and Nature, impact whether persons choose risky or safe behavior, whether a pharmaceutical company develops no drugs or one drug, or two drugs if a virus mutates, and the impact of subsidies by a donor.
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Affiliation(s)
- Kjell Hausken
- Faculty of Science and Technology, University of Stavanger, 4036 Stavanger, Norway
| | - Mthuli Ncube
- Said Business School, University of Oxford, Park End Street, OX1 1HP Oxford, United Kingdom
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Uzoaru F, Nwaozuru U, Ong JJ, Obi F, Obiezu-Umeh C, Tucker JD, Shato T, Mason SL, Carter V, Manu S, BeLue R, Ezechi O, Iwelunmor J. Costs of implementing community-based intervention for HIV testing in sub-Saharan Africa: a systematic review. Implement Sci Commun 2021; 2:73. [PMID: 34225820 PMCID: PMC8259076 DOI: 10.1186/s43058-021-00177-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 06/22/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Community-based interventions (CBIs) are interventions aimed at improving the well-being of people in a community. CBIs for HIV testing seek to increase the availability of testing services to populations that have been identified as at high risk by reaching them in homes, schools, or community centers. However, evidence for a detailed cost analysis of these community-based interventions in sub-Saharan Africa (SSA) is limited. We conducted a systematic review of the cost analysis of HIV testing interventions in SSA. METHODS Keyword search was conducted on SCOPUS, CINAHL, MEDLINE, PsycINFO, Web of Science, and Global Health databases. Three categories of key terms used were cost (implementation cost OR cost-effectiveness OR cost analysis OR cost-benefit OR marginal cost), intervention (HIV testing), and region (sub-Saharan Africa OR sub-Saharan Africa OR SSA). CBI studies were included if they primarily focused on HIV testing, was implemented in SSA, and used micro-costing or ingredients approach. RESULTS We identified 1533 citations. After screening, ten studies were included in the review: five from East Africa and five from Southern Africa. Two studies conducted cost-effectiveness analysis, and one study was a cost-utility analysis. The remainder seven studies were cost analyses. Four intervention types were identified: HIV self-testing (HIVST), home-based, mobile, and Provider Initiated Testing and Counseling. Commonly costed resources included personnel (n = 9), materials and equipment (n = 6), and training (n = 5). Cost outcomes reported included total intervention cost (n = 9), cost per HIV test (n = 9), cost per diagnosis (n = 5), and cost per linkage to care (n = 3). Overall, interventions were implemented at a higher cost than controls, with the largest cost difference with HIVST compared to facility-based testing. CONCLUSION To better inform policy, there is an urgent need to evaluate the costs associated with implementing CBIs in SSA. It is important for cost reports to be detailed, uniform, and informed by economic evaluation guidelines. This approach minimizes biases that may lead decision-makers to underestimate the resources required to scale up, sustain, or reproduce successful interventions in other settings. In an evolving field of implementation research, this review contributes to current resources on implementation cost studies.
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Affiliation(s)
- Florida Uzoaru
- College of Public Health and Social Justice, Saint Louis University, St Louis, MO, USA.
| | - Ucheoma Nwaozuru
- College of Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
| | - Jason J Ong
- Department of Clinical Research and Development, London School of Hygiene and Tropical Medicine, United Kingdom Central Clinical School, Monash University, Melbourne, Australia
| | - Felix Obi
- Health Policy Research Group, University of Nigeria, Nsukka, Nigeria
| | - Chisom Obiezu-Umeh
- College of Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
| | - Joseph D Tucker
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Thembekile Shato
- College of Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
| | - Stacey L Mason
- College of Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
| | - Victoria Carter
- College of Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
| | - Sunita Manu
- College of Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
| | - Rhonda BeLue
- College of Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
| | - Oliver Ezechi
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Juliet Iwelunmor
- College of Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
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Min C, Xue M, Haotian F, Jialian L, Lingli Z. An overview of the characteristics and quality assessment criteria in systematic review of pharmacoeconomics. PLoS One 2021; 16:e0246080. [PMID: 33556056 PMCID: PMC7870091 DOI: 10.1371/journal.pone.0246080] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 01/13/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The systematic review of economic evaluations plays a critical role in making well-informed decisions about competing healthcare interventions. The quality of these systematic reviews varies due to the lack of internationally recognized methodological evaluation standards. METHODS Nine English and Chinese databases including the Cochrane Library, PubMed, EMbase (Ovid), NHS economic evaluation database (NHSEED) (Ovid), Health Technology Assessment (HTA) database, Chinese National Knowledge Infrastructure (CNKI), WangFang, VIP Chinese Science & Technology Periodicals (VIP) and Chinese Biomedical Literature Database (CBM) were searched. Two reviewers independently screened studies and extracted data. The methodological quality of the literature was measured with modified AMSTAR. Data were narrative synthesized. RESULTS 165 systematic reviews were included. The overall methodological quality of the literature was moderate according to the AMSTAR scale. In these articles, thirteen quality assessment tools and 32 author self-defined criteria were used. The three most widely used tools were the Drummond checklist (19.4%), the BMJ checklist (15.8%), the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement (12.7%). Others included the Quality of Health Economic Studies (QHES), the Consensus on Health Economic Criteria (CHEC), the checklist of Center for Reviews and Dissemination (CRD), the Philips checklist, the World Health Organization (WHO) checklist, the checklist of Critical Appraisal Skills Program (CASP), the Pediatric Quality Appraisal Questionnaire (PQAQ), the Joanna Briggs Institute (JBI) checklist, Spanish and Chinese guidelines. The quantitative scales used in these literature were the QHES and PQAQ. CONCLUSIONS Evidence showed that pharmacoeconomic systematic reviews' methodology remained to be improved, and the quality assessment criteria were gradually unified. Multiple scales can be used in combination to evaluate the quality of economic research in different settings and types.
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Affiliation(s)
- Chen Min
- Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, P. R. China
| | - Mi Xue
- Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, P. R. China
| | - Fei Haotian
- Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, P. R. China
| | - Li Jialian
- Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, P. R. China
| | - Zhang Lingli
- Department of Pharmacy/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, P. R. China
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Shrader CH, Peters Jefferson K, Kanamori M, Rochat R, Siegler A. "I'd Rather Use a Refuse Bag:" A Qualitative Exploration of a South African Community's Perceptions of Government-Provided Condoms and Participant-Preferred Solutions. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:615-627. [PMID: 32367483 PMCID: PMC7609579 DOI: 10.1007/s10508-020-01701-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 03/26/2020] [Accepted: 03/31/2020] [Indexed: 05/26/2023]
Abstract
Despite South Africa experiencing one of the largest HIV epidemics in the world, condom use has decreased since 2008. However, condoms are the only low-cost HIV prevention technology widely available in South Africa. This study aims to explore a South African community's perceptions of condoms, recent condom use decrease, and suggestions for increasing condom use. In 2014, we conducted seven focus groups (n = 40 men) and 20 in-depth interviews (n = 9 men, n = 11 women) with participants aged ≥ 18 years recruited from four urban settlement health clinics in Cape Town, South Africa. Data were collected, coded, and analysed using a general inductive approach. Participants perceived government-provided condoms negatively, with themes including "disgust" for condom physical properties, concerns with social status associated with free condoms, and performance concerns. There was an intersection of themes surrounding masculinity, condom use, and sexual pleasure. Solutions to increase condom use included improving the quality and variety of free condoms and rebranding free condoms. Participants suggested that condoms are distributed with novel attributes (e.g., more colors, smells/flavors, sizes, and in-demand brands) and that government programs should consider offering all brands of condoms at no or low cost. This study suggests a substantial rethinking of condom branding for government-provided condoms. Our findings suggest that condom dissemination and promotion programs should proactively address public concerns regarding condoms. Existing societal and structural norms such as hegemonic masculinity must also be addressed using gender-transformative interventions. We also strongly suggest the creation of a Male Condom Acceptability Scale to understand condom users' needs.
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Affiliation(s)
- Cho-Hee Shrader
- Division of Prevention Science and Community Health, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St., Ste 1006, Miami, FL, 33132, USA.
| | | | - Mariano Kanamori
- Division of Prevention Science and Community Health, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St., Ste 1006, Miami, FL, 33132, USA
| | - Roger Rochat
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Aaron Siegler
- Department of Epidemiology and Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Demartoto A, Murti B, Zunariyah S. HIV/AIDS treatment funding system to support the people affected by HIV/AIDS in Surakarta, Indonesia. SAHARA J 2021; 18:1-16. [PMID: 33509063 PMCID: PMC7850395 DOI: 10.1080/17290376.2020.1858946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
People Living with HIV/AIDS (PLWHA's) quality of life (QoL) is determined by the lifetime treatment sustainability. Republic of Indonesia Minister of Health's Decree Number 328 of 2003 stated that government subsidies the PLWHA's medication and treatment, despite not covering entire medication and treatment cost. The objective of research was to analyse the cost assumed by PLWHA in accessing HIV/AIDS treatment service in Surakarta, Indonesia. The target group in this case study was PLWHAs, and related stakeholders of medical treatment in one of Public Health Centers and a Public Hospital in Surakarta; AIDS Commission of Surakarta City; Solo Plus Peer Support Group and AIDS-Care NGO selected purposively. Data collection was carried out using observation, in-depth interview, and documentation. Method and data source triangulations were used to validate data that was then analysed using Grossman's Demand for Health Capital theory. The result of research showed that the sources of HIV/AIDS treatment cost were self-income, Social Insurance Administration Organization (BPJS) fund and Local Government subsidy. Admission and physican services are given for free to PLWHA because it has been paid by BPJS Fund or has been subsidied by Local Government. Otherwise, they should pay registration cost of IDR 50,000, in Public Hospital and IDR 75,000 in Private Hospital. Physician service costs IDR 50,000–IDR 200,000. VCT Counsellor costs IDR 35,000-IDR 150,000. Non-Subsidy ARV costs IDR 687,000. 1 bottle containing 60 TB meningitis drug capsules costs IDR 145,000 for 10–20 d use and maximally IDR 210,000, while herpes drug costs IDR 295,000. CD4 examination costs IDR 126,000-IDR 297,000, RNA Viral load IDR 1,275,000–IDR 1,471,000, Haematology IDR 60,000-IRD 90,000, Cholesterol and triglyceride IDR 100,000-IDR 250,000, and SGOT/SGPT IDR 100,000–IDR 200,000. There is monthly non-medical cost the patient should spend, including transportation cost to go to health centre, and food, beverage, and newspaper cost while waiting for the service. BPJS fund and local government subsidy relieved health economic burden of PLWHAs, so that the average HIV/AIDS treatment cost in PLWHAs was relatively low, less than 10% of expense. National Insurance System including BPJS fund and local government subsidy as the answer to the integration of HIV/AIDS treatment funding management into national insurance system had provided PLWHA a funding access involving prevention, care, support, and treatment, and mitigated the effect despite less optimum.
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Affiliation(s)
| | - Bhisma Murti
- Department of Public Health, Universitas Sebelas Maret
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Lépine A, Treibich C, Ndour CT, Gueye K, Vickerman P. HIV infection risk and condom use among sex workers in Senegal: evidence from the list experiment method. Health Policy Plan 2020; 35:408-415. [PMID: 32040183 DOI: 10.1093/heapol/czz155] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2019] [Indexed: 11/13/2022] Open
Abstract
Social desirability bias, which is the tendency to under-report socially undesirable health behaviours, significantly distorts information on sensitive behaviours that is gained from self-reports. As a result, self-reported condom use among high-risk populations is thought to be systematically over-reported, and it is impossible to identify the determinants of condom use. The main objective of the article is to elicit unbiased information on condom use among female sex workers (FSWs) using the double list experiment method to analyse the role of HIV infection and exposure to HIV prevention methods in condom use. More specifically, the difference in levels of condom use between HIV-positive and HIV-negative FSWs is estimated. In addition, the role of FSWs' registration and participation in a pre-exposure prophylaxis (PrEP) demonstration project in condom use is considered. A list experiment was designed to elicit condom use information from 786 FSWs in Senegal who were surveyed in 2015 and 2017. Using the list experiment method, participants were randomly assigned to one of two groups (treatment or control) and were asked to report the number of statements they agreed with. Respondents assigned to the control group were presented with three non-sensitive items, whereas those allocated to the treatment group were presented with the same three statements plus the sensitive item (e.g. 'I used a condom during my last intercourse with a client'). Comparing the average number of sentences that were agreed with in both groups provides an estimation of the condom use rate in the treatment group and estimating such prevalence for several sub-groups allows the role of HIV infection risk in condom use to be identified. The percentage of FSWs using condoms in their last sexual intercourse with a client was 80% in 2015 and 78% in 2017, which was significantly lower than the 97% obtained in the face-to-face surveys in both waves. When estimating condom use among sub-groups with the list experiment method, we found that condom use among HIV-positive FSWs was only 34%, which was 47 percentage points lower than condom use among HIV-negative FSWs. We also found that registered FSWs are more likely to use condoms than clandestine FSWs. However, we did not find any difference in condom use between FSWs who were enrolled in the PrEP demonstration project and those who were not enrolled. Health policies should therefore aim to increase condom use among HIV-positive FSWs.
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Affiliation(s)
- Aurélia Lépine
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - Carole Treibich
- Univ. Grenoble Alpes, CNRS, INRAE, Grenoble INP, GAEL, 38000 Grenoble, France
| | - Cheikh Tidiane Ndour
- Division de Lutte contre le Sida et les IST/ nstitut d'hygiène Sociale, Avenue Blaise Diagne X Malick SY - BP 7381 Médina Dakar, Sénégal
| | - Khady Gueye
- Division de Lutte contre le Sida et les IST/ nstitut d'hygiène Sociale, Avenue Blaise Diagne X Malick SY - BP 7381 Médina Dakar, Sénégal
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Clifton BS8 2BN, UK
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Lépine A, Treibich C, D'Exelle B. Nothing but the truth: Consistency and efficiency of the list experiment method for the measurement of sensitive health behaviours. Soc Sci Med 2020; 266:113326. [PMID: 33059302 PMCID: PMC7724128 DOI: 10.1016/j.socscimed.2020.113326] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/05/2020] [Accepted: 08/20/2020] [Indexed: 11/29/2022]
Abstract
RATIONALE Social desirability bias, which is the tendency to under-report socially, undesirable health behaviours, significantly distorts information on sensitive behaviours, gained from self-reports and prevents accurate estimation of the prevalence of those, behaviours. We contribute to a growing body of literature that seeks to assess the performance of the list experiment method to improve estimation of these sensitive health behaviours. METHOD We use a double-list experiment design in which respondents serve as the treatment group for one list and as the control group for the other list to estimate the prevalence of two sensitive health behaviours in different settings: condom use among 500 female sex workers in urban Senegal and physical intimate partner violence among 1700 partnered women in rural Burkina Faso. First, to assess whether the list experiment improves the accuracy of estimations of the prevalence of sensitive behaviours, we compare the prevalence rates estimated from self-reports with those elicited through the list experiment. Second, we test whether the prevalence rates of the sensitive behaviours obtained using the double-list design are similar, and we estimate the reduction in the standard errors obtained with this design. Finally, we compare the results obtained through another indirect elicitation method, the polling vote method. RESULTS We show that the list experiment method reduces misreporting by 17 percentage points for condom use and 16-20 percentage points for intimate partner violence. Exploiting the double-list experiment design, we also demonstrate that the prevalence estimates obtained through the use of the two lists are identical in the full sample and across sub-groups and that the double-list design reduces the standard errors by approximately 40% compared to the standard errors in the simple list design. Finally, we show that the list experiment method leads to a higher estimation of the prevalence of sensitive behaviours than the polling vote method. CONCLUSION The study suggests that list experiments are an effective method to improve estimation of the prevalence of sensitive health behaviours.
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Affiliation(s)
- Aurélia Lépine
- University College London, Insitute for Global Health, London, UK.
| | - Carole Treibich
- Univ. Grenoble Alpes, CNRS, INRAE, Grenoble INP, GAEL, 38000, Grenoble, France
| | - Ben D'Exelle
- University of East Anglia, School of International Development, Norwich, UK
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Iwelunmor J, Nwaozuru U, Obiezu-Umeh C, Uzoaru F, Ehiri J, Curley J, Ezechi O, Airhihenbuwa C, Ssewamala F. Is it time to RE-AIM? A systematic review of economic empowerment as HIV prevention intervention for adolescent girls and young women in sub-Saharan Africa using the RE-AIM framework. Implement Sci Commun 2020; 1:53. [PMID: 32885209 PMCID: PMC7427963 DOI: 10.1186/s43058-020-00042-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 05/24/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Economic empowerment (EE) HIV prevention programs for adolescent girls and young women (AGYW) in sub-Saharan Africa are gaining traction as effective strategies to reduce HIV risk and vulnerabilities among this population. While intervention effectiveness is critical, there are numerous factors beyond effectiveness that shape an intervention's impact. The objective of this systematic review was to assess the reporting of implementation outcomes of EE HIV prevention programs for AGYW in SSA, as conceptualized in the RE-AIM (reach, efficacy/effectiveness, adoption, implementation, and maintenance) framework. METHODS We searched PubMed, Ovid/MEDLINE, Science Direct, Ebscohost, PsycINFO, Scopus, and Web of Science for EE HIV interventions for AGYW in SSA. Study selection and data extraction were conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Two researchers coded each article using a validated RE-AIM data extraction tool and independently extracted information from each article. The reporting of RE-AIM dimensions were summarized and synthesized across included interventions. RESULTS A total of 25 unique interventions (reported in 45 articles) met the predefined eligibility criteria. Efficacy/effectiveness 19(74.4%) was the highest reported RE-AIM dimension, followed by adoption 17(67.2%), reach 16(64.0%), implementation 9(38.0%), and maintenance 7(26.4%). Most interventions reported on RE-AIM components such as sample size 25(100.0%), intervention location 24(96.0%), and measures and results for at least one follow-up 24(96.0%). Few reported on RE-AIM components such as characteristics of non-participants 8(32.0%), implementation costs 3(12.0%), and intervention fidelity 0(0.0%). CONCLUSIONS Results of the review emphasize the need for future economic empowerment HIV prevention interventions for AGYW in SSA to report multiple implementation strategies and highlight considerations for translating such programs into real-world settings. Researchers should pay close attention to reporting setting-level adoption, implementation cost, and intervention maintenance. These measures are needed for policy decisions related to the full merit and worth of EE HIV interventions and their long-term sustainability for AGYW.
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Affiliation(s)
- Juliet Iwelunmor
- College for Public Health and Social Justice, Saint Louis University, Salus Center, 3545 Lafayette Avenue, Saint Louis, MO 63104 USA
| | - Ucheoma Nwaozuru
- College for Public Health and Social Justice, Saint Louis University, Salus Center, 3545 Lafayette Avenue, Saint Louis, MO 63104 USA
| | - Chisom Obiezu-Umeh
- College for Public Health and Social Justice, Saint Louis University, Salus Center, 3545 Lafayette Avenue, Saint Louis, MO 63104 USA
| | - Florida Uzoaru
- College for Public Health and Social Justice, Saint Louis University, Salus Center, 3545 Lafayette Avenue, Saint Louis, MO 63104 USA
| | - John Ehiri
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Avenue, Tucson, AZ 85724 USA
| | - Jami Curley
- College for Public Health and Social Justice, Saint Louis University, Salus Center, 3545 Lafayette Avenue, Saint Louis, MO 63104 USA
| | - Oliver Ezechi
- Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos State Nigeria
| | - Collins Airhihenbuwa
- School of Public Health, Global Research Against Noncommunicable Diseases, Georgia State University, 140 Decatur Street SE, Atlanta, GA 30303 USA
| | - Fred Ssewamala
- Brown School, Washington University in Saint Louis, 1 Brookings Drive, Saint Louis, MO 63130 USA
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Integrating Economic Evaluation and Implementation Science to Advance the Global HIV Response. J Acquir Immune Defic Syndr 2020; 82 Suppl 3:S314-S321. [PMID: 31764269 DOI: 10.1097/qai.0000000000002219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Numerous cost-effectiveness analyses have indicated good value for money from a wide array of interventions for treatment and prevention of HIV/AIDS. There is limited evidence, however, regarding how cost-effectiveness information contributes to better decision-making around investment and action in the global HIV response. METHODS We review challenges for economic evaluation relevant to the global HIV response and consider how the practice of cost-effectiveness analysis could integrate approaches and insights from implementation science to enhance the impact and efficiency of HIV investments. RESULTS In light of signals that cost-effectiveness analyses may be vulnerable to systematic bias toward overly optimistic conclusions, we emphasize two priorities for advancing the field of economic evaluation in HIV/AIDS and more broadly in global health: (1) systematic reevaluation of the cost-effectiveness literature with reference to ex-post empirical evidence on costs and effects in real-world programs and (2) development and adoption of good-practice guidelines for incorporating implementation and delivery aspects into economic evaluations. Toward the latter aim, we propose an integrative approach that focuses on comparative evaluation of strategies, which specify both technologies/interventions as well as the delivery platforms, complementary interventions, and actions needed to increase coverage, quality, and uptake of those technologies/interventions. Specific recommendations draw on several existing implementation science models that provide systematic frameworks for understanding implementation barriers and enablers, designing and choosing specific implementation and policy actions, and evaluating outcomes. DISCUSSION These preliminary steps aimed at bridging the divide between economic evaluation and implementation science can help to advance the practice of economic evaluation toward a science of comparative strategy evaluation.
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Bulstra CA, Hontelez JAC, Giardina F, Steen R, Nagelkerke NJD, Bärnighausen T, de Vlas SJ. Mapping and characterising areas with high levels of HIV transmission in sub-Saharan Africa: A geospatial analysis of national survey data. PLoS Med 2020; 17:e1003042. [PMID: 32142509 PMCID: PMC7059914 DOI: 10.1371/journal.pmed.1003042] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 02/05/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In the generalised epidemics of sub-Saharan Africa (SSA), human immunodeficiency virus (HIV) prevalence shows patterns of clustered micro-epidemics. We mapped and characterised these high-prevalence areas for young adults (15-29 years of age), as a proxy for areas with high levels of transmission, for 7 countries in Eastern and Southern Africa: Kenya, Malawi, Mozambique, Tanzania, Uganda, Zambia, and Zimbabwe. METHODS AND FINDINGS We used geolocated survey data from the most recent United States Agency for International Development (USAID) demographic and health surveys (DHSs) and AIDS indicator surveys (AISs) (collected between 2008-2009 and 2015-2016), which included about 113,000 adults-of which there were about 53,000 young adults (27,000 women, 28,000 men)-from over 3,500 sample locations. First, ordinary kriging was applied to predict HIV prevalence at unmeasured locations. Second, we explored to what extent behavioural, socioeconomic, and environmental factors explain HIV prevalence at the individual- and sample-location level, by developing a series of multilevel multivariable logistic regression models and geospatially visualising unexplained model heterogeneity. National-level HIV prevalence for young adults ranged from 2.2% in Tanzania to 7.7% in Mozambique. However, at the subnational level, we found areas with prevalence among young adults as high as 11% or 15% alternating with areas with prevalence between 0% and 2%, suggesting the existence of areas with high levels of transmission Overall, 15.6% of heterogeneity could be explained by an interplay of known behavioural, socioeconomic, and environmental factors. Maps of the interpolated random effect estimates show that environmental variables, representing indicators of economic activity, were most powerful in explaining high-prevalence areas. Main study limitations were the inability to infer causality due to the cross-sectional nature of the surveys and the likely under-sampling of key populations in the surveys. CONCLUSIONS We found that, among young adults, micro-epidemics of relatively high HIV prevalence alternate with areas of very low prevalence, clearly illustrating the existence of areas with high levels of transmission. These areas are partially characterised by high economic activity, relatively high socioeconomic status, and risky sexual behaviour. Localised HIV prevention interventions specifically tailored to the populations at risk will be essential to curb transmission. More fine-scale geospatial mapping of key populations,-such as sex workers and migrant populations-could help us further understand the drivers of these areas with high levels of transmission and help us determine how they fuel the generalised epidemics in SSA.
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Affiliation(s)
- Caroline A. Bulstra
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Heidelberg Institute of Global Health, Heidelberg University Medical Center, Heidelberg, Germany
| | - Jan A. C. Hontelez
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Heidelberg Institute of Global Health, Heidelberg University Medical Center, Heidelberg, Germany
| | - Federica Giardina
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Richard Steen
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nico J. D. Nagelkerke
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University Medical Center, Heidelberg, Germany
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
| | - Sake J. de Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Abstract
Purpose of Review Clinical trials have found that PrEP is highly effective in reducing risk of HIV acquisition across types of exposure, gender, PrEP regimens, and dosing schemes. Evidence is urgently needed to inform scale-up of PrEP to meet the ambitious WHO/UNAIDS prevention target of 3,000,000 individuals on PrEP by 2020. Recent Findings Successful models of delivering HIV services at scale evolved from years of formal research and programmatic evidence. These efforts produced lessons-learned relevant for scaling-up PrEP delivery, including the importance of streamlining laboratory tests, expanding prescription and management authority, differentiating medication access points, and reducing stigma and barriers of parental consent for PrEP uptake. Further research is especially needed in areas differentiating PrEP from ART delivery, including repeat HIV testing to ensure HIV negative status and defining and measuring prevention-effective adherence. Summary Evidence from 15 years of ART scale-up could immediately inform a public health approach to PrEP delivery.
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Williams LD, Aber JL. Using a Multi-level Framework to Test Empirical Relationships Among HIV/AIDS-Related Stigma, Health Service Barriers, and HIV Outcomes in KwaZulu-Natal, South Africa. AIDS Behav 2020; 24:81-94. [PMID: 30798458 PMCID: PMC6707890 DOI: 10.1007/s10461-019-02439-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
HIV/AIDS-related (HAR) stigma is an ongoing problem in Sub-Saharan Africa that is thought to impede HIV preventive and treatment interventions. This paper uses a systematic sample of households (Level 1) nested within near-neighbor clusters (Level 2) and communities (Level 3) to examine multilevel relationships of HAR stigma to health service barriers (HSBs) and HIV outcomes in KwaZulu-Natal, South Africa, thereby addressing methodological and conceptual gaps in the literature from this context. Findings suggest differential patterns of prediction at Level 1 when examining two different dimensions of stigma: more highly stigmatizing attitudes predicted more household health service barriers; and perceptions of greater levels of community normative HAR stigma predicted higher household HIV ratios. Level 2 findings were similarly dimension-differentiated. Cross-level analyses found that near-neighbor cluster-level (setting level) consensus about (standard deviation) and level of (mean) community normative HAR stigma significantly predicted household-level HSBs and HIV ratio, controlling for household-level community normative HAR stigma. These differential patterns of prediction suggest that HAR stigma is a multi-level construct with multiple dimensions that relate to important outcomes differently within and across multiple ecological levels. This has important implications for future research, and for developing interventions that address setting-level variation in stigma.
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Affiliation(s)
- Leslie D Williams
- Steinhardt School of Culture, Education, and Human Development, New York University, 246 Greene Street, 8th Floor, New York, NY, 10003, USA.
- National Development and Research Institutes, New York, NY, USA.
| | - J Lawrence Aber
- Steinhardt School of Culture, Education, and Human Development, New York University, 246 Greene Street, 8th Floor, New York, NY, 10003, USA
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Ling XX, Jin JJ, Zhu GD, Wang WM, Cao YY, Yang MM, Zhou HY, Cao J, Huang JY. Cost-effectiveness analysis of malaria rapid diagnostic tests: a systematic review. Infect Dis Poverty 2019; 8:104. [PMID: 31888731 PMCID: PMC6937952 DOI: 10.1186/s40249-019-0615-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 12/09/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Rapid diagnostic tests (RDT) can effectively manage malaria cases and reduce excess costs brought by misdiagnosis. However, few studies have evaluated the economic value of this technology. The purpose of this study is to systematically review the economic value of RDT in malaria diagnosis. MAIN TEXT A detailed search strategy was developed to identify published economic evaluations that provide evidence regarding the cost-effectiveness of malaria RDT. Electronic databases including MEDLINE, EMBASE, Biosis Previews, Web of Science and Cochrane Library were searched from Jan 2007 to July 2018. Two researchers screened studies independently based on pre-specified inclusion and exclusion criteria. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was applied to evaluate the quality of the studies. Then cost and effectiveness data were extracted and summarized in a narrative way. Fifteen economic evaluations of RDT compared to other diagnostic methods were identified. The overall quality of studies varied greatly but most of them were scored to be of high or moderate quality. Ten of the fifteen studies reported that RDT was likely to be a cost-effective approach compared to its comparisons, but the results could be influenced by the alternatives, study perspectives, malaria prevalence, and the types of RDT. CONCLUSIONS Based on available evidence, RDT had the potential to be more cost-effective than either microscopy or presumptive diagnosis. Further research is also required to draw a more robust conclusion.
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Affiliation(s)
- Xiao-Xiao Ling
- School of Public Health, Fudan University, Key Laboratory of Health Technology Assessment, National Health Commission, Shanghai, 200032, China
| | - Jia-Jie Jin
- School of Public Health, Fudan University, Key Laboratory of Health Technology Assessment, National Health Commission, Shanghai, 200032, China
| | - Guo-Ding Zhu
- National Health Commission Key Laboratory of Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, 214064, China
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
- Public Health Research Centre, Jiangnan University, Wuxi, 214122, China
| | - Wei-Ming Wang
- National Health Commission Key Laboratory of Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, 214064, China
| | - Yuan-Yuan Cao
- National Health Commission Key Laboratory of Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, 214064, China
| | - Meng-Meng Yang
- National Health Commission Key Laboratory of Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, 214064, China
| | - Hua-Yun Zhou
- National Health Commission Key Laboratory of Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, 214064, China
| | - Jun Cao
- National Health Commission Key Laboratory of Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, 214064, China.
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.
- Public Health Research Centre, Jiangnan University, Wuxi, 214122, China.
| | - Jia-Yan Huang
- School of Public Health, Fudan University, Key Laboratory of Health Technology Assessment, National Health Commission, Shanghai, 200032, China.
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MacCarthy S, Mendoza-Graf A, Huang H, Mukasa B, Linnemayr S. Supporting Adolescents to Adhere (SATA): Lessons learned from an intervention to achieve medication adherence targets among youth living with HIV in Uganda. CHILDREN AND YOUTH SERVICES REVIEW 2019; 102:56-62. [PMID: 31223179 PMCID: PMC6586245 DOI: 10.1016/j.childyouth.2019.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Youth in Uganda are disproportionately impacted by HIV and report significant barriers to ART adherence. We asked participants how fixed versus flexible adherence target setting for incentive interventions, in combination with other support systems, could help HIV-positive youth in Uganda reach medication adherence targets. METHODS Four focus groups conducted in Luganda were audiotaped, transcribed, and translated into English; the transcriptions were then coded using Dedoose software. Two members of the research team read the text and identified the basic topics covered. A codebook was developed that detailed inclusion and exclusion criteria for each topic area, as well as typical entries for each code. A directed content analysis was used to identify key themes. RESULTS Several themes were common across groups. Participants consistently maintained that they preferred to set their own adherence targets. But regardless of how adherence targets were assigned, participants noted that missing their target was disappointing. They commented positively on the use of Medication Event Monitoring System (MEMS) caps, noting that knowing their adherence information was being tracked often encouraged them to take their medications. Participants reported that receiving text messages further motivated them to take their medications; however, on occasions when they reported not doing well, they wanted intensive follow-up by staff. Participants said that the prize drawing alone did not motivate their ART adherence and that receiving 'zero' in the drawing was disheartening. CONCLUSION We found that participants preferred to set their own adherence targets and that doing so increased a sense of ownership in achieving them. All participants enjoyed using MEMS caps and expressed disappointment at needing to return the device at the study's completion. Participants noted that text message reminders may be a useful way to help patients stay motivated between clinic visits; however, ongoing engagement and support are needed from providers and counselors. Finally, our participants stressed the importance of including incentives with a small, positive value rather than 0 when designing the lowest prize.
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Affiliation(s)
- Sarah MacCarthy
- RAND Corporation, Behavioral and Policy Sciences, 1776 Main Street, Santa Monica, CA USA
| | | | - Haijing Huang
- RAND Corporation, 1776 Main Street, Santa Monica, CA USA
| | - Barbara Mukasa
- Mildmay, Uganda, 12 Km Entebbe Road, Naziba Hill, Lweza, Kampala, Uganda
| | - Sebastian Linnemayr
- RAND Corporation, Economics, Sociology, and Statistics, 1776 Main Street, Santa Monica, CA USA
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Mostafa A, Elsisi GH. A cost-effectiveness analysis of the use of safety-engineered syringes in reducing HBV, HCV, and HIV burden in Egypt. Expert Rev Med Devices 2019; 16:155-163. [PMID: 30571154 DOI: 10.1080/17434440.2019.1561267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION The objective of this study was to estimate the effects and costs of safety-engineered syringes (SS) as a prevention strategy from HBV, HCV, and HIV infections versus conventional syringes (CS). METHODS A decision-analytic model with five health states was constructed. The clinical parameters and utilities were derived using published data. Direct medical costs from the health care system perspective were sourced from national data. All costs and effects were discounted at 3.5% annually. RESULTS The estimate of total quality adjusted life years (QALYs) while using SS were 10.87 compared to 9.20 for the use of CS in the Egyptian population exposed to unsafe injection practices. The total costs for using SS and CS were EGP2,870 and EGP81,794 (I$1,130 and I$32,202), respectively, per 5.9 injections per person per year. Adopting SS resulted in better outcomes (difference; 1.66 QALYs) and total savings (EGP-78,924/I$-31,073) per person. CONCLUSION Introducing SS in the Egyptian health care system might help in preventing transmission of blood-borne infections that are acquired through health care settings. The overall benefit of investing in this technology is far more than CS. These findings encourage the urgent adoption of SS by health care delivery institutions in similar resource-limited settings.
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Affiliation(s)
- Aya Mostafa
- a Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine , Ain Shams University , Cairo , Egypt
| | - Gihan Hamdy Elsisi
- b HTA Office , LLC , Cairo , Egypt.,c Pharmacy Practice Department, Faculty of Pharmacy , Heliopolis University , Cairo , Egypt
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Treibich C, Lépine A. Estimating misreporting in condom use and its determinants among sex workers: Evidence from the list randomisation method. HEALTH ECONOMICS 2019; 28:144-160. [PMID: 30324751 DOI: 10.1002/hec.3835] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 08/30/2018] [Accepted: 09/15/2018] [Indexed: 06/08/2023]
Abstract
Social desirability bias, which is the tendency to underreport socially undesirable health behaviours, significantly distorts information on sensitive behaviours gained from self-reports. We applied the list randomisation method to indirectly elicit condom use among female sex workers and tested it among 651 female sex workers in Senegal, a country where sex workers face high social stigma and where the AIDS epidemic is mainly concentrated among this population. On the basis of our list randomisation, we found that the condom use rate in the last sexual intercourse with a client was 78%, which is significantly lower than the 97% obtained when asked directly in the survey. When estimating condom use among the subgroups, we found that female sex workers who are at a higher risk of infection are less likely to use condoms.
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Affiliation(s)
- Carole Treibich
- CNRS, INRA, Institute of Engineering Univ. Grenoble Alpes, University Grenoble Alpes, GAEL Grenoble, France
| | - Aurélia Lépine
- Department of Global Health and Development London, London School of Hygiene and Tropical Medicine, London, UK
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Rinaldi G, Kiadaliri AA, Haghparast-Bidgoli H. Cost effectiveness of HIV and sexual reproductive health interventions targeting sex workers: a systematic review. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2018; 16:63. [PMID: 30524207 PMCID: PMC6278021 DOI: 10.1186/s12962-018-0165-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 11/22/2018] [Indexed: 01/10/2023] Open
Abstract
Background Sex workers have high incidences of HIV and other sexually transmitted diseases. Although, interventions targeting sex workers have shown to be effective, evidence on which strategies are most cost-effective is limited. This study aims to systematically review evidence on the cost-effectiveness of sexual health interventions for sex workers on a global level. It also evaluates the quality of available evidence and summarizes the drivers of cost effectiveness. Methods A search of published articles until May 2018 was conducted. A search strategy consisted of key words, MeSH terms and other free text terms related to economic evaluation, sex workers and sexual and reproductive health (SRH) was developed to conduct literature search on Medline, Web of Science, Econlit and the NHS Economic Evaluation Database. The quality of reporting the evidence was evaluated using the CHEERS checklist and drivers of cost-effectiveness were reported. Results Overall, 19 studies met the inclusion criteria. The majority of the studies were based in middle-income countries and only three in low-income settings. Most of the studies were conducted in Asia and only a handful in Sub-Saharan Africa and Latin America. The reviewed studies mainly evaluated the integrated interventions, i.e. interventions consisted a combination of biomedical, structural or behavioural components. All interventions, except for one, were highly cost-effective. The reporting quality of the evidence was relatively good. The strongest drivers of cost-effectiveness, reported in the studies, were HIV prevalence, number of partners per sex worker and commodity costs. Furthermore, interventions integrated into existing health programs were shown to be most cost-effective. Conclusion This review found that there is limited economic evidence on HIV and SRH interventions targeting sex workers. The available evidence indicates that the majority of the HIV and SRH interventions targeting sex workers are highly cost-effective, however, more effort should be devoted to improving the quality of conducting and reporting cost-effectiveness evidence for these interventions to make them usable in policy making. This review identified potential factors that affect the cost-effectiveness and can provide useful information for policy makers when designing and implementing such interventions. Electronic supplementary material The online version of this article (10.1186/s12962-018-0165-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Aliasghar A Kiadaliri
- 2Clinical Epidemiology Unit, Department of Clinical Sciences, Orthopaedics, Faculty of Medicine, Lund University, Lund, Sweden
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Fan VY. Multi-criteria decision analysis: of politics, policy entrepreneurs, and processes. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2018; 16:50. [PMID: 30455609 PMCID: PMC6225609 DOI: 10.1186/s12962-018-0131-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Multi-criteria decision analysis (MCDA) has the potential to increase the consistency, transparency and rigour with which these criteria inform decisions. Political context is relevant not only as a motivation for turning to MCDA but also the context in which MCDA can be successfully implemented. A policy entrepreneur can spearhead the creation of a process to carry out MCDA and can help to create and build the capacity of a public institution that observes and convenes this process, an institution that has legal authority to carry out such a function.
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Affiliation(s)
- Victoria Y Fan
- 1Office of Public Health Studies, Myron B. Thompson School of Social Work, University of Hawai'i at Mānoa, 1960 East-West Road, Biomed D204, Honolulu, HI USA.,2François-Xavier Bagnoud Center for Health and Human Rights and the Department of Global Health & Population, Harvard T.H. Chan School of Public Health, 651 Huntington Ave, Boston, MA USA
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Baker H, Fried A, Cloete A, Sigel C, Miranda D, Guillen J, Rochat R, Siegler A. "Give What the People Want": A Situational Analysis of Condom Distribution and a Feasibility Study of User-Friendly Condoms in Cape Town, South Africa. J Assoc Nurses AIDS Care 2018; 29:887-901. [PMID: 29743146 DOI: 10.1016/j.jana.2018.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 04/08/2018] [Indexed: 11/25/2022]
Abstract
Condom use has remained low in South Africa despite efforts by the government to make condoms accessible to all. We assessed condom availability, procurement/distribution, and education practices, and explored perceptions of and interest in an expanded array of condom options, including fitted male condoms in Cape Town, South Africa. We conducted 11 key informant interviews with staff members from two sexual health organizations and four state-owned clinics. Key informants (a) were interested in their organizations offering an expanded variety of male condom options including different sizes, colors, and flavors; and (b) substantiated the capacity that their organizations had to integrate alternative condom options into existing procurement, distribution, and education programs. Challenges discussed included securing funding, educating clients, and addressing logistical issues of stocking and distributing new condom types. Further research should explore whether providing condoms with a greater array of characteristics could improve condom use in South Africa.
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Hausken K, Ncube M. Policy makers, the international community and the population in the prevention and treatment of diseases: case study on HIV/AIDS. HEALTH ECONOMICS REVIEW 2017; 7:5. [PMID: 28124313 PMCID: PMC5267592 DOI: 10.1186/s13561-016-0139-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 12/12/2016] [Indexed: 06/06/2023]
Abstract
A four-period game is developed between a policy maker, the international community, and the population. This research supplements, through implementing strategic interaction, earlier research analyzing "one player at a time". The first two players distribute funds between preventing and treating diseases. The population reacts by degree of risky behavior which may cause no disease, disease contraction, recovery, sickness/death. More funds to prevention implies less disease contraction but higher death rate given disease contraction. The cost effectiveness of treatment relative to prevention, country specific conditions, and how the international community converts funds compared with the policy maker in a country, are illustrated. We determine which factors impact funding, e.g. large probabilities of disease contraction, and death given contraction, and if the recovery utility and utility of remaining sick or dying are far below the no disease utility. We also delineate how the policy maker and international community may free ride on each other's contributions. The model is tested against empirical data for 43 African countries. The results show consistency between the theoretical model and empirical estimates. The paper argues for the need to create commitment mechanisms to ensure that free riding by both countries and the international community is avoided.
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Affiliation(s)
- Kjell Hausken
- Faculty of Social Sciences, University of Stavanger, 4036 Stavanger, Norway
| | - Mthuli Ncube
- Blavatnik School of Government & Fellow, St Antony’s College, University of Oxford, Radcliffe Observatory Quarter, Oxford, OX2 6GG UK
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Rutstein SE, Price JT, Rosenberg NE, Rennie SM, Biddle AK, Miller WC. Hidden costs: The ethics of cost-effectiveness analyses for health interventions in resource-limited settings. Glob Public Health 2017; 12:1269-1281. [PMID: 27141969 PMCID: PMC5303190 DOI: 10.1080/17441692.2016.1178319] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Cost-effectiveness analysis (CEA) is an increasingly appealing tool for evaluating and comparing health-related interventions in resource-limited settings. The goal is to inform decision-makers regarding the health benefits and associated costs of alternative interventions, helping guide allocation of limited resources by prioritising interventions that offer the most health for the least money. Although only one component of a more complex decision-making process, CEAs influence the distribution of health-care resources, directly influencing morbidity and mortality for the world's most vulnerable populations. However, CEA-associated measures are frequently setting-specific valuations, and CEA outcomes may violate ethical principles of equity and distributive justice. We examine the assumptions and analytical tools used in CEAs that may conflict with societal values. We then evaluate contextual features unique to resource-limited settings, including the source of health-state utilities and disability weights, implications of CEA thresholds in light of economic uncertainty, and the role of external donors. Finally, we explore opportunities to help align interpretation of CEA outcomes with values and budgetary constraints in resource-limited settings. The ethical implications of CEAs in resource-limited settings are vast. It is imperative that CEA outcome summary measures and implementation thresholds adequately reflect societal values and ethical priorities in resource-limited settings.
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Affiliation(s)
- Sarah E. Rutstein
- Department of Health Policy and Management, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
- Division of Infectious Diseases, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Stuart M. Rennie
- Department of Social Medicine, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Andrea K. Biddle
- Department of Health Policy and Management, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - William C. Miller
- Division of Infectious Diseases, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
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Masters R, Anwar E, Collins B, Cookson R, Capewell S. Return on investment of public health interventions: a systematic review. J Epidemiol Community Health 2017; 71:827-834. [PMID: 28356325 PMCID: PMC5537512 DOI: 10.1136/jech-2016-208141] [Citation(s) in RCA: 200] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 02/03/2017] [Indexed: 12/02/2022]
Abstract
BACKGROUND Public sector austerity measures in many high-income countries mean that public health budgets are reducing year on year. To help inform the potential impact of these proposed disinvestments in public health, we set out to determine the return on investment (ROI) from a range of existing public health interventions. METHODS We conducted systematic searches on all relevant databases (including MEDLINE; EMBASE; CINAHL; AMED; PubMed, Cochrane and Scopus) to identify studies that calculated a ROI or cost-benefit ratio (CBR) for public health interventions in high-income countries. RESULTS We identified 2957 titles, and included 52 studies. The median ROI for public health interventions was 14.3 to 1, and median CBR was 8.3. The median ROI for all 29 local public health interventions was 4.1 to 1, and median CBR was 10.3. Even larger benefits were reported in 28 studies analysing nationwide public health interventions; the median ROI was 27.2, and median CBR was 17.5. CONCLUSIONS This systematic review suggests that local and national public health interventions are highly cost-saving. Cuts to public health budgets in high income countries therefore represent a false economy, and are likely to generate billions of pounds of additional costs to health services and the wider economy.
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Affiliation(s)
- Rebecca Masters
- North Wales Local Public Health Team, Public Health Wales, Mold, Flintshire, UK
- Department of Public Health and Policy, University of Liverpool, UK
| | - Elspeth Anwar
- Department of Public Health and Policy, University of Liverpool, UK
- Department of Public Health, Halton Borough Council, Cheshire, UK
- Department of Public Health, Wirral Metropolitan Borough Council, Merseyside, UK
| | - Brendan Collins
- Department of Public Health and Policy, University of Liverpool, UK
- Department of Public Health, Wirral Metropolitan Borough Council, Merseyside, UK
| | | | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, UK
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Gunda R, Chimbari MJ. Cost-effectiveness analysis of malaria interventions using disability adjusted life years: a systematic review. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2017; 15:10. [PMID: 28680367 PMCID: PMC5494144 DOI: 10.1186/s12962-017-0072-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 06/24/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Malaria continues to be a public health problem despite past and on-going control efforts. For sustenance of control efforts to achieve the malaria elimination goal, it is important that the most cost-effective interventions are employed. This paper reviews studies on cost-effectiveness of malaria interventions using disability-adjusted life years. METHODS A review of literature was conducted through a literature search of international peer-reviewed journals as well as grey literature. Searches were conducted through Medline (PubMed), EMBASE and Google Scholar search engines. The searches included articles published in English for the period from 1996 to 2016. The inclusion criteria for the study were type of malaria intervention, year of publication and cost-effectiveness ratio in terms of cost per DALY averted. We included 40 studies which specifically used the DALY metric in cost-effectiveness analysis (CEA) of malaria interventions. RESULTS The majority of the reviewed studies (75%) were done using data from African settings with the majority of the interventions (60.0%) targeting all age categories. Interventions included case treatment, prophylaxis, vector control, insecticide treated nets, early detection, environmental management, diagnosis and educational programmes. Sulfadoxine-pyrimethamine was the most common drug of choice in malaria prophylaxis, while artemisinin-based combination therapies were the most common drugs for case treatment. Based on guidelines for CEA, most interventions proved cost-effective in terms of cost per DALYs averted for each intervention. CONCLUSION The DALY metric is a useful tool for determining the cost-effectiveness of malaria interventions. This paper demonstrates the importance of CEA in informing decisions made by policy makers.
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Affiliation(s)
- Resign Gunda
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Howard Campus, Durban, 4001 South Africa
| | - Moses John Chimbari
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Howard Campus, Durban, 4001 South Africa
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Kevany S, Matthews M. Diplomacy and Health: The End of the Utilitarian Era. Int J Health Policy Manag 2017; 6:191-194. [PMID: 28812802 PMCID: PMC5384981 DOI: 10.15171/ijhpm.2016.155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 12/24/2016] [Indexed: 11/09/2022] Open
Abstract
Cost-effectiveness analysis (CEA), as a system of allocative efficiency for global health programs, is an influential criterion for resource allocation in the context of diplomacy and inherent foreign policy decisions therein. This is because such programs have diplomatic benefits and costs that can be uploaded from the recipient and affect the broader foreign policy interests of the donor and the diplomacy landscape between both parties. These diplomatic implications are vital to the long-term success of both the immediate program and any subsequent programs; hence it is important to articulate them alongside program performance, in terms of how well their interrelated interventions were perceived by the communities served. Consequently, the exclusive focus of cost-effectiveness on medical outcomes ignores (1) the potential non-health benefits of less cost-effective interventions and (2) the potential of these collateral gains to form compelling cases across the interdisciplinary spectrum to increase the overall resource envelope for global health. The assessment utilizes the Kevany Riposte’s "K-Scores" methodology, which has been previously applied as a replicable evaluation tool1 and assesses the trade-offs of highly cost-effective but potentially "undiplomatic" global health interventions. Ultimately, we apply this approach to selected HIV/AIDS interventions to determine their wider benefits and demonstrate the value alternative evaluation and decision-making methodologies. Interventions with high "K-Scores" should be seriously considered for resource allocation independent of their cost-effectiveness. "Oregon Plan" thresholds2 are neither appropriate nor enforceable in this regard while "K-Score" results provide contextual information to policy-makers who may have, to date, considered only cost-effectiveness data. While CEA is a valuable tool for resource allocation, its use as a utilitarian focus should be approached with caution. Policy-makers and global health program managers should take into account a wide range of outcomes before agreeing upon selection and implementation.
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Kim J, Nanfuka M, Moore D, Shafic M, Nyonyitono M, Birungi J, Galenda F, King R. 'People say that we are already dead much as we can still walk': a qualitative investigation of community and couples' understanding of HIV serodiscordance in rural Uganda. BMC Infect Dis 2016; 16:665. [PMID: 27832759 PMCID: PMC5103364 DOI: 10.1186/s12879-016-1998-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 10/29/2016] [Indexed: 11/24/2022] Open
Abstract
Background Stable, co-habiting HIV serodiscordant couples are a key population in terms of heterosexual transmission in sub-Saharan Africa. Despite the wide availability of antiretroviral treatment and HIV educational programs, heterosexual transmission continues to drive the HIV epidemic in Africa. To investigate some of the factors involved in transmission or maintenance of serodiscordant status, we designed a study to examine participants’ understanding of HIV serodiscordance and the implications this posed for their HIV prevention practices. Methods In-depth interviews were conducted with 28 serodiscordant couples enrolled in a treatment-as-prevention study in Jinja, Uganda. Participants were asked questions regarding sexual behaviour, beliefs in treatment and prevention, participants’ and communities’ understanding and context around HIV serodiscordance. Qualitative framework analysis capturing several main themes was carried out by a team of four members, and was cross-checked for consistency. Results It was found that most couples had difficulty explaining the phenomenon of serodiscordance and tended to be confused regarding prevention. Many individuals still held beliefs in pseudoscientific explanations for HIV susceptibility such as blood type and blood “strength”. The participants’ trust of treatment and medical services were well established. However, the communities’ views of both serodiscordance and treatment were more pessimistic and wrought with mistrust. Stigmatization of serodiscordance and HIV-positive status were reported frequently. Conclusions The results indicate that despite years of treatment and prevention methods being available, stigmatization and mistrust persist in the communities of HIV-affected individuals and may directly contribute to new cases and seroconversion. We suggest that to optimize the effects of HIV treatment and prevention, clear education and support of such methods are sorely needed in sub-Saharan African communities.
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Affiliation(s)
- Jiho Kim
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | | | - David Moore
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | | - Rachel King
- Global Health Sciences, University of California San Francisco, San Francisco, California, USA.
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Abstract
This paper, by means of a quality framework, reviews health services research in relation to people with HIV infection. The relevance of oral health care services to people’s needs is considered in terms of the goal of health services to reduce the burden of disease on the everyday life of the population. Dental services may therefore have a role in primary prevention in the HIV epidemic, passing on information about HIV and promoting health through the early diagnosis and treatment of oral disease. Effectiveness research of oral health care in HIV assesses the usefulness of oral diagnosis, whether care is safe, and whether treatment is clinically effective. Few data are available on the efficiency of services. People with HIV still have problems accessing dental care, due to the volume of care available in relation to their need and acceptability of care. Access problems in the US are compounded by social inequality. Health services research data are particularly sparse in resource-poor countries, and there is a need to translate the available information into treatment guidelines appropriate to these settings. The research community and funding agencies should place greater emphasis on the quality of oral health services for people with HIV.
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Affiliation(s)
- P G Robinson
- Dept. of Oral Health and Development, School of Clinical Dentistry, University of Sheffield, Claremont Crescent, Sheffield S10 2TA, UK.
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Abstract
In industrialized countries, the incidence of syphilis has decreased dramatically since the discovery of penicillin in the 1940s. However, syphilis and congenital syphilis are far from eradicated, especially in low- and middle-income countries. Syphilis in pregnant women is a cause of adverse pregnancy outcomes that can be prevented by screening for syphilis and early treatment in pregnancy. Several studies have found screening of pregnant women for syphilis to be a highly cost-effective intervention, even if the prevalence of syphilis is low. Obstacles to universal screening of pregnant women include low awareness of syphilis and low quality of antenatal care and healthcare in general in many low- and middle-income countries. For these settings, we need simpler and more reliable serological tests for syphilis, but we also need to strengthen health services in general to ensure sustainable antenatal care services to ensure sustainability of syphilis screening programmes.
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Affiliation(s)
- Anne Buvé
- Institute of Tropical Medicine, Nationalestraat 155, B-2000 Antwerp, Begium, Tel.: + 32 3247 6533; Fax: + 32 3247 6532
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Abstract
Much of the current health approach to designing HIV/AIDS interventions in resource-poor settings involves behavior-change initiatives, particularly those adopting education-based and “culturally competent” frameworks for the reduction of HIV-associated “risk behaviors.” This article reviews the evidence and social assumptions behind this approach to preventing HIV transmission, and argues that these approaches are often inadequate or misguided, particularly in their conflation of the concept of “culture” with social circumstances. By analyzing the socioeconomic circumstances that constrain individual agency, and by combining data from prevention literature with analyses of international trade agreements and the controversies over antiretroviral drug distribution, the author argues that the movement of capital and the maintenance of inequality are central to the problems associated with behavior-change initiatives and must be addressed through new paradigms in order to respond appropriately to the global AIDS pandemic. Hardt and Negri's paradigm of “Empire”—that is, examining the system through which social inequalities are maintained not only between countries but also within them—offers prospects for the design of new interventions and targets for public health workers and social movements.
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Affiliation(s)
- Sanjay Basu
- Program in Infectious Disease and Social Change, Yale University School of Medicine, New Haven, CT 06510, USA.
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Atlani-Duault L, Dozon JP, Wilson A, Delfraissy JF, Moatti JP. State humanitarian verticalism versus universal health coverage: a century of French international health assistance revisited. Lancet 2016; 387:2250-62. [PMID: 27145710 DOI: 10.1016/s0140-6736(16)00379-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The French contribution to global public health over the past two centuries has been marked by a fundamental tension between two approaches: State-provided universal free health care and what we propose to call State humanitarian verticalism. Both approaches have historical roots in French colonialism and have led to successes and failures that continue until the present day. In this paper, the second in The Lancet's Series on France, we look at how this tension has evolved. During the French colonial period (1890s to 1950s), the Indigenous Medical Assistance structure was supposed to bring metropolitan France's model of universal and free public health care to the colonies, and French State imperial humanitarianism crystallised in vertical programmes inspired by Louis Pasteur, while vying with early private humanitarian activism in health represented by Albert Schweitzer. From decolonisation to the end of the Cold War (1960-99), French assistance to newly independent states was affected by sans frontièrisme, Health for All, and the AIDS pandemic. Since 2000, France has had an active role in development of global health initiatives and favoured multilateral action for health assistance. Today, with adoption of the 2030 Sustainable Development Goals and the challenges of non-communicable diseases, economic inequality, and climate change, French international health assistance needs new direction. In the context of current debate over global health as a universal goal, understanding and acknowledging France's history could help strengthen advocacy in favour of universal health coverage and contribute to advancing global equity through income redistribution, from healthy populations to people who are sick and from wealthy individuals to those who are poor.
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Affiliation(s)
- Laëtitia Atlani-Duault
- Department of Socio-Medical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA; UMR 912 (French National Institute for Development Research [IRD]/INSERM/AMU), and Laboratoire d'Ethnologie et de Sociologie Comparative (Paris University/CNRS), Paris, France.
| | - Jean-Pierre Dozon
- Institut des Mondes Africains and EHESS (École des Hautes Études en Sciences Sociales), Paris, France
| | - Andrew Wilson
- Fondation Maison des Sciences de l'Homme, Paris, France
| | - Jean-François Delfraissy
- ANRS (French National Agency for AIDS Research) and I3M (Immunology, Inflammation, Infectiology and Microbiology), INSERM, Paris, France
| | - Jean-Paul Moatti
- French National Institute for Development Research (IRD), Marseille, France
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Jain KM, Maulsby C, Brantley M, Kim JJ, Zulliger R, Riordan M, Charles V, Holtgrave DR. Cost and cost threshold analyses for 12 innovative US HIV linkage and retention in care programs. AIDS Care 2016; 28:1199-204. [PMID: 27017972 DOI: 10.1080/09540121.2016.1164294] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Out of >1,000,000 people living with HIV in the USA, an estimated 60% were not adequately engaged in medical care in 2011. In response, AIDS United spearheaded 12 HIV linkage and retention in care programs. These programs were supported by the Social Innovation Fund, a White House initiative. Each program reflected the needs of its local population living with HIV. Economic analyses of such programs, such as cost and cost threshold analyses, provide important information for policy-makers and others allocating resources or planning programs. Implementation costs were examined from societal and payer perspectives. This paper presents the results of cost threshold analyses, which provide an estimated number of HIV transmissions that would have to be averted for each program to be considered cost-saving and cost-effective. The methods were adapted from the US Panel on Cost-effectiveness in Health and Medicine. Per client program costs ranged from $1109.45 to $7602.54 from a societal perspective. The cost-saving thresholds ranged from 0.32 to 1.19 infections averted, and the cost-effectiveness thresholds ranged from 0.11 to 0.43 infections averted by the programs. These results suggest that such programs are a sound and efficient investment towards supporting goals set by US HIV policy-makers. Cost-utility data are pending.
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Affiliation(s)
- Kriti M Jain
- a Department of Health, Behavior, and Society , The Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Catherine Maulsby
- a Department of Health, Behavior, and Society , The Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Meredith Brantley
- a Department of Health, Behavior, and Society , The Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | | | - Jeeyon Janet Kim
- a Department of Health, Behavior, and Society , The Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Rose Zulliger
- a Department of Health, Behavior, and Society , The Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | | | | | - David R Holtgrave
- a Department of Health, Behavior, and Society , The Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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Pitt C, Goodman C, Hanson K. Economic Evaluation in Global Perspective: A Bibliometric Analysis of the Recent Literature. HEALTH ECONOMICS 2016; 25 Suppl 1:9-28. [PMID: 26804359 PMCID: PMC5042080 DOI: 10.1002/hec.3305] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 11/09/2015] [Accepted: 11/11/2015] [Indexed: 05/02/2023]
Abstract
We present a bibliometric analysis of recently published full economic evaluations of health interventions and reflect critically on the implications of our findings for this growing field. We created a database drawing on 14 health, economic, and/or general literature databases for articles published between 1 January 2012 and 3 May 2014 and identified 2844 economic evaluations meeting our criteria. We present findings regarding the sensitivity, specificity, and added value of searches in the different databases. We examine the distribution of publications between countries, regions, and health areas studied and compare the relative volume of research with disease burden. We analyse authors' country and institutional affiliations, journals and journal type, language, and type of economic evaluation conducted. More than 1200 economic evaluations were published annually, of which 4% addressed low-income countries, 4% lower-middle-income countries, 14% upper-middle-income countries, and 83% high-income countries. Across country income levels, 53, 54, 86, and 100% of articles, respectively, included an author based in a country within the income level studied. Biomedical journals published 74% of economic evaluations. The volume of research across health areas correlates more closely with disease burden in high-income than in low-income and middle-income countries. Our findings provide an empirical basis for further study on methods, research prioritization, and capacity development in health economic evaluation.
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Affiliation(s)
- Catherine Pitt
- Department of Global Health and DevelopmentLondon School of Hygiene & Tropical MedicineLondonUK
| | - Catherine Goodman
- Department of Global Health and DevelopmentLondon School of Hygiene & Tropical MedicineLondonUK
| | - Kara Hanson
- Department of Global Health and DevelopmentLondon School of Hygiene & Tropical MedicineLondonUK
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Mukandavire Z, Mitchell KM, Vickerman P. Comparing the impact of increasing condom use or HIV pre-exposure prophylaxis (PrEP) use among female sex workers. Epidemics 2015; 14:62-70. [PMID: 26972515 DOI: 10.1016/j.epidem.2015.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 10/21/2015] [Accepted: 10/25/2015] [Indexed: 02/03/2023] Open
Abstract
In many settings, interventions targeting female sex workers (FSWs) could significantly reduce the overall transmission of HIV. To understand the role HIV pre-exposure prophylaxis (PrEP) could play in controlling HIV transmission amongst FSWs, it is important to understand how its impact compares with scaling-up condom use-one of the proven HIV prevention strategies for FSWs. It is important to remember that condoms also have other benefits such as reducing the incidence of sexually transmitted infections and preventing pregnancy. A dynamic deterministic model of HIV transmission amongst FSWs, their clients and other male partners (termed 'pimps') was used to compare the protection provided by PrEP for HIV-negative FSWs with FSWs increasing their condom use with clients and/or pimps. For different HIV prevalence scenarios, levels of pimp interaction, and baseline condom use, we estimated the coverage of PrEP that gives the same reduction in endemic FSW HIV prevalence or HIV infections averted as different increases in condom use. To achieve the same impact on FSW HIV prevalence as increasing condom use by 1%, the coverage of PrEP has to increase by >2%. The relative impact of PrEP increases for scenarios where pimps contribute to HIV transmission, but not greatly, and decreases with higher baseline condom use. In terms of HIV infections averted over 10 years, the relative impact of PrEP compared to condoms was reduced, with a >3% increase in PrEP coverage achieving the same impact as a 1% increase in condom use. Condom promotion interventions should remain the mainstay HIV prevention strategy for FSWs, with PrEP only being implemented once condom interventions have been maximised or to fill prevention gaps where condoms cannot be used.
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Affiliation(s)
- Zindoga Mukandavire
- Social and Mathematical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK.
| | - Kate M Mitchell
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
| | - Peter Vickerman
- School of Social and Community Medicine, University of Bristol, Bristol, UK.
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Kim JJ, Maulsby C, Zulliger R, Jain K, Charles V, Riordan M, Davey-Rothwell M, Holtgrave DR. Cost and threshold analysis of positive charge, a multi-site linkage to HIV care program in the United States. AIDS Behav 2015; 19:1735-41. [PMID: 26139421 DOI: 10.1007/s10461-015-1124-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Positive Charge (PC) is a linkage to HIV care initiative implemented by AIDS United with sites in New York, Chicago, Louisiana, North Carolina, and the San Francisco/Bay Area. This study employed standard methods of cost and threshold analyses, as recommended by the US Panel on Cost-effectiveness in Health and Medicine, to calculate cost-saving and cost effective thresholds of the initiative. The overall societal cost of the linkage to care programs ranged from $48,490 to $370,525. The study found that PC's five unique evidence-based linkage to care programs have relatively low costs per client served and highly achievable cost-saving and cost-effectiveness thresholds. The findings from this study suggest that HIV linkage to care programs have the potential to be a highly productive use of public health resources.
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Affiliation(s)
- Jeeyon Janet Kim
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Cathy Maulsby
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Rose Zulliger
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kriti Jain
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Melissa Davey-Rothwell
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David R Holtgrave
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Muliira RS, Muliira JK. Health-promoting practices and the factors associated with self-reported poor health in caregivers of children orphaned by AIDS in southwest Uganda. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2015; 10:479-86. [PMID: 25865379 DOI: 10.2989/16085906.2011.646663] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Informal caregivers worldwide are faced with the dilemma of maintaining their health and meeting the caregiving demands of their loved ones. This study explores the health outcomes of caregiving, caregivers' health-promoting practices and the challenges to providing care among caregivers to children orphaned by AIDS in southwest Uganda. A descriptive design and interview questionnaires were used to collect data from 204 caregivers. The average age of the caregivers was 41.36 (±10.9) years and most of them (53%) were grandmothers to the orphans. The majority (65%) of the caregivers were caring for at least three orphans, had been in the caregiver role for more than five years (61%), and stated that their health had been negatively impacted by caregiving (61%). According to self-reports, the most common new health problems since taking up the caregiving role were chronic ill health (97%), social isolation (95%) and mental stress (92%). The health-promoting practices most often engaged in were eating a balanced diet (67%), seeking spiritual support (58%), and performing self-care activities (44%). The challenges to caregiving most often reported were poverty (88%) and a lack of time to seek personal medical care (59%). The predictors of self-reported poor health among the caregivers were stress (odds ratio [OR] = 3.43; p ≤ 0.01), caring for three or more orphans (OR = 2.19; p ≤ 0.01), female gender (OR = 1.77; p ≤ 0.01), and having spent more than five years as a caregiver to an orphan (OR = 1.35; p ≤ 0.01). The findings suggest that caregivers commonly experience poor health and their health-promoting practices are inadequate. There is a need for organised and formal health-promotion programmes for caregivers of children orphaned by AIDS, especially in rural areas of developing countries. Interventions for health promotion can be achieved through integrated programmes that provide health education, social services, respite from caregiving and counselling.
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Affiliation(s)
- Rhoda Suubi Muliira
- a Sultan Qaboos University, College of Nursing , PO Box 66, Al Khod, Muscat 123 , Oman
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Implementation and Operational Research: A Time-Motion Analysis of HIV Transmission Prevention Counseling and Antiretroviral Adherence Messages in Western Kenya. J Acquir Immune Defic Syndr 2015; 69:e135-41. [PMID: 25950208 DOI: 10.1097/qai.0000000000000666] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Shortages of health workers and large number of HIV-infected persons in Africa mean that time to provide antiretroviral therapy (ART) adherence and other messages to patients is limited. METHODS Using time-motion methodology, we documented the intensity and nature of counseling delivered to patients. The study was conducted at a rural and an urban HIV clinic in western Kenya. We recorded all activities of 190 adult patients on ART during their return clinic visits to assess type, frequency, and duration of counseling messages. RESULTS Mean visit length for patients at the rural clinic was 44.5 (SD = 27.9) minutes and at urban clinic was 78.2 (SD = 42.1) minutes. Median time spent receiving any counseling during a visit was 4.07 minutes [interquartile range (IQR), 1.57-7.33] at rural and 3.99 (IQR, 2.87-6.25) minutes at urban, representing 11% and 8% of total mean visit time, respectively. Median time patients received ART adherence counseling was 1.29 (IQR, 0.77-2.83) minutes at rural and 1.76 (IQR, 1.23-2.83) minutes at urban (P = 0.001 for difference). Patients received a median time of 0.18 (0-0.72) minutes at rural and 0.28 (IQR, 0-0.67) minutes at urban clinic of counseling regarding contraception and pregnancy. Most patients in the study did not receive any counseling regarding alcohol/substance use, emerging risks for ongoing HIV transmission. CONCLUSIONS Although ART adherence was discussed with most patients, time was limited. Reproductive counseling was provided to only half of the patients, and "positive prevention" messaging was minimal. There are strategic opportunities to enhance counseling and information received by clients within HIV programs in resource-limited settings.
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Vassall A, Chandrashekar S, Pickles M, Beattie TS, Shetty G, Bhattacharjee P, Boily MC, Vickerman P, Bradley J, Alary M, Moses S, Watts C. Community mobilisation and empowerment interventions as part of HIV prevention for female sex workers in Southern India: a cost-effectiveness analysis. PLoS One 2014; 9:e110562. [PMID: 25333501 PMCID: PMC4204894 DOI: 10.1371/journal.pone.0110562] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 09/19/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Most HIV prevention for female sex workers (FSWs) focuses on individual behaviour change involving peer educators, condom promotion and the provision of sexual health services. However, there is a growing recognition of the need to address broader societal, contextual and structural factors contributing to FSW risk behaviour. We assess the cost-effectiveness of adding community mobilisation (CM) and empowerment interventions (eg. community mobilisation, community involvement in programme management and services, violence reduction, and addressing legal policies and police practices), to core HIV prevention services delivered as part of Avahan in two districts (Bellary and Belgaum) of Karnataka state, Southern India. METHODS An ingredients approach was used to estimate economic costs in US$ 2011 from an HIV programme perspective of CM and empowerment interventions over a seven year period (2004-2011). Incremental impact, in terms of HIV infections averted, was estimated using a two-stage process. An 'exposure analysis' explored whether exposure to CM was associated with FSW's empowerment, risk behaviours and HIV/STI prevalence. Pathway analyses were then used to estimate the extent to which behaviour change may be attributable to CM and to inform a dynamic HIV transmission model. FINDINGS The incremental costs of CM and empowerment were US$ 307,711 in Belgaum and US$ 592,903 in Bellary over seven years (2004-2011). Over a 7-year period (2004-2011) the mean (standard deviation, sd.) number of HIV infections averted through CM and empowerment is estimated to be 1257 (308) in Belgaum and 2775 (1260) in Bellary. This translates in a mean (sd.) incremental cost per disability adjusted life year (DALY) averted of US$ 14.12 (3.68) in Belgaum and US$ 13.48 (6.80) for Bellary--well below the World Health Organisation recommended willingness to pay threshold for India. When savings from ART are taken into account, investments in CM and empowerment are cost saving. CONCLUSIONS Our findings suggest that CM and empowerment is, at worst, highly cost-effective and, at best, a cost-saving investment from an HIV programme perspective. CM and empowerment interventions should therefore be considered as core components of HIV prevention programmes for FSWs.
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Affiliation(s)
- Anna Vassall
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sudhashree Chandrashekar
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- St John's Research Institute, Bangalore, India
| | - Michael Pickles
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Imperial College, London, United Kingdom
| | - Tara S. Beattie
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | | | - Peter Vickerman
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Janet Bradley
- URESP, Centre de recherche du CHU de Québec, Québec, Canada
| | - Michel Alary
- URESP, Centre de recherche du CHU de Québec, Québec, Canada
- Département de médecine sociale et préventive, Université Laval, Québec, Canada
| | | | | | - Charlotte Watts
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Murray CJL, Ortblad KF, Guinovart C, Lim SS, Wolock TM, Roberts DA, Dansereau EA, Graetz N, Barber RM, Brown JC, Wang H, Duber HC, Naghavi M, Dicker D, Dandona L, Salomon JA, Heuton KR, Foreman K, Phillips DE, Fleming TD, Flaxman AD, Phillips BK, Johnson EK, Coggeshall MS, Abd-Allah F, Abera SF, Abraham JP, Abubakar I, Abu-Raddad LJ, Abu-Rmeileh NM, Achoki T, Adeyemo AO, Adou AK, Adsuar JC, Agardh EE, Akena D, Al Kahbouri MJ, Alasfoor D, Albittar MI, Alcalá-Cerra G, Alegretti MA, Alemu ZA, Alfonso-Cristancho R, Alhabib S, Ali R, Alla F, Allen PJ, Alsharif U, Alvarez E, Alvis-Guzman N, Amankwaa AA, Amare AT, Amini H, Ammar W, Anderson BO, Antonio CAT, Anwari P, Arnlöv J, Arsenijevic VSA, Artaman A, Asghar RJ, Assadi R, Atkins LS, Badawi A, Balakrishnan K, Banerjee A, Basu S, Beardsley J, Bekele T, Bell ML, Bernabe E, Beyene TJ, Bhala N, Bhalla A, Bhutta ZA, Abdulhak AB, Binagwaho A, Blore JD, Basara BB, Bose D, Brainin M, Breitborde N, Castañeda-Orjuela CA, Catalá-López F, Chadha VK, Chang JC, Chiang PPC, Chuang TW, Colomar M, Cooper LT, Cooper C, Courville KJ, Cowie BC, Criqui MH, Dandona R, Dayama A, De Leo D, Degenhardt L, Del Pozo-Cruz B, Deribe K, Des Jarlais DC, Dessalegn M, Dharmaratne SD, Dilmen U, Ding EL, Driscoll TR, Durrani AM, Ellenbogen RG, Ermakov SP, Esteghamati A, Faraon EJA, Farzadfar F, Fereshtehnejad SM, Fijabi DO, Forouzanfar MH, Fra Paleo U, Gaffikin L, Gamkrelidze A, Gankpé FG, Geleijnse JM, Gessner BD, Gibney KB, Ginawi IAM, Glaser EL, Gona P, Goto A, Gouda HN, Gugnani HC, Gupta R, Gupta R, Hafezi-Nejad N, Hamadeh RR, Hammami M, Hankey GJ, Harb HL, Haro JM, Havmoeller R, Hay SI, Hedayati MT, Pi IBH, Hoek HW, Hornberger JC, Hosgood HD, Hotez PJ, Hoy DG, Huang JJ, Iburg KM, Idrisov BT, Innos K, Jacobsen KH, Jeemon P, Jensen PN, Jha V, Jiang G, Jonas JB, Juel K, Kan H, Kankindi I, Karam NE, Karch A, Karema CK, Kaul A, Kawakami N, Kazi DS, Kemp AH, Kengne AP, Keren A, Kereselidze M, Khader YS, Khalifa SEAH, Khan EA, Khang YH, Khonelidze I, Kinfu Y, Kinge JM, Knibbs L, Kokubo Y, Kosen S, Defo BK, Kulkarni VS, Kulkarni C, Kumar K, Kumar RB, Kumar GA, Kwan GF, Lai T, Balaji AL, Lam H, Lan Q, Lansingh VC, Larson HJ, Larsson A, Lee JT, Leigh J, Leinsalu M, Leung R, Li Y, Li Y, De Lima GMF, Lin HH, Lipshultz SE, Liu S, Liu Y, Lloyd BK, Lotufo PA, Machado VMP, Maclachlan JH, Magis-Rodriguez C, Majdan M, Mapoma CC, Marcenes W, Marzan MB, Masci JR, Mashal MT, Mason-Jones AJ, Mayosi BM, Mazorodze TT, Mckay AC, Meaney PA, Mehndiratta MM, Mejia-Rodriguez F, Melaku YA, Memish ZA, Mendoza W, Miller TR, Mills EJ, Mohammad KA, Mokdad AH, Mola GL, Monasta L, Montico M, Moore AR, Mori R, Moturi WN, Mukaigawara M, Murthy KS, Naheed A, Naidoo KS, Naldi L, Nangia V, Narayan KMV, Nash D, Nejjari C, Nelson RG, Neupane SP, Newton CR, Ng M, Nisar MI, Nolte S, Norheim OF, Nowaseb V, Nyakarahuka L, Oh IH, Ohkubo T, Olusanya BO, Omer SB, Opio JN, Orisakwe OE, Pandian JD, Papachristou C, Caicedo AJP, Patten SB, Paul VK, Pavlin BI, Pearce N, Pereira DM, Pervaiz A, Pesudovs K, Petzold M, Pourmalek F, Qato D, Quezada AD, Quistberg DA, Rafay A, Rahimi K, Rahimi-Movaghar V, Ur Rahman S, Raju M, Rana SM, Razavi H, Reilly RQ, Remuzzi G, Richardus JH, Ronfani L, Roy N, Sabin N, Saeedi MY, Sahraian MA, Samonte GMJ, Sawhney M, Schneider IJC, Schwebel DC, Seedat S, Sepanlou SG, Servan-Mori EE, Sheikhbahaei S, Shibuya K, Shin HH, Shiue I, Shivakoti R, Sigfusdottir ID, Silberberg DH, Silva AP, Simard EP, Singh JA, Skirbekk V, Sliwa K, Soneji S, Soshnikov SS, Sreeramareddy CT, Stathopoulou VK, Stroumpoulis K, Swaminathan S, Sykes BL, Tabb KM, Talongwa RT, Tenkorang EY, Terkawi AS, Thomson AJ, Thorne-Lyman AL, Towbin JA, Traebert J, Tran BX, Dimbuene ZT, Tsilimbaris M, Uchendu US, Ukwaja KN, Uzun SB, Vallely AJ, Vasankari TJ, Venketasubramanian N, Violante FS, Vlassov VV, Vollset SE, Waller S, Wallin MT, Wang L, Wang X, Wang Y, Weichenthal S, Weiderpass E, Weintraub RG, Westerman R, White RA, Wilkinson JD, Williams TN, Woldeyohannes SM, Wong JQ, Xu G, Yang YC, Yano Y, Yentur GK, Yip P, Yonemoto N, Yoon SJ, Younis M, Yu C, Jin KY, El Sayed Zaki M, Zhao Y, Zheng Y, Zhou M, Zhu J, Zou XN, Lopez AD, Vos T. Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384:1005-70. [PMID: 25059949 PMCID: PMC4202387 DOI: 10.1016/s0140-6736(14)60844-8] [Citation(s) in RCA: 668] [Impact Index Per Article: 66.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The Millennium Declaration in 2000 brought special global attention to HIV, tuberculosis, and malaria through the formulation of Millennium Development Goal (MDG) 6. The Global Burden of Disease 2013 study provides a consistent and comprehensive approach to disease estimation for between 1990 and 2013, and an opportunity to assess whether accelerated progress has occured since the Millennium Declaration. METHODS To estimate incidence and mortality for HIV, we used the UNAIDS Spectrum model appropriately modified based on a systematic review of available studies of mortality with and without antiretroviral therapy (ART). For concentrated epidemics, we calibrated Spectrum models to fit vital registration data corrected for misclassification of HIV deaths. In generalised epidemics, we minimised a loss function to select epidemic curves most consistent with prevalence data and demographic data for all-cause mortality. We analysed counterfactual scenarios for HIV to assess years of life saved through prevention of mother-to-child transmission (PMTCT) and ART. For tuberculosis, we analysed vital registration and verbal autopsy data to estimate mortality using cause of death ensemble modelling. We analysed data for corrected case-notifications, expert opinions on the case-detection rate, prevalence surveys, and estimated cause-specific mortality using Bayesian meta-regression to generate consistent trends in all parameters. We analysed malaria mortality and incidence using an updated cause of death database, a systematic analysis of verbal autopsy validation studies for malaria, and recent studies (2010-13) of incidence, drug resistance, and coverage of insecticide-treated bednets. FINDINGS Globally in 2013, there were 1·8 million new HIV infections (95% uncertainty interval 1·7 million to 2·1 million), 29·2 million prevalent HIV cases (28·1 to 31·7), and 1·3 million HIV deaths (1·3 to 1·5). At the peak of the epidemic in 2005, HIV caused 1·7 million deaths (1·6 million to 1·9 million). Concentrated epidemics in Latin America and eastern Europe are substantially smaller than previously estimated. Through interventions including PMTCT and ART, 19·1 million life-years (16·6 million to 21·5 million) have been saved, 70·3% (65·4 to 76·1) in developing countries. From 2000 to 2011, the ratio of development assistance for health for HIV to years of life saved through intervention was US$4498 in developing countries. Including in HIV-positive individuals, all-form tuberculosis incidence was 7·5 million (7·4 million to 7·7 million), prevalence was 11·9 million (11·6 million to 12·2 million), and number of deaths was 1·4 million (1·3 million to 1·5 million) in 2013. In the same year and in only individuals who were HIV-negative, all-form tuberculosis incidence was 7·1 million (6·9 million to 7·3 million), prevalence was 11·2 million (10·8 million to 11·6 million), and number of deaths was 1·3 million (1·2 million to 1·4 million). Annualised rates of change (ARC) for incidence, prevalence, and death became negative after 2000. Tuberculosis in HIV-negative individuals disproportionately occurs in men and boys (versus women and girls); 64·0% of cases (63·6 to 64·3) and 64·7% of deaths (60·8 to 70·3). Globally, malaria cases and deaths grew rapidly from 1990 reaching a peak of 232 million cases (143 million to 387 million) in 2003 and 1·2 million deaths (1·1 million to 1·4 million) in 2004. Since 2004, child deaths from malaria in sub-Saharan Africa have decreased by 31·5% (15·7 to 44·1). Outside of Africa, malaria mortality has been steadily decreasing since 1990. INTERPRETATION Our estimates of the number of people living with HIV are 18·7% smaller than UNAIDS's estimates in 2012. The number of people living with malaria is larger than estimated by WHO. The number of people living with HIV, tuberculosis, or malaria have all decreased since 2000. At the global level, upward trends for malaria and HIV deaths have been reversed and declines in tuberculosis deaths have accelerated. 101 countries (74 of which are developing) still have increasing HIV incidence. Substantial progress since the Millennium Declaration is an encouraging sign of the effect of global action. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
| | | | | | - Stephen S Lim
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | | | - D Allen Roberts
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | | | - Nicholas Graetz
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Ryan M Barber
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | | | - Haidong Wang
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Herbert C Duber
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Daniel Dicker
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Lalit Dandona
- Institute for Health Metrics and Evaluation, Seattle, WA, USA; Public Health Foundation of India, New Delhi, India
| | | | - Kyle R Heuton
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | | | | | | | | | | | | | | | | | | | - Jerry P Abraham
- University of Texas School of Medicine San Antonio, San Antonio, TX, USA
| | | | | | - Niveen Me Abu-Rmeileh
- Institute of Community and Public Health-Birzeti University, Ramallah, West Bank, Occupied Palestinian Territory
| | | | | | | | | | | | | | | | | | | | - Gabriel Alcalá-Cerra
- Grupo de Investigación en Ciencias de la Salud y Neurociencias (CISNEURO), Cartagena de Indias, Colombia
| | - Miguel Angel Alegretti
- Facultad de Medicina, Departamento de Medicina Preventiva y Social, Universidad de la República, Montevideo, Uruguay
| | | | | | | | | | - Francois Alla
- School of Public Health, University of Lorraine, Nancy, France
| | | | | | | | | | | | - Azmeraw T Amare
- Department of Epidemiology, University of Groningen, Groningen, The Netherlands; College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Hassan Amini
- Kurdistan Environmental Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Kurdistan, Iran
| | | | | | | | | | | | | | | | - Rana J Asghar
- South Asian Public Health Forum, Islamabad, Pakistan
| | - Reza Assadi
- Mashhad University of Medical Sciences, Mashhad, Iran
| | - Lydia S Atkins
- Ministry of Health, Wellness, Human Services and Gender Relations, Castries, St. Lucia
| | - Alaa Badawi
- Public Health Agency of Canada, Toronto, ON, Canada
| | | | | | | | | | | | | | | | | | | | - Ashish Bhalla
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | | - Jed D Blore
- University of Melbourne, Melbourne, VIC, Australia
| | | | | | | | | | | | - Ferrán Catalá-López
- Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Medicines and Healthcare Products Agency (AEMPS), Ministry of Health, Madrid, Spain
| | | | | | | | - Ting-Wu Chuang
- Department of Parasitology, College of Medicine, Taipei Medical University, Taipei, Taiwan; Center for International Tropical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | | | | | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | | | - Benjamin C Cowie
- Victorian Infectious Diseases Reference Laboratory, North Melbourne, VIC, Australia
| | | | | | - Anand Dayama
- Emory University School of Medicine, Atlanta, GA, USA
| | | | | | | | | | | | - Muluken Dessalegn
- Africa Medical and Research Foundation in Ethiopia, Addis Ababa, Ethiopia
| | | | | | - Eric L Ding
- Harvard School of Public Health, Cambridge, MA, USA
| | | | | | | | - Sergey Petrovich Ermakov
- The Institute of Social and Economic Studies of Population at the Russian Academy of Sciences, Moscow, Russia
| | - Alireza Esteghamati
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | | | - Lynne Gaffikin
- Stanford University School of Medicine, Stanford, CA, USA
| | | | | | | | | | | | | | | | - Philimon Gona
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Atsushi Goto
- Department of Diabetes Research, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hebe N Gouda
- University of Queensland, Brisbane, QLD, Australia
| | | | | | - Rahul Gupta
- Kanawha Charleston Health Department, Charleston, WV, USA
| | - Nima Hafezi-Nejad
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mouhanad Hammami
- Wayne County Department of Health and Human Services, Detroit, MI, USA
| | - Graeme J Hankey
- School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
| | | | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, University of Barcelona, Sant Boi de Llobregat, Barcelona, Spain
| | | | | | | | | | - Hans W Hoek
- Parnassia Psychiatric Institute, The Hague, Netherlands
| | | | | | | | - Damian G Hoy
- School of Population Health, Brisbane, QLD, Australia; Public Health Division, Secretariat of the Pacific Community, Noumea, New Caledonia
| | | | | | | | - Kaire Innos
- National Institute for Health Development, Tallinn, Estonia
| | | | | | | | - Vivekanand Jha
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Guohong Jiang
- Tianjin Centers for Diseases Control and Prevention, Tianjin, China
| | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Knud Juel
- The National Institute of Public Health, Copenhagen, Denmark
| | | | | | | | - André Karch
- Helmholtz Centre for Infection Research, Braunschweig, Germany; German Center for Infection Research (DZIF), Hannover-Braunschweig site, Germany
| | | | - Anil Kaul
- Oklahoma State University, Tulsa, OK, USA
| | | | - Dhruv S Kazi
- University of California San Francisco, San Francisco, CA, USA
| | | | - Andre Pascal Kengne
- South African Medical Research Council, Cape Town, Western Cape, South Africa
| | - Andre Keren
- Cardiology, Hadassah Ein Kerem University Hospital, Jerusalem, Israel
| | - Maia Kereselidze
- National Centre for Disease Control and Public Health, Tbilisi, Georgia
| | | | | | | | - Young-Ho Khang
- Institute of Health Policy and Management, Seoul National University College of Medicine, Seoul, South Korea
| | - Irma Khonelidze
- National Centre for Disease Control and Public Health, Tbilisi, Georgia
| | | | | | - Luke Knibbs
- University of Queensland, Brisbane, QLD, Australia
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - S Kosen
- Center for Community Empowerment, Health Policy & Humanities, NIHRD, Jakarta, Indonesia
| | | | | | - Chanda Kulkarni
- Rajrajeshwari Medical College & Hospital, Bangalore, Karnataka, India
| | - Kaushalendra Kumar
- International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Ravi B Kumar
- Indian Institute of Public Health, Public Health Foundation of India, Gurgaon, Haryana, India
| | - G Anil Kumar
- Public Health Foundation of India, New Delhi, India
| | | | - Taavi Lai
- Fourth View Consulting, Tallinn, Estonia
| | | | - Hilton Lam
- Institute of Health Policy and Development Studies, National Institutes of Health, Manila, Philippines
| | - Qing Lan
- National Cancer Institute, Rockville, MD, USA
| | | | - Heidi J Larson
- London School of Hygiene and Tropical Medicine, Bloomsbury, UK
| | | | | | - James Leigh
- University of Sydney, Sydney, NSW, Australia
| | - Mall Leinsalu
- National Institute for Health Development, Tallinn, Estonia
| | - Ricky Leung
- University at Albany, The State University of New York, Rensselaer, NY, USA
| | - Yichong Li
- Genentech, Inc, South San Francisco, CA, USA
| | - Yongmei Li
- Genentech, Inc, South San Francisco, CA, USA
| | | | - Hsien-Ho Lin
- Institute of Epidemiology and Preventive Medicine, Taipei, Taiwan
| | | | - Shiwei Liu
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yang Liu
- Emory University, Atlanta, GA, USA
| | - Belinda K Lloyd
- Eastern Health Clinical School, VIC, Australia; Turning Point, Eastern Health, Fitzroy, VIC, Australia
| | | | | | | | | | - Marek Majdan
- Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovakia
| | | | | | | | - Joseph R Masci
- Elmhurst Hospital Center, Mount Sinai Services, Elmhurst, NY, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Ted R Miller
- Pacific Institute for Research & Evaluation, Calverton MD, USA; Centre for Population Health Research, Curtin University, Perth, WA, Australia
| | | | | | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | | | - Lorenzo Monasta
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo," Trieste, Italy
| | - Marcella Montico
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo," Trieste, Italy
| | | | - Rintaro Mori
- National Center for Child Health and Development, Setagaya, Tokyo, Japan
| | | | | | | | - Aliya Naheed
- International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Kovin S Naidoo
- University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Luigi Naldi
- Azienda Ospedaliera papa Giovanni XXIII, Bergamo, Italy
| | | | | | - Denis Nash
- School of Public Health, City University of New York, New York, NY, USA
| | | | - Robert G Nelson
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA
| | - Sudan Prasad Neupane
- Norwegian Center for Addiction Research (SERAF), University of Oslo, Oslo, Norway
| | - Charles R Newton
- Kenya Medical Research Institute Wellcome Trust Programme, Kilifi, Kenya
| | - Marie Ng
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | | | - Sandra Nolte
- Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | | | | | | | | | - John Nelson Opio
- Lira District Local Government, Lira Municipal Council, Northern Uganda, Uganda
| | - Orish Ebere Orisakwe
- Toxicology Unit, Faculty of Pharmacy, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
| | | | | | | | | | | | | | - Neil Pearce
- London School of Hygiene and Tropical Medicine, Bloomsbury, UK
| | - David M Pereira
- 3B's Research Group-Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine and ICVS/3B's-PT Government Associate Laboratory, Braga, Portugal
| | - Aslam Pervaiz
- Postgraduate Medical Institute, Lahore, Punjab, Pakistan
| | | | - Max Petzold
- Centre for Applied Biostatistics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Dima Qato
- College of Pharmacy, University of Illinois, Chicago, IL, USA
| | - Amado D Quezada
- National Institute of Public Health of Mexico, Cuernavaca, Morelos, Mexico
| | | | | | | | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Saleem M Rana
- Department of Public Health, University of the Punjab, Lahore, Punjab, Pakistan
| | - Homie Razavi
- Center for Disease Analysis, Louisville, CO, USA
| | | | - Giuseppe Remuzzi
- IRCCS Mario Negri Institute for Pharmacological Research, Centro Anna Maria Astori, Bergamo, Italy
| | | | - Luca Ronfani
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo," Trieste, Italy
| | | | | | | | | | - Genesis May J Samonte
- National HIV/AIDS & STI Surveillance and Strategic Information Unit, National Epidemiology Center, Department of Health, Manila, National Capital Region, Philippines
| | | | | | | | - Soraya Seedat
- Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Sadaf G Sepanlou
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Sara Sheikhbahaei
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Ivy Shiue
- Heriot-Watt University, Edinburgh, UK
| | - Rupak Shivakoti
- Center for Clinical Global Health Education, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Andrea P Silva
- Instituto Nacional de Epidemiología Dr Juan H Jara, Mar del Plata, Buenos Aires, Argentina
| | - Edgar P Simard
- Surveillance and Health Services Research Program American Cancer Society, Atlanta, GA, USA
| | | | | | - Karen Sliwa
- Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa, Cape Town, Western Cape, South Africa
| | | | - Sergey S Soshnikov
- Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation, Moscow, Russia
| | | | | | - Konstantinos Stroumpoulis
- KEELPNO (Centre for Disease Control, Greece, dispatched to "Alexandra" General Hospital of Athens), Athens, Greece
| | - Soumya Swaminathan
- National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | - Bryan L Sykes
- Department of Criminology, Law and Society (and Sociology), University of California-Irvine, Chicago, IL, USA
| | | | | | | | - Abdullah Sulieman Terkawi
- Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA; Department of Anesthesiology, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | | | - Jeffrey A Towbin
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Bach X Tran
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Zacharie Tsala Dimbuene
- Department of Population Sciences and Development, Faculty of Economics and Management, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | | | - Kingsley N Ukwaja
- Department of Internal Medicine, Federal Teaching Hospital Abakaliki, Abakailiki, Ebonyi State, Nigeria
| | | | | | | | | | | | | | - Stein Emil Vollset
- Norwegian Institute of Public Health, Oslo, Norway; University of Bergen, Bergen, Norway
| | - Stephen Waller
- Uniformed Services University of Health Sciences, Bethesda, MD, USA
| | - Mitchell T Wallin
- VA Medical Center and Georgetown University Neurology Department, Washington, DC, USA
| | - Linhong Wang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - XiaoRong Wang
- Shandong University Affiliated Jinan Central Hospital, Jinan, China
| | - Yanping Wang
- National Office for Maternal and Child Health Surveillance, Chengdu, China
| | | | | | - Robert G Weintraub
- University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia
| | | | - Richard A White
- Department of Infectious Disease Epidemiology, Division of Infectious Disease Control and Department of Health Statistics, Division of Epidemiology, Oslo, Norway
| | | | | | | | - John Q Wong
- Ateneo School of Medicine and Public Health, Pasig City, Metro Manila, Philippines
| | - Gelin Xu
- Nanjing University School of Medicine, Jinling Hospital, Nanjing, China
| | - Yang C Yang
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yuichiro Yano
- Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | | | - Paul Yip
- The University of Hong Kong, Hong Kong, Hong Kong
| | - Naohiro Yonemoto
- National Center of Neurology and Psychiatry, Kodira, Tokyo, Japan
| | | | | | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, School of Public Health and Global Health Institute, Wuhan University, Wuhan, China
| | - Kim Yun Jin
- TCM MEDICAL TK SDN BHD, Nusajaya, Johor Bahru, Malaysia
| | | | - Yong Zhao
- Chongqing Medical University, Chongqing, China
| | - Yingfeng Zheng
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Maigeng Zhou
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jun Zhu
- National Office for Maternal and Child Health Surveillance, Chengdu, China
| | - Xiao Nong Zou
- Cancer Institute/Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Alan D Lopez
- University of Melbourne, Melbourne, VIC, Australia
| | - Theo Vos
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
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Vassall A, Pickles M, Chandrashekar S, Boily MC, Shetty G, Guinness L, Lowndes CM, Bradley J, Moses S, Alary M, Vickerman P. Cost-effectiveness of HIV prevention for high-risk groups at scale: an economic evaluation of the Avahan programme in south India. LANCET GLOBAL HEALTH 2014; 2:e531-e540. [PMID: 25304420 DOI: 10.1016/s2214-109x(14)70277-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Avahan is a large-scale, HIV preventive intervention, targeting high-risk populations in south India. We assessed the cost-effectiveness of Avahan to inform global and national funding institutions who are considering investing in worldwide HIV prevention in concentrated epidemics. METHODS We estimated cost effectiveness from a programme perspective in 22 districts in four high-prevalence states. We used the UNAIDS Costing Guidelines for HIV Prevention Strategies as the basis for our costing method, and calculated effect estimates using a dynamic transmission model of HIV and sexually transmitted disease transmission that was parameterised and fitted to locally observed behavioural and prevalence trends. We calculated incremental cost-effective ratios (ICERs), comparing the incremental cost of Avahan per disability-adjusted life-year (DALY) averted versus a no-Avahan counterfactual scenario. We also estimated incremental cost per HIV infection averted and incremental cost per person reached. FINDINGS Avahan reached roughly 150 000 high-risk individuals between 2004 and 2008 in the 22 districts studied, at a mean cost per person reached of US$327 during the 4 years. This reach resulted in an estimated 61 000 HIV infections averted, with roughly 11 000 HIV infections averted in the general population, at a mean incremental cost per HIV infection averted of $785 (SD 166). We estimate that roughly 1 million DALYs were averted across the 22 districts, at a mean incremental cost per DALY averted of $46 (SD 10). Future antiretroviral treatment (ART) cost savings during the lifetime of the cohort exposed to HIV prevention were estimated to be more than $77 million (compared with the slightly more than $50 million spent on Avahan in the 22 districts during the 4 years of the study). INTERPRETATION This study provides evidence that the investment in targeted HIV prevention programmes in south India has been cost effective, and is likely to be cost saving if a commitment is made to provide ART to all that can benefit from it. Policy makers should consider funding and sustaining large-scale targeted HIV prevention programmes in India and beyond. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Anna Vassall
- London School of Hygiene & Tropical Medicine, London, UK.
| | - Michael Pickles
- London School of Hygiene & Tropical Medicine, London, UK; Imperial College, London, UK
| | - Sudhashree Chandrashekar
- London School of Hygiene & Tropical Medicine, London, UK; St John's Research Institute, Bangalore India
| | | | | | - Lorna Guinness
- London School of Hygiene & Tropical Medicine, London, UK
| | - Catherine M Lowndes
- London School of Hygiene & Tropical Medicine, London, UK; Public Health England, London, UK
| | - Janet Bradley
- Centre de Recherche du CHU Universitaire de Québec, QC, Canada
| | - Stephen Moses
- Karnataka Health Promotion Trust, Bangalore, India; University of Manitoba, Winnipeg, MB, Canada
| | - Michel Alary
- Centre de Recherche du CHU Universitaire de Québec, QC, Canada; Département de Médecine Sociale et Préventive, Université Laval, Québec, QC, Canada
| | | | - Peter Vickerman
- London School of Hygiene & Tropical Medicine, London, UK; Department of Social and Community Medicine, University of Bristol, Bristol, UK
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Yu W, Li C, Fu X, Cui Z, Liu X, Fan L, Zhang G, Ma J. The cost-effectiveness of different feeding patterns combined with prompt treatments for preventing mother-to-child HIV transmission in South Africa: estimates from simulation modeling. PLoS One 2014; 9:e102872. [PMID: 25055039 PMCID: PMC4108380 DOI: 10.1371/journal.pone.0102872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 06/23/2014] [Indexed: 12/02/2022] Open
Abstract
Objectives Based on the important changes in South Africa since 2009 and the Antiretroviral Treatment Guideline 2013 recommendations, we explored the cost-effectiveness of different strategy combinations according to the South African HIV-infected mothers' prompt treatments and different feeding patterns. Study Design A decision analytic model was applied to simulate cohorts of 10,000 HIV-infected pregnant women to compare the cost-effectiveness of two different HIV strategy combinations: (1) Women were tested and treated promptly at any time during pregnancy (Promptly treated cohort). (2) Women did not get testing or treatment until after delivery and appropriate standard treatments were offered as a remedy (Remedy cohort). Replacement feeding or exclusive breastfeeding was assigned in both strategies. Outcome measures included the number of infant HIV cases averted, the cost per infant HIV case averted, and the cost per life year(LY) saved from the interventions. One-way and multivariate sensitivity analyses were performed to estimate the uncertainty ranges of all outcomes. Results The remedy strategy does not particularly cost-effective. Compared with the untreated baseline cohort which leads to 1127 infected infants, 698 (61.93%) and 110 (9.76%) of pediatric HIV cases are averted in the promptly treated cohort and remedy cohort respectively, with incremental cost-effectiveness of $68.51 and $118.33 per LY, respectively. With or without the antenatal testing and treatments, breastfeeding is less cost-effective ($193.26 per LY) than replacement feeding ($134.88 per LY), without considering the impact of willingness to pay. Conclusion Compared with the prompt treatments, remedy in labor or during the postnatal period is less cost-effective. Antenatal HIV testing and prompt treatments and avoiding breastfeeding are the best strategies. Although encouraging mothers to practice replacement feeding in South Africa is far from easy and the advantages of breastfeeding can not be ignored, we still suggest choosing replacement feeding as far as possible.
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Affiliation(s)
- Wenhua Yu
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin, China
| | - Changping Li
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin, China
| | - Xiaomeng Fu
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin, China
| | - Zhuang Cui
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin, China
| | - Xiaoqian Liu
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin, China
| | - Linlin Fan
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin, China
| | - Guan Zhang
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin, China
| | - Jun Ma
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin, China
- * E-mail:
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Batura N, Hill Z, Haghparast-Bidgoli H, Lingam R, Colbourn T, Kim S, Sikander S, Pulkki-Brannstrom AM, Rahman A, Kirkwood B, Skordis-Worrall J. Highlighting the evidence gap: how cost-effective are interventions to improve early childhood nutrition and development? Health Policy Plan 2014; 30:813-21. [PMID: 24963156 PMCID: PMC4451167 DOI: 10.1093/heapol/czu055] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2014] [Indexed: 11/26/2022] Open
Abstract
There is growing evidence of the effectiveness of early childhood interventions to improve the growth and development of children. Although, historically, nutrition and stimulation interventions may have been delivered separately, they are increasingly being tested as a package of early childhood interventions that synergistically improve outcomes over the life course. However, implementation at scale is seldom possible without first considering the relative cost and cost-effectiveness of these interventions. An evidence gap in this area may deter large-scale implementation, particularly in low- and middle-income countries. We conduct a literature review to establish what is known about the cost-effectiveness of early childhood nutrition and development interventions. A set of predefined search terms and exclusion criteria standardized the search across five databases. The search identified 15 relevant articles. Of these, nine were from studies set in high-income countries and six in low- and middle-income countries. The articles either calculated the cost-effectiveness of nutrition-specific interventions (n = 8) aimed at improving child growth, or parenting interventions (stimulation) to improve early childhood development (n = 7). No articles estimated the cost-effectiveness of combined interventions. Comparing results within nutrition or stimulation interventions, or between nutrition and stimulation interventions was largely prevented by the variety of outcome measures used in these analyses. This article highlights the need for further evidence relevant to low- and middle-income countries. To facilitate comparison of cost-effectiveness between studies, and between contexts where appropriate, a move towards a common outcome measure such as the cost per disability-adjusted life years averted is advocated. Finally, given the increasing number of combined nutrition and stimulation interventions being tested, there is a significant need for evidence of cost-effectiveness for combined programmes. This too would be facilitated by the use of a common outcome measure able to pool the impact of both nutrition and stimulation activities.
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Affiliation(s)
- Neha Batura
- Institute for Global Health, University College London, London WC1N 1EH, UK, Maternal and Child Health Intervention Research Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Human Development Research Foundation, Islamabad 44000, Pakistan, Epidemiology and Global Health, Umeä University, 90187 Umeå, Sweden, Institute of Psychology, Health & Society, Child Mental Health Unit, University of Liverpool, Liverpool L69 3BX, UK, Department of Population Health and Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Health Economics and Systems Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK and Health Economics Unit, University of Cape Town, Observatory 7925, South Africa
| | - Zelee Hill
- Institute for Global Health, University College London, London WC1N 1EH, UK, Maternal and Child Health Intervention Research Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Human Development Research Foundation, Islamabad 44000, Pakistan, Epidemiology and Global Health, Umeä University, 90187 Umeå, Sweden, Institute of Psychology, Health & Society, Child Mental Health Unit, University of Liverpool, Liverpool L69 3BX, UK, Department of Population Health and Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Health Economics and Systems Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK and Health Economics Unit, University of Cape Town, Observatory 7925, South Africa
| | - Hassan Haghparast-Bidgoli
- Institute for Global Health, University College London, London WC1N 1EH, UK, Maternal and Child Health Intervention Research Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Human Development Research Foundation, Islamabad 44000, Pakistan, Epidemiology and Global Health, Umeä University, 90187 Umeå, Sweden, Institute of Psychology, Health & Society, Child Mental Health Unit, University of Liverpool, Liverpool L69 3BX, UK, Department of Population Health and Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Health Economics and Systems Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK and Health Economics Unit, University of Cape Town, Observatory 7925, South Africa
| | - Raghu Lingam
- Institute for Global Health, University College London, London WC1N 1EH, UK, Maternal and Child Health Intervention Research Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Human Development Research Foundation, Islamabad 44000, Pakistan, Epidemiology and Global Health, Umeä University, 90187 Umeå, Sweden, Institute of Psychology, Health & Society, Child Mental Health Unit, University of Liverpool, Liverpool L69 3BX, UK, Department of Population Health and Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Health Economics and Systems Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK and Health Economics Unit, University of Cape Town, Observatory 7925, South Africa
| | - Timothy Colbourn
- Institute for Global Health, University College London, London WC1N 1EH, UK, Maternal and Child Health Intervention Research Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Human Development Research Foundation, Islamabad 44000, Pakistan, Epidemiology and Global Health, Umeä University, 90187 Umeå, Sweden, Institute of Psychology, Health & Society, Child Mental Health Unit, University of Liverpool, Liverpool L69 3BX, UK, Department of Population Health and Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Health Economics and Systems Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK and Health Economics Unit, University of Cape Town, Observatory 7925, South Africa
| | - Sungwook Kim
- Institute for Global Health, University College London, London WC1N 1EH, UK, Maternal and Child Health Intervention Research Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Human Development Research Foundation, Islamabad 44000, Pakistan, Epidemiology and Global Health, Umeä University, 90187 Umeå, Sweden, Institute of Psychology, Health & Society, Child Mental Health Unit, University of Liverpool, Liverpool L69 3BX, UK, Department of Population Health and Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Health Economics and Systems Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK and Health Economics Unit, University of Cape Town, Observatory 7925, South Africa
| | - Siham Sikander
- Institute for Global Health, University College London, London WC1N 1EH, UK, Maternal and Child Health Intervention Research Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Human Development Research Foundation, Islamabad 44000, Pakistan, Epidemiology and Global Health, Umeä University, 90187 Umeå, Sweden, Institute of Psychology, Health & Society, Child Mental Health Unit, University of Liverpool, Liverpool L69 3BX, UK, Department of Population Health and Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Health Economics and Systems Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK and Health Economics Unit, University of Cape Town, Observatory 7925, South Africa
| | - Anni-Maria Pulkki-Brannstrom
- Institute for Global Health, University College London, London WC1N 1EH, UK, Maternal and Child Health Intervention Research Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Human Development Research Foundation, Islamabad 44000, Pakistan, Epidemiology and Global Health, Umeä University, 90187 Umeå, Sweden, Institute of Psychology, Health & Society, Child Mental Health Unit, University of Liverpool, Liverpool L69 3BX, UK, Department of Population Health and Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Health Economics and Systems Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK and Health Economics Unit, University of Cape Town, Observatory 7925, South Africa Institute for Global Health, University College London, London WC1N 1EH, UK, Maternal and Child Health Intervention Research Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Human Development Research Foundation, Islamabad 44000, Pakistan, Epidemiology and Global Health, Umeä University, 90187 Umeå, Sweden, Institute of Psychology, Health & Society, Child Mental Health Unit, University of Liverpool, Liverpool L69 3BX, UK, Department of Population Health and Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Health Economics and Systems Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK and Health Economics Unit, University of Cape Town, Observatory 7925, South Africa
| | - Atif Rahman
- Institute for Global Health, University College London, London WC1N 1EH, UK, Maternal and Child Health Intervention Research Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Human Development Research Foundation, Islamabad 44000, Pakistan, Epidemiology and Global Health, Umeä University, 90187 Umeå, Sweden, Institute of Psychology, Health & Society, Child Mental Health Unit, University of Liverpool, Liverpool L69 3BX, UK, Department of Population Health and Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Health Economics and Systems Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK and Health Economics Unit, University of Cape Town, Observatory 7925, South Africa
| | - Betty Kirkwood
- Institute for Global Health, University College London, London WC1N 1EH, UK, Maternal and Child Health Intervention Research Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Human Development Research Foundation, Islamabad 44000, Pakistan, Epidemiology and Global Health, Umeä University, 90187 Umeå, Sweden, Institute of Psychology, Health & Society, Child Mental Health Unit, University of Liverpool, Liverpool L69 3BX, UK, Department of Population Health and Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Health Economics and Systems Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK and Health Economics Unit, University of Cape Town, Observatory 7925, South Africa
| | - Jolene Skordis-Worrall
- Institute for Global Health, University College London, London WC1N 1EH, UK, Maternal and Child Health Intervention Research Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Human Development Research Foundation, Islamabad 44000, Pakistan, Epidemiology and Global Health, Umeä University, 90187 Umeå, Sweden, Institute of Psychology, Health & Society, Child Mental Health Unit, University of Liverpool, Liverpool L69 3BX, UK, Department of Population Health and Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Health Economics and Systems Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK and Health Economics Unit, University of Cape Town, Observatory 7925, South Africa Institute for Global Health, University College London, London WC1N 1EH, UK, Maternal and Child Health Intervention Research Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Human Development Research Foundation, Islamabad 44000, Pakistan, Epidemiology and Global Health, Umeä University, 90187 Umeå, Sweden, Institute of Psychology, Health & Society, Child Mental Health Unit, University of Liverpool, Liverpool L69 3BX, UK, Department of Population Health and Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Health Economics and Systems Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK and Health Economics Unit, University of Cape Town, Observatory 7925, South Africa Institute for Global Health, University College London, London WC1N 1EH, UK, Maternal and Child Health Intervention Research Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK, Human Development Research Foundation, Islamabad 44000, Pakistan, Epidemiology and Global Health, Umeä University, 90187 Umeå, Sweden, Institute of Psychology, Health & Society, Child Mental Health Unit, Unive
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Puett C, Salpéteur C, Lacroix E, Zimunya SD, Israël AD, Aït-Aïssa M. Cost-effectiveness of community vegetable gardens for people living with HIV in Zimbabwe. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2014; 12:11. [PMID: 24834014 PMCID: PMC4022439 DOI: 10.1186/1478-7547-12-11] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 04/21/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is little evidence to date of the potential impact of vegetable gardens on people living with HIV (PLHIV), who often suffer from social and economic losses due to the disease. From 2008 through 2011, Action Contre la Faim France (ACF) implemented a project in Chipinge District, eastern Zimbabwe, providing low-input vegetable gardens (LIGs) to households of PLHIV. Program partners included Médecins du Monde, which provided medical support, and Zimbabwe's Agricultural Extension Service, which supported vegetable cultivation. A survey conducted at the end of the program found LIG participants to have higher Food Consumption Scores (FCS) and Household Dietary Diversity Scores (HDDS) relative to comparator households of PLHIV receiving other support programs. This study assessed the incremental cost-effectiveness of LIGs to improve FCS and HDDS of PLHIV compared to other support programs. METHODS This analysis used an activity-based cost model, and combined ACF accounting data with estimates of partner and beneficiary costs derived using an ingredients approach to build an estimate of total program resource use. A societal perspective was adopted to encompass costs to beneficiary households, including their opportunity costs and an estimate of their income earned from vegetable sales. Qualitative methods were used to assess program benefits to beneficiary households. Effectiveness data was taken from a previously-conducted survey. RESULTS Providing LIGs to PLHIV cost an additional 8,299 EUR per household with adequate FCS and 12,456 EUR per household with HDDS in the upper tertile, relative to comparator households of PLHIV receiving other support programs. Beneficiaries cited multiple tangible and intangible benefits from LIGs, and over 80% of gardens observed were still functioning more than one year after the program had finished. CONCLUSIONS Cost outcomes were 20-30 times Zimbabwe's per capita GDP, and unlikely to be affordable within government services. This analysis concludes that LIGs are not cost-effective or affordable relative to other interventions for improving health and nutrition status of PLHIV. Nonetheless, given the myriad benefits acquired by participant households, such programs hold important potential to improve quality of life and reduce stigma against PLHIV.
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Affiliation(s)
- Chloe Puett
- Action Against Hunger, 247 West 37th Street, New York, NY 10018, USA
| | - Cécile Salpéteur
- Action contre la Faim - France, 4 rue Niepce, 75 662 Paris Cedex 14, France
| | - Elisabeth Lacroix
- Action contre la Faim - France, 78-D Thanlwin Road, Bahan Township, Yangon, Myanmar
| | | | | | - Myriam Aït-Aïssa
- Action contre la Faim - France, 4 rue Niepce, 75 662 Paris Cedex 14, France
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Harding R, Simms V, Penfold S, Downing J, Powell RA, Mwangi-Powell F, Namisango E, Moreland S, Gikaara N, Atieno M, Kataike J, Nsubuga C, Munene G, Banga G, Higginson IJ. Availability of essential drugs for managing HIV-related pain and symptoms within 120 PEPFAR-funded health facilities in East Africa: a cross-sectional survey with onsite verification. Palliat Med 2014; 28:293-301. [PMID: 23885009 DOI: 10.1177/0269216313498637] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND World Health Organization's essential drugs list can control the highly prevalent HIV-related pain and symptoms. Availability of essential medicines directly influences clinicians' ability to effectively manage distressing manifestations of HIV. AIM To determine the availability of pain and symptom controlling drugs in East Africa within President's Emergency Plan for AIDS Relief-funded HIV health care facilities. DESIGN Directly observed quantitative health facilities' pharmacy stock review. We measured availability, expiration and stock-outs of specified drugs required for routine HIV management, including the World Health Organization pain ladder. SETTING A stratified random sample in 120 President's Emergency Plan for AIDS Relief-funded HIV care facilities (referral and district hospitals, health posts/centres and home-based care providers) in Kenya and Uganda. RESULTS Non-opioid analgesics (73%) and co-trimoxazole (64%) were the most commonly available drugs and morphine (7%) the least. Drug availability was higher in hospitals and lower in health centres, health posts and home-based care facilities. Facilities generally did not use minimum stock levels, and stock-outs were frequently reported. The most common drugs had each been out of stock in the past 6 months in 47% of facilities stocking them. When a minimum stock level was defined, probability of a stock-out in the previous 6 months was 32.6%, compared to 45.5% when there was no defined minimum stock level (χ (2) = 5.07, p = 0.024). CONCLUSION The data demonstrate poor essential drug availability, particularly analgesia, limited by facility type. The lack of strong opioids, isoniazid and paediatric formulations is concerning. Inadequate drug availability prevents implementation of simple clinical pain and symptom control protocols, causing unnecessary distress. Research is needed to identify supply chain mechanisms that lead to these problems.
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Affiliation(s)
- Richard Harding
- 1Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
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Siapka M, Remme M, Obure CD, Maier CB, Dehne KL, Vassall A. Is there scope for cost savings and efficiency gains in HIV services? A systematic review of the evidence from low- and middle-income countries. Bull World Health Organ 2014; 92:499-511AD. [PMID: 25110375 DOI: 10.2471/blt.13.127639] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Revised: 12/26/2013] [Accepted: 12/31/2013] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To synthesize the data available--on costs, efficiency and economies of scale and scope--for the six basic programmes of the UNAIDS Strategic Investment Framework, to inform those planning the scale-up of human immunodeficiency virus (HIV) services in low- and middle-income countries. METHODS The relevant peer-reviewed and "grey" literature from low- and middle-income countries was systematically reviewed. Search and analysis followed Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. FINDINGS Of the 82 empirical costing and efficiency studies identified, nine provided data on economies of scale. Scale explained much of the variation in the costs of several HIV services, particularly those of targeted HIV prevention for key populations and HIV testing and treatment. There is some evidence of economies of scope from integrating HIV counselling and testing services with several other services. Cost efficiency may also be improved by reducing input prices, task shifting and improving client adherence. CONCLUSION HIV programmes need to optimize the scale of service provision to achieve efficiency. Interventions that may enhance the potential for economies of scale include intensifying demand-creation activities, reducing the costs for service users, expanding existing programmes rather than creating new structures, and reducing attrition of existing service users. Models for integrated service delivery--which is, potentially, more efficient than the implementation of stand-alone services--should be investigated further. Further experimental evidence is required to understand how to best achieve efficiency gains in HIV programmes and assess the cost-effectiveness of each service-delivery model.
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Affiliation(s)
- Mariana Siapka
- SaME Modelling and Economics, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, England
| | - Michelle Remme
- SaME Modelling and Economics, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, England
| | - Carol Dayo Obure
- SaME Modelling and Economics, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, England
| | - Claudia B Maier
- Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland
| | - Karl L Dehne
- Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland
| | - Anna Vassall
- SaME Modelling and Economics, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, England
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