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Cuccaro PM, Choi J, Gabay EK, Wilkerson JM, Santa Maria D, Misra SM, Aguilar McBride M, Vernon SW. Lessons Learned from All for Them: Best Practices for a Cross-Collaboration Approach to HPV Vaccination in Public Schools. Vaccines (Basel) 2023; 11:vaccines11050946. [PMID: 37243050 DOI: 10.3390/vaccines11050946] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023] Open
Abstract
The Community Preventive Services Task Force endorses vaccination programs in schools to increase access to vaccinations. However, implementing a school-based approach requires substantial coordination, planning, and resources. All for Them (AFT) is a multilevel, multicomponent approach to increase HPV vaccination among adolescents attending public schools in medically underserved areas in Texas. AFT comprised a social marketing campaign, school-based vaccination clinics, and school nurse continuing education. Process evaluation metrics and key informant interviews to understand experiences with AFT program implementation informed lessons learned. Lessons emerged in six domains: strong champion, school-level support, tailored and cost-effective marketing approaches, mobile provider collaboration, community presence, and crisis management. Strong support at district and school levels is vital for gaining principal and school nurse buy-in. Social marketing strategies are integral to program implementation and should be adjusted to maximize their effectiveness in motivating parents to vaccinate children against HPV, which also can be achieved through increased community presence of the project team. Preparing contingency plans and flexibility within the program can facilitate appropriate responses to provider restrictions in mobile clinics or in the event of unforeseen crises. These important lessons can offer useful guidelines for the development of prospective school-based vaccination programs.
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Affiliation(s)
- Paula M Cuccaro
- Department of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX 77030, USA
- Center for Health Promotion and Prevention Research, School of Public Health, The University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX 77030, USA
| | - Jihye Choi
- Department of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX 77030, USA
| | - Efrat K Gabay
- Center for Health Promotion and Prevention Research, School of Public Health, The University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX 77030, USA
| | - J Michael Wilkerson
- Department of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX 77030, USA
- Center for Health Promotion and Prevention Research, School of Public Health, The University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX 77030, USA
| | - Diane Santa Maria
- Center for Health Promotion and Prevention Research, School of Public Health, The University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX 77030, USA
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, 6901 Bertner Ave., Houston, TX 77030, USA
| | | | - Mayra Aguilar McBride
- Center for Health Promotion and Prevention Research, School of Public Health, The University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX 77030, USA
| | - Sally W Vernon
- Department of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX 77030, USA
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Shukla S, Fressin F, Un M, Coetzer H, Chaguturu SK. Optimizing vaccine distribution via mobile clinics: a case study on COVID-19 vaccine distribution to long-term care facilities. Vaccine 2022; 40:734-741. [PMID: 35027228 PMCID: PMC8710399 DOI: 10.1016/j.vaccine.2021.12.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 12/09/2021] [Accepted: 12/20/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND People living in clustered communities with health comorbidities are highly vulnerable to COVID-19 infection. Rapid vaccination of vulnerable populations is critical to reducing fatalities and mitigating strain on healthcare systems. We present a case study on COVID-19 vaccine distribution via mobile vans to residents/staff of 47,907 long-term care facilities (LTCFs) across the United States that relied on algorithms to optimize vaccine distribution. METHODS We developed a modeling framework for vaccine distribution to high-risk populations in a supply-constrained environment. Our framework decomposed this challenge as two separate problems: an assignment problem where we optimally mapped each LTCF to select CVS stores responsible for distributing vaccines; and a scheduling problem where we developed an algorithm to assign available resources efficiently. RESULTS We assigned 1,214 retail stores as depots for vaccine distribution to LTCFs throughout the United States. Forty-one percent of matched depot-LTCF pairs were within 5 miles of a depot, 74% were within 20 miles, and only 8% mapped to depots farther than 50 miles away. Our two-step approach ensured that the first LTCF vaccination dose was distributed within 9 days after the program start date in 76% of states, and greater than 90% of doses were administered in the minimum amount of time. CONCLUSIONS We demonstrate that algorithmic approaches are instrumental in maximizing vaccine distribution efficiency. Our learning and framework may be of use to other organizations, including communities where mobile clinics can be established to efficiently distribute vaccines and other healthcare resources in a variety of scenarios.
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Affiliation(s)
| | | | | | | | - Sreekanth K Chaguturu
- CVS Health, Woonsocket, RI, USA; Department of General Medicine, Massachusetts General Hospital, Boston, MA, USA
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Miller NP, Ardestani FB, Dini HS, Shafique F, Zunong N. Community health workers in humanitarian settings: Scoping review. J Glob Health 2021; 10:020602. [PMID: 33312508 PMCID: PMC7719274 DOI: 10.7189/jogh.10.020602] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background There is a need for greater understanding of experiences implementing community-based primary health care in humanitarian settings and of the adjustments needed to ensure continuation of essential services and utilization of services by the population, and to contribute to effective emergency response. We reviewed the evidence base on community health workers (CHWs) in humanitarian settings, with the goal of improving delivery of essential services to the most vulnerable populations. Methods We conducted a scoping review of published and grey literature related to health and nutrition services provided by CHWs in humanitarian settings. Extracted data from retained documents were analyzed inductively for key themes. Results Of 3709 documents screened, 219 were included in the review. Key findings from the literature include: 1) CHWs were often able to continue providing services during acute and protracted crises, including prolonged periods of conflict and insecurity and during population displacement. 2) CHWs carried out critical emergency response activities during acute crises. 3) Flexible funding facilitated transitions between development and humanitarian programming. 4) Communities that did not have a locally-resident CHW experienced reduced access to services when travel was limited. 5) Community selection of CHWs and engagement of respected local leaders were crucial for community trust and acceptance and high utilization of services. 6) Selection of local supervisors and use of mobile phones facilitated continued supervision. 7) Actions taken to maintain supplies included creating parallel supply chains, providing buffer stocks to CHWs, and storing commodities in decentralized locations. 8) When travel was restricted, reporting and data collection were continued using mobile phones and use of local data collectors. 9) CHWs and supervisors faced security threats and psychological trauma as a result of their work. Conclusions To achieve impact, policy makers and program implementers will have to address the bottlenecks to CHW service delivery common in stable low-income settings as well as the additional challenges unique to humanitarian settings. Future interventions should take into account the lessons learned from years of experience with implementation of community-based primary health care in humanitarian settings. There is also a need for rigorous assessments of community-based primary health care interventions in humanitarian settings.
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Affiliation(s)
- Nathan P Miller
- UNICEF, New York, USA.,Columbia University Mailman School of Public Health, New York, USA
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Okafor CE. Management of Chest Indrawing Pneumonia in Children Under Five Years at the Outpatient Health Facilities in Nigeria: An Economic Evaluation. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2021; 19:429-437. [PMID: 33354754 DOI: 10.1007/s40258-020-00627-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/23/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND The recommendation of the World Health Organization (WHO) for the management of children aged < 5 years with chest indrawing pneumonia with oral amoxicillin dispersible tablets (DT) at the outpatient health facilities is imperative, especially in a high pneumonia mortality and low-resource setting like Nigeria. However, this recommendation has not been widely adopted in Nigeria due to poor access to healthcare and sub-optimal outpatient management and follow-up system to ensure patients' safety and management effectiveness. This study aimed to evaluate the cost effectiveness and the cost benefit of the WHO recommendation relative to usual practices in Nigeria. The outcome of this study will provide supporting evidence to healthcare providers and inform their management decisions. METHODS A cost-effectiveness and cost-benefit analyses of this study used a Markov cohort model from the healthcare provider perspective for a time horizon of five years. Three approaches were compared: a conventional approach (base-comparator); the amoxicillin DT (WHO) approach; and a parenteral approach. Bottom-up costing method was used. Health outcome was expressed as disability-adjusted life years averted and converted to monetary terms (benefit). RESULTS The incremental cost-effectiveness ratio (ICER) and the benefit-cost ratio (BCR) of the amoxicillin DT approach dominate the conventional approach. The parenteral approach was more effective and more beneficial than the amoxicillin DT approach but the ICER and BCR were $75,655/DALY averted and 0.035, respectively. CONCLUSIONS The use of amoxicillin DT proves to be the optimal choice with high benefit and low cost. The opportunity cost of not adopting an approach more effective than amoxicillin DT will be offset by the cost saved. Its use in chest indrawing pneumonia management needs to be scaled up.
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Affiliation(s)
- Charles E Okafor
- Centre for Applied Health Economics, School of Medicine, Griffith University Queensland, 170 Kessels Road, Nathan, QLD, 4111, Australia.
- Menzies Health Institute, Southport, QLD, Australia.
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Okafor CE, Ekwunife OI, Nduaguba SO. Promoting the integrated community case management of pneumonia in children under 5 years in Nigeria through the proprietary and patent medicine vendors: a cost-effectiveness analysis. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2021; 19:12. [PMID: 33632245 PMCID: PMC7905852 DOI: 10.1186/s12962-021-00265-9] [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] [Received: 08/19/2020] [Accepted: 02/11/2021] [Indexed: 11/12/2022] Open
Abstract
Background While evidence-based recommendations for the management pneumonia in under-5-year-olds at the community level with amoxicillin dispersible tablets (DT) were made by the World Health Organisation, initiatives to promote the integrated community case management (iCCM) of pneumonia through the proprietary and patent medicine vendors (PPMVs) have been poorly utilized in Nigeria, possibly due to low financial support and perceived benefit. This study provides costs, benefits and cost-effectiveness estimates and implications of promoting the iCCM through the PPMVs’ education and support. The outcome of this study will help inform healthcare decisions in Nigeria. Methods This study was a cost-effectiveness analysis using a simulation-based Markov model. Two approaches were compared, the ‘no promotion’ and the ‘promotion’ scenarios. The health outcomes include disability-adjusted life years averted and severe pneumonia hospitalisation cost averted. The costs were expressed in 2019 US dollars. Results The promotion of iCCM through the PPMVs was very cost effective with an incremental cost-effectiveness ratio of US$143.77 (95% CI US$137.42–150.50)/DALY averted. The promotion will prevent 28,359 cases of severe pneumonia hospitalisation with an estimated healthcare cost of US$390,578. It will also avert 900 deaths in a year. Conclusion Promoting the iCCM for the treatment of pneumonia in children under 5 years through education and support of the PPMVs holds promise to harness the benefits of amoxicillin DT and provide a high return on investment. A nationwide promotion exercise should be considered especially in remote areas of the country.
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Affiliation(s)
- Charles E Okafor
- Centre for Applied Health Economics, School of Medicine, Griffith University, 170 Kessels Road, Nathan, QLD, 4111, Australia. .,Menzies Health Institute, Southport, QLD, Australia.
| | - Obinna I Ekwunife
- Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
| | - Sabina O Nduaguba
- Pharmaceutical Outcomes and Policy Department, University of Florida College of Pharmacy, Gainesville, FL, USA.,Center for Drug Effectiveness and Safety, University of Florida, Gainesville, FL, USA
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McGowan CR, Baxter L, Deola C, Gayford M, Marston C, Cummings R, Checchi F. Mobile clinics in humanitarian emergencies: a systematic review. Confl Health 2020; 14:4. [PMID: 32021649 PMCID: PMC6993397 DOI: 10.1186/s13031-020-0251-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/22/2020] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Despite the widespread reliance on mobile clinics for delivering health services in humanitarian emergencies there is little empirical evidence to support their use. We report a narrative systematic review of the empirical evidence evaluating the use of mobile clinics in humanitarian settings. METHODS We searched MEDLINE, EMBASE, Global Health, Health Management Information Consortium, and The Cochrane Library for manuscripts published between 2000 and 2019. We also conducted a grey literature search via Global Health, Open Grey, and the WHO publication database. Empirical studies were included if they reported on at least one of the following evaluation criteria: relevance/appropriateness, connectedness, coherence, coverage, efficiency, effectiveness, and impact. FINDINGS Five studies met the inclusion criteria: all supported the use of mobile clinics in the particular setting under study. Three studies included controls. Two studies were assessed as good quality. The studies reported on mobile clinics providing non-communicable disease interventions, mental health services, sexual and reproductive health services, and multiple primary health care services in Afghanistan, the Democratic Republic of the Congo , Haiti, and the Occupied Palestinian Territories. Studies assessed one or more of the following evaluation domains: relevance/appropriateness, coverage, efficiency, and effectiveness. Four studies made recommendations including: i) ensure that mobile clinics are designed to complement clinic-based services; ii) improve technological tools to support patient follow-up, improve record-keeping, communication, and coordination; iii) avoid labelling services in a way that might stigmatise attendees; iv) strengthen referral to psychosocial and mental health services; v) partner with local providers to leverage resources; and vi) ensure strong coordination to optimise the continuum of care. Recommendations regarding the evaluation of mobile clinics include carrying out comparative studies of various modalities (including fixed facilities and community health workers) in order to isolate the effects of the mobile clinics. In the absence of a sound evidence base informing the use of mobile clinics in humanitarian crises, we encourage the integration of: i) WASH services, ii) nutrition services, iii) epidemic surveillance, and iv) systems to ensure the quality and safety of patient care. We recommend that future evaluations report against an established evaluation framework. CONCLUSION Evidence supporting the use of mobile clinics in humanitarian emergencies is limited. We encourage more studies of the use of mobile clinics in emergency settings. FUNDING Salary support for this review was provided under the RECAP project by United Kingdom Research and Innovation as part of the Global Challenges Research Fund, grant number ES/P010873/1.
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Affiliation(s)
- Catherine R. McGowan
- Humanitarian Public Health Technical Unit, Save the Children UK, London, UK
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK
| | - Louisa Baxter
- Humanitarian Public Health Technical Unit, Save the Children UK, London, UK
| | - Claudio Deola
- Humanitarian Public Health Technical Unit, Save the Children UK, London, UK
| | - Megan Gayford
- Humanitarian Public Health Technical Unit, Save the Children UK, London, UK
| | - Cicely Marston
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK
| | - Rachael Cummings
- Humanitarian Public Health Technical Unit, Save the Children UK, London, UK
| | - Francesco Checchi
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Blanchet K, Ramesh A, Frison S, Warren E, Hossain M, Smith J, Knight A, Post N, Lewis C, Woodward A, Dahab M, Ruby A, Sistenich V, Pantuliano S, Roberts B. Evidence on public health interventions in humanitarian crises. Lancet 2017; 390:2287-2296. [PMID: 28602563 DOI: 10.1016/s0140-6736(16)30768-1] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Recognition of the need for evidence-based interventions to help to improve the effectiveness and efficiency of humanitarian responses has been increasing. However, little is known about the breadth and quality of evidence on health interventions in humanitarian crises. We describe the findings of a systematic review with the aim of examining the quantity and quality of evidence on public health interventions in humanitarian crises to identify key research gaps. We identified 345 studies published between 1980 and 2014 that met our inclusion criteria. The quantity of evidence varied substantially by health topic, from communicable diseases (n=131), nutrition (n=77), to non-communicable diseases (n=8), and water, sanitation, and hygiene (n=6). We observed common study design and weaknesses in the methods, which substantially reduced the ability to determine causation and attribution of the interventions. Considering the major increase in health-related humanitarian activities in the past three decades and calls for a stronger evidence base, this paper highlights the limited quantity and quality of health intervention research in humanitarian contexts and supports calls to scale up this research.
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Affiliation(s)
- Karl Blanchet
- Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Anita Ramesh
- Faculty of Public Health and Policy and Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Severine Frison
- Faculty of Public Health and Policy and Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Emily Warren
- Faculty of Public Health and Policy and Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Mazeda Hossain
- ECOHOST-The Centre for Health and Social Change, London School of Hygiene and Tropical Medicine, London, UK
| | - James Smith
- Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Abigail Knight
- Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Nathan Post
- ECOHOST-The Centre for Health and Social Change, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Aniek Woodward
- ECOHOST-The Centre for Health and Social Change, London School of Hygiene and Tropical Medicine, London, UK
| | - Maysoon Dahab
- ECOHOST-The Centre for Health and Social Change, London School of Hygiene and Tropical Medicine, London, UK
| | - Alexander Ruby
- ECOHOST-The Centre for Health and Social Change, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Bayard Roberts
- ECOHOST-The Centre for Health and Social Change, London School of Hygiene and Tropical Medicine, London, UK.
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Khanna AB, Narula SA. Mobile health units: Mobilizing healthcare to reach unreachable. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2016. [DOI: 10.1080/20479700.2015.1101915] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Floyd J, Wu L, Hay Burgess D, Izadnegahdar R, Mukanga D, Ghani AC. Evaluating the impact of pulse oximetry on childhood pneumonia mortality in resource-poor settings. Nature 2015; 528:S53-9. [PMID: 26633766 DOI: 10.1038/nature16043] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
It is estimated that pneumonia is responsible for 15% of childhood deaths worldwide. Recent research has shown that hypoxia and malnutrition are strong predictors of mortality in children hospitalized for pneumonia. It is estimated that 15% of children under 5 who are hospitalized for pneumonia have hypoxaemia and that around 1.5 million children with severe pneumonia require oxygen treatment each year. We developed a deterministic compartmental model that links the care pathway to disease progression to assess the impact of introducing pulse oximetry as a prognostic tool to distinguish severe from non-severe pneumonia in under-5 year olds across 15 countries with the highest burden worldwide. We estimate that, assuming access to supplemental oxygen, pulse oximetry has the potential to avert up to 148,000 deaths if implemented across the 15 countries. By contrast, integrated management of childhood illness alone has a relatively small impact on mortality owing to its low sensitivity. Pulse oximetry can significantly increase the incidence of correctly treated severe cases as well as reduce the incidence of incorrect treatment with antibiotics. We also found that the combination of pulse oximetry with integrated management of childhood illness is highly cost-effective, with median estimates ranging from US$2.97 to $52.92 per disability-adjusted life year averted in the 15 countries analysed. This combination of substantial burden reduction and favourable cost-effectiveness makes pulse oximetry a promising candidate for improving the prognosis for children with pneumonia in resource-poor settings.
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Affiliation(s)
- Jessica Floyd
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, Norfolk Place, London W2 1PG, UK
| | - Lindsey Wu
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, Norfolk Place, London W2 1PG, UK.,Department of Immunology and Infection, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Deborah Hay Burgess
- The Bill &Melinda Gates Foundation, 500 Fifth Avenue North, Seattle, Washington 98109, USA
| | - Rasa Izadnegahdar
- The Bill &Melinda Gates Foundation, 500 Fifth Avenue North, Seattle, Washington 98109, USA
| | - David Mukanga
- The Bill &Melinda Gates Foundation, 500 Fifth Avenue North, Seattle, Washington 98109, USA
| | - Azra C Ghani
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, Norfolk Place, London W2 1PG, UK
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