Economic evaluation studies in the field of HIV/AIDS: bibliometric analysis on research development and scopes (GAPRESEARCH)

Modelling Methods of Economic Evaluations of HIV Testing Strategies in Sub-Saharan Africa: A Systematic Review

BACKGROUND AND OBJECTIVE

Economic evaluations, a decision-support tool for policy makers, will be crucial in planning and tailoring HIV prevention and treatment strategies especially in the wake of stalled and decreasing funding for the global HIV response. As HIV testing and treatment coverage increase, case identification becomes increasingly difficult and costly. Determining which subset of the population these strategies should be targeted to becomes of vital importance as well. Generating quality economic evidence begins with the validity of the modelling approach and the model structure employed. This study synthesises and critiques the reporting around modelling methodology of economic models in the evaluation of HIV testing strategies in sub-Saharan Africa.

METHODS

The following databases were searched from January 2000 to September 2020: MEDLINE, Embase, Scopus, EconLit and Global Health. Any model-based economic evaluation of a unique HIV testing strategy conducted in sub-Saharan Africa presenting a cost-effectiveness measure published from 2013 onwards was eligible. Data were extracted around three components: general study characteristics; economic evaluation design; and quality of model reporting using a novel tool developed for the purposes of this study.

RESULTS

A total of 21 studies were included; 10 cost-effectiveness analyses, 11 cost-utility analyses. All but one study was conducted in Eastern and Southern Africa. Modelling approaches for HIV testing strategies can be broadly characterised as static aggregate models (3/21), static individual models (6/21), dynamic aggregate models (5/21) and dynamic individual models (7/21). Adequate reporting around data handling was the highest of the three categories assessed (74%), and model validation, the lowest (45%). Limitations to model structure, justification of chosen time horizon and cycle length, and description of external model validation process were all adequately reported in less than 40% of studies. The predominant limitation of this review relates to the potential implications of the narrow inclusion criteria.

CONCLUSIONS

This review is the first to synthesise economic evaluations of HIV testing strategies in sub-Saharan Africa. The majority of models exhibited dynamic, stochastic and individual properties. Model reporting against the 13 criteria in our novel tool was mixed. Future model-based economic evaluations of HIV testing strategies would benefit from transparency around the choice of modelling approach, model structure, data handling procedures and model validation techniques.

A global bibliometric analysis of intimate partner violence in the field of HIV/AIDS: implications for interventions and research development

This study aimed to explore the research landscape of intimate partner violence (IPV)-harm-induced behavior in an intimate relationship and HIV/AIDS to determine lessons learnt and gaps that may be filled by future research. Publications related to IPV, and HIV/AIDS published from 1997 to 2019 were collected from Web of Science (WoS). STATA and VOSviewer software tools were used for bibliometric analysis. Content analysis, common topics, and the map of co-occurrence terms were structured by Latent Dirichlet allocation and VOSviewer software tool. 941 studies were included. Factors associated with domestic violence and interventions to reduce IPV were the two most common themes. Meanwhile, mental health illness among pregnant women affected by HIV and IPV, and HIV-risk among youth suffering from IPV have not received adequate attention. We suggest that more research focusing on adolescents and pregnant women affected by HIV and IPV. In addition, the development of collaborative networks between developed and developing countries should also be addressed.

Scholarly literature in HIV-related lesbian, gay, bisexual, and transgender studies: A bibliometric analysis

Introduction

Lesbian, gay, bisexual, and transgendered (LGBT) people are marginalized and understudied. Analyzing research activity worldwide is vital to better understand their needs in confronting the HIV epidemic. This study aimed to evaluate the global literature to identify the research collaboration, content, and tendency in HIV-related issues among the LGBT populations.

Methods

Peer-reviewed original articles and reviews were achieved from the Web of Science Core Collection database. Country's collaborations and co-occurrence of most frequent terms were illustrated by VOSviewer software. The Latent Dirichlet Allocation (LDA) and the linear regression model were utilized to uncover the hidden topics and examine the research trend.

Results

From 1990 to 2019, a total of 13,096 publications were found. Stigma, sexual risk behaviors and HIV testing were the major topics in the LGBT research during the study period. Among 15 topics, topics about HIV/Sexually transmitted infections (STIs) prevalence, Outcomes of HIV/AIDS care and treatment, and Opportunistic infections in HIV-positive LGBT people showed decreasing attention over years, while other topics had a slight to moderate increase.

Discussion

Our study underlined the exponential growth of publications on the LGBT population in HIV research, and suggested the importance of performing regional collaborations in improving research capacity. Moreover, further research should focus on examining the manner to increase the coverage of HIV testing and treatment, as well as implement HIV-interventions with low cost and easy to scale-up.

The Cost-Effectiveness of HIV/STI Prevention in High-Income Countries with Concentrated Epidemic Settings: A Scoping Review

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.

HIV Rapid Testing in the General Population and the Usefulness of PrEP in Ecuador: A Cost–Utility Analysis

Introduction

HIV is considered one of the most important chronic transmitted diseases worldwide. The Joint United Nations Program on HIV/AIDS in 2020 proposed the strategy “95–95–95” which goals to achieve a 95% of cases identified, receives ART, and will have achieved suppression of the virus. In Ecuador by 2020, according to the Ministry of Public Health, 45,056 persons are living with HIV, principally men between 15 and 49 years, and a mortality rate of 4.8/100,000 habitats. This study aims to determine the cost–utility of applying an early screening to a sexually active population vs. only a high-risk population and if the use of PrEP is justified depending on different contexts.

Methods

For the cost–utility evaluation, it was compared: (a) HIV screening performed only in the high-risk population vs. HIV screening in all population sexually active; and (b) the use of ART only for HIV treatment vs. ART as a treatment in diagnosed cases and the use of PrEP (only at a high-risk population of acquiring HIV). Calculation and weight of DALYs for HIV/SIDA were obtained through WHO guidelines. To generate the Markov model for HIV/AIDS, subjects were classified as symptomatic or asymptomatic, as well as the HIV deaths.

Results

Cost–benefit analysis (CUA) showed that ICER for early diagnosis had a negative value which means a saving if the strategy will be implemented as a regular test (–$591, –$4,360) and −108 and −934 DALYs, in the case of ART and PrEP, ICER the $30,541–$59,410, which resulted in more than the GDP's threshold and health years between 2,511 and 10,635 in the general population. With a reduction of 70% in the assigned budget for the early diagnosis, Ecuadorian people could lose between 4 and 6 DALYs, while if the budget reduces more than 50% to ART, it will generate a loss of 10–12 years of healthy life.

Conclusion

CUA demonstrates that an early diagnosis in a sexually active population is cost-beneficial. This, combined with ART or PrEP, is ideal to add years of healthy life.

A bibliometric review on development economics research in Vietnam from 2008 to 2020

This study adopts the bibliometric approach to identify the key characteristics in the relationship of demographic factors (age, gender, affiliations, and locations), scientific productivity, and the collaboration among development economics researchers in Vietnam during the period 2008–2020. Overall, the number of publications and authors in development economics are rising steeply with the average annual growth rate of nearly 23% and 26%, respectively. Moreover, the ‘quality’ of the research appears to be high as 59% of the articles are published in journals in the first and second quartile according Scimago journal ranking. However, the citation counts for these studies indicate their impacts are far more languishing in comparison. In terms of research trends, this study identified three emerging areas of studies that are relatively under-researched, namely natural resources, technology, and urbanization. As for publishing practices, There is also a positive sign for the adoption of open science among Vietnamese researchers in this field. The findings are useful for predicting future research trends. In addition, the study provides several implications for policymakers in Vietnam to enhance research capacity.

Cost-Efficacy of Antiretroviral Regimens Recommended in Treatment-Naive HIV-Infected Adults. A Single Center Experience

We aimed to assess the prescription trends of combined antiretroviral therapy (cART) in one infectious diseases department and the cost-efficacy (C/E) of different regimens used in treatment-naïve patients. The C/E was assessed with a software application developed by a group of researchers in Spain. The efficacy was already calculated in the application. The costs included the local cost of antiretrovirals and other direct costs specific to our institution. In the software application, the C/E reference regimen was ABC/3TC/DTG. In total, 181 HIV-infected patients were diagnosed and initiated cART during 2015–2019. The proportion of patients treated with integrase-strand transfer inhibitor (INSTI)-based regimens increased from 2015–2018 (54%) to the end of 2019 (81%). The relative C/E ranged from 0.90 to 1.28 for the evaluated INSTI-based regimens. Among INSTI-based regimens, ABC/3TC/DTG and TAF/FTC/EVG/c are the regimens with similar efficacy and relative C/E.

Retrospective and prospective approaches of coronavirus publications in the last half-century: a Latent Dirichlet allocation analysis

Purpose

The present article's primary purpose is the topic modeling of the global coronavirus publications in the last 50 years.

Design/methodology/approach

The present study is applied research that has been conducted using text mining. The statistical population is the coronavirus publications that have been collected from the Web of Science Core Collection (1970–2020). The main keywords were extracted from the Medical Subject Heading browser to design the search strategy. Latent Dirichlet allocation and Python programming language were applied to analyze the data and implement the text mining algorithms of topic modeling.

Findings

The findings indicated that the SARS, science, protein, MERS, veterinary, cell, human, RNA, medicine and virology are the most important keywords in the global coronavirus publications. Also, eight important topics were identified in the global coronavirus publications by implementing the topic modeling algorithm. The highest number of publications were respectively on the following topics: “structure and proteomics,” “Cell signaling and immune response,” “clinical presentation and detection,” “Gene sequence and genomics,” “Diagnosis tests,” “vaccine and immune response and outbreak,” “Epidemiology and Transmission” and “gastrointestinal tissue.”

Originality/value

The originality of this article can be considered in three ways. First, text mining and Latent Dirichlet allocation were applied to analyzing coronavirus literature for the first time. Second, coronavirus is mentioned as a hot topic of research. Finally, in addition to the retrospective approaches to 50 years of data collection and analysis, the results can be exploited with prospective approaches to strategic planning and macro-policymaking.

An Emerging Syndemic of Smoking and Cardiopulmonary Diseases in People Living with HIV in Africa

Background: African countries have the highest number of people living with HIV (PWH). The continent is home to 12% of the global population, but accounts for 71% of PWH globally. Antiretroviral therapy has played an important role in the reduction of the morbidity and mortality rates for HIV, which necessitates increased surveillance of the threats from pernicious risks to which PWH who live longer remain exposed. This includes cardiopulmonary comorbidities, which pose significant public health and economic challenges. A significant contributor to the cardiopulmonary comorbidities is tobacco smoking. Indeed, globally, PWH have a 2–4-fold higher utilization of tobacco compared to the general population, leading to endothelial dysfunction and atherogenesis that result in cardiopulmonary diseases, such as chronic obstructive pulmonary disease and coronary artery disease. In the context of PWH, we discuss (1) the current trends in cigarette smoking and (2) the lack of geographically relevant data on the cardiopulmonary conditions associated with smoking; we then review (3) the current evidence on chronic inflammation induced by smoking and the potential pathways for cardiopulmonary disease and (4) the multifactorial nature of the syndemic of smoking, HIV, and cardiopulmonary diseases. This commentary calls for a major, multi-setting cohort study using a syndemics framework to assess cardiopulmonary disease outcomes among PWH who smoke. Conclusion: We call for a parallel program of implementation research to promote the adoption of evidence-based interventions, which could improve health outcomes for PWH with cardiopulmonary diseases and address the health inequities experienced by PWH in African countries.

Collaboration Network and Trends of Global Coronavirus Disease Research: A Scientometric Analysis

As a global pandemic threatens health and livelihoods, finding effective treatments has become a vital issue that requires worldwide collaboration. This study examines research collaboration and network profiles through a case study of coronavirus diseases, including both the extinct severe acute respiratory syndrome coronavirus (SARS-CoV) and the emerging species (SARS-CoV-2). A scientometric process was designed to apply quantitative tools and a qualitative approach employing technological expertise to accomplish a three-level collaboration analysis. The text mining software, VantagePoint, was used to analyze research articles from the Web of Science database to identify the key national, organizational, and individual players in the coronavirus research field combined with indicators, namely, the breadth and depth of collaboration. The results show that China and the United States are at the center of coronavirus research networks at all three levels, including many endeavors involving single or joint entities. This study demonstrates how governments, public sectors, and private sectors, such as the pharmaceutical industry, can use scientometric analysis to gain insight into the holistic research trends and networks of players in this field, leading to the formulation of strategies to strengthen research and development programs. Furthermore, this approach can be utilized as a visualization and decision support tool for further policy planning, identification and execution of collaboration, and research exchange opportunities. This scientometric process should be directly applicable to other fields.

Health related quality of life of people receiving highly active antiretroviral therapy in Southwest Ethiopia

BACKGROUND

Highly Active Antiretroviral Therapy (HAART) is a standard of HIV management to suppress viral load and delay progression to AIDS. However, questions have been raised about the use of antiretroviral therapy and how it affects quality of life (QoL) of people living with HIV/AIDS (PLWHA). The study hence aimed to assess the QoL of PLWHA who were taking HAART at Mizan-Tepi University Teaching Hospital (MTUTH) and identify factors associated with QoL.

METHODS

A cross sectional study was conducted among PLWHA receiving HAART at MTUTH from March 04-April 1, 2018. Patients were recruited consecutively and interviewed with structured questionnaire. A data abstraction tool was used to extract data from patient medical records. Quality of life was assessed using the World Health Organization Quality of Life HIV- BREF (WHOQOL-HIV-BREF) standard tool. Data was entered to Epi-Info version 3.5.3 and analyzed using SPSS version 22 for windows. A multivariable logistic regression analysis was fitted to identify factors associated with QoL. A statistical significance was established at a p value <0.05.

RESULTS

A total of 240 participants with the mean age of 35.11 (SD = 9.08) years were included in the study. This study found that 57.1% of the patients had high global score of QoL. Patients with normal current health (AOR = 3.38, 95% CI = 1.56-7.31)) and having family support (AOR = 3.12, 95% CI = 1.51-6.46) were positively associated with high global score of QoL, while patients with low HAART adherence (AOR = 0.40, 95%, CI = 0.19-0.86) were negatively associated with high global score of QoL.

CONCLUSION

The study revealed that more than half of the participants had high global score of QoL. Normal current health and family support were associated with better global score of QoL, while low HAART adherence was found to be associated with the lower global score of QoL.

Factors associated with high-risk behaviors of people newly diagnosed with HIV/AIDS: results from a cross-sectional study in Vietnam

Towards the elimination of this global epidemic, understanding the high-risk behaviors of people newly diagnosed with HIV/AIDS (PNDWH) is essential. This study aimed to describe the general characteristics and high-risk behaviors of PNDWH and identify associated factors for adopting high-risk behaviors. A cross-sectional survey was conducted in Vietnam to explore the high-risk behaviors of 506 PNDWH. Associated factors were identified using multivariable logistic regressions. 83.2% of participants had sex without using a condom, and 27.9% had more than two sex partners. Among injected drug users, 44% had shared needles with an average number of 2.1 shared partners. Male, Kinh ethnicity (Vietnamese), high income, and high educational level were risk factors for high-risk behaviors. Our findings revealed the first time a comprehensive picture of PNDWH and emphasized the high prevalence of STIs, including untreated STIs and the long delay since the early HIV diagnosis. Also, our model found much higher risk behaviors among participants who were non-adherent to ART and those currently enrolled in ART. By better managing newly-diagnosed cases, better integrating STI management services and prevention consultants, as well as improving ART adherence programs, Vietnam can make better progress towards the complete control of HIV for its most vulnerable populations.