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Malhotra K, Wong BNX, Lee S, Franco H, Singh C, Cabrera Silva LA, Iraqi H, Sinha A, Burger S, Breedt DS, Goyal K, Dagli MM, Bawa A. Role of Artificial Intelligence in Global Surgery: A Review of Opportunities and Challenges. Cureus 2023; 15:e43192. [PMID: 37692604 PMCID: PMC10486145 DOI: 10.7759/cureus.43192] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
Global surgery broadly refers to a rapidly expanding multidisciplinary field concerned with providing better and equitable surgical care across international health systems. Global surgery initiatives primarily focus on capacity building, advocacy, education, research, and policy development in low- and middle-income countries (LMICs). The inadequate surgical, anesthetic, and obstetric care currently contributes to 18 million preventable deaths each year. Hence, there is a growing interest in the rapid growth of artificial intelligence (AI) that provides a distinctive opportunity to enhance surgical services in LMICs. AI modalities have been used for personalizing surgical education, automating administrative tasks, and developing realistic and cost-effective simulation-training programs with provisions for people with special needs. Furthermore, AI may assist with providing insights for governance, infrastructure development, and monitoring/predicting stock take or logistics failure that can help in strengthening global surgery pillars. Numerous AI-assisted telemedicine-based platforms have allowed healthcare professionals to virtually assist in complex surgeries that may help to improve surgical accessibility across LMICs. Challenges in implementing AI technology include the misrepresentation of minority populations in the datasets leading to discriminatory bias. Human hesitancy, employment uncertainty, automation bias, and role of confounding factors need to be further studied for equitable utilization of AI. With a focused and evidence-based approach, AI could help several LMICs overcome bureaucratic inefficiency and develop more efficient surgical systems.
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Affiliation(s)
- Kashish Malhotra
- Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, IND
| | | | - Susie Lee
- Department of Orthopaedics, Toowoomba Hospital, Queensland, AUS
| | - Helena Franco
- Department of Surgery, Bond University, Queensland, AUS
| | - Carol Singh
- Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, IND
| | | | - Habab Iraqi
- Department of Surgery, Al-Yarmouk College of Medical Sciences, Khartoum, SDN
| | - Akatya Sinha
- Department of Surgery, MGM (Mahatma Gandhi Mission's) Medical College and Hospital, Mumbai, IND
| | - Sule Burger
- Department of Surgery, Ngwelezana Hospital, KwaZulu-Natal, ZAF
| | | | - Kashish Goyal
- Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Mert Marcel Dagli
- Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Ashvind Bawa
- Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, IND
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Doan AH, Vu CMH, Nguyen TT, Green KE, Phan HTT, Janamnuaysook R, Vu BN, Le TM, Do KQ, Tran TT, Ngo TM, Basu L, Tran LK, Humeau Z. Caring for the whole person: transgender-competent HIV pre-exposure prophylaxis as part of integrated primary healthcare services in Vietnam. J Int AIDS Soc 2022; 25 Suppl 5:e25996. [PMID: 36225133 PMCID: PMC9557015 DOI: 10.1002/jia2.25996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 07/19/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction Although HIV prevalence among transgender women who have sex with men in Vietnam is high (16–18%), uptake of pre‐exposure prophylaxis (PrEP) is low compared to other populations. When PrEP was initiated in 2017, gender‐affirming healthcare was largely unavailable. Lack of access to competent, stigma‐free healthcare is a well‐documented barrier to transgender women's uptake of PrEP and primary healthcare (PHC). We aimed to demonstrate the utility of a PrEP quality improvement intervention in pinpointing and addressing barriers to PrEP use among transgender women in Vietnam. Methods We applied a real‐world participatory continuous quality improvement (CQI) and Plan‐Do‐Study‐Act (PDSA) methodology to ascertain barriers to PrEP uptake among transgender women and determine priority actions for quality improvement. A CQI team representing transgender women leaders, key population (KP)‐clinic staff, public‐sector HIV managers and project staff applied PDSA to test solutions to identified barriers that addressed the primary quality improvement outcome of the monthly change in PrEP uptake among transgender women and secondary outcomes, including month‐3 PrEP continuation, the impact of offering PHC on PrEP uptake and unmet PrEP need. We utilized routine programmatic data and a descriptive cross‐sectional study enrolling 124 transgender women to measure these outcomes from October 2018 to September 2021. Results Five key barriers to PrEP uptake among transgender women were identified and corresponding solutions were put in place: (1) offering gender‐affirming care training to KP‐clinics and community‐based organizations; (2) integrating gender‐affirming services into 10 KP‐clinics; (3) offering PHC through five one‐stop shop (OSS) clinics; (4) implementing a campaign addressing concerns related to hormone use and PrEP interactions; and (5) developing national HIV and transgender healthcare guidelines. New PrEP enrolment and month‐3 PrEP continuation increased significantly among transgender women. Of 235 transgender women who initially sought healthcare other than PrEP at OSS clinics, 26.4% subsequently enrolled in PrEP. About one‐third of transgender women reported unmet PrEP need, while two‐thirds indicated an interest in long‐acting cabotegravir. Conclusions Offering gender‐competent, integrated PHC can increase PrEP enrolment and continuation, and can be an entry‐point for PrEP among those seeking care within PHC clinics. More work is needed to expand access to transgender women‐led and ‐competent healthcare in Vietnam.
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Affiliation(s)
| | | | | | | | - Huong T. T. Phan
- Vietnam Administration for HIV/AIDS ControlMinistry of HealthHanoiVietnam
| | | | | | | | | | | | - Trang M. Ngo
- US Agency for International DevelopmentHanoiVietnam
| | - Lopa Basu
- US Agency for International DevelopmentHanoiVietnam
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Karamagi HC, Berhane A, Ngusbrhan Kidane S, Nyawira L, Ani-Amponsah M, Nyanjau L, Maoulana K, Seydi ABW, Nzinga J, Dangou JM, Nkurunziza T, K. Bisoborwa G, Sillah JS, W. Muriithi A, Nirina Razakasoa H, Bigirimana F. High impact health service interventions for attainment of UHC in Africa: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000945. [PMID: 36962639 PMCID: PMC10021619 DOI: 10.1371/journal.pgph.0000945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/23/2022] [Indexed: 11/19/2022]
Abstract
African countries have prioritized the attainment of targets relating to Universal Health Coverage (UHC), Health Security (HSE) and Coverage of Health Determinants (CHD)to attain their health goals. Given resource constraints, it is important to prioritize implementation of health service interventions with the highest impact. This is important to be identified across age cohorts and public health functions of health promotion, disease prevention, diagnostics, curative, rehabilitative and palliative interventions. We therefore explored the published evidence on the effectiveness of existing health service interventions addressing the diseases and conditions of concern in the Africa Region, for each age cohort and the public health functions. Six public health and economic evaluation databases, reports and grey literature were searched. A total of 151 studies and 357 interventions were identified across different health program areas, public health functions and age cohorts. Of the studies, most were carried out in the African region (43.5%), on communicable diseases (50.6%), and non-communicable diseases (36.4%). Majority of interventions are domiciled in the health promotion, disease prevention and curative functions, covering all age cohorts though the elderly cohort was least represented. Neonatal and communicable conditions dominated disease burden in the early years of life and non-communicable conditions in the later years. A menu of health interventions that are most effective at averting disease and conditions of concern across life course in the African region is therefore consolidated. These represent a comprehensive evidence-based set of interventions for prioritization by decision makers to attain desired health goals. At a country level, we also identify principles for identifying priority interventions, being the targeting of higher implementation coverage of existing interventions, combining interventions across all the public health functions-not focusing on a few functions, provision of subsidies or free interventions and prioritizing early identification of high-risk populations and communities represent these principles.
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Affiliation(s)
- Humphrey Cyprian Karamagi
- Data Analytics and Knowledge Management, World Health Organization (WHO) Regional Office for Africa, Brazzaville, Republic of Congo
| | - Araia Berhane
- Conmmunicable Diseases Control Division, Ministry of Health, Asmara, Eritrea
| | - Solyana Ngusbrhan Kidane
- Data Analytics and Knowledge Management, World Health Organization (WHO) Regional Office for Africa, Brazzaville, Republic of Congo
| | - Lizah Nyawira
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | | | | | - Koulthoume Maoulana
- Ministry of Health, Solidarity, Social Protection and Gender Promotion, Moroni, Comoros
| | - Aminata Binetou Wahebine Seydi
- Data Analytics and Knowledge Management, World Health Organization (WHO) Regional Office for Africa, Brazzaville, Republic of Congo
| | - Jacinta Nzinga
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
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Buchanan J, Altunkaya J, Van Kinh N, Van Vinh Chau N, Trieu Ly V, Thi Thanh Thuy P, Hai Vinh V, Thi Hong Hanh D, Thuy Hang N, Phuong Thuy T, van Doorn R, Thwaites G, Gray A, Le T. Cost-Effectiveness of Amphotericin B Deoxycholate Versus Itraconazole for Induction Therapy of Talaromycosis in Human Immunodeficiency Virus-Infected Adults in Vietnam. Open Forum Infect Dis 2021; 8:ofab357. [PMID: 34337101 PMCID: PMC8320272 DOI: 10.1093/ofid/ofab357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/02/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Talaromycosis (penicilliosis) is an invasive fungal infection and a major cause of human immunodeficiency virus (HIV)-related deaths in Southeast Asia. Guidelines recommend induction therapy with amphotericin B deoxycholate; however, treatment with itraconazole has fewer toxic effects, is easier to administer, and is less expensive. Our recent randomized controlled trial in Vietnam found that amphotericin B was superior to itraconazole with respect to 6-month mortality. We undertook an economic evaluation alongside this trial to determine whether the more effective treatment is cost-effective. METHODS Resource use, direct and indirect costs, and health and quality-of-life outcomes (measured using quality-adjusted life-years [QALYs]) were evaluated for 405 trial participants from 2012 to 2016. Both a Vietnamese health service and a broader societal costing perspective were considered. Mean costs and QALYs were combined to calculate the within-trial cost-effectiveness of amphotericin vs itraconazole from both perspectives. RESULTS From a Vietnamese health service perspective, amphotericin increases costs but improves health outcomes compared to itraconazole, at a cost of $3013/QALY gained. The probability that amphotericin is cost-effective at a conventional (World Health Organization CHOICE) threshold of value for money is 46%. From a societal perspective, amphotericin is cost-reducing and improves outcomes compared to itraconazole, and is likely to be a cost-effective strategy at any value for money threshold greater than $0. CONCLUSIONS Our analysis indicates that induction therapy with amphotericin is a cost-effective treatment strategy for HIV-infected adults diagnosed with talaromycosis in Vietnam. These results provide the evidence base for health care providers and policy makers to improve access to and use of amphotericin.
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Affiliation(s)
- James Buchanan
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - James Altunkaya
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | | | | | - Vo Trieu Ly
- University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | | | | | | | - Nguyen Thuy Hang
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Tran Phuong Thuy
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Rogier van Doorn
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Guy Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Thuy Le
- Duke University School of Medicine, Durham, North Carolina, USA
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Tran BX, Mai HT, Fleming M, Do HN, Nguyen TMT, Vuong QH, Ho MT, Van Dam N, Vuong TT, Ha GH, Truong NT, Latkin CA, Ho CSH, Ho RCM. Factors Associated with Substance Use and Sexual Behavior among Drug Users in Three Mountainous Provinces of Vietnam. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15091885. [PMID: 30200283 PMCID: PMC6165320 DOI: 10.3390/ijerph15091885] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/20/2018] [Accepted: 08/28/2018] [Indexed: 11/16/2022]
Abstract
Due to their geographical characteristics, the mountainous areas of Vietnam are particularly vulnerable to illicit drug use. Drug users in remote areas are also more likely to engage in risky sexual behaviors. This study aimed to describe the prevalence and characteristics of substance use and sexual behaviors and explored their related factors among newly admitted drug users in three mountainous provinces of Vietnam. A cross-sectional study was conducted on 300 newly-admitted drug users registering for Methadone Maintenance Treatment (MMT) at 6 clinics in three provinces: Dien Bien, Lai Chau and Yen Bai from October 2014 to December 2015. Information about the socio-demographic characteristics, history of substance use, and sexual behaviors were collected. The multivariate logistic regression model was used to identify potential predictors of four outcomes, which included: drug injection, re-use of needles, using condoms during the last time of having sex, and having sexual intercourse with female sex workers. The proportion of injecting drug users was 68.3%; of those 9% never re-used needles. Of note, 69% of those who reported having sex with female sex workers in the last month did not use condoms. Regression models showed that those who injected drugs and had health problems in last 30 days had greater odds of having sex with female sex workers. Drug users in mountainous settings acknowledged the high prevalence of human immunodeficiency virus (HIV)-related risk behaviors and a demand for physical and psychological care. Scaling up MMT services is key to approaching this high-risk group; however, at the same time, comprehensive harm-reduction interventions, counseling, and health care services should also be made accessible and effective in this setting.
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Affiliation(s)
- Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam.
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
- Vietnam Young Physician Association, Hanoi 100000, Vietnam.
| | - Hue Thi Mai
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam.
| | - Mercedes Fleming
- School of Medicine and Medical Science, University College Dublin, D04 V1W8 Dublin, Ireland.
| | - Ha Ngoc Do
- Youth Research Institute, Vietnam (YRI)-Ho Chi Minh Communist Youth Union, Hanoi 100000, Vietnam.
| | - Tam Minh Thi Nguyen
- Vietnam Authority of HIV/AIDS Control, Ministry of Health, Hanoi 100000, Vietnam.
| | - Quan Hoang Vuong
- Center for Interdisciplinary Social Research, Thanh Tay University, Hanoi 100000, Vietnam.
- Solvay Brussels School of Economics and Management, Centre Emile Bernheim, Université Libre de Bruxelles, B-1050 Brussels, Belgium.
| | - Manh Tung Ho
- Institute of Philosophy, Vietnam Academy of Social Sciences, Hanoi 100000, Vietnam.
| | - Nhue Van Dam
- Faculty of Graduate Studies, National Economics University, Hanoi 100000, Vietnam.
| | | | - Giang Hai Ha
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam.
| | - Nu Thi Truong
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam.
| | - Carl A Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
| | - Cyrus S H Ho
- Department of Psychological Medicine, National University Hospital, Singapore 119074, Singapore.
| | - Roger C M Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore 119228, Singapore.
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Tran BX, Fleming M, Nguyen CT, Latkin CA. Financial mobilization for antiretroviral therapy program: multi-level predictors of willingness to pay among patients with HIV/AIDS in Vietnam. AIDS Care 2018; 30:1488-1497. [PMID: 30047280 DOI: 10.1080/09540121.2018.1503633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
In Vietnam, significant progress has been made in increasing the number of patients receiving antiretroviral therapy (ART) in the last number of years. As this number increases and international aid and funding for HIV services declines, a greater proportion of ART funding will need to be provided by the government budget, health insurance or by the patients themselves. This study aims to evaluate the willingness of HIV patients to pay for ART. A cross-sectional study which included 1133 HIV-positive patients was conducted across 8 outpatient centers in Hanoi and Nam Binh in Northern Vietnam in 2013. Contingent valuation method was used to assess the willingness to pay (WTP) of patient for ART. Over 90% of the patients were willing to pay for ART for an average amount of 19.7 USD per month. Regression models showed that the willingness of patients to pay for ART was influenced by factors such as employment, income, quality of life and social factors. The amount patients were willing to pay was also associated with gender, living place and level of HIV service administration. By establishing these factors which influence the amount of WTP for ART, plans for the future can be effectively designed and patient groups at risk can be appropriately managed.
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Affiliation(s)
- Bach Xuan Tran
- a Department of Health Economics, Institute for Preventive Medicine and Public Health , Hanoi Medical University , Hanoi , Vietnam.,b Department of Health, Behavior and Society ,, Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Mercedes Fleming
- c School of Medicine and Medical Science , University College Dublin , Dublin , Ireland
| | - Cuong Tat Nguyen
- d Institute for Global Health Innovations, Duy Tan University , Danang , Vietnam
| | - Carl A Latkin
- b Department of Health, Behavior and Society ,, Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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Green KE, Vu BN, Phan HTT, Tran MH, Ngo HV, Vo SH, Ngo TM, Doan AH, Tran TT, Nguyen TNN, Bao A, Hang LTX, Le TM, Doan TT, Dang LH, Ha GTT. From conventional to disruptive: upturning the HIV testing status quo among men who have sex with men in Vietnam. J Int AIDS Soc 2018; 21 Suppl 5:e25127. [PMID: 30033557 PMCID: PMC6055123 DOI: 10.1002/jia2.25127] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 05/17/2018] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION HIV prevalence among men who have sex with men (MSM) in Vietnam is increasing, while annual HIV testing uptake has remained consistently low, posing a significant challenge to reaching the 90-90-90 goals. Barriers to MSM seeking HIV testing include concerns regarding confidentiality and lack of convenient testing options. Two new HIV testing strategies-HIV lay provider and HIV self-testing (HIVST)-were piloted alongside intensive social media outreach to increase access to and uptake of HIV testing among MSM not actively engaged in services. METHODS We measured the proportion of first-time MSM HIV testers opting for HIV lay or self-testing, and factors that were associated with first-time testing, as part of a larger HIV lay and self-testing study among key populations in Vietnam. We also assessed MSM satisfaction with HIV lay or self-testing, and testing location and provider preferences. Finally, we calculated linkage to care cascade among MSM that were diagnosed and enrolled in anti-retroviral therapy (ART) services. RESULTS Among MSM that sought HIV lay and self-testing, 57.9% (n = 320) and 51.3% (n = 412) were first-time testers respectively. In the final adjusted models, the odds of being a first-time tester and opting for HIV lay testing were higher among MSM who were young, had lower levels of income and had never exchanged sex for money; for HIVST, the odds of being a first-time HIV tester were higher among MSM that had attained lower levels of education. HIV lay and self-testing resulted in higher detection of new HIV cases (6.8%) compared to conventional HIV testing among key populations (estimated at 1.6% in 2016), while MSM linked to testing through social media interventions presented with even higher HIV-positivity (11%). Combined, 1655 HIV cases were diagnosed and more than 90% were registered for ART services. CONCLUSIONS Our findings suggest that MSM-delivered HIV testing and self-testing, promoted through online or face-to-face interactions, offer important additions to MSM HIV testing services in Vietnam, and could significantly contribute to epidemic control by increasing HIV testing among harder-to-reach and higher-risk MSM, effectively enrolling them in ART, and reducing onward transmission.
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Affiliation(s)
| | | | - Huong TT Phan
- Ministry of Health/Vietnam Administration of HIV/AIDS ControlViet Nam
| | - Minh H Tran
- Center for Creative Initiatives in Health and PopulationViet Nam
| | | | - Son H Vo
- Ministry of Health/Vietnam Administration of HIV/AIDS ControlViet Nam
| | - Trang M Ngo
- United States Agency for International DevelopmentViet Nam
| | | | | | | | | | | | | | | | - Linh H Dang
- Center for Creative Initiatives in Health and PopulationViet Nam
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Abstract
When standard optimization methods fail to find a satisfactory solution for a parameter fitting problem, a tempting recourse is to adjust parameters manually. While tedious, this approach can be surprisingly powerful in terms of achieving optimal or near-optimal solutions. This paper outlines an optimization algorithm, Adaptive Stochastic Descent (ASD), that has been designed to replicate the essential aspects of manual parameter fitting in an automated way. Specifically, ASD uses simple principles to form probabilistic assumptions about (a) which parameters have the greatest effect on the objective function, and (b) optimal step sizes for each parameter. We show that for a certain class of optimization problems (namely, those with a moderate to large number of scalar parameter dimensions, especially if some dimensions are more important than others), ASD is capable of minimizing the objective function with far fewer function evaluations than classic optimization methods, such as the Nelder-Mead nonlinear simplex, Levenberg-Marquardt gradient descent, simulated annealing, and genetic algorithms. As a case study, we show that ASD outperforms standard algorithms when used to determine how resources should be allocated in order to minimize new HIV infections in Swaziland.
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Safarnejad A, Pavlova M, Son VH, Phuong HL, Groot W. Criteria for prioritization of HIV programs in Viet Nam: a discrete choice experiment. BMC Health Serv Res 2017; 17:719. [PMID: 29132355 PMCID: PMC5683339 DOI: 10.1186/s12913-017-2679-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 11/03/2017] [Indexed: 11/21/2022] Open
Abstract
Background With the decline in funding for Viet Nam’s response to the HIV epidemic, there is a need for evidence on the criteria to guide the prioritization of HIV programs. There is a gap in the research on the relative importance of multiple criteria for prioritizing a package of interventions. This study elicits preferences and the trade-offs made between different HIV programs by relevant stakeholders and decision-makers in Viet Nam. It also pays attention to how differences in social and professional characteristics of stakeholders and their agency affiliations shape preferences for HIV program criteria in Viet Nam. Methods This study uses self-explicated ranking and discrete choice experiments to determine the relative importance of five criteria - effectiveness, feasibility, cost-effectiveness, rate of investment and prevention/treatment investment ratio - to stakeholders when they evaluate and select hypothetical HIV programs. The study includes 69 participants from government, civil society, and international development partners. Results Results of the discrete choice experiment show that overall the feasibility criterion is ranked highest in importance to the participants when choosing a hypothetical HIV program, followed by sustainability, treatment to prevention spending ratio, and effectiveness. The participant’s work in management, programming, or decision-making has a significant effect on the importance of some criteria to the participant. In the self-explicated ranking effectiveness is the most important criterion and the cost-effectiveness criterion ranks low in importance across all groups. Conclusions This study has shown that the preferred HIV program in Viet Nam is feasible, front-loaded for sustainability, has a higher proportion of investment on prevention, saves more lives and prevents more infections. Similarities in government and civil society rankings of criteria can create common grounds for future policy dialogues between stakeholders. Innovative models of planning should be utilized to allow inputs of informed stakeholders at relevant stages of the HIV program planning process. Electronic supplementary material The online version of this article (10.1186/s12913-017-2679-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ali Safarnejad
- Maastricht Graduate School of Governance, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, Netherlands.
| | - Milena Pavlova
- Department of Health Services Research; CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Vo Hai Son
- Viet Nam Authority of HIV/AIDS Control (VAAC), Ministry of Health, Hanoi, Vietnam
| | - Huynh Lan Phuong
- The Joint United Nations Programme on HIV/AIDS (UNAIDS), Hanoi, Vietnam
| | - Wim Groot
- Department of Health Services Research; CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
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Getting it right when budgets are tight: Using optimal expansion pathways to prioritize responses to concentrated and mixed HIV epidemics. PLoS One 2017; 12:e0185077. [PMID: 28972975 PMCID: PMC5626425 DOI: 10.1371/journal.pone.0185077] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 09/06/2017] [Indexed: 12/04/2022] Open
Abstract
Background Prioritizing investments across health interventions is complicated by the nonlinear relationship between intervention coverage and epidemiological outcomes. It can be difficult for countries to know which interventions to prioritize for greatest epidemiological impact, particularly when budgets are uncertain. Methods We examined four case studies of HIV epidemics in diverse settings, each with different characteristics. These case studies were based on public data available for Belarus, Peru, Togo, and Myanmar. The Optima HIV model and software package was used to estimate the optimal distribution of resources across interventions associated with a range of budget envelopes. We constructed “investment staircases”, a useful tool for understanding investment priorities. These were used to estimate the best attainable cost-effectiveness of the response at each investment level. Findings We find that when budgets are very limited, the optimal HIV response consists of a smaller number of ‘core’ interventions. As budgets increase, those core interventions should first be scaled up, and then new interventions introduced. We estimate that the cost-effectiveness of HIV programming decreases as investment levels increase, but that the overall cost-effectiveness remains below GDP per capita. Significance It is important for HIV programming to respond effectively to the overall level of funding availability. The analytic tools presented here can help to guide program planners understand the most cost-effective HIV responses and plan for an uncertain future.
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Abstract
With HIV funding plateauing and the number of people living with HIV increasing due to the rollout of life-saving antiretroviral therapy, policy makers are faced with increasingly tighter budgets to manage the ongoing HIV epidemic. Cost-effectiveness and modeling analyses can help determine which HIV interventions may be of best value. Incidence remains remarkably high in certain populations and countries, making prevention key to controlling the spread of HIV. This paper briefly reviews concepts in modeling and cost-effectiveness methodology and then examines results of recently published cost-effectiveness analyses on the following HIV prevention strategies: condoms and circumcision, behavioral- or community-based interventions, prevention of mother-to-child transmission, HIV testing, pre-exposure prophylaxis, and treatment as prevention. We find that the majority of published studies demonstrate cost-effectiveness; however, not all interventions are affordable. We urge continued research on combination strategies and methodologies that take into account willingness to pay and budgetary impact.
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Affiliation(s)
- Margo M Jacobsen
- Medical Practice Evaluation Center (RPW, MMJ), Divisions of Infectious Diseases and General Internal Medicine (RPW), Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA, 02114, USA
| | - Rochelle P Walensky
- Medical Practice Evaluation Center (RPW, MMJ), Divisions of Infectious Diseases and General Internal Medicine (RPW), Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA, 02114, USA. .,Division of Infectious Diseases, Brigham and Women's Hospital (RPW), Boston, MA, USA. .,Harvard University Center for AIDS Research (RPW), Harvard Medical School, Boston, MA, USA.
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