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Taylor HA, Dowdy DW, Searle AR, Stennett AL, Dukhanin V, Zwerling AA, Merritt MW. Disadvantage and the Experience of Treatment for Multidrug-Resistant Tuberculosis (MDR-TB). SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100042. [PMID: 35252955 PMCID: PMC8896740 DOI: 10.1016/j.ssmqr.2022.100042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Holly A Taylor
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205 USA
| | - David W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, Maryland 21205 USA
| | - Alexandra R Searle
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, Maryland 21205 USA
| | - Andrea L Stennett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, Maryland 21205 USA
| | - Vadim Dukhanin
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205 USA
| | - Alice A Zwerling
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand, Ottawa ON K1G 5Z3 Canada
| | - Maria W Merritt
- Johns Hopkins Berman Institute of Bioethics; and Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, Maryland 21205 USA
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2
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Munung NS, de Vries J, Pratt B. Towards equitable genomics governance in Africa: Guiding principles from theories of global health governance and the African moral theory of Ubuntu. BIOETHICS 2022; 36:411-422. [PMID: 35041227 PMCID: PMC9050794 DOI: 10.1111/bioe.12995] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 09/13/2021] [Accepted: 11/25/2021] [Indexed: 05/03/2023]
Abstract
The post-genomics era promises a revolution characterized by precision medicine and the integration of genomics into almost every area of biomedical research. At the same time, there are concerns that if care is not taken, the genomics revolution may widen global inequities in science and health. In Africa, these concerns are primarily linked to the underrepresentation of African populations in genomics research, limited genomics research capacity in Africa and associated macro-level justice issues such as benefit sharing, inequitable international research collaborations, and the contribution of genomics to the health and research priorities of Africa. Addressing these concerns requires an in-depth reflection on how the ideals of global justice and equity may be advanced in genomics research. To contribute to the limited but growing scholarship on global genomics equity, especially in the African context, we performed a conceptual analysis of three accounts of justice and governance namely, Ubuntu, shared health governance and global governance of health, with the aim of identifying principles that could inform genomics governance in Africa. We used a convergence approach in the conceptual analysis, resulting in the identification of nine principles namely: solidarity, furthering the ideals of health justice, reciprocity, shared decision-making, shared resources, shared responsibility, mutual trust, transparency, and mutual collective accountability. Examples of how the principles may be applied are provided. We recommend that these principles should form the foundation of any mechanism that seeks to systematically advance justice, fairness and equity in genomics research in Africa and more broadly, global health and science equity.
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Affiliation(s)
- Nchangwi Syntia Munung
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jantina de Vries
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Bridget Pratt
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Australia
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3
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Wahyuhadi J, Efendi F, Al Farabi MJ, Harymawan I, Ariana AD, Arifin H, Adnani QES, Levkovich I. Association of stigma with mental health and quality of life among Indonesian COVID-19 survivors. PLoS One 2022; 17:e0264218. [PMID: 35196326 PMCID: PMC8865694 DOI: 10.1371/journal.pone.0264218] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 02/05/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Coronavirus disease 2019 (COVID-19) survivors face societal stigma. The study aims to analyze the association of this stigma with the mental health and quality of life of COVID-19 survivors. METHODS In this cross-sectional study, we observed 547 adults who were previously documented as severe acute respiratory syndrome coronavirus (SARS-CoV-2) positive by a polymerase chain reaction (PCR) test, treated in a hospital or an emergency hospital and proven to be SARS-CoV-2 negative by their latest PCR test. We adopted the Berger HIV Stigma Scale to measure stigma; the World Health Organization Quality of Life Brief Form to measure quality of life; and the Mental Health Inventory-38 to measure mental health. The chi-square and binary logistic regression tests were used to find the correlation between the variables. RESULTS The multivariate analysis revealed that medium stigma was more likely related to quality of life and mental health than low stigma. Females were less likely to experience stigma related to mental health than men, and respondents who worked as laborers and entrepreneurs were less likely to experience stigma related to mental health than those who worked as civil workers/army personnel/teachers/lecturers. COVID-19 survivors experienced medium stigma in society and lower quality of life and mental health status. We found that quality of life and mental health were affected by stigma, sex, and occupation. CONCLUSION COVID-19 survivors are a vulnerable group that is most at risk when they return to their communities. Creating a safe environment and providing respectful care, including addressing complex stigma factors, is vital for developing appropriate interventions.
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Affiliation(s)
- Joni Wahyuhadi
- Department of Neurosurgery, Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Ferry Efendi
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
- * E-mail:
| | | | - Iman Harymawan
- Faculty of Economy and Business, Universitas Airlangga, Surabaya, Indonesia
| | | | - Hidayat Arifin
- Department of Medical-Surgical, Critical, Emergency, and Disaster Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung, Indonesia
| | | | - Inbar Levkovich
- Faculty of Graduate Studies, Oranim Academic College of Education, Kiryat Tiyon, Israel
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4
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Antillon M, Huang CI, Rock KS, Tediosi F. Economic evaluation of disease elimination: An extension to the net-benefit framework and application to human African trypanosomiasis. Proc Natl Acad Sci U S A 2021; 118:e2026797118. [PMID: 34887355 PMCID: PMC8685684 DOI: 10.1073/pnas.2026797118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2021] [Indexed: 12/11/2022] Open
Abstract
The global health community has earmarked a number of diseases for elimination or eradication, and these goals have often been praised on the premise of long-run cost savings. However, decision makers must contend with a multitude of demands on health budgets in the short or medium term, and costs per case often rise as the burden of a disease falls, rendering such efforts beyond the cost-effective use of scarce resources. In addition, these decisions must be made in the presence of substantial uncertainty regarding the feasibility and costs of elimination or eradication efforts. Therefore, analytical frameworks are necessary to consider the additional effort for reaching global goals, like elimination or eradication, that are beyond the cost-effective use of country resources. We propose a modification to the net-benefit framework to consider the implications of switching from an optimal strategy, in terms of cost-per-burden averted, to a strategy with a higher likelihood of meeting the global target of elimination or eradication. We illustrate the properties of our framework by considering the economic case of efforts to eliminate the transmission of gambiense human African trypanosomiasis (gHAT), a vector-borne, parasitic disease in West and Central Africa, by 2030.
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Affiliation(s)
- Marina Antillon
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland;
- University of Basel, 4001 Basel, Switzerland
| | - Ching-I Huang
- Zeeman Institute, University of Warwick, Coventry CV4 7AL, United Kingdom
- Mathematics Institute, University of Warwick, Coventry CV4 7AL, United Kingdom
| | - Kat S Rock
- Zeeman Institute, University of Warwick, Coventry CV4 7AL, United Kingdom
- Mathematics Institute, University of Warwick, Coventry CV4 7AL, United Kingdom
| | - Fabrizio Tediosi
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland
- University of Basel, 4001 Basel, Switzerland
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5
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Addiss DG, Kienast Y, Lavery JV. Ethical dimensions of neglected tropical disease programming. Trans R Soc Trop Med Hyg 2021; 115:190-195. [PMID: 33339025 PMCID: PMC7842092 DOI: 10.1093/trstmh/traa155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/14/2020] [Accepted: 11/20/2020] [Indexed: 11/13/2022] Open
Abstract
The global movement to control and eliminate neglected tropical diseases (NTDs) is grounded in an ethic of social justice, solidarity and health equity. NTD programmes deliver significant health benefits in socially complex environments characterized by poverty and economic disparity. We used two ethics frameworks—principlism and Upshur's public health framework—to examine ethical challenges faced by NTD programmes. They include management of serious adverse reactions associated with preventive chemotherapy, centralization of decision-making, ‘opt-out’ policies for school-based deworming, incomplete evidence for ‘pro-poor’ impact and persistent inequities in global partnerships. NTD programmes must actively address ethical challenges while pursuing global health goals.
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Affiliation(s)
- David G Addiss
- Focus Area for Compassion and Ethics, Task Force for Global Health, Decatur, GA, USA
| | - Yvonne Kienast
- Focus Area for Compassion and Ethics, Task Force for Global Health, Decatur, GA, USA.,Center for Ethics, Emory University, Atlanta, GA, USA
| | - James V Lavery
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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6
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Sotgiu G, Dobler CC. Social stigma in the time of coronavirus disease 2019. Eur Respir J 2020; 56:13993003.02461-2020. [PMID: 32631833 PMCID: PMC7338401 DOI: 10.1183/13993003.02461-2020] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 06/25/2020] [Indexed: 12/23/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has dramatically changed the lives of people around the globe since it appeared in Wuhan, China, at the beginning of December 2019. The burden of disease and its death toll have had an unprecedented impact on the healthcare, economic and financial systems of low-, middle- and high-income countries [1–3]. Peoples’ lives have been disrupted and negatively impacted by COVID-19-related suffering and lockdowns at community and household level. Addressing COVID-19-related stigmahttps://bit.ly/2CPuxO1
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Affiliation(s)
- Giovanni Sotgiu
- Dept of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Claudia C Dobler
- Institute for Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia.,Dept of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, New South Wales, Australia
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7
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Pratt B, Cheah PY, Marsh V. Solidarity and Community Engagement in Global Health Research. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:43-56. [PMID: 32364467 PMCID: PMC7613329 DOI: 10.1080/15265161.2020.1745930] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Community engagement (CE) is gaining prominence in global health research. A number of ethical goals-spanning the instrumental, intrinsic, and transformative-have been ascribed to CE in global health research. This paper draws attention to an additional transformative value that CE is not typically linked to but that seems very relevant: solidarity. Both are concerned with building relationships and connecting parties that are distant from one another. This paper first argues that furthering solidarity should be recognized as another ethical goal for CE in global health research. It contends that, over time, CE can build the bases of solidaristic relationships-moral imagination, recognition, understanding, empathy-between researchers and community members. Applying concepts from existing accounts of solidarity, the paper develops preliminary ideas about who should be engaged and how to advance solidarity. The proposed approach is compared to current CE practice in global health research. Finally, the paper briefly considers how solidaristic CE could affect how global health research is performed.
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Affiliation(s)
- Bridget Pratt
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Phaik Yeong Cheah
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Vicki Marsh
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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8
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Dowdy DW, Zwerling AA, Stennett A, Searle A, Dukhanin V, Taylor HA, Merritt MW. Measuring Stigma to Assess the Social Justice Implications of Health-Related Policy Decisions: Application to Novel Treatment Regimens for Multidrug-Resistant Tuberculosis. MDM Policy Pract 2020; 5:2381468320915239. [PMID: 32440569 PMCID: PMC7227142 DOI: 10.1177/2381468320915239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 02/28/2020] [Indexed: 01/18/2023] Open
Abstract
In making policy decisions with constrained resources, an important consideration is the impact of alternative policy options on social justice. Social justice considers interactions between individuals and society and can be conceptualized across domains of agency, association, and respect. Despite its importance, social justice is rarely considered formally in health policy decision making, partially reflecting challenges in its measurement. We define three criteria for considering social justice in health-related policy decisions: 1) linkage of social justice to a measurable construct; 2) ability to reproducibly and feasibly estimate the impacts of a policy decision on the selected construct; and 3) appropriate presentation to decision makers of the expected social justice implications using that construct. We use preliminary data from qualitative interviews from three groups of respondents in South Africa and Uganda to demonstrate that stigma meets the first of these criteria. We then use the example of policy addressing novel treatment regimens for multidrug-resistant tuberculosis and a validated tuberculosis stigma scale to illustrate how policy effects on stigma could be estimated (criterion 2) and presented to decision makers in the form of justice-enhanced cost-effectiveness analysis (criterion 3). Finally, we provide a point-by-point guide for conducting similar assessments to facilitate consideration of social justice in health-related policy decisions. Our case study and guide for how to make social justice impacts more apparent to decision makers also illustrates the importance of local data and local capacity. Performing social justice assessments alongside more traditional evaluations of cost-effectiveness, budget impact, and burden of disease could help represent data-informed considerations of social justice in health care decision making more broadly.
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Affiliation(s)
- David W Dowdy
- Departments of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Alice A Zwerling
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Canada
| | - Andrea Stennett
- Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Alexandra Searle
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Vadim Dukhanin
- Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Holly A Taylor
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Maria W Merritt
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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9
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DiStefano MJ. Characterizing ‘Civil Unrest’ within Public Health: Implications for Public Health Research and Practice. Public Health Ethics 2020. [DOI: 10.1093/phe/phaa002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Following the death on April 19, 2015 of Freddie Gray from injuries sustained while unarmed and in police custody, many citizens of Baltimore took to the streets and the National Guard was called into the city. A 2017 article published in the American Journal of Public Health measured the effect of this civil unrest on maternal and child health. I argue that this research does not acknowledge the full range of motivations, behaviors, aims and values that may have been inherent in this unrest. I first describe the article’s characterization of Baltimore’s unrest as community violence. I then provide a negative argument against employing this characterization alone, before providing positive arguments for two alternative characterizations—as protest and apt anger. Finally, I discuss upshots of considering these alternatives. Broadly, while viewing civil unrest as community violence focuses exclusive attention on victims of unrest, these alternatives direct attention to unrest participants, with implications for public health research and practice. While I focus on Baltimore’s 2015 unrest, the proposals raised here apply wherever civil unrest occurs.
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Affiliation(s)
- Michael J DiStefano
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health and Berman Institute of Bioethics, Johns Hopkins University
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10
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Pratt B. Social Justice and the Ethical Goals of Community Engagement in Global Health Research. JOURNAL OF BIOETHICAL INQUIRY 2019; 16:571-586. [PMID: 31863256 DOI: 10.1007/s11673-019-09948-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 10/30/2019] [Indexed: 06/10/2023]
Abstract
Social justice has been identified as a foundational moral commitment for global health research ethics. Yet what a commitment to social justice means for community engagement in such research has not been critically examined. This paper draws on the rich social justice literature from political philosophy to explore the normative question: What should the ethical goals of community engagement be if it is to help connect global health research to social justice? Five ethical goals for community engagement are proposed that promote well-being, agency, and self-development, particularly for those considered disadvantaged and marginalized. The paper also considers how key terms used in the proposed goals should be defined using existing theories of health and social justice. This analysis is done to give global health researchers and their partners a better idea of what the ethical goals mean. Patterns of convergence amongst different theories are identified that support relying on particular definitions of key terms.
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Affiliation(s)
- Bridget Pratt
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, 207 Bouverie St, Carlton, Victoria, 3053, Australia.
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11
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Hamill LC, Haslam D, Abrahamsson S, Hill B, Dixon R, Burgess H, Jensen K, D’Souza S, Schmidt E, Downs P. People are neglected, not diseases: the relationship between disability and neglected tropical diseases. Trans R Soc Trop Med Hyg 2019; 113:829-834. [PMID: 31111941 PMCID: PMC6903785 DOI: 10.1093/trstmh/trz036] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/04/2019] [Accepted: 05/02/2019] [Indexed: 01/24/2023] Open
Abstract
People with disabilities and the neglected tropical diseases (NTDs) are separately receiving increased focus. In light of this positive development, and the similarities and intersections between the negative impacts experienced by both people with disabilities and people with NTDs, we believe now is the right time to focus attention on the overlap between the two. Both people with NTDs and people with disabilities experience a myriad of overlapping negative health, financial and socio-cultural consequences. Despite this, we believe that disability is not yet properly prioritised on the development agenda, and that there are multiple opportunities to make NTD programming more inclusive, to the benefit of those at this neglected intersection and beyond. There are both opportunities and need to scale up, integrate, and invest in inclusive, health system-focused NTD programming. Realisation of the Sustainable Development Goals, Universal Health Coverage, and the control and elimination of NTDs all rely on ensuring people with disabilities are not left behind.
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Affiliation(s)
| | - Dominic Haslam
- Sightsavers, 35 Perrymount Road, Haywards Heath, West Sussex, UK
| | | | - Becks Hill
- Sightsavers, 35 Perrymount Road, Haywards Heath, West Sussex, UK
| | - Ruth Dixon
- Sightsavers, 35 Perrymount Road, Haywards Heath, West Sussex, UK
| | - Heather Burgess
- Sightsavers, 35 Perrymount Road, Haywards Heath, West Sussex, UK
| | - Kimberly Jensen
- Sightsavers, 35 Perrymount Road, Haywards Heath, West Sussex, UK
| | - Susan D’Souza
- Sightsavers, 35 Perrymount Road, Haywards Heath, West Sussex, UK
| | - Elena Schmidt
- Sightsavers, 35 Perrymount Road, Haywards Heath, West Sussex, UK
| | - Philip Downs
- Sightsavers, 35 Perrymount Road, Haywards Heath, West Sussex, UK
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12
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Kondeti PK, Ravi K, Mutheneni SR, Kadiri MR, Kumaraswamy S, Vadlamani R, Upadhyayula SM. Applications of machine learning techniques to predict filariasis using socio-economic factors. Epidemiol Infect 2019; 147:e260. [PMID: 31475670 PMCID: PMC6805759 DOI: 10.1017/s0950268819001481] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 07/22/2019] [Accepted: 08/02/2019] [Indexed: 11/23/2022] Open
Abstract
Filariasis is one of the major public health concerns in India. Approximately 600 million people spread across 250 districts of India are at risk of filariasis. To predict this disease, a pilot scale study was carried out in 30 villages of Karimnagar district of Telangana from 2004 to 2007 to collect epidemiological and socio-economic data. The collected data are analysed by employing various machine learning techniques such as Naïve Bayes (NB), logistic model tree, probabilistic neural network, J48 (C4.5), classification and regression tree, JRip and gradient boosting machine. The performances of these algorithms are reported using sensitivity, specificity, accuracy and area under ROC curve (AUC). Among all employed classification methods, NB yielded the best AUC of 64% and was equally statistically significant with the rest of the classifiers. Similarly, the J48 algorithm generated 23 decision rules that help in developing an early warning system to implement better prevention and control efforts in the management of filariasis.
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Affiliation(s)
- Phani Krishna Kondeti
- Bioinformatics Group, Department of Applied Biology, CSIR-Indian Institute of Chemical Technology, Hyderabad-500 007, Andhra Pradesh, India
| | - Kumar Ravi
- Centre for Excellence in Analytics, Institute for Development and Research in Banking Technology, Hyderabad-500 057, Telangana, India
| | - Srinivasa Rao Mutheneni
- Bioinformatics Group, Department of Applied Biology, CSIR-Indian Institute of Chemical Technology, Hyderabad-500 007, Andhra Pradesh, India
| | - Madhusudhan Rao Kadiri
- Bioinformatics Group, Department of Applied Biology, CSIR-Indian Institute of Chemical Technology, Hyderabad-500 007, Andhra Pradesh, India
| | - Sriram Kumaraswamy
- Bioinformatics Group, Department of Applied Biology, CSIR-Indian Institute of Chemical Technology, Hyderabad-500 007, Andhra Pradesh, India
| | - Ravi Vadlamani
- Centre for Excellence in Analytics, Institute for Development and Research in Banking Technology, Hyderabad-500 057, Telangana, India
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13
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Addiss DG, Amon JJ. Apology and Unintended Harm in Global Health. Health Hum Rights 2019; 21:19-32. [PMID: 31239611 PMCID: PMC6586980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Over the past few decades, investments in global health programs have contributed to massive advances in health for human populations. As with clinical medicine, however, global health interventions sometimes result in unintended harm, economic adversity, or social disruption. In clinical medicine, when medical error occurs, it is increasingly common for health care workers to offer apology, which involves acknowledging the error, taking responsibility for it, and expressing genuine remorse. In addition, hospitals are beginning to offer affected patients and their families reparation or compensation in an attempt to restore patients' health and repair relationships, as well as take steps to prevent similar harm in the future. By contrast, little is known about apology and reparation for unintentional harm in global health practice. Several factors, including the scale of global health programs, diffusion of responsibility across international networks of state and non-state actors, and concern that acknowledging harm could threaten otherwise successful health programs, render apology and reparation in global health more difficult than in clinical medicine. This article examines how and when individuals and global health organizations address inadvertent harm, illustrated by four case studies. It also describes ethical, legal, and human rights principles that could inform a more systematic approach. Addressing unintended harm in global health requires further attention at the individual, organizational, and global levels.
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Affiliation(s)
- David G. Addiss
- Director of the Focus Area for Compassion and Ethics at the Task Force for Global Health, Decatur, USA
| | - Joseph J. Amon
- Director of global health and clinical professor at Dornsife School of Public Health, Drexel University, Philadelphia, USA
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14
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Sutherland CS, Tediosi F. Is the elimination of 'sleeping sickness' affordable? Who will pay the price? Assessing the financial burden for the elimination of human African trypanosomiasis Trypanosoma brucei gambiense in sub-Saharan Africa. BMJ Glob Health 2019; 4:e001173. [PMID: 31139437 PMCID: PMC6509604 DOI: 10.1136/bmjgh-2018-001173] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 03/07/2019] [Accepted: 03/09/2019] [Indexed: 12/11/2022] Open
Abstract
Introduction Programme to eliminate neglected tropical diseases (NTDs) have gained global recognition, and may allow for improvements to universal health coverage and poverty alleviation. It is hoped that elimination of human African trypanosomiasis (HAT) Trypanosoma brucei gambiense (Tbg) would assist in this goal, but the financial costs are still unknown. The objective of this analysis was to forecast the financial burden of direct costs of HAT Tbg to funders and society. Methods In order to estimate the total costs to health services and individuals: (1) potential elimination programmes were defined; (2) the direct costs of programmes were calculated; (3) the per case out-of-pocket payments (OOPs) by programme and financial risk protection indicators were estimated. The total estimated costs for control and elimination programme were reported up till 2020 in international dollars. The mean results for both direct programme costs and OOPs were calculated and reported along with 95% CIs. Results Across sub-Saharan Africa, HAT Tbg maintaining ‘Control’ would lead to a decline in cases and cost US$630.6 million. In comparison, the cost of ‘Elimination’ programme ranged from US$410.9 million to US$1.2 billion. Maintaining ‘Control’ would continue to cause impoverishment and financial hardship to households; while all ‘Elimination’ programme would lead to significant reductions in poverty. Conclusion Overall, the total costs of either control or elimination programme would be near US$1 billion in the next decade. However, only elimination programme will reduce the number of cases and improve financial risk protection for households who are impacted by HAT Tbg.
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Affiliation(s)
- C Simone Sutherland
- Institute of Pharmaceutical Medicine, Universitat Basel Medizinische Fakultat, Basel, Switzerland.,Department of Epidemiology and Public Health (EPH), Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Fabrizio Tediosi
- Department of Epidemiology and Public Health (EPH), Swiss Tropical and Public Health Institute, Basel, Switzerland.,Department of Public Health, University of Basel, Basel, Switzerland
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15
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Pratt B, Sheehan M, Barsdorf N, Hyder AA. Exploring the ethics of global health research priority-setting. BMC Med Ethics 2018; 19:94. [PMID: 30522485 PMCID: PMC6282311 DOI: 10.1186/s12910-018-0333-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 11/20/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Thus far, little work in bioethics has specifically focused on global health research priority-setting. Yet features of global health research priority-setting raise ethical considerations and concerns related to health justice. For example, such processes are often exclusively disease-driven, meaning they rely heavily on burden of disease considerations. They, therefore, tend to undervalue non-biomedical research topics, which have been identified as essential to helping reduce health disparities. In recognition of these ethical concerns and the limited scholarship and dialogue addressing them, we convened an international workshop in September 2015. The workshop aimed to initiate discussion on the appropriate relationship between global and national levels of health research priority-setting and to begin exploring what might be ethically required for priority-setting at each of those levels. MAIN TEXT This paper comprises our reflections following the workshop. Its main objective is to launch a research agenda for the ethics of global health research priority-setting. We identify three domains of global health research priority-setting-scope, underlying values and substantive requirements, and procedural considerations. For each domain, specific research questions are highlighted and why they need to be explored is explained. Some preliminary thoughts and normative arguments as to how the research questions might be answered are also offered. For example, we provide initial ideas about the appropriate relationship between different priority-setting levels and what values and substantive considerations should guide or underpin global health research priority-setting as a matter of justice. CONCLUSION We anticipate that framing a new research agenda for the ethics of global health research priority-setting will spur ethicists, researchers, and policymakers to refocus their efforts on developing more rigorous and ethically sound approaches to priority-setting.
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Affiliation(s)
- Bridget Pratt
- Nossal Institute for Global Health and Centre for Health Equity, School of Population and Global Health, University of Melbourne, 207 Bouverie St Street, Carlton, VIC 3053 Australia
| | - Mark Sheehan
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nicola Barsdorf
- Health Research Ethics, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Adnan A. Hyder
- Milken Institute School of Public Health, George Washington University, Washington, USA
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Merritt MW, Sutherland CS, Tediosi F. Ethical Considerations for Global Health Decision-Making: Justice-Enhanced Cost-Effectiveness Analysis of New Technologies for Trypanosoma brucei gambiense. Public Health Ethics 2018; 11:275-292. [PMID: 30429873 PMCID: PMC6225893 DOI: 10.1093/phe/phy013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
We sought to assess formally the extent to which different control and elimination strategies for human African trypanosomiasis Trypanosoma brucei gambiense (Gambiense HAT) would exacerbate or alleviate experiences of societal disadvantage that traditional economic evaluation does not take into account. Justice-enhanced cost-effectiveness analysis (JE-CEA) is a normative approach under development to address social justice considerations in public health decision-making alongside other types of analyses. It aims to assess how public health interventions under analysis in comparative evaluation would be expected to influence the clustering of disadvantage across three core dimensions of well-being: agency, association and respect. As a case study to test the approach, we applied it to five strategies for Gambiense HAT control and elimination, in combination with two different other evaluations: a cost-effectiveness analysis and a probability of elimination analysis. We have demonstrated how JE-CEA highlights the ethical importance of adverse social justice impacts of otherwise attractive options and how it indicates specific modifications to policy options to mitigate such impacts. JE-CEA holds promise as an approach to help decision makers and other stakeholders consider social justice more fully, explicitly and systematically in evaluating public health programs.
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Affiliation(s)
- Maria W Merritt
- Johns Hopkins Berman Institute of Bioethics and Department of International Health, Johns Hopkins Bloomberg School of Public Health
| | | | - Fabrizio Tediosi
- Swiss Tropical and Public Health Institute and Universität Basel
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Affiliation(s)
- Michael J. DiStefano
- The author is with the Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, and the Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD
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Zwerling A, Dowdy D, von Delft A, Taylor H, Merritt MW. Incorporating social justice and stigma in cost-effectiveness analysis: drug-resistant tuberculosis treatment. Int J Tuberc Lung Dis 2018; 21:69-74. [PMID: 29025487 DOI: 10.5588/ijtld.16.0839] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Novel therapies for multidrug-resistant tuberculosis (MDR-TB) are likely to be expensive. The cost of novel drugs (e.g., bedaquiline, delamanid) may be so prohibitively high that a traditional cost-effectiveness analysis (CEA) would rate regimens containing these drugs as not cost-effective. Traditional CEA may not appropriately account for considerations of social justice, and may put the most disadvantaged populations at greater risk. Using the example of novel drug regimens for MDR-TB, we propose a novel methodology, 'justice-enhanced CEA', and demonstrate how such an approach can simultaneously assess social justice impacts alongside traditional cost-effectiveness ratios. Justice-enhanced CEA, as we envision it, is performed in three steps: 1) systematic data collection about patients' lived experiences, 2) use of empirical findings to inform social justice assessments, and 3) incorporation of data-informed social justice assessments into a decision analytic framework that includes traditional CEA. These components are organized around a core framework of social justice developed by Bailey et al. to compare impacts on disadvantage not otherwise captured by CEA. Formal social justice assessments can produce three composite levels: 'expected not to worsen…', 'may worsen…', and 'expected to worsen clustering of disadvantage'. Levels of social justice impact would be assessed for each major type of outcome under each policy scenario compared. Social justice assessments are then overlaid side-by-side with cost-effectiveness assessments corresponding to each branch pathway on the decision tree. In conclusion, we present a 'justice-enhanced' framework that enables the incorporation of social justice concerns into traditional CEA for the evaluation of new regimens for MDR-TB.
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Affiliation(s)
- A Zwerling
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - D Dowdy
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - A von Delft
- TB Proof, Cape Town, South Africa, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - H Taylor
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, USA
| | - M W Merritt
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, USA
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Pratt B, Hyder AA. Ethical responsibilities of health research funders to advance global health justice. Glob Public Health 2018; 14:80-90. [PMID: 29724152 DOI: 10.1080/17441692.2018.1471148] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Research funders from high-income countries have an ethical obligation to support health research in low and middle-income countries that promotes justice in global health. Conceptual work from bioethics proposes funders should do so through their design of grants programs, investments, and grants management. That work has begun to specify the content of funders' ethical responsibility with regards to health systems research, but it has thus far not been informed by their practice. As a first step to bridge that gap, this paper focuses on health systems research funders' design of grants programs. It aims to test the content of funders' proposed ethical responsibility against recent empirical work describing how they design their health systems research grants programs to help address global health disparities. Based on that analysis, recommendations are made for how to better articulate the content of health systems research funders' obligation. Such recommendations may be pertinent to funders of other types of international research. The paper also provides an initial picture of how well health systems research grants programs' designs may align with the ideals of global health justice.
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Affiliation(s)
- Bridget Pratt
- a Nossal Institute for Global Health and Centre for Health Equity, School of Population and Global Health , University of Melbourne , Melbourne , Australia.,b Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Adnan A Hyder
- b Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.,c Johns Hopkins Berman Institute of Bioethics , Baltimore , MD , USA
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Dukhanin V, Searle A, Zwerling A, Dowdy DW, Taylor HA, Merritt MW. Integrating social justice concerns into economic evaluation for healthcare and public health: A systematic review. Soc Sci Med 2018; 198:27-35. [PMID: 29274616 PMCID: PMC6545595 DOI: 10.1016/j.socscimed.2017.12.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 12/06/2017] [Accepted: 12/11/2017] [Indexed: 11/21/2022]
Abstract
Social justice is the moral imperative to avoid and remediate unfair distributions of societal disadvantage. In priority setting in healthcare and public health, social justice reaches beyond fairness in the distribution of health outcomes and economic impacts to encompass fairness in the distribution of policy impacts upon other dimensions of well-being. There is an emerging awareness of the need for economic evaluation to integrate all such concerns. We performed a systematic review (1) to describe methodological solutions suitable for integrating social justice concerns into economic evaluation, and (2) to describe the challenges that those solutions face. To be included, publications must have captured fairness considerations that (a) involve cross-dimensional subjective personal life experience and (b) can be manifested at the level of subpopulations. We identified relevant publications using an electronic search in EMBASE, PubMed, EconLit, PsycInfo, Philosopher's Index, and Scopus, including publications available in English in the past 20 years. Two reviewers independently appraised candidate publications, extracted data, and synthesized findings in narrative form. Out of 2388 publications reviewed, 26 were included. Solutions sought either to incorporate relevant fairness considerations directly into economic evaluation or to report them alongside cost-effectiveness measures. The majority of reviewed solutions, if adapted to integrate social justice concerns, would require their explicit quantification. Four broad challenges related to the implementation of these solutions were identified: clarifying the normative basis; measuring and determining the relative importance of criteria representing that basis; combining the criteria; and evaluating trade-offs. All included solutions must grapple with an inherent tension: they must either face the normative and operational challenges of quantifying social justice concerns or accede to offering incomplete policy guidance. Interdisciplinary research and broader collaborations are crucial to address these challenges and to support due attention to social justice in priority setting.
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Affiliation(s)
- Vadim Dukhanin
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alexandra Searle
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alice Zwerling
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; School of Epidemiology, Public Health & Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
| | - David W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Holly A Taylor
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA
| | - Maria W Merritt
- Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Kastner RJ, Sicuri E, Stone CM, Matwale G, Onapa A, Tediosi F. How much will it cost to eradicate lymphatic filariasis? An analysis of the financial and economic costs of intensified efforts against lymphatic filariasis. PLoS Negl Trop Dis 2017; 11:e0005934. [PMID: 28949987 PMCID: PMC5630187 DOI: 10.1371/journal.pntd.0005934] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Revised: 10/06/2017] [Accepted: 09/05/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Lymphatic filariasis (LF), a neglected tropical disease (NTD) preventable through mass drug administration (MDA), is one of six diseases deemed possibly eradicable. Previously we developed one LF elimination scenario, which assumes MDA scale-up to continue in all countries that have previously undertaken MDA. In contrast, our three previously developed eradication scenarios assume all LF endemic countries will undertake MDA at an average (eradication I), fast (eradication II), or instantaneous (eradication III) rate of scale-up. In this analysis we use a micro-costing model to project the financial and economic costs of each of these scenarios in order to provide evidence to decision makers about the investment required to eliminate and eradicate LF. METHODOLOGY/KEY FINDINGS Costing was undertaken from a health system perspective, with all results expressed in 2012 US dollars (USD). A discount rate of 3% was applied to calculate the net present value of future costs. Prospective NTD budgets from LF endemic countries were reviewed to preliminarily determine activities and resources necessary to undertake a program to eliminate LF at a country level. In consultation with LF program experts, activities and resources were further reviewed and a refined list of activities and necessary resources, along with their associated quantities and costs, were determined and grouped into the following activities: advocacy and communication, capacity strengthening, coordination and strengthening partnerships, data management, ongoing surveillance, monitoring and supervision, drug delivery, and administration. The costs of mapping and undertaking transmission assessment surveys and the value of donated drugs and volunteer time were also accounted for. Using previously developed scenarios and deterministic estimates of MDA duration, the financial and economic costs of interrupting LF transmission under varying rates of MDA scale-up were then modelled using a micro-costing approach. The elimination scenario, which includes countries that previously undertook MDA, is estimated to cost 929 million USD (95% Credible Interval: 884m-972m). Proceeding to eradication is anticipated to require a higher financial investment, estimated at 1.24 billion USD (1.17bn-1.30bn) in the eradication III scenario (immediate scale-up), with eradication II (intensified scale-up) projected at 1.27 billion USD (1.21bn-1.33bn), and eradication I (slow scale-up) estimated at 1.29 billion USD (1.23bn-1.34bn). The economic costs of the eradication III scenario are estimated at approximately 7.57 billion USD (7.12bn-7.94bn), while the elimination scenario is projected to have an economic cost of 5.21 billion USD (4.91bn-5.45bn). Countries in the AFRO region will require the greatest investment to reach elimination or eradication, but also stand to gain the most in cost savings. Across all scenarios, capacity strengthening and advocacy and communication represent the greatest financial costs, whereas mapping, post-MDA surveillance, and administration comprise the least. CONCLUSIONS/SIGNIFICANCE Though challenging to implement, our results indicate that financial and economic savings are greatest under the eradication III scenario. Thus, if eradication for LF is the objective, accelerated scale-up is projected to be the best investment.
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Affiliation(s)
- Randee J. Kastner
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Elisa Sicuri
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Christopher M. Stone
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Gabriel Matwale
- Vector Control Division, Ministry of Health, Kampala, Uganda
| | | | - Fabrizio Tediosi
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Steinmann P, Reed SG, Mirza F, Hollingsworth TD, Richardus JH. Innovative tools and approaches to end the transmission of Mycobacterium leprae. THE LANCET. INFECTIOUS DISEASES 2017; 17:e298-e305. [DOI: 10.1016/s1473-3099(17)30314-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 03/26/2017] [Accepted: 04/06/2017] [Indexed: 12/23/2022]
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Krubiner CB, Merritt MW. Which strings attached: ethical considerations for selecting appropriate conditionalities in conditional cash transfer programmes. JOURNAL OF MEDICAL ETHICS 2017; 43:167-176. [PMID: 27707877 DOI: 10.1136/medethics-2016-103386] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 08/16/2016] [Accepted: 09/14/2016] [Indexed: 06/06/2023]
Abstract
Conditional cash transfers (CCTs) present a promising approach to simultaneously tackle chronic poverty and poor health. While these programmes clearly embody beneficent aims, questions remain regarding the ethical design of CCTs. Limited guidance exists for the ethical evaluation of the defining feature of these programmes: the conditionalities. Drawing upon prominent public health ethics frameworks and social justice theories, this paper outlines five categories of morally relevant considerations that CCT programme designers should consider when assessing which behaviours or outcomes they select as conditionalities for payment: (1) likelihood of yielding desired health outcomes, (2) risks and burdens, (3) receptivity, (4) attainability and (5) indirect impacts and externalities. When evaluating potential conditionalities across these five categories of considerations, it is important to recognise that not all beneficiaries or subgroups of beneficiaries will fare equally on each. Given that most CCTs aim to reduce inequities and promote long-term health and prosperity for the most disadvantaged, it is critical to apply these considerations with due attention to how different segments of the beneficiary population will be differentially affected. Taken on balance, with due reflection on distributional effects, these five categories represent a comprehensive set of considerations for the moral analysis of specific conditionalities and will help ensure that CCT designers structure programmes in a way that is both morally sound and effective in achieving their goals.
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Affiliation(s)
| | - Maria W Merritt
- Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, USA
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Abstract
BACKGROUND Health systems research is increasingly being conducted in low and middle-income countries (LMICs). Such research should aim to reduce health disparities between and within countries as a matter of global justice. For such research to do so, ethical guidance that is consistent with egalitarian theories of social justice proposes it ought to (amongst other things) focus on worst-off countries and research populations. Yet who constitutes the worst-off is not well-defined. METHODS AND RESULTS By applying existing work on disadvantage from political philosophy, the paper demonstrates that (at least) two options exist for how to define the worst-off upon whom equity-oriented health systems research should focus: those who are worst-off in terms of health or those who are systematically disadvantaged. The paper describes in detail how both concepts can be understood and what metrics can be relied upon to identify worst-off countries and research populations at the sub-national level (groups, communities). To demonstrate how each can be used, the paper considers two real-world cases of health systems research and whether their choice of country (Uganda, India) and research population in 2011 would have been classified as amongst the worst-off according to the proposed concepts. CONCLUSIONS The two proposed concepts can classify different countries and sub-national populations as worst-off. It is recommended that health researchers (or other actors) should use the concept that best reflects their moral commitments-namely, to perform research focused on reducing health inequalities or systematic disadvantage more broadly. If addressing the latter, it is recommended that they rely on the multidimensional poverty approach rather than the income approach to identify worst-off populations.
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Affiliation(s)
- Bridget Pratt
- Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, 161 Barry Street Carlton, VIC 3053 Australia
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205 USA
| | - Adnan A. Hyder
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205 USA
- Johns Hopkins Berman Institute of Bioethics, 1809 Ashland Avenue, Baltimore, MD 21205 USA
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Lessons Learned From Developing an Eradication Investment Case for Lymphatic Filariasis. ADVANCES IN PARASITOLOGY 2016; 94:393-417. [PMID: 27756458 DOI: 10.1016/bs.apar.2016.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In the last few years, the concepts of disease elimination and eradication have again gained consideration from the global health community, with Guinea worm disease (dracunculiasis) on track to become the first parasitic disease to be eradicated. Given the many complex and interlinking issues involved in committing to a disease eradication initiative, such commitments must be based on a solid assessment of a broad range of factors. In this chapter, we discuss the value and implications of undertaking a systematic and fact-based analysis of the overall situation prior to embarking on an elimination or eradication programme. As an example, we draw upon insights gained from a series of lymphatic filariasis (LF) studies from our research group that adopted an eradication investment case (EIC) framework. The justification for EICs, and related epidemiological, geospatial and other mathematical/operational research modelling, stems from the necessity for proper planning prior to committing to disease eradication. Across all considerations for LF eradication, including: time, treatments, level of investments necessary, health impact, cost-effectiveness, and broader economic benefits, scaling-up mass drug administration coverage to all endemic communities immediately provided the most favourable results. The coherent and consistent pursuit of eradication goals, operationally tailored to a given socioecological system and based on integrated measures of available tools will lead relatively rapidly to elimination in many parts of endemic areas and provide the cornerstone towards eradication.
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Stone CM, Kastner R, Steinmann P, Chitnis N, Tanner M, Tediosi F. Modelling the health impact and cost-effectiveness of lymphatic filariasis eradication under varying levels of mass drug administration scale-up and geographic coverage. BMJ Glob Health 2016; 1:e000021. [PMID: 28588916 PMCID: PMC5321305 DOI: 10.1136/bmjgh-2015-000021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 01/15/2016] [Accepted: 01/21/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND A global programme to eliminate lymphatic filariasis (GPELF) is underway, yet two key programmatic features are currently still lacking: (1) the extension of efforts to all lymphatic filariasis (LF) endemic countries, and (2) the expansion of geographic coverage of mass drug administration (MDA) within countries. For varying levels of scale-up of MDA, we assessed the health benefits and the incremental cost-effectiveness ratios (ICERs) associated with LF eradication, projected the potential savings due to decreased morbidity management needs, and estimated potential household productivity gains as a result of reduced LF-related morbidity. METHODS We extended an LF transmission model to track hydrocele and lymphoedema incidence in order to obtain estimates of the disability adjusted life years (DALYs) averted due to scaling up MDA over a period of 50 years. We then estimated the ICERs and the cost-effectiveness acceptability curves associated with different rates of MDA scale-up. Health systems savings were estimated by considering the averted morbidity, treatment-seeking behaviour and morbidity management costs. Gains in worker productivity were estimated by multiplying estimated working days lost as a result of morbidity with country-specific per-worker agricultural wages. RESULTS Our projections indicate that a massive scaling-up of MDA could lead to 4.38 million incremental DALYs averted over a 50-year time horizon compared to a scenario which mirrors current efforts against LF. In comparison to maintaining the current rate of progress against LF, massive scaling-up of MDA-pursuing LF eradication as soon as possible-was most likely to be cost-effective above a willingness to pay threshold of US$71.5/DALY averted. Intensified MDA scale-up was also associated with lower ICERs. Furthermore, this could result in health systems savings up to US$483 million. Extending coverage to all endemic areas could generate additional economic benefits through gains in worker productivity between US$3.4 and US$14.4 billion. CONCLUSIONS In addition to ethical and political motivations for scaling-up MDA rapidly, this analysis provides economic support for increasing the intensity of MDA programmes.
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Affiliation(s)
- Christopher M Stone
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- Universität Basel, Basel, Switzerland
- Department of Statistics, North Carolina State University, Raleigh, North Carolina, USA
| | - Randee Kastner
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- Universität Basel, Basel, Switzerland
| | - Peter Steinmann
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- Universität Basel, Basel, Switzerland
| | - Nakul Chitnis
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- Universität Basel, Basel, Switzerland
| | - Marcel Tanner
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- Universität Basel, Basel, Switzerland
| | - Fabrizio Tediosi
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- Universität Basel, Basel, Switzerland
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Basáñez M, Walker M, Turner H, Coffeng L, de Vlas S, Stolk W. River Blindness: Mathematical Models for Control and Elimination. ADVANCES IN PARASITOLOGY 2016; 94:247-341. [PMID: 27756456 DOI: 10.1016/bs.apar.2016.08.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Human onchocerciasis (river blindness) is one of the few neglected tropical diseases (NTDs) whose control strategies have been informed by mathematical modelling. With the change in focus from elimination of the disease burden to elimination of Onchocerca volvulus, much remains to be done to refine, calibrate and validate existing models. Under the impetus of the NTD Modelling Consortium, the teams that developed EPIONCHO and ONCHOSIM have joined forces to compare and improve these frameworks to better assist ongoing elimination efforts. We review their current versions and describe how they are being used to address two key questions: (1) where can onchocerciasis be eliminated with current intervention strategies by 2020/2025? and (2) what alternative/complementary strategies could help to accelerate elimination where (1) cannot be achieved? The control and elimination of onchocerciasis from the African continent is at a crucial crossroad. The African Programme for Onchocerciasis Control closed at the end of 2015, and although a new platform for support and integration of NTD control has been launched, the disease will have to compete with a myriad of other national health priorities at a pivotal time in the road to elimination. However, never before had onchocerciasis control a better arsenal of intervention strategies as well as diagnostics. It is, therefore, timely to present two models of different geneses and modelling traditions as they come together to produce robust decision-support tools. We start by describing the structural and parametric assumptions of EPIONCHO and ONCHOSIM; we continue by summarizing the modelling of current treatment strategies with annual (or biannual) mass ivermectin distribution and introduce a number of alternative strategies, including other microfilaricidal therapies (such as moxidectin), macrofilaricidal (anti-wolbachial) treatments, focal vector control and the possibility of an onchocerciasis vaccine. We conclude by discussing challenges, opportunities and future directions.
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Financial and Economic Costs of the Elimination and Eradication of Onchocerciasis (River Blindness) in Africa. PLoS Negl Trop Dis 2015; 9:e0004056. [PMID: 26360917 PMCID: PMC4567329 DOI: 10.1371/journal.pntd.0004056] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 08/14/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Onchocerciasis (river blindness) is a parasitic disease transmitted by blackflies. Symptoms include severe itching, skin lesions, and vision impairment including blindness. More than 99% of all cases are concentrated in sub-Saharan Africa. Fortunately, vector control and community-directed treatment with ivermectin have significantly decreased morbidity, and the treatment goal is shifting from control to elimination in Africa. METHODS We estimated financial resources and societal opportunity costs associated with scaling up community-directed treatment with ivermectin and implementing surveillance and response systems in endemic African regions for alternative treatment goals--control, elimination, and eradication. We used a micro-costing approach that allows adjustment for time-variant resource utilization and for the heterogeneity in the demographic, epidemiological, and political situation. RESULTS The elimination and eradication scenarios, which include scaling up treatments to hypo-endemic and operationally challenging areas at the latest by 2021 and implementing intensive surveillance, would allow savings of $1.5 billion and $1.6 billion over 2013-2045 as compared to the control scenario. Although the elimination and eradication scenarios would require higher surveillance costs ($215 million and $242 million) than the control scenario ($47 million), intensive surveillance would enable treatments to be safely stopped earlier, thereby saving unnecessary costs for prolonged treatments as in the control scenario lacking such surveillance and response systems. CONCLUSIONS The elimination and eradication of onchocerciasis are predicted to allow substantial cost-savings in the long run. To realize cost-savings, policymakers should keep empowering community volunteers, and pharmaceutical companies would need to continue drug donation. To sustain high surveillance costs required for elimination and eradication, endemic countries would need to enhance their domestic funding capacity. Societal and political will would be critical to sustaining all of these efforts in the long term.
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