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Sawers L, Wallon M, Mandelbrot L, Villena I, Stillwaggon E, Kieffer F. Prevention of congenital toxoplasmosis in France using prenatal screening: A decision-analytic economic model. PLoS One 2022; 17:e0273781. [PMID: 36331943 PMCID: PMC9635746 DOI: 10.1371/journal.pone.0273781] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 08/15/2022] [Indexed: 11/06/2022] Open
Abstract
Background Toxoplasma gondii is one of the world’s most common parasites. Primary infection of the mother during pregnancy can lead to transmission to the fetus with risks of brain and eye lesions, which may cause lifelong disabilities. France instituted a national program based on monthly retesting of susceptible pregnant women to reduce the number of severe cases through prompt antenatal and postnatal treatment and follow-up. Objective To evaluate the ability of the French prenatal retesting program to reduce the lifetime costs of congenital toxoplasmosis. Methods We measured and then compared the costs and benefits of screening vs. not screening using decision-tree modelling. It included direct and indirect costs to society of treatment and care, and the lifetime lost earnings of children and caregivers. A probabilistic sensitivity analysis was carried out. Findings Total lifetime costs per live born child identified as congenitally infected were estimated to be €444 for those identified through prenatal screening vs €656 for those who were not screened. Estimates were robust to changes in all costs of diagnosis, treatment, and sequelae. Interpretation Screening for the prevention of the congenital T. gondii infection in France is cost saving at €212 per birth. Compared with no screening, screening every pregnant woman in France for toxoplasmosis in 2020 would have saved the country €148 million in addition to reducing or eliminating the devastating physical and emotional suffering caused by T. gondii. Our findings reinforce the conclusions of other decision-analytic modelling of prenatal toxoplasmosis screening.
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Affiliation(s)
- Larry Sawers
- Department of Economics, American University, Washington, D.C., United States of America
| | - Martine Wallon
- Department of Parasitology and Medical Mycology, Hospices Civils de Lyon, Lyon, France
- Walking Team, Centre for Research in Neuroscience, Lyon, Bron, France
| | - Laurent Mandelbrot
- Obstetrics and Gynecology Department, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes, France
- Université de Paris, Paris, France
- INSERM, IAME, UMR 1137, Paris, France
| | - Isabelle Villena
- Department of Parasitology and Medical Mycology, National Reference Centre on Toxoplasmosis, Hôpital Reims, Reims, France
- Team EA 7510, SFR CAP-SANTE, University of Reims Champagne Ardenne, Reims, France
| | - Eileen Stillwaggon
- National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - François Kieffer
- Department of Neonatology, Hôpital Armand Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
- * E-mail:
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2
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Felín MS, Wang K, Raggi C, Moreira A, Pandey A, Grose A, Caballero Z, Rengifo-Herrera C, Ramirez M, Moossazadeh D, Castro C, Montalvo JLS, Leahy K, Zhou Y, Clouser FA, Siddiqui M, Leong N, Goodall P, Michalowski M, Ismail M, Christmas M, Schrantz S, Norero X, Estripeaut D, Ellis D, Ashi K, Dovgin S, Dixon A, Li X, Begeman I, Heichman S, Lykins J, Villalobos-Cerrud D, Fabrega L, Mendivil C, Quijada MR, Fernández-Pirla S, de La Guardia V, Wong D, de LadrónGuevara M, Flores C, Borace J, García A, Caballero N, de Saez MTM, Politis M, Ross S, Dogra M, Dhamsania V, Graves N, Kirchberg M, Mathur K, Aue A, Restrepo CM, Llanes A, Guzman G, Rebollon A, Boyer K, Heydemann P, Noble AG, Swisher C, Rabiah P, Withers S, Hull T, Su C, Blair M, Latkany P, Mui E, Vasconcelos-Santos DV, Villareal A, Perez A, Galvis CAN, Montes MV, Perez NIC, Ramirez M, Chittenden C, Wang E, Garcia-López LL, Muñoz-Ortiz J, Rivera-Valdivia N, Bohorquez-Granados MC, de-la-Torre GC, Padrieu G, Hernandez JDV, Celis-Giraldo D, Acosta Dávila JA, Torres E, Oquendo MM, Arteaga-Rivera JY, Nicolae D, Rzhetsky A, Roizen N, Stillwaggon E, Sawers L, Peyron F, Wallon M, Chapey E, Levigne P, Charter C, De Frias M, Montoya J, Press C, Ramirez R, Contopoulos-Ioannidis D, Maldonado Y, Liesenfeld O, Gomez C, Wheeler K, Holfels E, Frim D, McLone D, Penn R, Cohen W, Zehar S, McAuley J, Limonne D, Houze S, Abraham S, Piarroux R, Tesic V, Beavis K, Abeleda A, Sautter M, El Mansouri B, El Bachir A, Amarir F, El Bissati K, de-la-Torre A, Britton G, Motta J, Ortega-Barria E, Romero IL, Meier P, Grigg M, Gómez-Marín J, Kosagisharaf JR, Llorens XS, Reyes O, McLeod R. Building Programs to Eradicate Toxoplasmosis Part III: Epidemiology and Risk Factors. Curr Pediatr Rep 2022; 10:109-124. [PMID: 37744780 PMCID: PMC10516319 DOI: 10.1007/s40124-022-00265-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 11/25/2022]
Abstract
Purpose of Review Review comprehensive data on rates of toxoplasmosis in Panama and Colombia. Recent Findings Samples and data sets from Panama and Colombia, that facilitated estimates regarding seroprevalence of antibodies to Toxoplasma and risk factors, were reviewed. Summary Screening maps, seroprevalence maps, and risk factor mathematical models were devised based on these data. Studies in Ciudad de Panamá estimated seroprevalence at between 22 and 44%. Consistent relationships were found between higher prevalence rates and factors such as poverty and proximity to water sources. Prenatal screening rates for anti-Toxoplasma antibodies were variable, despite existence of a screening law. Heat maps showed a correlation between proximity to bodies of water and overall Toxoplasma seroprevalence. Spatial epidemiological maps and mathematical models identify specific regions that could most benefit from comprehensive, preventive healthcare campaigns related to congenital toxoplasmosis and Toxoplasma infection.
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Affiliation(s)
| | - Kanix Wang
- Institute for Genomics and Systems Biology, The University
of Chicago, Chicago, IL, USA
| | - Catalina Raggi
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
- Instituto de Investigaciones Científicas Y Servicios
de Alta Tecnología AIP (INDICASAT-AIP), Ciudad de Panamá, Panama
- Department of Pediatrics Infectious Diseases/Department of
Neonatology, Hospital del Niño Doctor José Renán Esquivel,
Ciudad de Panamá, Panama
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
- The College, The University of Chicago, Chicago, IL,
USA
- The Global Health Center, The University of Chicago,
Chicago, IL, USA
| | - Aliya Moreira
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
- The College, The University of Chicago, Chicago, IL,
USA
- The Global Health Center, The University of Chicago,
Chicago, IL, USA
| | - Abhinav Pandey
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
- The College, The University of Chicago, Chicago, IL,
USA
- The Global Health Center, The University of Chicago,
Chicago, IL, USA
| | - Andrew Grose
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
| | - Zuleima Caballero
- Instituto de Investigaciones Científicas Y Servicios
de Alta Tecnología AIP (INDICASAT-AIP), Ciudad de Panamá, Panama
| | | | - Margarita Ramirez
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
- The College, The University of Chicago, Chicago, IL,
USA
- The Global Health Center, The University of Chicago,
Chicago, IL, USA
| | - Davina Moossazadeh
- The College, The University of Chicago, Chicago, IL,
USA
- The Global Health Center, The University of Chicago,
Chicago, IL, USA
- Department of Statistics, The University of Chicago,
Chicago, IL, USA
| | - Catherine Castro
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
| | - José Luis Sanchez Montalvo
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
- The College, The University of Chicago, Chicago, IL,
USA
| | - Karen Leahy
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
| | - Ying Zhou
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
| | | | - Maryam Siddiqui
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
| | - Nicole Leong
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
| | - Perpetua Goodall
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
| | - Morgan Michalowski
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
| | - Mahmoud Ismail
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
| | - Monica Christmas
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
| | - Stephen Schrantz
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
| | - Ximena Norero
- Department of Pediatrics Infectious Diseases/Department of
Neonatology, Hospital del Niño Doctor José Renán Esquivel,
Ciudad de Panamá, Panama
| | - Dora Estripeaut
- Department of Pediatrics Infectious Diseases/Department of
Neonatology, Hospital del Niño Doctor José Renán Esquivel,
Ciudad de Panamá, Panama
| | - David Ellis
- Department of Pediatrics Infectious Diseases/Department of
Neonatology, Hospital del Niño Doctor José Renán Esquivel,
Ciudad de Panamá, Panama
| | - Kevin Ashi
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
| | - Samantha Dovgin
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
- The College, The University of Chicago, Chicago, IL,
USA
| | - Ashtyn Dixon
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
| | - Xuan Li
- Rush University Medical School/Rush University Medical
Center, Chicago, IL, USA
| | - Ian Begeman
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
| | - Sharon Heichman
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
| | - Joseph Lykins
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
| | - Delba Villalobos-Cerrud
- Instituto de Investigaciones Científicas Y Servicios
de Alta Tecnología AIP (INDICASAT-AIP), Ciudad de Panamá, Panama
| | - Lorena Fabrega
- Instituto de Investigaciones Científicas Y Servicios
de Alta Tecnología AIP (INDICASAT-AIP), Ciudad de Panamá, Panama
| | - Connie Mendivil
- Instituto de Investigaciones Científicas Y Servicios
de Alta Tecnología AIP (INDICASAT-AIP), Ciudad de Panamá, Panama
| | - Mario R. Quijada
- Instituto de Investigaciones Científicas Y Servicios
de Alta Tecnología AIP (INDICASAT-AIP), Ciudad de Panamá, Panama
| | - Silvia Fernández-Pirla
- Toxoplasmosis Programs and Initiatives in Panamá,
Ciudad de Panamá, Panama
- Academia Interamericana de Panamá, Ciudad de
Panamá, Panama
| | - Valli de La Guardia
- Instituto de Investigaciones Científicas Y Servicios
de Alta Tecnología AIP (INDICASAT-AIP), Ciudad de Panamá, Panama
| | - Digna Wong
- Instituto de Investigaciones Científicas Y Servicios
de Alta Tecnología AIP (INDICASAT-AIP), Ciudad de Panamá, Panama
| | - Mayrene de LadrónGuevara
- Instituto de Investigaciones Científicas Y Servicios
de Alta Tecnología AIP (INDICASAT-AIP), Ciudad de Panamá, Panama
| | | | | | - Anabel García
- Instituto de Investigaciones Científicas Y Servicios
de Alta Tecnología AIP (INDICASAT-AIP), Ciudad de Panamá, Panama
| | | | - Maria Theresa Moreno de Saez
- Department of Pediatrics Infectious Diseases/Department of
Neonatology, Hospital del Niño Doctor José Renán Esquivel,
Ciudad de Panamá, Panama
| | - Michael Politis
- Toxoplasmosis Programs and Initiatives in Panamá,
Ciudad de Panamá, Panama
| | - Stephanie Ross
- Rush University Medical School/Rush University Medical
Center, Chicago, IL, USA
| | - Mimansa Dogra
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
| | - Vishan Dhamsania
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
- Capstone Program, Global Health Center, The University of
Chicago, Chicago, IL, USA
| | - Nicholas Graves
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
- Capstone Program, Global Health Center, The University of
Chicago, Chicago, IL, USA
| | - Marci Kirchberg
- Capstone Program, Global Health Center, The University of
Chicago, Chicago, IL, USA
- Harris School of Public Policy, The University of
Chicago, Chicago, IL, USA
| | - Kopal Mathur
- Capstone Program, Global Health Center, The University of
Chicago, Chicago, IL, USA
- Harris School of Public Policy, The University of
Chicago, Chicago, IL, USA
| | - Ashley Aue
- Harris School of Public Policy, The University of
Chicago, Chicago, IL, USA
| | - Carlos M. Restrepo
- Instituto de Investigaciones Científicas Y Servicios
de Alta Tecnología AIP (INDICASAT-AIP), Ciudad de Panamá, Panama
| | - Alejandro Llanes
- Instituto de Investigaciones Científicas Y Servicios
de Alta Tecnología AIP (INDICASAT-AIP), Ciudad de Panamá, Panama
| | - German Guzman
- Instituto de Investigaciones Científicas Y Servicios
de Alta Tecnología AIP (INDICASAT-AIP), Ciudad de Panamá, Panama
| | - Arturo Rebollon
- Sanofi Aventis de Panamá S.A, University of South
Florida, Ciudad de Panamá, Panama
| | - Kenneth Boyer
- Rush University Medical School/Rush University Medical
Center, Chicago, IL, USA
| | - Peter Heydemann
- Rush University Medical School/Rush University Medical
Center, Chicago, IL, USA
| | - A. Gwendolyn Noble
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
- Northwestern University Feinberg School of Medicine,
Chicago, IL, USA
| | - Charles Swisher
- Northwestern University Feinberg School of Medicine,
Chicago, IL, USA
| | | | - Shawn Withers
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
| | - Teri Hull
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
| | - Chunlei Su
- Department of Microbiology, The University of Tennessee,
Knoxville, TN, USA
| | - Michael Blair
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
| | - Paul Latkany
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
| | - Ernest Mui
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
| | | | - Alcibiades Villareal
- Instituto de Investigaciones Científicas Y Servicios
de Alta Tecnología AIP (INDICASAT-AIP), Ciudad de Panamá, Panama
| | - Ambar Perez
- Instituto de Investigaciones Científicas Y Servicios
de Alta Tecnología AIP (INDICASAT-AIP), Ciudad de Panamá, Panama
| | | | | | | | - Morgan Ramirez
- The College, The University of Chicago, Chicago, IL,
USA
| | - Cy Chittenden
- The College, The University of Chicago, Chicago, IL,
USA
| | - Edward Wang
- The College, The University of Chicago, Chicago, IL,
USA
| | | | - Juliana Muñoz-Ortiz
- Grupo de Investigación en Neurociencias,
Universidad del Rosario, Bogotá, Colombia
| | | | | | | | - Guillermo Padrieu
- The University of South Florida College of Public Health,
Tampa, FL, USA
| | | | - Daniel Celis-Giraldo
- Grupo de Investigación en Neurociencias,
Universidad del Rosario, Bogotá, Colombia
| | | | - Elizabeth Torres
- Grupo de Investigación en Neurociencias,
Universidad del Rosario, Bogotá, Colombia
| | | | | | - Dan Nicolae
- Department of Statistics, The University of Chicago,
Chicago, IL, USA
| | - Andrey Rzhetsky
- Institute for Genomics and Systems Biology, The University
of Chicago, Chicago, IL, USA
| | - Nancy Roizen
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
| | | | - Larry Sawers
- Department of Economics, American University, Washington,
D.C, USA
| | - Francois Peyron
- Institut Des Agents Infectieux, Hôpital de La
Croix-Rousse, Lyon, France
| | - Martine Wallon
- Institut Des Agents Infectieux, Hôpital de La
Croix-Rousse, Lyon, France
| | - Emanuelle Chapey
- Institut Des Agents Infectieux, Hôpital de La
Croix-Rousse, Lyon, France
| | - Pauline Levigne
- Institut Des Agents Infectieux, Hôpital de La
Croix-Rousse, Lyon, France
| | | | | | - Jose Montoya
- Remington Specialty Laboratory, Palo Alto, CA, USA
| | - Cindy Press
- Remington Specialty Laboratory, Palo Alto, CA, USA
| | | | - Despina Contopoulos-Ioannidis
- Department of Pediatrics, Division of Infectious
Diseases, Stanford University College of Medicine, Stanford, CA, USA
| | - Yvonne Maldonado
- Department of Pediatrics, Division of Infectious
Diseases, Stanford University College of Medicine, Stanford, CA, USA
| | | | - Carlos Gomez
- Department of Economics, Gettysburg College, Gettysburg,
PA, USA
| | - Kelsey Wheeler
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
| | - Ellen Holfels
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
| | - David Frim
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
| | - David McLone
- Northwestern University Feinberg School of Medicine,
Chicago, IL, USA
| | - Richard Penn
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
| | - William Cohen
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
| | - Samantha Zehar
- Northwestern University Feinberg School of Medicine,
Chicago, IL, USA
| | - James McAuley
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
| | | | - Sandrine Houze
- Laboratory of Parasitologie, Bichat-Claude Bernard
Hopital, Paris, France
| | - Sylvie Abraham
- Laboratory of Parasitologie, Bichat-Claude Bernard
Hopital, Paris, France
| | | | - Vera Tesic
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
| | - Kathleen Beavis
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
| | - Ana Abeleda
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
| | - Mari Sautter
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
| | | | | | - Fatima Amarir
- Faculty of Sciences Aïn Chok, University Hassan
II, Casablanca, Morocco
| | - Kamal El Bissati
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
- INH, Rabat, Morocco
| | | | - Gabrielle Britton
- Instituto de Investigaciones Científicas Y Servicios
de Alta Tecnología AIP (INDICASAT-AIP), Ciudad de Panamá, Panama
- Sistema Nacional de Investigadores de Panamá
(SNI), Clayton, Panama
| | - Jorge Motta
- Tecnología E Innovación (SENACYT),
Secretaría Nacional de Ciencia, Ciudad de Panamá, Panama
| | - Eduardo Ortega-Barria
- Tecnología E Innovación (SENACYT),
Secretaría Nacional de Ciencia, Ciudad de Panamá, Panama
- GSK Vaccines, Panamá, Panama
| | - Isabel Luz Romero
- Tecnología E Innovación (SENACYT),
Secretaría Nacional de Ciencia, Ciudad de Panamá, Panama
| | - Paul Meier
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
| | - Michael Grigg
- Molecular Parasitology Section Laboratory of Parasitic
Diseases, National Institutes of Health, NIAID, Bethesda, MD, USA
| | | | - Jagannatha Rao Kosagisharaf
- Instituto de Investigaciones Científicas Y Servicios
de Alta Tecnología AIP (INDICASAT-AIP), Ciudad de Panamá, Panama
| | - Xavier Sáez Llorens
- Department of Pediatrics Infectious Diseases/Department of
Neonatology, Hospital del Niño Doctor José Renán Esquivel,
Ciudad de Panamá, Panama
- Sistema Nacional de Investigadores de Panamá
(SNI), Clayton, Panama
| | - Osvaldo Reyes
- Academia Interamericana de Panamá, Ciudad de
Panamá, Panama
- Hospital Santo Tomás, Ciudad de Panamá,
Panama
- Sistema Nacional de Investigadores de Panamá
(SNI), Clayton, Panama
| | - Rima McLeod
- Toxoplasmosis Programs and Initiatives in Panamá,
Ciudad de Panamá, Panama
- Institute for Genomics and Systems Biology, The University
of Chicago, Chicago, IL, USA
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
- The College, The University of Chicago, Chicago, IL,
USA
- The Global Health Center, The University of Chicago,
Chicago, IL, USA
- Toxoplasmosis Center, The University of Chicago, and
Toxoplasmosis Research Institute, Chicago, IL, USA
- Department of Pediatrics (Infectious Diseases), The
University of Chicago, Chicago, IL, USA
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3
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Felín MS, Wang K, Moreira A, Grose A, Leahy K, Zhou Y, Clouser FA, Siddiqui M, Leong N, Goodall P, Michalowski M, Ismail M, Christmas M, Schrantz S, Caballero Z, Norero X, Estripeaut D, Ellis D, Raggi C, Castro C, Rengifo-Herrera C, Moossazadeh D, Ramirez M, Pandey A, Ashi K, Dovgin S, Dixon A, Li X, Begeman I, Heichman S, Lykins J, Villalobos-Cerrud D, Fabrega L, Montalvo JLS, Mendivil C, Quijada MR, Fernández-Pirla S, de La Guardia V, Wong D, de Guevara ML, Flores C, Borace J, García A, Caballero N, de Saez MTM, Politis M, Ross S, Dogra M, Dhamsania V, Graves N, Kirchberg M, Mathur K, Aue A, Restrepo CM, Llanes A, Guzman G, Rebellon A, Boyer K, Heydemann P, Noble AG, Swisher C, Rabiah P, Withers S, Hull T, Frim D, McLone D, Su C, Blair M, Latkany P, Mui E, Vasconcelos-Santos DV, Villareal A, Perez A, Galvis CAN, Montes MV, Perez NIC, Ramirez M, Chittenden C, Wang E, Garcia-López LL, Muñoz-Ortiz J, Rivera-Valdivia N, Bohorquez-Granados MC, de-la-Torre GC, Padrieu G, Hernandez JDV, Celis-Giraldo D, Dávila JAA, Torres E, Oquendo MM, Arteaga-Rivera JY, Nicolae DL, Rzhetsky A, Roizen N, Stillwaggon E, Sawers L, Peyron F, Wallon M, Chapey E, Levigne P, Charter C, De Frias M, Montoya J, Press C, Ramirez R, Contopoulos-Ioannidis D, Maldonado Y, Liesenfeld O, Gomez C, Wheeler K, Zehar S, McAuley J, Limonne D, Houze S, Abraham S, Piarroux R, Tesic V, Beavis K, Abeleda A, Sautter M, El Mansouri B, El Bachir A, Amarir F, El Bissati K, Holfels E, Penn R, Cohen W, de-la-Torre A, Britton G, Motta J, Ortega-Barria E, Romero IL, Meier P, Grigg M, Gómez-Marín J, Kosagisharaf JR, Llorens XS, Reyes O, McLeod R. Building Programs to Eradicate Toxoplasmosis Part II: Education. Curr Pediatr Rep 2022; 10:93-108. [PMID: 36969368 PMCID: PMC10035399 DOI: 10.1007/s40124-022-00267-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Purpose of Review
Review work to create and evaluate educational materials that could serve as a primary prevention strategy to help both providers and patients in Panama, Colombia, and the USA reduce disease burden of Toxoplasma infections.
Recent Findings
Educational programs had not been evaluated for efficacy in Panama, USA, or Colombia.
Summary
Educational programs for high school students, pregnant women, medical students and professionals, scientists, and lay personnel were created. In most settings, short-term effects were evaluated. In Panama, Colombia, and USA, all materials showed short-term utility in transmitting information to learners. These educational materials can serve as a component of larger public health programs to lower disease burden from congenital toxoplasmosis. Future priorities include conducting robust longitudinal studies of whether education correlates with reduced adverse disease outcomes, modifying educational materials as new information regarding region-specific risk factors is discovered, and ensuring materials are widely accessible.
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Affiliation(s)
| | - Kanix Wang
- Institute for Genomics and Systems Biology, The University
of Chicago, Chicago, IL, USA
| | - Aliya Moreira
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
- Instituto de Investigaciones Científicas y Servicios
de Alta Tecnología AIP (INDICASAT-AIP), Panama City, Panama
- Department of Pediatrics Infectious Diseases/Department of
Neonatology, Hospital del Niño Doctor José Renán Esquivel,
Panama City, Panama
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
- The College, The University of Chicago, Chicago, IL,
USA
- The Global Health Center, The University of Chicago,
Chicago, IL, USA
| | - Andrew Grose
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
- The Global Health Center, The University of Chicago,
Chicago, IL, USA
| | - Karen Leahy
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
| | - Ying Zhou
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
| | | | - Maryam Siddiqui
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
| | - Nicole Leong
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
| | - Perpetua Goodall
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
| | - Morgan Michalowski
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
| | - Mahmoud Ismail
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
| | - Monica Christmas
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
| | - Stephen Schrantz
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
| | - Zuleima Caballero
- Instituto de Investigaciones Científicas y Servicios
de Alta Tecnología AIP (INDICASAT-AIP), Panama City, Panama
| | - Ximena Norero
- Department of Pediatrics Infectious Diseases/Department of
Neonatology, Hospital del Niño Doctor José Renán Esquivel,
Panama City, Panama
| | - Dora Estripeaut
- Department of Pediatrics Infectious Diseases/Department of
Neonatology, Hospital del Niño Doctor José Renán Esquivel,
Panama City, Panama
| | - David Ellis
- Department of Pediatrics Infectious Diseases/Department of
Neonatology, Hospital del Niño Doctor José Renán Esquivel,
Panama City, Panama
| | - Catalina Raggi
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
- The College, The University of Chicago, Chicago, IL,
USA
- The Global Health Center, The University of Chicago,
Chicago, IL, USA
| | - Catherine Castro
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
- The Global Health Center, The University of Chicago,
Chicago, IL, USA
| | - Claudia Rengifo-Herrera
- Instituto de Investigaciones Científicas y Servicios
de Alta Tecnología AIP (INDICASAT-AIP), Panama City, Panama
- Universidad de Panamá, Panama City, Panama
| | - Davina Moossazadeh
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
- The College, The University of Chicago, Chicago, IL,
USA
- The Global Health Center, The University of Chicago,
Chicago, IL, USA
- Department of Statistics, The University of Chicago,
Chicago, IL, USA
| | - Margarita Ramirez
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
- The College, The University of Chicago, Chicago, IL,
USA
- The Global Health Center, The University of Chicago,
Chicago, IL, USA
| | - Abhinav Pandey
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
- The College, The University of Chicago, Chicago, IL,
USA
- The Global Health Center, The University of Chicago,
Chicago, IL, USA
| | - Kevin Ashi
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
- The Global Health Center, The University of Chicago,
Chicago, IL, USA
| | - Samantha Dovgin
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
- The College, The University of Chicago, Chicago, IL,
USA
| | - Ashtyn Dixon
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
| | - Xuan Li
- Rush University Medical School/Rush University Medical
Center, Chicago, IL, USA
| | - Ian Begeman
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
| | - Sharon Heichman
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
| | - Joseph Lykins
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
| | - Delba Villalobos-Cerrud
- Instituto de Investigaciones Científicas y Servicios
de Alta Tecnología AIP (INDICASAT-AIP), Panama City, Panama
| | - Lorena Fabrega
- Instituto de Investigaciones Científicas y Servicios
de Alta Tecnología AIP (INDICASAT-AIP), Panama City, Panama
| | - José Luis Sanchez Montalvo
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
- The Global Health Center, The University of Chicago,
Chicago, IL, USA
| | - Connie Mendivil
- Instituto de Investigaciones Científicas y Servicios
de Alta Tecnología AIP (INDICASAT-AIP), Panama City, Panama
| | - Mario R. Quijada
- Instituto de Investigaciones Científicas y Servicios
de Alta Tecnología AIP (INDICASAT-AIP), Panama City, Panama
| | - Silvia Fernández-Pirla
- Toxoplasmosis Programs and Initiatives in Panamá,
Panama City, Panama
- Instituto de Investigaciones Científicas y Servicios
de Alta Tecnología AIP (INDICASAT-AIP), Panama City, Panama
- Academia Interamericana de Panamá, Panama City,
Panama
- Hospital Santo Tomás, Panama City, Panama
| | - Valli de La Guardia
- Toxoplasmosis Programs and Initiatives in Panamá,
Panama City, Panama
- Instituto de Investigaciones Científicas y Servicios
de Alta Tecnología AIP (INDICASAT-AIP), Panama City, Panama
- Hospital Santo Tomás, Panama City, Panama
- Hospital San Miguel de Arcangel, Ciudad de Panama,
Panama
| | - Digna Wong
- Instituto de Investigaciones Científicas y Servicios
de Alta Tecnología AIP (INDICASAT-AIP), Panama City, Panama
| | - Mayrene Ladrón de Guevara
- Instituto de Investigaciones Científicas y Servicios
de Alta Tecnología AIP (INDICASAT-AIP), Panama City, Panama
- Hospital Santo Tomás, Panama City, Panama
| | | | | | - Anabel García
- Instituto de Investigaciones Científicas y Servicios
de Alta Tecnología AIP (INDICASAT-AIP), Panama City, Panama
| | | | - Maria Theresa Moreno de Saez
- Department of Pediatrics Infectious Diseases/Department of
Neonatology, Hospital del Niño Doctor José Renán Esquivel,
Panama City, Panama
| | - Michael Politis
- Toxoplasmosis Programs and Initiatives in Panamá,
Panama City, Panama
| | - Stephanie Ross
- Rush University Medical School/Rush University Medical
Center, Chicago, IL, USA
| | - Mimansa Dogra
- The Global Health Center, The University of Chicago,
Chicago, IL, USA
| | - Vishan Dhamsania
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
- The Global Health Center, The University of Chicago,
Chicago, IL, USA
- Capstone Program, Global Health Center, The University of
Chicago, Chicago, IL, USA
| | - Nicholas Graves
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
- The Global Health Center, The University of Chicago,
Chicago, IL, USA
- Capstone Program, Global Health Center, The University of
Chicago, Chicago, IL, USA
| | - Marci Kirchberg
- Capstone Program, Global Health Center, The University of
Chicago, Chicago, IL, USA
- Harris School of Public Policy, The University of
Chicago, Chicago, IL, USA
| | - Kopal Mathur
- Capstone Program, Global Health Center, The University of
Chicago, Chicago, IL, USA
- Harris School of Public Policy, The University of
Chicago, Chicago, IL, USA
| | - Ashley Aue
- The Global Health Center, The University of Chicago,
Chicago, IL, USA
- Harris School of Public Policy, The University of
Chicago, Chicago, IL, USA
| | - Carlos M. Restrepo
- Instituto de Investigaciones Científicas y Servicios
de Alta Tecnología AIP (INDICASAT-AIP), Panama City, Panama
| | - Alejandro Llanes
- Instituto de Investigaciones Científicas y Servicios
de Alta Tecnología AIP (INDICASAT-AIP), Panama City, Panama
| | - German Guzman
- Instituto de Investigaciones Científicas y Servicios
de Alta Tecnología AIP (INDICASAT-AIP), Panama City, Panama
| | - Arturo Rebellon
- Sanofi Aventis de Panamá S.A., University of South
Florida, Panama City, Panama
| | - Kenneth Boyer
- Rush University Medical School/Rush University Medical
Center, Chicago, IL, USA
| | - Peter Heydemann
- Rush University Medical School/Rush University Medical
Center, Chicago, IL, USA
| | - A. Gwendolyn Noble
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
- Northwestern University Feinberg School of Medicine,
Chicago, IL, USA
| | - Charles Swisher
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
- Northwestern University Feinberg School of Medicine,
Chicago, IL, USA
| | - Peter Rabiah
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
- NorthShore Evanston Hospital, Evanston, IL, USA
| | - Shawn Withers
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
| | - Teri Hull
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
| | - David Frim
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
| | - David McLone
- Northwestern University Feinberg School of Medicine,
Chicago, IL, USA
| | - Chunlei Su
- Department of Microbiology, The University of Tennessee,
Knoxville, TN, USA
| | - Michael Blair
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
| | - Paul Latkany
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
| | - Ernest Mui
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
| | | | - Alcibiades Villareal
- Instituto de Investigaciones Científicas y Servicios
de Alta Tecnología AIP (INDICASAT-AIP), Panama City, Panama
| | - Ambar Perez
- Instituto de Investigaciones Científicas y Servicios
de Alta Tecnología AIP (INDICASAT-AIP), Panama City, Panama
| | | | | | | | - Morgan Ramirez
- The College, The University of Chicago, Chicago, IL,
USA
| | - Cy Chittenden
- The College, The University of Chicago, Chicago, IL,
USA
| | - Edward Wang
- The College, The University of Chicago, Chicago, IL,
USA
| | | | - Juliana Muñoz-Ortiz
- Grupo de Investigación en Neurociencias,
Universidad del Rosario, Bogotá, Colombia
| | | | | | | | - Guillermo Padrieu
- Toxoplasmosis Programs and Initiatives in Panamá,
Panama City, Panama
- Instituto de Investigaciones Científicas y Servicios
de Alta Tecnología AIP (INDICASAT-AIP), Panama City, Panama
- Grupo de Investigación en Neurociencias,
Universidad del Rosario, Bogotá, Colombia
| | | | | | | | | | | | | | - Dan L. Nicolae
- Department of Statistics, The University of Chicago,
Chicago, IL, USA
| | - Andrey Rzhetsky
- Institute for Genomics and Systems Biology, The University
of Chicago, Chicago, IL, USA
| | - Nancy Roizen
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
| | | | - Larry Sawers
- Department of Economics, American University, D,
Washington .C, USA
| | - Francois Peyron
- Institut des agents infectieux, Hôpital de la
Croix-Rousse, Lyon, France
| | - Martine Wallon
- Institut des agents infectieux, Hôpital de la
Croix-Rousse, Lyon, France
| | - Emanuelle Chapey
- Institut des agents infectieux, Hôpital de la
Croix-Rousse, Lyon, France
| | - Pauline Levigne
- Institut des agents infectieux, Hôpital de la
Croix-Rousse, Lyon, France
| | | | | | - Jose Montoya
- Remington Specialty Laboratory, Palo Alto, CA, USA
| | - Cindy Press
- Remington Specialty Laboratory, Palo Alto, CA, USA
| | | | - Despina Contopoulos-Ioannidis
- Department of Pediatrics, Division of Infectious
Diseases, Stanford University College of Medicine, Stanford, CA, USA
| | - Yvonne Maldonado
- Department of Pediatrics, Division of Infectious
Diseases, Stanford University College of Medicine, Stanford, CA, USA
| | | | - Carlos Gomez
- Department of Pediatrics, Division of Infectious
Diseases, Stanford University College of Medicine, Stanford, CA, USA
| | - Kelsey Wheeler
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
- The College, The University of Chicago, Chicago, IL,
USA
| | - Samantha Zehar
- Northwestern University Feinberg School of Medicine,
Chicago, IL, USA
| | - James McAuley
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
| | | | - Sandrine Houze
- Laboratory of Parasitologie, Bichat-Claude Bernard
Hopital, Paris, France
| | - Sylvie Abraham
- Laboratory of Parasitologie, Bichat-Claude Bernard
Hopital, Paris, France
| | | | - Vera Tesic
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
| | - Kathleen Beavis
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
| | - Ana Abeleda
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
| | - Mari Sautter
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
| | | | | | - Fatima Amarir
- Faculty of Sciences Ain Chock, University Hassan II,
Casablanca, Morocco
| | - Kamal El Bissati
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
- INH, Rabat, Morocco
| | - Ellen Holfels
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
| | - Richard Penn
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
| | - William Cohen
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
- The College, The University of Chicago, Chicago, IL,
USA
| | | | - Gabrielle Britton
- Instituto de Investigaciones Científicas y Servicios
de Alta Tecnología AIP (INDICASAT-AIP), Panama City, Panama
- Sistema Nacional de investigadores de Panamá
(SNI), Panama City, Panama
| | - Jorge Motta
- Sistema Nacional de investigadores de Panamá
(SNI), Panama City, Panama
- Secretaría Nacional de Ciencia, Tecnología
e Innovación (SENACYT), Panama City, Panama
| | - Eduardo Ortega-Barria
- Sistema Nacional de investigadores de Panamá
(SNI), Panama City, Panama
- Secretaría Nacional de Ciencia, Tecnología
e Innovación (SENACYT), Panama City, Panama
- GSK Vaccines, Panama City, Panama
| | - Isabel Luz Romero
- Secretaría Nacional de Ciencia, Tecnología
e Innovación (SENACYT), Panama City, Panama
| | - Paul Meier
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
| | - Michael Grigg
- Molecular Parasitology Section, Laboratory of Parasitic
Diseases, National Institutes of Health, NIAID, Bethesda, MD, USA
| | - Jorge Gómez-Marín
- Universidad del Quindío, Armenia, Colombia
- Jorge Gómez-Marín,
, Jagannatha Rao Kosagisharaf,
, Xavier Sáez Llorens,
, Osvaldo Reyes,
, Rima McLeod,
| | - Jagannatha Rao Kosagisharaf
- Instituto de Investigaciones Científicas y Servicios
de Alta Tecnología AIP (INDICASAT-AIP), Panama City, Panama
- Sistema Nacional de investigadores de Panamá
(SNI), Panama City, Panama
- Jorge Gómez-Marín,
, Jagannatha Rao Kosagisharaf,
, Xavier Sáez Llorens,
, Osvaldo Reyes,
, Rima McLeod,
| | - Xavier Sáez Llorens
- Department of Pediatrics Infectious Diseases/Department of
Neonatology, Hospital del Niño Doctor José Renán Esquivel,
Panama City, Panama
- Sistema Nacional de investigadores de Panamá
(SNI), Panama City, Panama
- Jorge Gómez-Marín,
, Jagannatha Rao Kosagisharaf,
, Xavier Sáez Llorens,
, Osvaldo Reyes,
, Rima McLeod,
| | - Osvaldo Reyes
- Universidad de Panamá, Panama City, Panama
- Hospital Santo Tomás, Panama City, Panama
- Sistema Nacional de investigadores de Panamá
(SNI), Panama City, Panama
- Jorge Gómez-Marín,
, Jagannatha Rao Kosagisharaf,
, Xavier Sáez Llorens,
, Osvaldo Reyes,
, Rima McLeod,
| | - Rima McLeod
- Toxoplasmosis Programs and Initiatives in Panamá,
Panama City, Panama
- Institute for Genomics and Systems Biology, The University
of Chicago, Chicago, IL, USA
- Pritzker School of Medicine, The University of Chicago,
Chicago, IL, USA
- Department of Ophthalmology and Visual Sciences, The
University of Chicago, Chicago, IL, USA
- The College, The University of Chicago, Chicago, IL,
USA
- The Global Health Center, The University of Chicago,
Chicago, IL, USA
- Toxoplasmosis Center, The University of Chicago, and
Toxoplasmosis Research Institute, Chicago, IL, USA
- Department of Pediatrics (Infectious Diseases), The
University of Chicago, Chicago, IL, USA
- Jorge Gómez-Marín,
, Jagannatha Rao Kosagisharaf,
, Xavier Sáez Llorens,
, Osvaldo Reyes,
, Rima McLeod,
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4
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Eze CC, Ekeke N, Alphonsus C, Lehman L, Chukwu JN, Nwafor CC, Stillwaggon E, Meka AO, Sawers L, Ikebudu J, Anyim MC, Ukwaja KN. Effectiveness of self-care interventions for integrated morbidity management of skin neglected tropical diseases in Anambra State, Nigeria. BMC Public Health 2021; 21:1748. [PMID: 34563162 PMCID: PMC8465703 DOI: 10.1186/s12889-021-11729-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 09/03/2021] [Indexed: 12/03/2022] Open
Abstract
Background Lymphatic filariasis (LF), Buruli ulcer (BU) and leprosy are neglected tropical diseases (NTDs) of the skin co-endemic in some communities in Nigeria. Not enough is known about the effectiveness of integrated morbidity management and disability prevention in people with these conditions. An integrated self-care intervention was carried out for people with these skin NTDs in two endemic communities of Anambra state, Nigeria. The objective of the study was to assess the effectiveness of self-care practices on costs of care, disability status and health-related quality of life. Methods This study utilised a quasi-experimental pre-test/post-test design to assess the effectiveness of the self-care interventions for people affected by NTDs to care for these impairments at home. Data were collected using questionnaires administered at the beginning and at the end of the intervention on monthly cost of morbidity care, and on participants’ disability status and their quality of life (QoL). Focus group discussions (FGDs) were held with both the participants and healthcare workers at follow-up. Results Forty-eight participants were recruited. Thirty participants (62.5%) continued the self-care interventions until the end of the project. Of those, 25 (83%) demonstrated improvement from their baseline impairment status. The mean household costs of morbidity care per participant decreased by 66% after the intervention, falling from US$157.50 at baseline to US$53.24 after 6 months of self-care (p = 0.004). The mean disability score at baseline was 22.3; this decreased to 12.5 after 6 months of self-care (p < 0.001). Among the 30 participants who continued the interventions until the end of the project, 26 (86.7%) had severe disability score (i.e. a score of 10–46) at baseline, and the number with severe disability fell to 18 (60%) of the 30 after the intervention. The mean QoL score increased from 45.7 at baseline to 57.5 at the end of the intervention (p = 0.004). Conclusions The 6-month self-care intervention for participants affected by BU, leprosy, or LF led to lower costs of care (including out-of-pocket costs and lost earnings due to morbidity), improved QoL scores, and reduced disability status. Trial registration ISRCTN Registry: ISRCTN20317241; 27/08/2021, Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11729-1.
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Affiliation(s)
- Chinwe C Eze
- Medical Department, German Leprosy and TB Relief Association, Enugu, Enugu State, Nigeria
| | - Ngozi Ekeke
- Medical Department, German Leprosy and TB Relief Association, Enugu, Enugu State, Nigeria
| | - Chukwuka Alphonsus
- Medical Department, German Leprosy and TB Relief Association, Enugu, Enugu State, Nigeria
| | - Linda Lehman
- American Leprosy Missions, 120 Broadus Ave, Greenville, SC, 29601, USA
| | - Joseph N Chukwu
- Medical Department, German Leprosy and TB Relief Association, Enugu, Enugu State, Nigeria
| | - Charles C Nwafor
- Medical Department, German Leprosy and TB Relief Association, Enugu, Enugu State, Nigeria
| | | | - Anthony O Meka
- Medical Department, German Leprosy and TB Relief Association, Enugu, Enugu State, Nigeria
| | - Larry Sawers
- Department of Economics, American University, Washington, DC, 20016-8029, USA
| | - Joy Ikebudu
- Medical Department, German Leprosy and TB Relief Association, Enugu, Enugu State, Nigeria
| | - Moses C Anyim
- Medical Department, German Leprosy and TB Relief Association, Enugu, Enugu State, Nigeria
| | - Kingsley N Ukwaja
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria.
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5
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Sawers L, Stillwaggon E. Economic Costs and Benefits of Community-Based Lymphedema-Management Programs for Lymphatic Filariasis in India. Am J Trop Med Hyg 2020; 103:295-302. [PMID: 32653050 PMCID: PMC7356420 DOI: 10.4269/ajtmh.19-0898] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Lymphatic filariasis (LF) is endemic in 72 countries; 15 million persons live with chronic filarial lymphedema. It can be a disabling condition, frequently painful, leading to reduced mobility, social exclusion, and depression. The Global Program to Eliminate Lymphatic Filariasis aims to stop new infections and care for affected persons, but morbidity management has been initiated in only 38 countries. We examine economic costs and benefits of alleviating chronic lymphedema and its effects through simple limb care. We use economic and epidemiological data from 12 Indian states in which 99% of Indians with filariasis reside. Using census data, we calculate the age distribution of filarial lymphedema and predict the burden of morbidity of infected persons. We estimate lifetime medical costs and lost earnings due to lymphedema and acute dermatolymphangioadenitis (ADLA) with and without community-based limb-care programs. Programs of community-based limb care in all Indian endemic areas would reduce costs of disability by 52%, saving a per person average of US$2,721, equivalent to 703 workdays. Per-person savings are 185 times the program's per-person cost. Chronic lymphedema and ADLA impose a substantial physical and economic burden in filariasis-endemic areas. Low-cost programs for lymphedema management based on limb washing and topical medication are effective in reducing the number of ADLA episodes and stopping progression of disabling lymphedema. With reduced disability, people can work longer hours per day, more days per year, and in more strenuous, higher paying jobs, resulting in important economic benefits to themselves, their families, and their communities.
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Affiliation(s)
- Larry Sawers
- Department of Economics, American University, Washington, District of Columbia
| | - Eileen Stillwaggon
- Department of Economics, Gettysburg College, Gettysburg, Pennsylvania.,Department of Pediatrics, Tropical Medicine Section, Baylor College of Medicine, Houston, Texas
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6
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Perez-Zetune V, Bialek SR, Montgomery SP, Stillwaggon E. Congenital Chagas Disease in the United States: The Effect of Commercially Priced Benznidazole on Costs and Benefits of Maternal Screening. Am J Trop Med Hyg 2020; 102:1086-1089. [PMID: 32100696 PMCID: PMC7204569 DOI: 10.4269/ajtmh.20-0005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Chagas disease, caused by Trypanosoma cruzi, is transmitted by insect vectors, and through transfusions, transplants, insect feces in food, and mother to child during gestation. An estimated 30% of infected persons will develop lifelong, potentially fatal cardiac or digestive complications. Treatment of infants with benznidazole is highly efficacious in eliminating infection. This work evaluates the costs of maternal screening and infant testing and treatment for Chagas disease in the United States, including the cost of commercially available benznidazole. We compare costs of testing and treatment for mothers and infants with the lifetime societal costs without testing and consequent morbidity and mortality due to lack of treatment or late treatment. We constructed a decision-analytic model, using one tree that shows the combined costs for every possible mother–child pairing. Savings per birth in a targeted screening program are $1,314, and with universal screening, $105 per birth. At current screening costs, universal screening results in $420 million in lifetime savings per birth-year cohort. We found that a congenital Chagas screening program in the United States is cost saving for all rates of congenital transmission greater than 0.001% and all levels of maternal prevalence greater than 0.06% compared with no screening program.
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Affiliation(s)
| | - Stephanie R Bialek
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan P Montgomery
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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7
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Sawers L, Stillwaggon E, Chiphwanya J, Mkwanda SZ, Betts H, Martindale S, Kelly-Hope LA. Economic benefits and costs of surgery for filarial hydrocele in Malawi. PLoS Negl Trop Dis 2020; 14:e0008003. [PMID: 32210436 PMCID: PMC7094819 DOI: 10.1371/journal.pntd.0008003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 12/18/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Lymphatic filariasis (LF) is endemic in 72 countries of Africa, Asia, Oceania, and the Americas. An estimated 25 million men live with the disabling effects of filarial hydrocele. Hydrocele can be corrected with surgery with few complications. For most men, hydrocelectomy reduces or corrects filarial hydrocele and permits them to resume regular activities of daily living and gainful employment. METHODOLOGY AND PRINCIPAL FINDINGS This study measures the economic loss due to filarial hydrocele and the benefits of hydrocelectomy and is based on pre- and post-operative surveys of patients in southern Malawi. We find the average number of days of work lost due to filarial hydrocele and daily earnings for men in rural Malawi. We calculate average annual lost earnings and find the present discounted value for all years from the time of surgery to the end of working life. We estimate the total costs of surgery. We compare the benefit of the work capacity restored to the costs of surgery to determine the benefit-cost ratio. For men younger than 65 years old, the average annual earnings loss attributed to hydrocele is US$126. The average discounted present value of lifetime earnings loss for those men is US$1684. The average budgetary cost of the hydrocelectomy is US$68. The ratio of the benefit of surgery to its costs is US$1684/US$68 or 24.8. Sensitivity analysis demonstrates that the results are robust to variations in cost of surgery and length of working life. CONCLUSION The lifetime benefits of hydrocelectomy-to the man, his family, and his community-far exceed the costs of repairing the hydrocele. Scaling up subsidies to hydrocelectomy campaigns should be a priority for governments and international aid organizations to prevent and alleviate disability and lost earnings that aggravate poverty among the many millions of men with filarial hydrocele.
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Affiliation(s)
- Larry Sawers
- Department of Economics, American University, Washington, District of Columbia, United States of America
| | - Eileen Stillwaggon
- Department of Economics, Gettysburg College, Gettysburg, Pennsylvania, United States of America
| | | | | | - Hannah Betts
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sarah Martindale
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Louise A. Kelly-Hope
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Bobić B, Villena I, Stillwaggon E. Prevention and mitigation of congenital toxoplasmosis. Economic costs and benefits in diverse settings. Food Waterborne Parasitol 2019; 16:e00058. [PMID: 32095628 PMCID: PMC7034037 DOI: 10.1016/j.fawpar.2019.e00058] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 05/13/2019] [Accepted: 05/13/2019] [Indexed: 11/27/2022] Open
Abstract
Congenital toxoplasmosis (CT), the result of a primary infection of pregnant women with Toxoplasma gondii which was transmitted to the fetus, may result in mild to deep injuries occurring in the newborn or later in its development or in adolescence. The visual and cognitive impairment that can result imposes substantial economic costs on the individual and society. Numerous observational studies favor the conclusion that, with preventive measures currently available, it is possible to reduce the incidence of infections in pregnant women, the incidence of fetal infection by preventing transplacental transmission, and the gravity of injury in infected newborns. Treatment of infected newborns can also reduce the severity of consequences and the frequency of their occurrence later in life. Prevention programs, however, are applied in only a few countries; in most countries implementation of a national prevention program has not been considered or has been thought to be too expensive. This article lists the methods of prevention of CT and describes existing national prevention programs in France and Austria. It analyzes the economic costs and benefits of maternal screening for CT prevention and mitigation for society and for health systems. The economic feasibility of implementing national screening in low-prevalence, high-cost countries is illustrated with the example of the United States. New diagnostic tools are discussed and the implication of lower costs is considered, for countries with well-established screening programs as well as those with inadequate prenatal care networks.
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Affiliation(s)
- Branko Bobić
- Institute for Medical Research, University of Belgrade, Centre of Excellence for Food- and Vector-borne Zoonoses, National Reference Laboratory for Toxoplasmosis, Serbia
| | - Isabelle Villena
- EA 7510, UFR Médecine, University Reims Champagne-Ardenne, National Reference Center on Toxoplasmosis, Hospital Reims, France
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9
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Stillwaggon E, Perez-Zetune V, Bialek SR, Montgomery SP. Congenital Chagas Disease in the United States: Cost Savings through Maternal Screening. Am J Trop Med Hyg 2018; 98:1733-1742. [PMID: 29714163 PMCID: PMC6086189 DOI: 10.4269/ajtmh.17-0818] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Chagas disease, caused by Trypanosoma cruzi, is transmitted by insect vectors through transfusions, transplants, insect feces in food, and from mother to child during gestation. Congenital infection could perpetuate Chagas disease indefinitely, even in countries without vector transmission. An estimated 30% of infected persons will develop lifelong, potentially fatal, cardiac or digestive complications. Treatment of infants with benznidazole is highly efficacious in eliminating infection. This work evaluates the costs of maternal screening and infant testing and treatment of Chagas disease in the United States. We constructed a decision-analytic model to find the lower cost option, comparing costs of testing and treatment, as needed, for mothers and infants with the lifetime societal costs without testing and the consequent morbidity and mortality due to lack of treatment or late treatment. We found that maternal screening, infant testing, and treatment of Chagas disease in the United States are cost saving for all rates of congenital transmission greater than 0.001% and all levels of maternal prevalence above 0.06% compared with no screening program. Newly approved diagnostics make universal screening cost saving with maternal prevalence as low as 0.008%. The present value of lifetime societal savings due to screening and treatment is about $634 million saved for every birth year cohort. The benefits of universal screening for T. cruzi as part of routine prenatal testing far outweigh the program costs for all U.S. births.
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Affiliation(s)
| | - Victoria Perez-Zetune
- International Finance Division, Board of Governors of the Federal Reserve System, Washington, District of Columbia
| | - Stephanie R Bialek
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan P Montgomery
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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Prusa AR, Kasper DC, Sawers L, Walter E, Hayde M, Stillwaggon E. Congenital toxoplasmosis in Austria: Prenatal screening for prevention is cost-saving. PLoS Negl Trop Dis 2017; 11:e0005648. [PMID: 28692640 PMCID: PMC5503164 DOI: 10.1371/journal.pntd.0005648] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 05/17/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Primary infection of Toxoplasma gondii during pregnancy can be transmitted to the unborn child and may have serious consequences, including retinochoroiditis, hydrocephaly, cerebral calcifications, encephalitis, splenomegaly, hearing loss, blindness, and death. Austria, a country with moderate seroprevalence, instituted mandatory prenatal screening for toxoplasma infection to minimize the effects of congenital transmission. This work compares the societal costs of congenital toxoplasmosis under the Austrian national prenatal screening program with the societal costs that would have occurred in a No-Screening scenario. METHODOLOGY/PRINCIPAL FINDINGS We retrospectively investigated data from the Austrian Toxoplasmosis Register for birth cohorts from 1992 to 2008, including pediatric long-term follow-up until May 2013. We constructed a decision-analytic model to compare lifetime societal costs of prenatal screening with lifetime societal costs estimated in a No-Screening scenario. We included costs of treatment, lifetime care, accommodation of injuries, loss of life, and lost earnings that would have occurred in a No-Screening scenario and compared them with the actual costs of screening, treatment, lifetime care, accommodation, loss of life, and lost earnings. We replicated that analysis excluding loss of life and lost earnings to estimate the budgetary impact alone. Our model calculated total lifetime costs of €103 per birth under prenatal screening as carried out in Austria, saving €323 per birth compared with No-Screening. Without screening and treatment, lifetime societal costs for all affected children would have been €35 million per year; the implementation costs of the Austrian program are less than €2 million per year. Calculating only the budgetary impact, the national program was still cost-saving by more than €15 million per year and saved €258 million in 17 years. CONCLUSIONS/SIGNIFICANCE Cost savings under a national program of prenatal screening for toxoplasma infection and treatment are outstanding. Our results are of relevance for health care providers by supplying economic data based on a unique national dataset including long-term follow-up of affected infants.
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Affiliation(s)
- Andrea-Romana Prusa
- Department of Pediatrics and Adolescent Medicine, Toxoplasmosis Reference Laboratory, Medical University of Vienna, Vienna, Austria
| | - David C. Kasper
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Larry Sawers
- Department of Economics, American University, Washington DC, United States of America
| | - Evelyn Walter
- Institute for Pharmaeconomic Research, Vienna, Austria
| | - Michael Hayde
- Department of Pediatrics and Adolescent Medicine, Toxoplasmosis Reference Laboratory, Medical University of Vienna, Vienna, Austria
| | - Eileen Stillwaggon
- Department of Economics, Gettysburg College, Gettysburg, Pennsylvania, United States of America
- * E-mail:
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Begeman IJ, Lykins J, Zhou Y, Lai BS, Levigne P, El Bissati K, Boyer K, Withers S, Clouser F, Noble AG, Rabiah P, Swisher CN, Heydemann PT, Contopoulos-Ioannidis DG, Montoya JG, Maldonado Y, Ramirez R, Press C, Stillwaggon E, Peyron F, McLeod R. Point-of-care testing for Toxoplasma gondii IgG/IgM using Toxoplasma ICT IgG-IgM test with sera from the United States and implications for developing countries. PLoS Negl Trop Dis 2017. [PMID: 28650970 PMCID: PMC5501679 DOI: 10.1371/journal.pntd.0005670] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Congenital toxoplasmosis is a serious but preventable and treatable disease. Gestational screening facilitates early detection and treatment of primary acquisition. Thus, fetal infection can be promptly diagnosed and treated and outcomes can be improved. Methods We tested 180 sera with the Toxoplasma ICT IgG-IgM point-of-care (POC) test. Sera were from 116 chronically infected persons (48 serotype II; 14 serotype I-III; 25 serotype I-IIIa; 28 serotype Atypical, haplogroup 12; 1 not typed). These represent strains of parasites infecting mothers of congenitally infected children in the U.S. 51 seronegative samples and 13 samples from recently infected persons known to be IgG/IgM positive within the prior 2.7 months also were tested. Interpretation was confirmed by two blinded observers. A comparison of costs for POC vs. commercial laboratory testing methods was performed. Results We found that this new Toxoplasma ICT IgG-IgM POC test was highly sensitive (100%) and specific (100%) for distinguishing IgG/IgM-positive from negative sera. Use of such reliable POC tests can be cost-saving and benefit patients. Conclusions Our work demonstrates that the Toxoplasma ICT IgG-IgM test can function reliably as a point-of-care test to diagnose Toxoplasma gondii infection in the U.S. This provides an opportunity to improve maternal-fetal care by using approaches, diagnostic tools, and medicines already available. This infection has serious, lifelong consequences for infected persons and their families. From the present study, it appears a simple, low-cost POC test is now available to help prevent morbidity/disability, decrease cost, and make gestational screening feasible. It also offers new options for improved prenatal care in low- and middle-income countries. Toxoplasmosis, a disease caused by the parasite Toxoplasma gondii, presents a major health burden in both the developed and developing world. Untreated congenital toxoplasmosis causes damage to the eye and brain, but early detection and treatment reduce transmission and disease. Fetal infection can be promptly diagnosed and treated and outcomes can be improved. Gestational screening for toxoplasmosis has international precedent. In this paper, we demonstrated that the new Toxoplasma ICT IgG-IgM test had 100% sensitivity and specificity in detecting Toxoplasma infection (N = 180 U.S. sera from uninfected persons and those with varying parasite serotypes). The use of an inexpensive, easy-to-use point-of-care test facilitates screening of pregnant women for T. gondii infection. In turn, this facilitates prompt treatment for the infection and thereby reduces the health burden caused by this disease. This provides an opportunity to improve maternal-fetal care by using approaches, diagnostic tools, and medicines already available.
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Affiliation(s)
- Ian J. Begeman
- Department of Ophthalmology and Visual Science, The University of Chicago, Chicago, Illinois, United States of America
| | - Joseph Lykins
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois, United States of America
| | - Ying Zhou
- Department of Ophthalmology and Visual Science, The University of Chicago, Chicago, Illinois, United States of America
| | - Bo Shiun Lai
- Department of Ophthalmology and Visual Science, The University of Chicago, Chicago, Illinois, United States of America
| | - Pauline Levigne
- Institut de Parasitologie et de Mycologie Médicale Hôpital de la Croix Rousse, Lyon, France
| | - Kamal El Bissati
- Department of Ophthalmology and Visual Science, The University of Chicago, Chicago, Illinois, United States of America
| | - Kenneth Boyer
- Department of Ophthalmology and Visual Science, The University of Chicago, Chicago, Illinois, United States of America
- Rush University and Medical Center, Chicago, Illinois, United States of America
| | - Shawn Withers
- Department of Ophthalmology and Visual Science, The University of Chicago, Chicago, Illinois, United States of America
| | - Fatima Clouser
- Department of Ophthalmology and Visual Science, The University of Chicago, Chicago, Illinois, United States of America
| | - A. Gwendolyn Noble
- Department of Ophthalmology and Visual Science, The University of Chicago, Chicago, Illinois, United States of America
- Lurie Children’s Hospital and Northwestern University, Chicago, Illinois, United States of America
| | - Peter Rabiah
- Department of Ophthalmology and Visual Science, The University of Chicago, Chicago, Illinois, United States of America
- Northshore Hospital, Evanston, Illinois, United States of America
| | - Charles N. Swisher
- Department of Ophthalmology and Visual Science, The University of Chicago, Chicago, Illinois, United States of America
- Lurie Children’s Hospital and Northwestern University, Chicago, Illinois, United States of America
| | - Peter T. Heydemann
- Department of Ophthalmology and Visual Science, The University of Chicago, Chicago, Illinois, United States of America
- Rush University and Medical Center, Chicago, Illinois, United States of America
| | - Despina G. Contopoulos-Ioannidis
- Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, Stanford, California, United States of America
| | - Jose G. Montoya
- Palo Alto Medical Foundation Toxoplasma Serology Laboratory, Palo Alto, California, United States of America
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - Yvonne Maldonado
- Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, Stanford, California, United States of America
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, United States of America
| | - Raymund Ramirez
- Palo Alto Medical Foundation Toxoplasma Serology Laboratory, Palo Alto, California, United States of America
| | - Cindy Press
- Palo Alto Medical Foundation Toxoplasma Serology Laboratory, Palo Alto, California, United States of America
| | | | - François Peyron
- Institut de Parasitologie et de Mycologie Médicale Hôpital de la Croix Rousse, Lyon, France
| | - Rima McLeod
- Department of Ophthalmology and Visual Science, The University of Chicago, Chicago, Illinois, United States of America
- Department of Pediatrics (Infectious Diseases), Institute of Genomics, Genetics, and Systems Biology, Global Health Center, Toxoplasmosis Center, the Center for Health and the Social Sciences, CHeSS, the College, The University of Chicago, Chicago Medicine, Chicago, Illinois, United States of America
- * E-mail:
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Stillwaggon E, Sawers L, Rout J, Addiss D, Fox L. Economic Costs and Benefits of a Community-Based Lymphedema Management Program for Lymphatic Filariasis in Odisha State, India. Am J Trop Med Hyg 2016; 95:877-884. [PMID: 27573626 PMCID: PMC5062793 DOI: 10.4269/ajtmh.16-0286] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 07/07/2016] [Indexed: 11/12/2022] Open
Abstract
Lymphatic filariasis afflicts 68 million people in 73 countries, including 17 million persons living with chronic lymphedema. The Global Programme to Eliminate Lymphatic Filariasis aims to stop new infections and to provide care for persons already affected, but morbidity management programs have been initiated in only 24 endemic countries. We examine the economic costs and benefits of alleviating chronic lymphedema and its effects through a simple limb-care program. For Khurda District, Odisha State, India, we estimated lifetime medical costs and earnings losses due to chronic lymphedema and acute dermatolymphangioadenitis (ADLA) with and without a community-based limb-care program. The program would reduce economic costs of lymphedema and ADLA over 60 years by 55%. Savings of US$1,648 for each affected person in the workforce are equivalent to 1,258 days of labor. Per-person savings are more than 130 times the per-person cost of the program. Chronic lymphedema and ADLA impose a substantial physical and economic burden on the population in filariasis-endemic areas. Low-cost programs for lymphedema management based on limb washing and topical medication for infection are effective in reducing the number of ADLA episodes and stopping progression of disabling and disfiguring lymphedema. With reduced disability, people are able to work longer hours, more days per year, and in more strenuous, higher-paying jobs, resulting in an important economic benefit to themselves, their families, and their communities. Mitigating the severity of lymphedema and ADLA also reduces out-of-pocket medical expense.
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Affiliation(s)
| | - Larry Sawers
- Department of Economics, American University, Washington, District of Columbia
| | - Jonathan Rout
- Church's Auxiliary for Social Action (CASA), Bhubaneswar, India
| | - David Addiss
- Children Without Worms, Task Force for Global Health, Decatur, Georgia
| | - LeAnne Fox
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
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Sawers L, Isaac AG, Stillwaggon E. HIV and concurrent sexual partnerships: modelling the role of coital dilution. J Int AIDS Soc 2011; 14:44. [PMID: 21914208 PMCID: PMC3182950 DOI: 10.1186/1758-2652-14-44] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 09/13/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The concurrency hypothesis asserts that high prevalence of overlapping sexual partnerships explains extraordinarily high HIV levels in sub-Saharan Africa. Earlier simulation models show that the network effect of concurrency can increase HIV incidence, but those models do not account for the coital dilution effect (non-primary partnerships have lower coital frequency than primary partnerships). METHODS We modify the model of Eaton et al (AIDS and Behavior, September 2010) to incorporate coital dilution by assigning lower coital frequencies to non-primary partnerships. We parameterize coital dilution based on the empirical work of Morris et al (PLoS ONE, December 2010) and others. Following Eaton et al, we simulate the daily transmission of HIV over 250 years for 10 levels of concurrency. RESULTS At every level of concurrency, our focal coital-dilution simulation produces epidemic extinction. Our sensitivity analysis shows that this result is quite robust; even modestly lower coital frequencies in non-primary partnerships lead to epidemic extinction. CONCLUSIONS In order to contribute usefully to the investigation of HIV prevalence, simulation models of concurrent partnering and HIV epidemics must incorporate realistic degrees of coital dilution. Doing so dramatically reduces the role that concurrency can play in accelerating the spread of HIV and suggests that concurrency cannot be an important driver of HIV epidemics in sub-Saharan Africa. Alternative explanations for HIV epidemics in sub-Saharan Africa are needed.
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Affiliation(s)
- Larry Sawers
- Department of Economics, American University, Washington DC, USA
| | - Alan G Isaac
- Department of Economics, American University, Washington DC, USA
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14
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Stillwaggon E, Carrier CS, Sautter M, McLeod R. Maternal serologic screening to prevent congenital toxoplasmosis: a decision-analytic economic model. PLoS Negl Trop Dis 2011; 5:e1333. [PMID: 21980546 PMCID: PMC3181241 DOI: 10.1371/journal.pntd.0001333] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 08/10/2011] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine a cost-minimizing option for congenital toxoplasmosis in the United States. METHODOLOGY/PRINCIPAL FINDINGS A decision-analytic and cost-minimization model was constructed to compare monthly maternal serological screening, prenatal treatment, and post-natal follow-up and treatment according to the current French (Paris) protocol, versus no systematic screening or perinatal treatment. Costs are based on published estimates of lifetime societal costs of developmental disabilities and current diagnostic and treatment costs. Probabilities are based on published results and clinical practice in the United States and France. One- and two-way sensitivity analyses are used to evaluate robustness of results. Universal monthly maternal screening for congenital toxoplasmosis with follow-up and treatment, following the French protocol, is found to be cost-saving, with savings of $620 per child screened. Results are robust to changes in test costs, value of statistical life, seroprevalence in women of childbearing age, fetal loss due to amniocentesis, and to bivariate analysis of test costs and incidence of primary T. gondii infection in pregnancy. Given the parameters in this model and a maternal screening test cost of $12, screening is cost-saving for rates of congenital infection above 1 per 10,000 live births. If universal testing generates economies of scale in diagnostic tools-lowering test costs to about $2 per test-universal screening is cost-saving at rates of congenital infection well below the lowest reported rates in the United States of 1 per 10,000 live births. CONCLUSION/SIGNIFICANCE Universal screening according to the French protocol is cost saving for the US population within broad parameters for costs and probabilities.
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Affiliation(s)
- Eileen Stillwaggon
- Department of Economics, Gettysburg College, Gettysburg, Pennsylvania, USA.
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Sawers L, Stillwaggon E. Concurrent sexual partnerships do not explain the HIV epidemics in Africa: a systematic review of the evidence. J Int AIDS Soc 2010; 13:34. [PMID: 20836882 PMCID: PMC3161340 DOI: 10.1186/1758-2652-13-34] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Accepted: 09/13/2010] [Indexed: 11/10/2022] Open
Abstract
The notion that concurrent sexual partnerships are especially common in sub-Saharan Africa and explain the region's high HIV prevalence is accepted by many as conventional wisdom. In this paper, we evaluate the quantitative and qualitative evidence offered by the principal proponents of the concurrency hypothesis and analyze the mathematical model they use to establish the plausibility of the hypothesis.We find that research seeking to establish a statistical correlation between concurrency and HIV prevalence either finds no correlation or has important limitations. Furthermore, in order to simulate rapid spread of HIV, mathematical models require unrealistic assumptions about frequency of sexual contact, gender symmetry, levels of concurrency, and per-act transmission rates. Moreover, quantitative evidence cited by proponents of the concurrency hypothesis is unconvincing since they exclude Demographic and Health Surveys and other data showing that concurrency in Africa is low, make broad statements about non-African concurrency based on very few surveys, report data incorrectly, report data from studies that have no information about concurrency as though they supported the hypothesis, report incomparable data and cite unpublished or unavailable studies. Qualitative evidence offered by proponents of the hypothesis is irrelevant since, among other reasons, there is no comparison of Africa with other regions.Promoters of the concurrency hypothesis have failed to establish that concurrency is unusually prevalent in Africa or that the kinds of concurrent partnerships found in Africa produce more rapid spread of HIV than other forms of sexual behaviour. Policy makers should turn attention to drivers of African HIV epidemics that are policy sensitive and for which there is substantial epidemiological evidence.
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Affiliation(s)
- Larry Sawers
- Department of Economics, American University, Washington, DC USA
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Affiliation(s)
- Peter Hotez
- George Washington University, Washington, DC, USA
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17
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Abstract
Global AIDS policy still treats HIV as an exceptional case, abstracting from the context in which infection occurs. Policy is based on a simplistic theory of HIV causation, and evaluated using outdated tools of health economics. Recent calls for a health systems strategy – preventing and treating HIV within a programme of comprehensive health care – have not yet influenced the silo approach of AIDS policy. Evidence continues to accumulate, showing that multiple factors, such as malnutrition, malaria and helminthes, increase the risk of sexual and vertical transmission of HIV. Moreover, complementary interventions that reduce viral load, improve immune response, and interrupt pathways of transmission could increase the effectiveness of antiretroviral drugs and other tools of AIDS policy. In health economics, the omission of estimates of increasing returns generated by disease or treatment synergies biases cost-effectiveness analysis against multiple, yet inexpensive, interventions. Current tools of cost-effectiveness analysis only identify local maxima in a complex landscape, and can play, at best, a marginal role in the epidemic, especially where it is already generalized. Cost-effectiveness analyses for HIV that are based on the wrong epidemiological model can generate Type III errors: we get precise answers to the wrong questions about how to intervene. To control the epidemic, AIDS policy needs to utilize an epidemiological model that reflects the interactions of biological as well as behavioural variables that determine the course of HIV epidemics around the world. Cost-effectiveness analysis can benefit from using economic concepts of externalities and increasing returns to incorporate disease interactions and beneficial treatment spillovers for coinfections in HIV-prevention policy.
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Abstract
This article shows that the burden of certain tropical disease infections, after controlling for other factors, is positively correlated with HIV prevalence. Using cross-national data and multivariate linear regression analysis, we investigate the determinants of HIV prevalence in low- and middle-income countries. We begin with social and economic variables used in other cross-national studies and then incorporate data on parasitic and infectious diseases endemic in poor populations, which are found to be strongly and significantly correlated with--and are potent predictors of--HIV prevalence. The paper concludes by arguing that treating tropical diseases may be a cost-effective add-on to HIV-prevention and -treatment programs, thus slowing the spread of HIV in disease-burdened populations.
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Affiliation(s)
- L Sawers
- Department of Economics, American University, Washington, DC, USA.
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Birn AE, Stillwaggon E. Stunted Lives, Stagnant Economies: Poverty, Disease, and Underdevelopment. J Public Health Policy 2000. [DOI: 10.2307/3343332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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