Estimating the Cost-Effectiveness of HIV Self-Testing in the United States Using Net Benefit Regression

BACKGROUND

Cost-effectiveness analysis of HIV self-testing using patient-level data from a randomized clinical trial can inform HIV prevention funding decisions. Cost-effectiveness analysis using net-benefit regression addresses the sampling uncertainty in the trial data and the variability of policymakers' willingness to pay (WTP).

METHODS

We used published data from a 12-month longitudinal randomized clinical trial that enrolled 2665 men who had sex with men randomly assigned to the self-testing arm (participants receiving self-test kits) and control arm (participants receiving standard-of-care), and the self-testing arm identified 48 additional new HIV cases. We used net-benefit regression to investigate the cost-effectiveness of an HIV self-testing intervention, which compared the incremental cost per new HIV diagnosis with policymakers' WTP thresholds. We addressed the uncertainties in estimating the incremental cost and the policymakers' WTP per new diagnosis through the incremental net-benefit (INB) regression and cost-effectiveness acceptability curve (CEAC) analyses.

RESULTS

From the health care provider's perspective, the INB analysis showed a positive net benefit of HIV self-testing compared with standard-of-care when policymakers' WTP per new HIV diagnosis was $9365 (95% confidence interval: $5700 to $25,500) or higher. The CEAC showed that the probability of HIV self-testing being cost-effective compared with standard-of-care was 58% and >99% at a WTP of $10 000 and $50 000 per new HIV diagnosis, respectively.

CONCLUSION

The INB and CEAC analyses suggest that HIV self-testing has the potential to be cost-effective for relatively low values of policymakers' WTP.

Nutrient density of Bangladeshi foods and its application in planning diet for pregnant women

Nutrient profiling is a method that classifies foods based on their nutrient content and identifies foods that are high in micronutrients both across and within food groups. This study aimed to identify foods that are rich sources of the seven micronutrients (iron, zinc, calcium, thiamine, riboflavin, vitamin A, and vitamin B12) of public health concern for the Bangladeshi population.. This study developed a metric termed "naturally nutrient-rich score 7 (NNR7)" specifically for third-trimester pregnant women to identify nutrient-dense foods. Further, it computed the nutrient adequacy score (NAS) of the top NNR7-scored foods for seven micronutrients to assess the extent (percent) to which foods can meet pregnant women's recommended dietary allowances (RDA). A linear programming technique was then used to construct a nutrient-adequate model diet for third-trimester pregnant women using the top ten NNR7-scored foods. According to the NNR7, food groups such as leafy vegetables, fish, meat, poultry and eggs, and vegetables are the richest sources of the problem micronutrients. Mutton liver (916.7%), soybean (39.3%), lamb liver (2160%) and duck liver (50.0%) were found to fulfill the highest percentage of the RDA of vitamin A, zinc, vitamin B12, and iron, respectively. In the formulated nutrient-adequate diets for pregnant women, rice, potato, brown wheat flour, and soya oil were universal to all three diets and Bengal gram, orange, Ganges River sprat, and duck liver were the most common ones. The study findings highlight the need for the consumption of foods such as leafy vegetables, fish, meat, poultry, eggs, pulses and vegetables to increase the intake of problematic micronutrients. Planning a nutrient-adequate diet for pregnant women using linear programming can be an alternative approach to optimize and shape food choices to meet their nutritional requirements.

Complementary feeding practices and their determinants among children aged 6-23 months in rural Bangladesh: evidence from Bangladesh Integrated Household Survey (BIHS) 2018-2019 evaluated against WHO/UNICEF guideline -2021

BACKGROUND

Appropriate Complementary feeding (CF) practices play a crucial role in determining child nutrition, growth, and development. This study seeks to examine CF practices and their predictors among children aged 6 to 23 months in rural Bangladesh according to the most recently updated WHO/UNICEF guidelines for CF.

METHODS

A total of 665 children aged 6 to 23 months from the Bangladesh Integrated Household Survey (BIHS) 2018-2019 dataset were analyzed. The WHO/UNICEF guidelines for CF were followed to evaluate each of the nine CF practice indicators. We also examined the effect of the child, maternal, household, and community-level factors on different CF components using multiple logistic regression analyses.

RESULTS

Approximately two-thirds of the children initiated complementary feeding on time (63.5%) but had zero vegetable or fruit consumption (63.2%). More than half (52.4%) and the majority (86.5%) of children had minimum meal frequency and minimum milk feeding frequency, respectively. On the other hand, the proportion of minimum dietary diversity was quite low (18.3%), as reflected in the alarming prevalence (16.3%) of minimum acceptable diet. Egg and/or flesh food, sweet beverage, and unhealthy food consumption were 23.3%, 2.5%, and 12.2%, respectively. Child age, mothers' education level, antenatal care visit, household food security, monthly household income, and place of residence were found to be associated with CF practices.

CONCLUSION

When compared to results obtained using the previous guideline, the new one has resulted in a lower prevalence of Introduction of solid, semi-solid, or soft foods (ISSF), Minimum dietary diversity (MDD), Minimum meal frequency (MMF), and Minimum acceptable diet (MAD). It is crucial to convey the new knowledge for better child feeding and nutrition as the country prepares to apply the new guideline.

Closing the gaps in the continuum of depression care for persons with HIV: modeling the impact on viral suppression in the United States

OBJECTIVE

Depression is prevalent among persons with HIV (PWH) and is associated with poorer adherence and lack of viral load suppression (VLS). When treated for depression, PWH are more likely to stay in HIV care and adhere to medications; however, for many PWH, depression is not adequately diagnosed or treated. We adapted Progression and Transmission of HIV (PATH 3.0), a U.S. agent-based dynamic stochastic simulation model, by incorporating a continuum of depression care and estimating the impact on VLS of an enhanced depression diagnosis and care scenario (EDC).

METHODS

We compared EDC - whereby every PWH is assessed for depression, gets treatment if diagnosed, and of those, half achieve remission - to a status quo scenario (SQ) on VLS. Based on published findings, assumptions for SQ were: 34.7% depressed, 45% diagnosed, 55.3% treated and 33% of treated achieving remission. Compared to PWH without depression, we assumed the probability of being non-virally suppressed increased by 1.57 times for PWH with depression (PWH-D), and by 0.95 times for PWH with remitted depression.

RESULTS

There was an average increase of 14.6% (11.5-18.5) in the proportion of PWH-D who achieved VLS in EDC compared to SQ. Among all PWH, there was a 4.7% (3.4-6.0) increase in the proportion who achieved VLS in EDC compared to SQ.

CONCLUSIONS

Fully diagnosing and adequately treating depression would improve health and quality of life for a substantial proportion of PWH-D and result in a nearly 5% increase in expected rates of VLS in the United States, supporting national prevention goals.

Dietary diversity and micronutrients adequacy among the women of reproductive age at St. Martin's island in Bangladesh

Minimum dietary diversity for women, an important dimension of diet quality, has been widely used as a proxy indicator for micronutrient adequacy. In low- and middle-income countries (LMICs), women of reproductive age (WRA) particularly are at high risk of inadequate micronutrient intake resulting from poor diversified diets. Therefore, the present study aimed to assess dietary diversity and micronutrients adequacy in the diets of WRA of St. Martin's island, along with their socio-economic determinants. A cross-sectional study was conducted on a representative sample of 201 WRA living at St. Martin's island. Utilizing the Estimated Average Requirement (EAR) cut-point approach, the adequacy of micronutrient intake was evaluated from observed 24-h recall dietary data. The recent guideline of FAO was employed to evaluate Minimum Dietary Diversity for Women (MDD-W). Binary logistic regression and multiple linear regression analyses were performed to identify socio-economic determinants of MDD-W and micronutrients adequacy. The mean (SD) dietary diversity score was 4.25 (1.17) and about 40.3% of the participants met the MDD-W cut-off. Starchy staples (100%), meat/poultry/fish (87%), and other vegetables (79%) were consumed more frequently, while, the least reported food groups were dairy (2%), nuts and seeds (11%), and vitamin A-rich fruits and vegetables (11%). Except for Niacin, intake of all micronutrients was inadequate, with an inadequacy prevalence of 36-100%. Educational level, and decision-making role of women were significantly related to their dietary diversity. On the other hand, age, decision-making role, and MDD-W were important determinants of micronutrient adequacy. In conclusion, the WRA of St. Martin's island consumed neither a sufficient amount of micronutrients nor an adequate diversity of foods. In addition, several socio-economic components are linked with dietary diversity and micronutrient adequacy. Therefore, attention is needed to decide on the best strategies to improve the quality of diet and dietary diversity for WRA in this setting.

Association of clinico-epidemiological features with locally advanced stage of cervical cancer patients presenting at Bangabandhu Sheikh Mujib Medical University, Bangladesh

Cervical cancer is one of the most prevalent gynecological cancers in women in Bangladesh. The objective of this study was to assess the clincoepidemiological association with the histology of locally advanced cervical cancer. We have done this observational study in the department of Clinical Oncology at Bangabandhu Sheikh Mujib Medical University from July to December 2019. Sixty-six biopsy-proven locally advanced (stage IIB to IVA) squamous cell carcinoma of uterine cervix were included in this study. The mean age of patients at diagnosis was 48.5 (±8.6) years. Commonly observed epidemiological characteristics of locally advanced carcinoma cervix were illiteracy (46.9%), oral contraceptive use (62.1%), multi para (78.7%) and early marriage (74.2%). Most frequent clinical presentation was post-coital bleeding (37.87%). Most patients presented in stage IIB (65.1%). The association of the stages of the disease with age, parity, oral contraceptive use, age at marriage and clinical presentation were statistically nonsignificant, whereas illiteracy was statistically significant. Most women had poor awareness regarding their need for routine check-up and screening as indicated by the late medical care seeking. Social stigma might have played some role. Relevant programmes should create awareness among women, especially those with socioeconomic deprivation. BSMMU J 2022; 15(3): 175-179

Malnutrition among under-five children in St. Martin's Island, Bangladesh: A cross-sectional study on prevalence and associated factors

Objectives

Early childhood nutrition is critical for physical and mental development, and any hindrance (malnutrition) at this stage adversely affects adulthood which makes them more susceptible to a variety of communicable and non-communicable diseases. St. Martin's Island was the focus of this study, which examined the prevalence and risk factors for malnutrition among under-five children.

Methods

In this cross-sectional study, 256 children aged under five were assessed for anthropometry, and multiple logistic regression models were fitted to identify potential predictors of malnutrition. For analysis, SPSS and WHO Anthro software were used.

Results

The prevalence of stunting, wasting, underweight, and overweight were 34.4%, 17.6%, 18.9%, and 6.9% respectively among children under-five years of age in St. Martin's Island. An increase in child's age decreases their risk of being stunted (AOR = 0.97, p = 0.006). Males were more likely than females to be wasted (AOR = 2.03, p = 0.001). Both stunting (AOR = 2.42, p = 0.004) and wasting (AOR = 2.82, p = 0.015) rate were higher among the poorer section as compared to the richest. On the contrary, underweight was low among the poorest section (AOR = 0.37, p = 0.024). Other socio-economic factors, for example, household food insecurity, and parental occupation affect these forms of malnutrition significantly.

Conclusion

Prevalence of all forms of malnutrition except underweight was higher as compared to the national perspective in St. Martin's Island among the under-five children. Community-based approaches by the local government in collaboration with various non-government organizations should be taken to reduce and prevent malnutrition among children.

Antimicrobial Resistance of E Coli Causing Urinary Tract Infection in Bangladesh

Rapid spread of multidrug resistant microorganisms is a matter of great concern throughout the glove including Bangladesh. The objective was to identify the causative organisms for urinary tract infection (UTI) and their sensitivity patterns to antibiotics. This descriptive cross-sectional study was conducted on patients admitted with UTI (n=60) at a tertiary level hospital in Dhaka, Bangladesh from March 2019 to September 2019. Data were collected through clinical record reviews. Data of all these 60 cases were analyzed for socio-demographic characteristics. Of the 60 patients, culture and sensitivity report was available for 42 patients. Therefore, data were further analyzed for these 42 cases. Median age of patients was 35 years and 80% were female. The main organisms isolated from urine culture of UTI patients were E. coli (64%), Klebsiella (12%) and Enterococci species (10%). Susceptibility to antibiotics was analyzed only for E. coli (n=27) since the number of isolates of other organisms were small. E. coli was found to be resistant to most of the first- and second-line antibiotics, such as Amoxicillin (100%), Amoxyclav (72%), Co-trimoxazole (89%), Nalidixic acid (78%), Ceftazidim (94%), Ceftriaxone (73%), Cefuroxime (100%), Ciprofloxacin (59%), Cephotaxime (80%), Cefixime (100%) and Moxifloxacin (100%). E. coli was the predominant organism responsible for UTI and was resistant to most of the first- and second-line antibiotics. Immediate action is needed to develop empirical guideline for empirical management of UTI and establish surveillance system for monitoring.

Effect of heat stress on carcass and meat quality of indigenous sheep of Bangladesh

The research was conducted to study the effect of heat stress on carcass characteristics and meat quality in indigenous sheep. Nine sheep were divided into three groups which were almost similar in age, sex and weight. Three groups were divided as zero hour (T0), four hours (T4) and eight hours (T8) heat exposure to direct sunlight. During experimental period temperature–humidity index (THI) value was calculated as 27.09 which indicated T4 and T8 groups were subjected to heat stress condition for at least four hours and eight hours respectively every day. Slaughter weight, body length and heart girth had no significant difference among the treatment groups. Dry matter, ash and ether extract had no significant difference (p>0.05) among the treatment groups but crude protein were increased with the increase of heat stress from T0 to T8 group (p<0.05). Drip loss was increased (p<0.05) in non-exposure group than treated groups but there is no significant result (p>0.05) found in pH and cooking loss. Carcass weight and eye muscle area had no significant difference (p>0.05) among the treatment groups but dressing percentage was decreased with the increase of time in heat treated groups (p<0.01). Significant difference (p<0.05) were found in weight of heart, kidney, lung + trachea and pluck between control and heat treated groups. The significant difference (p>0.05) in empty gut was found in gut with content and gut fill in heat treated groups. It can be concluded that heat stress had significant changes on carcass characteristics and meat quality of indigenous sheep.DOI: http://dx.doi.org/10.3329/bjas.v43i2.20717 Bang. J. Anim. Sci. 2014. 43 (2): 147-153

Effect of Quadriceps Strengthening Exercise on Reduction of Pain in Knee Osteoarthritis

Osleoarthritis is the leading cause of musculoskeletal pain and disability. Nonsteroidal anti-inflammatory drugs and physical modalities like Quadriceps muscle strengthening exercise can be used to treat such cases. This Randomized clinical trial study was done in the department of Physical Medicine and Rehabilitation, Sylhet M.A.G Osmani Medical College Hospital Sylhet, lo evaluate the role of quadriceps strengthening exercise in knee osteoarthritis during 1st April 2009 to 3lst October 2009. Sixty patients with knee osteoarthritis were selected according to inclusion and exclusion criteria. They were divided in, group A and group B randomly. Group- A was treated with NSAID (Aceclofenac 100 mg 12hrly) and group-B with NSAID and quadriceps strengthening exercise 10 repetition 3 times daily. Each patient was followed try every week for four weeks. The mean age was 61.067 ± 8.320 years and male female ratio was 1.4:1. Marked improvement was observed in both the groups assessed by pain score (p<0.001), physicians global assessment (p<0.001) and patients global assessment (p<0 001); and was continued throughout the treatment period of 4 weeks; with significantly marked in group A than group B beginning at 1st week of treatment [pain score (p<0.001), physicians global assessment (p<0.040) and patients global assessment (p<0.034)] and was continued at the 4th week of treatment [pain score (p<0.001), physicians global assessment (p<0.001) and patients global assessment (p<0.001)]. The overall difference between the groups from baseline to end point of treatment is significant with group A (exercise plus NSAIDs) experienced a faster pain relief than that of group B (Only NSAID) (p:<0.001). So from the present study, it may be concluded that quadriceps strengthening exercise is useful in reduction of pain in knee osteoarthritis and may be an adjuvant therapy in knee osteoarthritis. DOI: http://dx.doi.org/10.3329/bmj.v41i3.18953 Bangladesh Medical Journal 2012 Vol.41(3): 19-22