Considering equity in priority setting using transmission models: Recommendations and data needs

OBJECTIVES

Disease transmission models are used in impact assessment and economic evaluations of infectious disease prevention and treatment strategies, prominently so in the COVID-19 response. These models rarely consider dimensions of equity relating to the differential health burden between individuals and groups. We describe concepts and approaches which are useful when considering equity in the priority setting process, and outline the technical choices concerning model structure, outputs, and data requirements needed to use transmission models in analyses of health equity.

METHODS

We reviewed the literature on equity concepts and approaches to their application in economic evaluation and undertook a technical consultation on how equity can be incorporated in priority setting for infectious disease control. The technical consultation brought together health economists with an interest in equity-informative economic evaluation, ethicists specialising in public health, mathematical modellers from various disease backgrounds, and representatives of global health funding and technical assistance organisations, to formulate key areas of consensus and recommendations.

RESULTS

We provide a series of recommendations for applying the Reference Case for Economic Evaluation in Global Health to infectious disease interventions, comprising guidance on 1) the specification of equity concepts; 2) choice of evaluation framework; 3) model structure; and 4) data needs. We present available conceptual and analytical choices, for example how correlation between different equity- and disease-relevant strata should be considered dependent on available data, and outline how assumptions and data limitations can be reported transparently by noting key factors for consideration.

CONCLUSIONS

Current developments in economic evaluations in global health provide a wide range of methodologies to incorporate equity into economic evaluations. Those employing infectious disease models need to use these frameworks more in priority setting to accurately represent health inequities. We provide guidance on the technical approaches to support this goal and ultimately, to achieve more equitable health policies.

HIV/AIDS surveillance in Egypt: current status and future challenges

By international standards, HIV/AIDS prevalence is low in Egypt (< 0.1%). However, questions about the accuracy of this figure are coupled with fears of an imminent increase in prevalence, with evidence suggesting that, despite Egypt's conservative culture, high-risk behaviour is more widespread than commonly reported and the country's changing socioeconomic context is perpetuating this trend. Through an analysis of the current HIV/AIDS surveillance system in Egypt, this paper explores some of the unique challenges this country faces in dealing with the HIV/AIDS epidemic. It concludes that constraints, such as Egypt's cultural norms and laws, the population's lack of knowledge about HIV/AIDS and the bureaucratic health system, hinder the development and implementation of effective surveillance systems.