1.  Peer Reviewed Title: Universal voluntary HIV testing and immediate antiretroviral therapy [letter] Author: Assefa Y; Lera M Source: Lancet. 2009 Mar 28;373(9669):1080; author reply 1080-1. Abstract: Reuben Granich and colleagues use mathematical models to show that annual screening of most adults for HIV, with immediate commencement of antiretroviral therapy for all infected, would strikingly reduce HIV incidence. The findings are very interesting. We would like to share our lessons from Ethiopia. Ethiopia had a millennium AIDS campaign with the objective of increasing the number of people tested for HIV through universal voluntary counselling and testing and providing antiretroviral treatment for eligible patients. We were able to increase the number of people tested in 1 year from 560 000 in 2005/06 to 4.6 million in 2007/08. The number of patients started on antiretroviral therapy per month increased from 3500 to more than 5700. Even though we accomplished a lot in terms of HIV testing and antiretroviral therapy provision, we had challenges during the rapid scale-up of these services. We learnt that mass testing is very resource-intensive and needs a strong health system, including adequate human resources and a continuous supply of commodities. As a result, our current guiding principle is "high yield" and "high impact" through targeted testing of most-at-risk populations: patients with tuberculosis or sexually transmitted diseases, and pregnant women. Universal voluntary HIV testing and antiretroviral therapy provision might be effective in reducing HIV transmission, but with the current health system constraints in many sub-Saharan African countries such as Ethiopia, it is really not feasible to practise it. We recommend "high yield" and "high impact" HIV testing with early initiation of antiretroviral therapy, and improved adherence and retention of patients in care and treatment. (full-text) Language: English Keywords: DEVELOPING COUNTRIES | THEORETICAL STUDIES | RESEARCH PROPOSAL | THEORETICAL MODELS | COST BENEFIT ANALYSIS | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | BEST PRACTICES | HIV PREVENTION | PUBLIC HEALTH | TIME FACTORS | COST EFFECTIVENESS | ETHICS | NOTIFICATION | Studies | Research Methodology | Quantitative Evaluation | Evaluation | HIV Infections | Viral Diseases | Diseases | HIV | Programs | Organization and Administration | Health | Population Dynamics | Demographic Factors | Population | Evaluation Indexes | Sociocultural Factors | Political Factors Document Number: 330977 |
| 2. Peer Reviewed Title: "Conditional scholarships" for HIV/AIDS health workers: educating and retaining the workforce to provide antiretroviral treatment in sub-Saharan Africa. Author: Barnighausen T; Bloom DE Source: Social Science and Medicine. 2009 Feb;68(3):544-51. Abstract: Without large increases in the number of health workers to treat HIV/AIDS (HAHW) many countries in sub-Saharan Africa will be unable to achieve universal coverage with antiretroviral treatment (ART), leading to large numbers of avoidable deaths among people living with HIV/AIDS. We conduct a cost-benefit analysis of a health care education scholarship that is conditional on the recipient committing to work for several years after graduation delivering ART in sub-Saharan Africa. Such a scholarship could address two of the main reasons for the low numbers of health workers in sub-Saharan Africa: low education rates and high emigration rates. We use Markov Monte Carlo microsimulation to estimate the expected net present value (eNPV) of "conditional scholarships" in sub-Saharan Africa. The scholarships are highly eNPV-positive under a wide range of assumptions. Conditional scholarships for a HAHW team sufficient to provide ART for 500 patients have an eNPV of 1.24 million year-2000 US dollars, assuming that the scholarship recipients are in addition to the health workers who would have been educated without scholarships and that the scholarships reduce annual HAHW emigration probabilities from 15% to 5% for five years. The eNPV of the education effect of the scholarships is larger than eNPV of the migration effect. Policy makers should consider implementing "conditional scholarships" for HAHW, especially in countries where health worker education capacity is currently underutilized or can be rapidly expanded. Language: English Keywords: AFRICA, SUB SAHARAN | RESEARCH REPORT | MARKOV CHAIN | LABOR FORCE | HEALTH PERSONNEL | HUMAN RESOURCES | ANTIRETROVIRAL THERAPY | HIV INFECTIONS | AIDS | COST BENEFIT ANALYSIS | MANAGEMENT | Africa | Developing Countries | Probability | Statistical Studies | Studies | Research Methodology | Economic Factors | Delivery of Health Care | Health | HIV | Viral Diseases | Diseases | Quantitative Evaluation | Evaluation | Organization and Administration Document Number: 330870 |
| 3. Title: On what diseases and health conditions should new economic research on health and development focus? Author: Behrman JR; Behrman JA; Perez NM Source: Health Economics. 2009 Apr;18 Suppl 1:S109-28. Abstract: Given the public goods nature of research, economic research on health in developing countries is likely to have the highest returns by focusing, inter alia, on diseases and health conditions that are relatively widespread and costly and that are relatively rapidly growing. This article first summarizes the time patterns in economic research on diseases and health in developing countries for 1990-2005. It then compares those time patterns with the distribution of disability-adjusted life years (DALYs) for diseases and health conditions in developing countries estimated for 2005 and for 2030. These comparisons suggest relatively overemphasis on HIV/AIDS and underemphasis on noncommunicable diseases (NCDs). This opens the possibility for individuals or organizations initiating, re-evaluating, or increasing their economic research on health and development to make a significant contribution by focusing particularly on the analysis of behaviour and policy choices related to NCDs. Careful consideration must, of course, be given to other demands, but on the basis of these two criteria, potential contributions are likely to be greatest from research with such a focus. Language: English Keywords: GLOBAL | CRITIQUE | LITERATURE REVIEW | RESEARCH ACTIVITIES | ECONOMICS | ECONOMIC DEVELOPMENT | HEALTH | HIV INFECTIONS | DISEASES | INTERVENTIONS | COST BENEFIT ANALYSIS | LENGTH OF LIFE | Research Methodology | Social Sciences | Science | Sociocultural Factors | Economic Factors | Viral Diseases | Programs | Organization and Administration | Quantitative Evaluation | Evaluation | Mortality | Population Dynamics | Demographic Factors | Population Document Number: 341823 |
| 4. Peer Reviewed Title: Economic analysis of HIV prevention interventions in Andhra Pradesh state of India to inform resource allocation. Author: Dandona L; Kumar SG; Kumar GA; Dandona R Source: AIDS. 2009 Jan 14;23(2):233-42. Abstract: OBJECTIVE: To conduct composite economic analysis of HIV prevention interventions to inform efficient utilization of resources in India. METHODS: We obtained output and economic cost data for the 2005-2006 fiscal year from a representative sample of 128 public-funded HIV prevention programmes of 14 types in Andhra Pradesh state of India. Using data from various sources, we developed a model to estimate the number of HIV infections averted. We estimated the additional HIV infections that could be averted if each intervention reached optimal coverage and the associated cost. RESULTS: In a year, 9688 HIV infections were averted by public-funded HIV prevention interventions in Andhra Pradesh. Scaling-up interventions to the optimal level would require US$38.8 million annually, 2.8 times the US$13.8 million economic cost in 2005-2006. This could increase the number of HIV infections averted by 2.4-fold, if with higher resources there were many-fold increases in the proportional allocation for programmes for migrant labourers, men who have sex with men and voluntary counselling and testing, and reduction of the high proportion for mass media campaigns to one-third of the 2005-2006 proportion of resource utilization. If the proportions of resource allocation for interventions remained similar to 2005-2006, the higher resources would avert 54% of the additional avertable HIV infections. CONCLUSION: The recent four-fold increase in public funding for HIV/AIDS control in India should be adequate to scale-up HIV prevention interventions to an optimal level in Andhra Pradesh, but the prevention would be suboptimal if additional investments were not preferentially directed to some particular interventions. Language: English Keywords: INDIA | RESEARCH REPORT | INTERVENTIONS | HIV INFECTIONS | COST BENEFIT ANALYSIS | ECONOMIC FACTORS | RESOURCE ALLOCATION | FUNDS | FINANCIAL ACTIVITIES | Developing Countries | Asia, Southern | Asia | Programs | Organization and Administration | Viral Diseases | Diseases | Quantitative Evaluation | Evaluation Document Number: 330502 |
| 5. Peer Reviewed Title: Tubal sterilization by laparoscopy or hysteroscopy: which is the most cost-effective procedure? Author: Franchini M; Cianferoni L; Lippi G; Calonaci F; Calzolari S; Mazzini M; Florio P Source: Fertility and Sterility. 2009 Apr;91(4 Suppl):1499-502. Abstract: By using the activity-based cost/management (ABC/M) system we computed and compared costs needed for laparoscopic tubal sterilization (LTS) and Essure hysteroscopic tubal occlusion (EHTO). We found that total health costs related to consultation and presurgery did not differ between LTS and EHTO; EHTO has low recovery unit costs but is more costly for the operating theater, mainly due to Essure microinserts. Language: English Keywords: UNITED STATES OF AMERICA | ITALY | RESEARCH REPORT | WOMEN | TUBAL LIGATION | FEMALE STERILIZATION | SURGERY | COST BENEFIT ANALYSIS | TREATMENT | DELIVERY OF HEALTH CARE | MANAGEMENT | LOGISTICS | SCREENING | PROGRAM EFFICIENCY | Developed Countries | North America | Americas | Europe, Southern | Europe | Demographic Factors | Population | Sterilization, Sexual | Family Planning | Medical Procedures | Medicine | Health Services | Health | Quantitative Evaluation | Evaluation | Organization and Administration | Examinations and Diagnoses | Program Evaluation | Programs Document Number: 341007 |
| 6. Title: A prospective study evaluating clinical outcomes and costs of three NNRTI-based HAART regimens in Kerala, India. Author: George C; Yesoda A; Jayakumar B; Lal L Source: Journal of Clinical Pharmacy and therapeutics. 2009 Feb;34(1):33-40. Abstract: OBJECTIVE: This prospective, observational, study evaluates the clinical outcomes, drug utilization patterns, and adherence to treatment of patients on highly active anti retroviral therapy (HAART) at a government institution in Kerala, India. METHODS: Patients who met criteria for treatment of HIV/AIDS were enrolled into the study, given free NNRTI-based combination therapy, and were followed for a period of 6 months. Data regarding demographics, clinical outcome, laboratory results, drug utilization, adherence and adverse effects were collected. Analysis was conducted utilizing descriptive statistics, anova, Fisher-exact, andt-test. RESULTS: One hundred and forty-two patients with HIV-1 were enrolled in the study into three treatment groups. The mean age was 37.88 years, 64% of the patients were male, and 92% were married. Group 1 was given zidovudine, lamivudine, and nevirapine [n = 52 (37%)], group 2 was given lamivudine, stavudine, and nevirapine [n = 51 (36%)], and group 3 was given lamivudine, stavudine, and efavirenz [n = 39 (27%)]. The increase in CD4 was 107.46 (SD: 106.25). Mean medication adherence for the 104 patients who completed the study, was 90.7%; for group 1: 92.06%, group 2: 93.37%1, and group 3: 85.71% (P > 0.05). Forty (38%) patients have at least one adverse event to HARRT, with headache being the most common side effect (11.5%). Mortality rate was 3.5% during the course of the study. CONCLUSION: Provision of free NNRTI-based combination therapy to patients in Kerala, India, resulted in greater than 90% adherence leading to better clinical outcomes in terms of increasing CD4 counts and low mortality, for patients consistently attending a treatment clinic. Language: English Keywords: INDIA | RESEARCH REPORT | CLINICAL RESEARCH | PROSPECTIVE STUDIES | COST BENEFIT ANALYSIS | COMPARATIVE STUDIES | PERSONS LIVING WITH HIV/AIDS | COST EFFECTIVENESS | HIV INFECTIONS | ANTIRETROVIRAL THERAPY | USER COMPLIANCE | HEADACHE | SIDE EFFECTS | DEATH RATE | Developing Countries | Asia, Southern | Asia | Research Methodology | Studies | Quantitative Evaluation | Evaluation | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Evaluation Indexes | HIV | Behavior | Signs and Symptoms | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Mortality | Population Dynamics | Demographic Factors | Population Document Number: 330372 |
| 7. Peer Reviewed Title: The effect of interrupted 5-day training on Integrated Management of Neonatal and Childhood Illness on the knowledge and skills of primary health care workers. Author: Kumar D; Aggarwal AK; Kumar R Source: Health Policy and Planning. 2009 Mar;24(2):94-100. Abstract: The conventional 8-day Integrated Management of Neonatal and Childhood Illness (IMNCI) training package poses several operational constraints, particularly due to its long duration. A 5-day training package was developed and administered in an interrupted mode of 3 days and 2 days duration with a break of 4 days in-between, in a district of Haryana state in northern India. Improvement in the knowledge and skills of 50 primary health care workers following the interrupted 5-day training was compared with that of 35 primary health care workers after the conventional 8-day IMNCI training package. The average score increased significantly (P < 0.05) from 46.3 to 74.6 in 8-day training and from 40.0 to 73.2 in 5-day training. Knowledge score improved for all health conditions, like anaemia, diarrhoea, immunization, malnutrition, malaria, meningitis and possible severe bacterial infection, and for breastfeeding in 8-day as well as in 5-day training. Average skills score for respiratory problems increased from 38 to 57 in 8-day training and from 41 to 91 in 5-day training. Corresponding increases in skill scores for diarrhoea assessment were from 28 to 67 and 48 to 75, and for breastfeeding assessment from 33 to 84 and 42 to 86 in 8-day and 5-day training, respectively. Average counselling skill score also rose from 42 to 89 in 8-day and from 37 to 70 in 5-day training. A direct cost saving of US$813 for a batch of 25 trainees and an indirect cost saving of 3 days per trainee and resource person makes the interrupted 5-day IMNCI training more cost-effective. Language: English Keywords: INDIA | RESEARCH REPORT | KAP SURVEYS | COMPARATIVE STUDIES | COST BENEFIT ANALYSIS | HEALTH PERSONNEL | TRAINING PROGRAMS | NEONATAL DISEASES AND ABNORMALITIES | CHILD HEALTH | INTEGRATED PROGRAMS | TIME FACTORS | PRIMARY HEALTH CARE | KNOWLEDGE | EXAMINATIONS AND DIAGNOSES | COST EFFECTIVENESS | Asia, Southern | Asia | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Quantitative Evaluation | Evaluation | Delivery of Health Care | Health | Education | Diseases | Programs | Organization and Administration | Population Dynamics | Demographic Factors | Population | Health Services | Sociocultural Factors | Medical Procedures | Medicine | Evaluation Indexes Document Number: 331230 |
| 8. Peer Reviewed Title: Exploring the costs and economic consequences of unsafe abortion in Mexico City before legalisation. Author: Levin C; Grossman D; Berdichevsky K; Diaz C; Aracena B; Garcia SG Source: Reproductive Health Matters. 2009 May;17(33):120-132. Abstract: An assessment of abortion outcomes and costs to the health care system in Mexico City was conducted in 2005 at a mix of public and private facilities prior to the legalisation of abortion. Data were obtained from hospital staff, administrative records and patients. Direct cost estimates included personnel, drugs, disposable supplies, and medical equipment for inducing abortion or treating incomplete abortions and other complications. Indirect patient costs for travel, childcare and lost wages were also estimated. The average cost per abortion with dilatation and curettage was US $143. For manual vacuum aspiration it was US $111 in three public hospitals and US $53 at a private clinic. The average cost of medical abortion with misoprostol alone was US $79. The average cost of treating severe abortion complications at the public hospitals ranged from US $601 to over US $2,100. Increasing access to manual vacuum aspiration and early abortion with misoprostol could reduce government costs by 62%, with potential savings of up to US $1.6 million per year. Reducing complications by improving access to safe services in outpatient settings would further reduce the costs of abortion care, with significant benefits both to Mexico's health care system and women seeking abortion. Additional research is needed to explore whether cost savings have been realised post-legalisation. Spanish Abstract: En 2005, antes de la legalización del aborto en el Distrito Federal de México, se realizó una evaluación del impacto y los costos del aborto en el sistema de salud del D.F., en diversos establecimientos públicos y privados. Se obtuvieron datos de personal hospitalario, registros administrativos y pacientes. Los cálculos de costos directos incluían personal, medicamentos, suministros desechables, y equipo médico para inducir el aborto o tratar abortos incompletos y otras complicaciones. También se calcularon los costos indirectos de las pacientes en viajes, cuido de niños y sueldos perdidos. El costo promedio por cada aborto con dilatación y curetaje fue de US $143. Para la aspiración manual endouterina (AMEU), fue de US $111 en tres hospitales públicos y US $53 en una clínica privada. El costo promedio del aborto inducido con misoprostol solo fue de US $79. El costo promedio de tratar las complicaciones graves del aborto en los hospitales públicos varió de US $601 a más de US $2,100. Al ampliar el acceso a la AMEU y al aborto precoz con misoprostol, se podrían disminuir los costos gubernamentales en un 62%, un posible ahorro de hasta US $1.6 millones al año. Al disminuir las complicaciones tras mejorar el acceso a los servicios seguros en ámbitos ambulatorios, disminuirían también los costos de la atención del aborto, lo cual sería un gran beneficio tanto para el sistema de salud de México como para las mujeres que buscan servicios de aborto. Aún se necesitan más investigaciones para explorar si se han logrado ahorros en costos post-legalización. French Abstract: En 2005, avant la légalisation de l'avortement, on a évalué les résultats et le coût de l'avortement sur le système sanitaire à Mexico, dans des établissements publics et privés. Les données ont été obtenues auprès du personnel hospitalier et des patientes, et dans les dossiers administratifs. Les estimations directes des coûts incluaient le personnel, les médicaments, les consommables et l'équipement médical pour provoquer l'avortement ou traiter les avortements incomplets et d'autres complications. Les frais indirects de déplacement, de garde d'enfants et de perte de gain des patientes ont aussi été calculés. Le coût moyen par avortement avec dilatation et curetage était de $US143. Par aspiration manuelle, il était de $US 111 dans trois hôpitaux publics et $US 53 dans une clinique privée. Le coût moyen de l'avortement médicamenteux avec du misoprostol seul était de $US 79. En moyenne, le traitement des complications graves de l'avortement dans les hôpitaux publics allait de $US 601 à plus de $US 2100. Un accès élargi à l'aspiration manuelle et à l'avortement précoce au misoprostol permettrait de réduire de 62% les coûts gouvernementaux, avec des économies potentielles se chiffrant à $US 1,6 million par an. En réduisant les complications par l'amélioration de l'accès à des services ambulatoires sûrs, on diminuerait encore le coût des soins de l'avortement, avec de nets avantages pour le système de santé mexicain et les femmes souhaitant avorter. Il faut mener des recherches supplémentaires pour déterminer si des économies ont été réalisées après l'adoption de la légalisation. Language: English Keywords: MEXICO | URBAN AREAS | RESEARCH REPORT | CLIENTS | ABORTION | ABORTION LAW | EXPENDITURES | FEES | CERVICAL DILATATION | CURETTAGE | PROGRAM ACCESSIBILITY | COST BENEFIT ANALYSIS | North America | Americas | Developing Countries | Geographic Factors | Population | Program Activities | Programs | Organization and Administration | Fertility Control, Postconception | Family Planning | Financial Activities | Economic Factors | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Obstetrical Surgery | Surgery | Program Evaluation | Quantitative Evaluation | Evaluation Document Number: 342021 Notification |
| 9. Peer Reviewed Title: Actual cost of providing long-acting reversible contraception: a study of Implanon((R)) cost. Author: Lipetz C; Phillips C; Fleming C Source: Journal of Family Planning and Reproductive Health Care. 2009 Apr;35(2):75-9. Abstract: BACKGROUND: The National Institute for Health and Clinical Excellence (NICE) has judged Implanon((R)) to be the most cost effective of the long-acting reversible contraception (LARC) methods, and its cost effectiveness is enhanced with increased duration of use. Gwent Sexual and Reproductive Health service provides unrestricted use of Implanon, and with the number of implants fitted increasing annually the service wanted to know how long clients were keeping their contraceptive implants in and the cost of implant provision. METHODS: The actual cost of providing Implanon was calculated in a cohort of 493 patients within a community-based sexual and reproductive health service, and compared to that predicted in the NICE Clinical Guideline 30 on LARC. RESULTS: The annual cost for the method (using Implanon) was pound77.49, 25% lower than the estimate made by NICE, despite a shorter duration of use of the method. CONCLUSION: The actual cost in this community-based sexual and reproductive health service may not be transferable to other settings such as general practice. Language: English Keywords: UNITED KINGDOM | RESEARCH REPORT | CLINICAL RESEARCH | COST BENEFIT ANALYSIS | COHORT ANALYSIS | WOMEN | CONTRACEPTIVE IMPLANTS | COST EFFECTIVENESS | COMMUNITY HEALTH SERVICES | FAMILY PLANNING PROGRAM EVALUATION | TIME FACTORS | Developed Countries | Europe, Western | Europe | Research Methodology | Quantitative Evaluation | Evaluation | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Evaluation Indexes | Primary Health Care | Health Services | Delivery of Health Care | Health | Family Planning Programs | Population Dynamics Document Number: 330950 |
| 10. Peer Reviewed Title: Health economics of contraception. Author: Mavranezouli I Source: Best Practice and Research. Clinical Obstetrics and Gynaecology. 2009 Apr;23(2):187-198. Abstract: Unintended pregnancies constitute a global problem associated with substantial costs to health and social services, and emotional distress to women, their families and society as a whole. Provision of contraception has been demonstrated to be a particularly cost-effective healthcare intervention as, besides preventing a significant number of unintended pregnancies, it also results in great cost-savings to society. Male and female sterilization and long-acting reversible methods (such as the copper-T intra-uterine device and the subdermal implant) constitute the most cost-effective contraceptive options, followed by other hormonal methods (such as oral contraceptives); barrier and behavioural methods (such as the male condom and withdrawal, respectively) are least cost-effective compared with other contraceptive options. Nevertheless, when compared with no method, they still prevent a large number of unintended pregnancies, thus leading to important cost-savings. Improvements in compliance and continuation rates are expected to further enhance the contraceptive benefits and cost-savings associated with contraceptive use. Language: English Keywords: UNITED KINGDOM | RESEARCH REPORT | COST BENEFIT ANALYSIS | ECONOMICS | FEES | CONTRACEPTION | PUBLIC HEALTH | Developed Countries | Europe, Western | Europe | Quantitative Evaluation | Evaluation | Social Sciences | Science | Sociocultural Factors | Financial Activities | Economic Factors | Family Planning | Health Document Number: 329667 |
11.  Title: Family-Friendly Workplace: A model for estimating the cost savings of implementing family-friendly policies. Author: Plosky WD; Winfrey B Source: Washington, D.C., Futures Group International, Health Policy Initiative, 2009 Jan. 21 p. (USAID Contract No. GPO-I-01-05-00040-00) Abstract: The Family-Friendly Workplace (FFW) Model is designed to engage individuals and groups from diverse institutions in all sectors to make workplaces more family-friendly. The FFW model will help reproductive health advocates and employers of women understand the benefits and costs of implementing policies that support women in their reproductive years. Users of the model may be human resource departments of medium-sized and large companies, family planning advocates, maternal health advocates or groups representing women in the workplace. Language: English Keywords: GLOBAL | SUMMARY REPORT | MANUAL | WOMEN | WORKPLACE | FAMILY POLICY | REPRODUCTIVE HEALTH | EXPENDITURES | COST BENEFIT ANALYSIS | PREGNANCY | WORKPLAN | MATERNITY BENEFITS | Demographic Factors | Population | Employment | Macroeconomic Factors | Economic Factors | Social Policy | Policy | Political Factors | Sociocultural Factors | Health | Financial Activities | Quantitative Evaluation | Evaluation | Reproduction | Planning | Organization and Administration | Microeconomic Factors Document Number: 331541 |
| 12. Peer Reviewed Title: Human papillomavirus infection and cervical cytology in HIV-infected and HIV-uninfected Rwandan women. Author: Singh DK; Anastos K; Hoover DR; Burk RD; Shi Q; Ngendahayo L; Mutimura E; Cajigas A; Bigirimani V; Cai X; Rwamwejo J; Vuolo M; Cohen M; Castle PE Source: Journal of Infectious Diseases. 2009 Jun 15;199(12):1851-61. Abstract: BACKGROUND: Data on human papillomavirus (HPV) prevalence are essential for developing cost-effective cervical cancer prevention programs. METHODS: In 2005, 710 human immunodeficiency virus (HIV)-positive and 226 HIV-negative Rwandan women enrolled in an observational prospective cohort study. Sociodemographic data, CD4+ cell counts, and cervical specimens were obtained. Cervicovaginal lavage specimens were collected from each woman and tested for >40 HPV types by a polymerase chain reaction assay; HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68 were considered primary carcinogenic HPV types. RESULTS: The prevalence of HPV was higher in HIV-positive women than in HIV-negative women in all age groups. Among HIV-infected women, 69% were positive for >or=1 HPV type, 46% for a carcinogenic HPV type, and 10% for HPV-16. HPV prevalence peaked at 75% in the HIV-positive women aged 25-34 years and then declined with age to 37.5% in those >or=55 years old (Ptrend<.001). A significant trend of higher prevalence of HPV and carcinogenic HPV with lower CD4+ cell counts and increasing cytologic severity was seen among HIV-positive women. CONCLUSIONS: We found a higher prevalence of HPV infection in HIV-positive than in HIV-negative Rwandan women, and the prevalence of HPV and carcinogenic HPV infection decreased with age. Language: English Keywords: RWANDA | RESEARCH REPORT | PREVALENCE | WOMEN | PERSONS LIVING WITH HIV/AIDS | CERVICAL CANCER | COST BENEFIT ANALYSIS | PREVENTION AND CONTROL | CYTOLOGY | PROGRAM EVALUATION | Africa, Central | Africa, Sub Saharan | Africa | Developing Countries | Measurement | Research Methodology | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Cancer | Neoplasms | Quantitative Evaluation | Evaluation | Biology | Programs | Organization and Administration Document Number: 342067 |
| 13. Title: When to start antiretroviral therapy in resource-limited settings. Author: Walensky RP; Wolf LL; Wood R; Fofana MO; Freedberg KA; Martinson NA; Paltiel AD; Anglaret X; Weinstein MC; Losina E Author: CEPAC (Cost-Effectiveness of Preventing AIDS Complications)-International Source: Annals of Internal Medicine. 2009 Aug 4;151(3):157-66. Abstract: BACKGROUND: The results of international clinical trials that are assessing when to initiate antiretroviral therapy (ART) will not be available for several years. OBJECTIVE: To inform HIV treatment decisions about the optimal CD4 threshold at which to initiate ART in South Africa while awaiting the results of these trials. DESIGN: Cost-effectiveness analysis by using a computer simulation model of HIV disease. DATA SOURCES: Published data from randomized trials and observational cohorts in South Africa. TARGET POPULATION: HIV-infected patients in South Africa. TIME HORIZON: 5-year and lifetime. PERSPECTIVE: Modified societal. INTERVENTION: No treatment, ART initiated at a CD4 count less than 0.250 x 10(9) cells/L, and ART initiated at a CD4 count less than 0.350 x 10(9) cells/L. OUTCOME MEASURES: Morbidity, mortality, life expectancy, medical costs, and cost-effectiveness. RESULTS OF BASE-CASE ANALYSIS: If 10% to 100% of HIV-infected patients are identified and linked to care, a CD4 count threshold for ART initiation of 0.350 x 10(9) cells/L would reduce severe opportunistic diseases by 22,000 to 221,000 and deaths by 25,000 to 253,000 during the next 5 years compared with ART initiation at 0.250 x 10(9) cells/L; cost increases would range from $142 million (10%) to $1.4 billion (100%). Either ART initiation strategy would increase long-term survival by at least 7.9 years, with a mean per-person life expectancy of 3.8 years with no ART and 12.5 years with an initiation threshold of 0.350 x 10(9) cells/L. Compared with an initiation threshold of 0.250 x 10(9) cells/L, a threshold of 0.350 x 10(9) cells/L has an incremental cost-effectiveness ratio of $1200 per year of life saved. RESULTS OF SENSITIVITY ANALYSIS: Initiating ART at a CD4 count less than 0.350 x 10(9) cells/L would remain cost-effective over the next 5 years even if the probability that the trial would demonstrate the superiority of earlier therapy is as low as 17%. LIMITATION: This model does not consider the possible benefits of initiating ART at a CD4 count greater than 0.350 x 10(9) cells/L or of reduced HIV transmission. CONCLUSION: Earlier initiation of ART in South Africa will probably reduce morbidity and mortality, improve long-term survival, and be cost-effective. While awaiting trial results, treatment guidelines should be liberalized to allow initiation at CD4 counts less than 0.350 x 10(9) cells/L, earlier than is currently recommended. PRIMARY FUNDING SOURCE: National Institute of Allergy and Infectious Diseases and the Doris Duke Charitable Foundation. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | COST BENEFIT ANALYSIS | CLINICAL TRIALS | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | LIFE EXPECTANCY | MORBIDITY | MORTALITY | TIME FACTORS | ANTIRETROVIRAL THERAPY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Quantitative Evaluation | Evaluation | Clinical Research | Research Methodology | Viral Diseases | Diseases | Length of Life | Population Dynamics | Demographic Factors | Population | HIV Document Number: 342686 |
| 14. Title: Long-acting and permanent methods. Author: Family Health International [FHI] Source: Family Health Research. 2008 Feb;2(1):1-8. Abstract: In this issue, the authors examin the unrealized potential of long-term contraception to help family planning programs meet the needs of clients and improve public health. Long-acting and permanent methods (LAPMs) of contraception include reversible contraceptive implants and intrauterine devices (also known as intrauterine contraceptive devices, or IUCDs), as well as the permanent methods of vasectomy and female sterilization. LAPMs are the most effective modern methods for preventing unintended pregnancies. Because they are also cost-effective, increases in their use can help sustain family planning programs. But the use of LAPMs is limited in most countries in sub-Saharan Africa. Challenges to LAPM use persist. However, experience from Kenya and other countries suggests that comprehensive efforts to improve service delivery and to educate potential clients can increase use. And research conducted by FHI has identified ways to improve access to LAPM services. Language: English Keywords: KENYA | SUMMARY REPORT | WOMEN | FAMILY PLANNING | CONTRACEPTIVE IMPLANTS | IUD | FEMALE STERILIZATION | VASECTOMY | COST BENEFIT ANALYSIS | FAMILY PLANNING PROGRAMS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Demographic Factors | Population | Contraceptive Methods | Contraception | Sterilization, Sexual | Male Sterilization | Quantitative Evaluation | Evaluation Document Number: 341180 |
| 15. Title: Paying the price. The economic cost of failing to educate girls. Author: Plan Source: Woking, United Kingdom, Plan, 2008. 11 p. Abstract: Perhaps it is impossible to quantify the difference it makes to individuals' confidence, well-being and life-chances. But there is increasing evidence that we can make a serious estimate of the cost to economies of failing to educate girls to the same standard as boys. This report presents a new analysis of the economic cost of failing to educate girls. Based on World Bank research and economic data and UNESCO education statistics, it estimates the economic cost to 65 low and middle income and transitional countries of failing to educate girls to the same standard as boys as a staggering US$92 billion each year. This is just less than the $103bn annual overseas development aid budget of the developed world. The message is clear: investment in girls' education will deliver real returns, not just for individuals but for the whole of society. (excerpt) Language: English Keywords: DEVELOPING COUNTRIES | PROGRESS REPORT | COST BENEFIT ANALYSIS | CROSS-CULTURAL COMPARISONS | CHILD, FEMALE | EDUCATION | MACROECONOMIC FACTORS | ECONOMIC DEVELOPMENT | COST EFFECTIVENESS | FOREIGN AID | INEQUALITIES | PROGRAM ACCESSIBILITY | WOMEN'S EMPOWERMENT | SEX DISCRIMINATION | SCHOOL ENROLLMENT | Quantitative Evaluation | Evaluation | Comparative Studies | Studies | Research Methodology | Child | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Economic Factors | Evaluation Indexes | Financial Activities | Socioeconomic Factors | Program Evaluation | Programs | Organization and Administration | Women's Status | Social Discrimination | Social Problems | Sociocultural Factors | Educational Status | Socioeconomic Status Document Number: 326794 |
| 16. Title: Abortions averted through contraception. Author: Population Resource Center Source: [Washington, D.C.], Population Resource Center, [2008]. [4] p. Abstract: An estimated 26 million legal and 20 million illegal abortions were performed worldwide. The resulting overall abortion rate was 35 per 1,000 women aged 15-44. Among the sub regions of the world, Eastern Europe had the highest abortion rate (90 per 1,000) and Western Europe the lowest rate (11 per 1,000). In response to the findings of surveys, the United Nations Population Fund, the UNFPA, and USAID launched targeted family planning programs in Eastern Europe, as well as other high risk regions like Asia and Latin America. (excerpt) Language: English Keywords: DEVELOPING COUNTRIES | EVALUATION REPORT | COST BENEFIT ANALYSIS | PERIOD ANALYSIS | WOMEN IN DEVELOPMENT | CONTRACEPTIVE USAGE | ABORTION RATE | UNFPA | UNAIDS | FAMILY PLANNING PROGRAM EVALUATION | CONTRACEPTIVE PREVALENCE | FOREIGN AID | Evaluation | Quantitative Evaluation | Research Methodology | Economic Development | Economic Factors | Contraception | Family Planning | Fertility Control, Postconception | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Family Planning Programs | Financial Activities Document Number: 325658 Notification |
| 17. Title: Assessment of urine-diverting EcoSan toilets in Nepal. Report. Author: WaterAid Source: Kupondole, Nepal, WaterAid in Nepal, 2008 Sep. 72 p. Abstract: The study has found that, overall, the development and promotion of EcoSan toilets in Nepal has been very good. Based on the findings of this study, the following measures are recommended as a way forward for regulating and scaling up EcoSan in Nepal: 1. Institute regulated system for promoting EcoSan by designing a system to standardize designs based on local needs, develop a uniform financing system and ensure quality control. 2. Use the agricultural sector, including research institutions and the large network of extension workers, to further promote EcoSan throughout Nepal. 3. Demonstrate EcoSan in different areas outside the Kathmandu valley - particularly in communities where availability of water and fertilizer is a problem and use of human excreta is not a social taboo. 4. Include EcoSan promotion in existing sanitation and agriculture-related projects and programmes. 5. Promote urine utilization by ensuring that a good urine collection system, with 100 litre plastic tanks, and proper training is mandatory for all EcoSan toilets. 6. Demonstrate the concept of a urine bank that collects urine from different EcoSan users or from places where urine is produced in large quantities and then stores it properly and distributes it when there is a demand for it. 7. Reduce the cost of EcoSan and introduce cost effective models. 8. Promote organic fertilizer. 9. Build local capacity by providing training. 10. Raise awareness of EcoSan through mass communication as well as interpersonal communication. 11. Conduct regular research and monitoring on the performance of EcoSan toilets. 12. Build effective networks for learning and coordination among individuals and organizations involved in promoting EcoSan in Nepal. (Excerpts) Language: English Keywords: NEPAL | EVALUATION REPORT | SANITATION | WASTE MANAGEMENT | APPROPRIATE TECHNOLOGY | LATRINES | AGRICULTURE | PERCEPTION | COST BENEFIT ANALYSIS | PROMOTION | Developing Countries | Asia, Southern | Asia | Evaluation | Public Health | Health | Environment | Technology | Economic Factors | Macroeconomic Factors | Psychological Factors | Behavior | Quantitative Evaluation | Marketing Document Number: 331420 |
| 18. Title: Integrated management of childhood illness: efficiency of primary health in Northeast Brazil. Author: Amorim DG; Adam T; Amaral JJ; Gouws E; Bryce J Source: Revista de Saude Publica. 2008 Apr;42(2):183-190. Abstract: OBJECTIVE: The Integrated Management of Childhood Illness is a strategy designed to address major causes of child mortality. The aim of this study was to assess the impact of the strategy on the quality of child health care provided at primary facilities. METHODS: Child health quality of care and costs were compared in four states in Northeastern Brazil, in 2001. There were studied 48 health facilities considered to have had stable strategy implementation at least two years before the start of study, with 48 matched comparison facilities in the same states. A single measure of correct management of sick children was used to assess care provided to all sick children. Costs included all resources at the national, state, local and facility levels associated with child health care. RESULTS: Facilities providing strategy-based care had significantly better management of sick children at no additional cost to municipalities relative to the comparison municipalities. At strategy facilities 72% of children were correctly managed compared with 56% in comparison facilities (p=0.001). The cost per child managed correctly was US$13.20 versus US$21.05 in the strategy and comparison municipalities, respectively, after standardization for population size. CONCLUSIONS: The strategy improves the efficiency of primary facilities in Northeastern Brazil. It leads to better health outcomes at no extra cost. Language: English Keywords: BRAZIL | EVALUATION REPORT | COST BENEFIT ANALYSIS | CASE CONTROL STUDIES | CHILDREN | INTEGRATED PROGRAMS | CHILD HEALTH SERVICES | PRIMARY HEALTH CARE | CHILD SURVIVAL | QUALITY OF HEALTH CARE | COST EFFECTIVENESS | PERFORMANCE IMPROVEMENT | Developing Countries | South America, Eastern | South America | Latin America | Americas | Evaluation | Quantitative Evaluation | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Programs | Organization and Administration | Maternal-Child Health Services | Health Services | Delivery of Health Care | Health | Survivorship | Length of Life | Mortality | Population Dynamics | Health Services Evaluation | Program Evaluation | Evaluation Indexes | Management Document Number: 308957 |
| 19. Peer Reviewed Title: Costs and benefits of HAART for patients with HIV in a public hospital in Mexico. Author: Aracena-Genao B; Navarro JO; Lamadrid-Figueroa H; Forsythe S; Trejo-Valdivia B Source: AIDS. 2008 Jul;22 Suppl 1:S141-8. Abstract: BACKGROUND: The Mexican government is currently implementing strategies to improve and expand comprehensive treatment for people living with HIV. Limited data, however, are available on the benefits obtained and costs incurred by these strategies. OBJECTIVE: To estimate the effects of highly active antiretroviral therapy (HAART) on a cohort of people living with HIV and to estimate the cost of extending patients' lives. METHODS: A survival analysis was used to follow a dynamic cohort of 797 people receiving AIDS treatment in Mexico from 1982 to 2006. The Kaplan-Meier method was applied to estimate the probability of survival for different lengths of time starting on the date of diagnosis. The Cox's proportional hazards regression model was used to assess differences in AIDS mortality by antiretroviral therapy regimen, age and sex. RESULTS: The probability of survival after diagnosis without antiretroviral therapy (ART) was approximately 0.73 (95% CI 0.69-0.77) after the first year, 0.36 (95% CI 0.32-0.40) at 5 years, 0.28 (95% CI 0.24-0.33) at the tenth year, 0.26 (95% CI 0.21-0.31) at the fifteenth year and 0.22 (95% CI 0.14-0.30) thereafter. The results showed a longer life expectancy when patients took HAART (as opposed to monotherapy or dual therapy) from the beginning of their treatment. Results from the Cox model showed that those who started and continued on HAART were 7.1 (P < 0.01) times more likely to survive than those who received no treatment. Extending the length of life beyond 15 years after the initial diagnosis represents an accumulated cost of more than US$280,000.00 per individual. Language: English Keywords: MEXICO | RESEARCH REPORT | COMPARATIVE STUDIES | RETROSPECTIVE STUDIES | COST BENEFIT ANALYSIS | HIV INFECTIONS | ANTIRETROVIRAL DRUGS | ANTIRETROVIRAL THERAPY | HOSPITALS | PERSONS LIVING WITH HIV/AIDS | LENGTH OF LIFE | ESTIMATION TECHNIQUES | North America | Americas | Developing Countries | Studies | Research Methodology | Quantitative Evaluation | Evaluation | Viral Diseases | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV | Health Facilities | Persons Living With HIV/AIDS | Mortality | Population Dynamics | Demographic Factors | Population Document Number: 328247 |
| 20. Peer Reviewed Title: Estimating the resources needed and savings anticipated from roll-out of adult male circumcision in sub-Saharan Africa. Author: Auvert B; Marseille E; Korenromp EL; Lloyd-Smith J; Sitta R Source: PLoS One. 2008 Aug 6;3(8):e2679. Abstract: Trials in Africa indicate that medical adult male circumcision (MAMC) reduces the risk of HIV by 60%. MAMC may avert 2 to 8 million HIV infections over 20 years in sub-Saharan Africa and cost less than treating those who would have been infected. This paper estimates the financial and human resources required to roll out MAMC and the net savings due to reduced infections. We developed a model which included costing, demography and HIV epidemiology. We used it to investigate 14 countries in sub-Saharan Africa where the prevalence of male circumcision was lower than 80% and HIV prevalence among adults was higher than 5%, in addition to Uganda and the Nyanza province in Kenya. We assumed that the roll-out would take 5 years and lead to an MC prevalence among adult males of 85%. We also assumed that surgery would be done as it was in the trials. We calculated public program cost, number of full-time circumcisers and net costs or savings when adjusting for averted HIV treatments. Costs were in USD, discounted to 2007. 95% percentile intervals (95% PI) were estimated by Monte Carlo simulations. In the first 5 years the number of circumcisers needed was 2 282 (95% PI: 2 018 to 2 959), or 0.24 (95% PI: 0.21 to 0.31) per 10 000 adults. In years 6-10, the number of circumcisers needed fell to 513 (95% PI: 452 to 664). The estimated 5-year cost of rolling out MAMC in the public sector was $919 million (95%PI: 726 to 1 245). The cumulative net cost over the first 10 years was $672 million (95% PI: 437 to 1 021) and over 20 years there were net savings of $2.3 billion (95% PI: 1.4 to 3.4). A rapid roll-out of MAMC in sub-Saharan Africa requires substantial funding and a high number of circumcisers for the first five years. These investments are justified by MAMC's substantial health benefits and the savings accrued by averting future HIV infections. Lower ongoing costs and continued care savings suggest long-term sustainability. (author's) Language: English Keywords: AFRICA, SUB SAHARAN | RESEARCH REPORT | THEORETICAL MODELS | MALE CIRCUMCISION | HIV PREVENTION | INTERVENTIONS | COST BENEFIT ANALYSIS | COST EFFECTIVENESS | ESTIMATION TECHNIQUES | PRIVATE SECTOR | PUBLIC SECTOR | PROGRAM SUSTAINABILITY | Africa | Developing Countries | Research Methodology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV Infections | Viral Diseases | Diseases | Programs | Organization and Administration | Quantitative Evaluation | Evaluation | Evaluation Indexes | Macroeconomic Factors | Economic Factors Document Number: 328126 |
| 21. Peer Reviewed Title: Optimizing resource allocation for HIV/AIDS prevention programmes: an analytical framework. Author: Bautista-Arredondo S; Gadsden P; Harris JE; Bertozzi SM Source: AIDS. 2008 Jul;22 Suppl 1:S67-74. Abstract: INTRODUCTION: Although investment in HIV/AIDS prevention has increased worldwide, it remains uncertain how the additional resources can be most efficiently allocated to maximize the number of infections averted, especially at the country, regional and local levels. METHODS: Data from developing countries in Africa, Asia and Latin America were reviewed on the allocation of HIV/AIDS prevention funds in relation to the prevalence of infection, as well as budgetary allocations for specific population groups at high risk of infection, such as sex workers, intravenous drug users and men who have sex with men. The variation in unit costs of voluntary counselling and testing in five countries was also examined. RESULTS: Evidence was found of three distinct sources of inefficiency in the allocation of HIV/AIDS prevention resources: inefficiency in the mix of interventions selected; inefficient targeting of key populations; and technical inefficiency in the production of HIV prevention services. CONCLUSION:A general conceptual framework for evaluating the efficiency of HIV/AIDS prevention programmes at the country, regional and local levels is proposed. This framework stresses three equally important components of programme efficiency: cost-effectiveness (the choice of the mix of interventions); targeting (the choice of the mix of target populations); and technical efficiency (the delivery of prevention services at least cost). Language: English Keywords: AFRICA | ASIA | LATIN AMERICA | HIV INFECTIONS | HIV PREVENTION | COST BENEFIT ANALYSIS | DEVELOPING COUNTRIES | PROGRAM EVALUATION | RESOURCE ALLOCATION | HEALTH SERVICES | PREVENTIVE MEDICINE | FUNDS | POPULATION AT RISK | SEX WORKERS | IV DRUG USERS | MEN HAVING SEX WITH MEN | Americas | Viral Diseases | Diseases | Quantitative Evaluation | Evaluation | Programs | Organization and Administration | Financial Activities | Economic Factors | Delivery of Health Care | Health | Medicine | Research Methodology | Sex Behavior | Behavior | Drug Use and Abuse Document Number: 328239 |
| 22. Peer Reviewed Title: Why and how to monitor the cost and evaluate the cost-effectiveness of HIV services in countries. Author: Beck EJ; Santas XM; Delay PR Source: AIDS. 2008 Jul;22 Suppl 1:S75-85. Abstract: The number of people in the world living with HIV is increasing as HIV-related mortality has declined but the annual number of people newly infected with HIV has not. The international response to contain the HIV pandemic, meanwhile, has grown. Since 2006, an international commitment to scale up prevention, treatment, care and support services in middle and lower-income countries by 2010 has been part of the Universal Access programme, which itself plays an important part in achieving the Millennium Development Goals by 2015. Apart from providing technical support, donor countries and agencies have substantially increased their funding to enable countries to scale up HIV services. Many countries have been developing their HIV monitoring and evaluation systems to generate the strategic information required to track their response and ensure the best use of the new funds. Financial information is an important aspect of the strategic information required for scaling up existing services as well as assessing the effect of new ones. It involves two components: tracking the money available and spent on HIV at all levels, through budget tracking, national health accounts and national AIDS spending assessments, and estimating the cost and efficiency of HIV services. The cost of service provision should be monitored over time, whereas evaluations of the cost-effectiveness of services are required periodically; both should be part of any country's HIV monitoring and evaluation system. This paper provides country examples of the complementary relationship between monitoring the cost of HIV services and evaluating their cost-effectiveness. It also summarizes global initiatives that enable countries to develop their own HIV monitoring and evaluation systems and to generate relevant, robust and up-to-date strategic information. Language: English Keywords: DEVELOPING COUNTRIES | COST BENEFIT ANALYSIS | PROGRAM EFFICIENCY | DELIVERY OF HEALTH CARE | HIV INFECTIONS | HEALTH SERVICES | FINANCIAL ACTIVITIES | INTERNATIONAL COOPERATION | PROGRAM EVALUATION | DRUGS | Quantitative Evaluation | Evaluation | Programs | Organization and Administration | Health | Viral Diseases | Diseases | Economic Factors | Political Factors | Sociocultural Factors | Treatment | Medical Procedures | Medicine Document Number: 328238 |
| 23. Title: Cost-effectiveness of HIV monitoring strategies in resource-limited settings: a southern African analysis. Author: Bendavid E; Young SD; Katzenstein DA; Bayoumi AM; Sanders GD Source: Archives of Internal Medicine. 2008 Sep 22;168(17):1910-8. Abstract: BACKGROUND: Although the number of infected persons receiving highly active antiretroviral therapy (HAART) in low- and middle-income countries has increased dramatically, optimal disease management is not well defined. METHODS: We developed a model to compare the costs and benefits of 3 types of human immunodeficiency virus monitoring strategies: symptom-based strategies, CD4-based strategies, and CD4 counts plus viral load strategies for starting, switching, and stopping HAART. We used clinical and cost data from southern Africa and performed a cost-effectiveness analysis. All assumptions were tested in sensitivity analyses. RESULTS: Compared with the symptom-based approaches, monitoring CD4 counts every 6 months and starting treatment at a threshold of 200/muL was associated with a gain in life expectancy of 6.5 months (61.9 months vs 68.4 months) and a discounted lifetime cost savings of US $464 per person (US $4069 vs US $3605, discounted 2007 dollars). The CD4-based strategies in which treatment was started at the higher threshold of 350/microL provided an additional gain in life expectancy of 5.3 months at a cost-effectiveness of US $107 per life-year gained compared with a threshold of 200/microL. Monitoring viral load with CD4 was more expensive than monitoring CD4 counts alone, added 2.0 months of life, and had an incremental cost-effectiveness ratio of US $5414 per life-year gained relative to monitoring of CD4 counts. In sensitivity analyses, the cost savings from CD4 count monitoring compared with the symptom-based approaches was sensitive to cost of inpatient care, and the cost-effectiveness of viral load monitoring was influenced by the per test costs and rates of virologic failure. CONCLUSIONS: Use of CD4 monitoring and early initiation of HAART in southern Africa provides large health benefits relative to symptom-based approaches for HAART management. In southern African countries with relatively high costs of hospitalization, CD4 monitoring would likely reduce total health care expenditures. The cost-effectiveness of viral load monitoring depends on test prices and rates of virologic failure. Language: English Keywords: AFRICA, SOUTHERN | RESEARCH REPORT | COST BENEFIT ANALYSIS | COST EFFECTIVENESS | HIV | MONITORING | SIGNS AND SYMPTOMS | LIFE EXPECTANCY | PRICES | Africa, Sub Saharan | Africa | Developing Countries | Quantitative Evaluation | Evaluation | Evaluation Indexes | HIV Infections | Viral Diseases | Diseases | Length of Life | Mortality | Population Dynamics | Demographic Factors | Population | Commerce | Macroeconomic Factors | Economic Factors Document Number: 328592 |
| 24. Peer Reviewed Title: Field evaluation of the performance and testing costs of a rapid point-of-care test for syphilis in a red-light district of Manaus, Brazil. Author: Benzaken AS; Sabido M; Galban EG; Pedroza V; Vasquez F; Araujo A; Peeling RW; Mayaud P Source: Sexually Transmitted Infections. 2008;84:297-302. Abstract: The objective of this study was to assess the performance, usefulness and cost of a rapid treponemal antibody assay (VisiTect Syphilis) to detect syphilis in high risk populations. People who attended STI clinics in Manaus, Brazil, were screened for syphilis using the fluorescent treponemal antibody absorption (FTA-Abs) test and a nontreponemal test (Venereal Diseases Research Laboratory (VDRL)), and for HIV. Finger prick blood samples were tested with VisiTect Syphilis. The rapid test was evaluated against the reference FTA-Abs and for its usefulness in detecting active syphilis (FTA-Abs and VDRL positive). Operational performance was assessed through providers' and patients' interviews. An economic evaluation was conducted from the provider's perspective. 510 patients (60% men) were enrolled, of whom 13 (2.5%) were HIV-1 seropositive. Syphilis prevalence (FTA-Abs) was 18% and active syphilis prevalence was 7.5%. 11% (57/506) of samples were positive by VisiTect. The sensitivity, specificity, positive and negative predictive values of VisiTect Syphilis were 57% (95% CI 45.8 to 66.7), 99% (95% CI 97.0 to 99.6), 91% (95% CI 80.0 to 96.7) and 91% (95% CI 88.0 to 93.5), respectively. VisiTect Syphilis identified 79% (30/38) of active syphilis cases. The cost per case of syphilis was $16.8 for VDRL, $33.2 for low cost and $56.3 for high cost VisiTect Syphilis; the cost per case of active syphilis was $21.3, $57.5 and $97.6, respectively. Patients identified finger prick pain and preference for venous blood collection as minor barriers to test use. VisiTect Syphilis had low sensitivity in field use and was less cost effective than conventional VDRL. However, rapid and correct identification of a high proportion of active syphilis cases combined with operational characteristics suggest a role in high risk populations. Language: English Keywords: BRAZIL | RESEARCH REPORT | COST BENEFIT ANALYSIS | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | WOMEN IN DEVELOPMENT | SEX WORKERS | TESTING | SYPHILIS | COST EFFECTIVENESS | ECONOMIC FACTORS | PREVALENCE | HIV INFECTIONS | Developing Countries | South America, Eastern | South America | Latin America | Americas | Quantitative Evaluation | Evaluation | Research Methodology | Economic Development | Sex Behavior | Behavior | Measurement | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | Evaluation Indexes | Viral Diseases Document Number: 323038 |
| 25. Peer Reviewed Title: How can we calculate the "E" in "CEA"? Author: Bollinger LA Source: AIDS. 2008 Jul;22 Suppl 1:S51-7. Abstract: Because full funding for HIV/AIDS prevention interventions is unlikely to occur in the near future, it is essential that the resources available are spent in the most effective way possible. This paper presents a matrix of effectiveness coefficients for HIV/AIDS-related prevention interventions that can be used as an integral part of the coordinated strategic planning process currently underway by the World Bank and UNAIDS, as the interventions in the matrix are harmonized with the interventions in that process. Coefficients for four types of sexual behavior change (condom use, partner reduction, sexually transmitted infection treatment-seeking behavior, age at first sex) across three different risk groups (high, medium, low) are presented, along with their interquartile ranges. Results indicate that: (1) impacts seem greater when an intervention includes interpersonal contact, rather than targeting a more general audience; (2) although significant impacts are observed in the columns measuring changing condom use, other impacts are lower, and sometimes are actually (measured) zero; and (3) additional studies have evaluations of the number of sexual partners and have found a greater impact than previous studies. Although progress has been made in increasing the number of evaluation studies that can be utilized in this impact matrix, particularly in the area of youth interventions, there are still empty cells in which no studies report impacts. Finally, it is important to note that issues such as quality differences and synergies between programmes could have an effect on the impacts calculated for a particular strategic plan. Language: English Keywords: DEVELOPING COUNTRIES | RESEARCH REPORT | HIV INFECTIONS | COST BENEFIT ANALYSIS | PROGRAM EVALUATION | RESOURCE ALLOCATION | RISK REDUCTION BEHAVIOR | SEX BEHAVIOR | WORLD BANK | UNAIDS | CONDOM USE | SEXUAL PARTNERS | AGE FACTORS | FIRST INTERCOURSE | Viral Diseases | Diseases | Quantitative Evaluation | Evaluation | Programs | Organization and Administration | Financial Activities | Economic Factors | Behavior | International Agencies | Organizations | Political Factors | Sociocultural Factors | UN | Population Characteristics | Demographic Factors | Population Document Number: 328241 |
| 26. Peer Reviewed Title: Cost and cost-effectiveness of nationwide school-based helminth control in Uganda: Intra-country variation and effects of scaling-up. Author: Brooker S; Kabatereine NB; Fleming F; Devlin N Source: Health Policy and Planning. 2008 Jan;23(1):24-35. Abstract: Estimates of cost and cost-effectiveness are typically based on a limited number of small-scale studies with no investigation of the existence of economies to scale or intra-country variation in cost and cost-effectiveness. This information gap hinders the efficient allocation of health care resources and the ability to generalize estimates to other settings. The current study investigates the intracountry variation in the cost and cost-effectiveness of nationwide school-based treatment of helminth (worm) infection in Uganda. Programme cost data were collected through semi-structured interviews with district officials and from accounting records in six of the 23 intervention districts. Both financial and economic costs were assessed. Costs were estimated on the basis of cost in US$ per schoolchild treated, and an incremental cost-effectiveness ratio (cost in US$ per case of anaemia averted) was used to evaluate programme cost-effectiveness. Sensitivity analysis was performed to assess the effect of discount rate and drug price. The overall economic cost per child treated in the six districts was US$0.54 and the cost-effectiveness was US$3.19 per case of anaemia averted. Analysis indicated that estimates of both cost and cost-effectiveness differ markedly with the total number of children who received treatment, indicating economies of scale. There was also substantial variation between districts in the cost per individual treated (US$0.41-0.91) and cost per anaemia case averted (US$1.70-9.51). Independent variables were shown to be statistically associated with both sets of estimates. This study highlights the potential bias in transferring data across settings without understanding the nature of observed variations. (author's) Language: English Keywords: UGANDA | RESEARCH REPORT | INTERVIEWS | GOVERNMENT OFFICIALS | SCHOOLS | PARASITIC DISEASES | TREATMENT | PREVENTION AND CONTROL | INTERVENTIONS | ECONOMIC FACTORS | COST EFFECTIVENESS | COST BENEFIT ANALYSIS | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Data Collection | Research Methodology | Administrative Personnel | Organization and Administration | Education | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Programs | Evaluation Indexes | Quantitative Evaluation | Evaluation Document Number: 323130 |
| 27. Peer Reviewed Title: Evaluation design for large-scale HIV prevention programmes: the case of Avahan, the India AIDS initiative. Author: Chandrasekaran P; Dallabetta G; Loo V; Mills S; Saidel T; Adhikary R; Alary M; Lowndes CM; Boily MC; Moore J Source: AIDS. 2008 Dec;22 Suppl 5:S1-15. Abstract: BACKGROUND: Closing the HIV prevention gap to prevent HIV infections requires rapid, worldwide rollout of large-scale national programmes. Evaluating such programmes is challenging and complex, requiring clarity of evaluation purpose and evidential approaches substantively different to those employed for pilots and small programmes. OBJECTIVES: This paper describes the evaluation design for the implementation phase of Avahan, the India AIDS initiative, a large HIV prevention programme funded by the Bill and Melinda Gates Foundation. Avahan, which began in December 2003, has a 10-year charter to impact the Indian epidemic and its response by implementing an HIV prevention programme targeting core and bridge groups in 83 districts of six Indian states, transferring the programme to the Government of India, and disseminating programme learning. METHODS: The foundation commissioned an external process to design Avahan's evaluation framework. An independent advisory group oversees and guides course corrections in the execution of this framework. RESULTS: Avahan's evaluation framework comprises: trend and synthetic analysis of data from core, bridge and household biobehavioural surveys in a subset of intervention districts, denominator estimates and programme monitoring from all intervention districts, and government's antenatal surveillance (two sites per district in all districts); bespoke transmission dynamics modelling to estimate infections averted (subset of districts); cost effectiveness studies (subset of districts). In addition, there are other knowledge-building and quality-monitoring activities. CONCLUSION: Rather than a small set of monofocal outcome measures, scaled programmes require nuanced evaluations that approximate programmatic scale by collecting data with different levels of geographical scope, synthesize multiple data and methods to arrive at a composite picture, and can cope with continuous environmental and programme evolution. Language: English Keywords: INDIA | METHODOLOGICAL STUDIES | EVALUATION RESEARCH | STUDY DESIGN | ESTIMATION TECHNIQUES | MATHEMATICAL MODEL | CLINICAL RESEARCH | COST BENEFIT ANALYSIS | KAP SURVEYS | TARGET POPULATION | HIV PREVENTION | PROGRAM EVALUATION | GOVERNMENT PROGRAMS | COST EFFECTIVENESS | HUMAN GEOGRAPHY | Developing Countries | Asia, Southern | Asia | Evaluation Methodology | Evaluation | Research Methodology | Theoretical Models | Quantitative Evaluation | Surveys | Sampling Studies | Studies | Program Design | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | Evaluation Indexes | Geography | Social Sciences | Science | Sociocultural Factors Document Number: 330248 |
| 28. Peer Reviewed Title: Assessing efficiency and costs of scaling up HIV treatment. Author: Cleary SM; McIntyre D; Boulle AM Source: AIDS. 2008 Jul;22 Suppl 1:S35-42. Abstract: INTRODUCTION: Whereas cost-effectiveness/utility analyses theoretically assess efficiency in HIV treatment, in practice they are of limited use to policy makers who are also concerned with the total costs of scaling up. This paper proposes an approach to simultaneously assessing both factors when setting priorities for HIV treatment. METHODS: Three interventions were assessed: a no antiretroviral therapy (ART) status quo, ART including first-line only, and ART including first and second-line regimens. Data were from a cohort receiving healthcare in a poor South African setting. Markov modelling was used to calculate patient-level lifetime costs and quality-adjusted life-years (QALY) as well as population-level total costs and QALY in each intervention. Linear programming was used to assess efficiency at the population level. RESULTS: First-line ART costs US$795 per QALY gained compared to no ART, while first and second-line costs US$1625 compared to first-line alone. The efficiency of either ART strategy depends on the HIV treatment budget. If this is less than US$10 billion during the planning period, first-line ART is most efficient. A combination of first-line with first and second-line treatment is most efficient if the budget is US$10-12 billion. Using both first and second-line treatment for everyone becomes efficient as the main strategy only at budgets greater than US$13 billion. CONCLUSION: An approach has been developed to HIV treatment priority setting that simultaneously considers efficiency and the costs of scaling up. This can help to establish explicit and evidence-based priorities and budgets to meet scaling up challenges. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | ANTIRETROVIRAL DRUGS | ANTIRETROVIRAL THERAPY | COST BENEFIT ANALYSIS | COST EFFECTIVENESS | HIV INFECTIONS | TREATMENT | FINANCIAL ACTIVITIES | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV | Viral Diseases | Diseases | Quantitative Evaluation | Evaluation | Evaluation Indexes | Economic Factors Document Number: 328244 |
| 29. Peer Reviewed Title: Changing cost of HIV interventions in the context of scaling-up in India. Author: Dandona L; Kumar SP; Ramesh Y; Rao MC; Kumar AA Source: AIDS. 2008 Jul;22 Suppl 1:S43-9. Abstract: BACKGROUND: A rapid scaling up of HIV interventions in India is anticipated, but systematic information on how costs of HIV interventions change over time and programme scale is not available to inform planning. METHODS: We studied the changes in unit costs of two major interventions, voluntary counseling and testing (VCT) and sex worker programmes in the south Indian state of Andhra Pradesh between 2002-2003 and 2005-2006 fiscal years. Economic costs (from the provider perspective) and output data from 17 publicly funded VCT centers and 14 sex worker programmes were collected using standardized methods. We calculated unit costs for each programme in each period and explored possible reasons for the changes seen. RESULTS: In 2005-2006, the VCT centers served 66 445 clients and the sex worker programmes served 32 550. The unit cost of providing VCT dropped over 3 years by half to Indian Rupees (INR) 147.5 (US$3.33) mainly because the number of clients doubled. There was no decrease in the average time spent counseling each client. The unit cost of providing services to sex workers increased 2.4 times over 3 years to INR 1401 (US$31.6) as a result of increases in male condom distribution, staff salaries and training, and treatment for sexually transmitted infections, all suggesting improved services. CONCLUSION: The unit cost of these two interventions changed dramatically over a 3-year period, but in opposite directions. The current unit cost for VCT in Andhra Pradesh is much lower than the estimated global average for low-income settings. These local longitudinal cost data are useful to inform the currently planned scaling up of HIV interventions in India. Language: English Keywords: INDIA | RESEARCH REPORT | HIV INFECTIONS | COST BENEFIT ANALYSIS | GOVERNMENT FINANCING | HEALTH SERVICES | RESOURCE ALLOCATION | VOLUNTARY COUNSELING AND TESTING | SEX WORKERS | LOW INCOME POPULATION | Developing Countries | Asia, Southern | Asia | Viral Diseases | Diseases | Quantitative Evaluation | Evaluation | Financial Activities | Economic Factors | Delivery of Health Care | Health | HIV Testing | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Sex Behavior | Behavior | Social Class | Socioeconomic Status | Socioeconomic Factors Document Number: 328243 |
| 30. Peer Reviewed Title: Saving newborn lives in Asia and Africa: Cost and impact of phased scale-up of interventions within the continuum of care. Author: Darmstadt GL; Walker N; Lawn JE; Bhutta ZA; Haws RA Source: Health Policy and Planning. 2008 Mar;23(2):101-117. Abstract: Policy makers and programme managers require more detailed information on the cost and impact of packages of evidenced-based interventions to save newborn lives, particularly in South Asia and sub-Saharan Africa, where most of the world's 4 million newborn deaths occur. We estimated the newborn deaths that could be averted by scaling up 16 interventions in 60 countries. We bundled the interventions in a variety of existing maternal and child health packages according to time period of delivery and service delivery mode, and calculated the additional running costs of implementing these interventions at scale (90% coverage) in sub-Saharan Africa and South Asia. The phased introduction and expansion of interventions was modelled to represent incremental strategies for scaling up neonatal care in developing country health systems. Increasing coverage of 16 interventions to 90% could save 0.59-1.08 million lives in South Asia annually at an additional cost of US$0.90-1.76 billion. In sub-Saharan Africa, 0.45-0.80 million lives saved would cost US$0.68-1.32 billion. Additional costs for increased antenatal interventions are low, but given relatively high baseline coverage and lower impact, fewer additional newborn lives can be saved through this package (5-10%). Intrapartum care has higher impact (19-34% of deaths averted) but is costly (US$1.66-3.25 billion). Postnatal family-community care, with potential for high impact at low cost (10-27%, US$0.38-0.75 billion), has been neglected. A first phase of scaling up care in 36 high (NMR 30-45) and 15 very high (NMR greater than 45) mortality countries would cost approximately US$0.56-1.10 and US$0.09-0.17 billion annually, respectively, and would avert 15-32% and 13-29% of neonatal deaths, respectively, in these countries. Full coverage with all interventions in the 51 high and very high mortality countries would cost US$2.23-4.37 billion, and avert 38-68% of neonatal deaths (1.13-2.05 million), at an extra cost per death averted of US$1100-3900. Low-cost, effective newborn health interventions can save millions of lives, primarily in South Asia and sub-Saharan Africa. Modelling costs and impact of intervention packages scaled up incrementally as health systems capacity increases can assist programme planning and help policy makers and donors identify stepwise targets for investments in newborn health. (author's) Language: English Keywords: ASIA, SOUTHERN | AFRICA, SUB SAHARAN | RESEARCH REPORT | INFANT MORTALITY | INFANT HEALTH | PREVENTION AND CONTROL | INTERVENTIONS | DELIVERY OF HEALTH CARE | COST BENEFIT ANALYSIS | COST EFFECTIVENESS | IMPACT | THEORETICAL MODELS | PROGRAM DESIGN | HEALTH AND WELFARE PLANNING | HEALTH POLICY | Developing Countries | Asia | Africa | Mortality | Population Dynamics | Demographic Factors | Population | Child Health | Health | Diseases | Programs | Organization and Administration | Quantitative Evaluation | Evaluation | Evaluation Indexes | Communication | Research Methodology | Social Planning | Economic Factors | Policy | Political Factors | Sociocultural Factors Document Number: 324154 |
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