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Peer Reviewed

Title: Free distribution of insecticide treated bed nets to pregnant women in Kinshasa: an effective way to achieve 80% use by women and their newborns.
Author: Pettifor A; Taylor E; Nku D; Duvall S; Tabala M; Mwandagalirwa K; Meshnick S; Behets F
Source: Tropical Medicine and International Health. 2009 Jan;14(1):20-8.
Abstract: OBJECTIVE: To determine whether long lasting insecticide treated bed nets (LLINs) distributed free of charge to pregnant women at their first antenatal clinic visit in Kinshasa, DRC are used from the time of distribution to delivery and 6 months after delivery. METHODS: Women were enrolled into a cohort study at their first antenatal care (ANC) visit and provided LLINs free of charge. Reported use of these nets was then measured at the time of delivery (n = 328) and in a random sample of women (n = 100) 6 months post-delivery using an interviewer administered, structured questionnaire. RESULTS: At baseline, only 25% of women reported having slept under a bed net the night before the interview. At the time of delivery, after being provided an LLIN for free, this increased to 79%. Six months post-delivery (n = 100), 80% of women reported sleeping under a net with a child under the age of 5 the night before the interview. CONCLUSIONS: Freely distributed bed nets are acceptable, feasible and result in high usage. Free distribution of bed nets during antenatal clinic visits may be a highly effective way to rapidly increase the use of bed nets among both pregnant women and their newborn infants in areas with high levels of ANC attendance.
Language: English
Keywords:
REPUBLIC OF THE CONGO | RESEARCH REPORT | KAP SURVEYS | WOMEN IN DEVELOPMENT | INFANT | MOTHERS | PREGNANT WOMEN | PESTICIDES | BED NETS | PRICES | DISTRIBUTIONAL ACTIVITIES | ANTENATAL CARE | PREVALENCE | MALARIA PREVENTION | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Economic Development | Economic Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Ingredients and Chemicals | Parasite Control | Public Health | Health | Commerce | Macroeconomic Factors | Program Activities | Programs | Organization and Administration | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Measurement | Malaria | Parasitic Diseases | Diseases
Document Number: 330250

2.
Title: Emergency contraception - knowledge in medical students [letter]
Author: Sharma JB; Bahadur A; Chadha S; Mehta S; Mittal S
Source: Indian Journal of Medical Sciences. 2009 Mar;63(3):115-7.
Abstract: Emergency contraception (EC) is a method of contraception that can be used to prevent pregnancy after an unprotected act of sexual intercourse. Recent multicentric and WHO sponsored studies have found a dose of 0.75 mg of levonorgestrel (LNG) repeated 12 hours after the first dose and within 72 hours of exposure as the preferred method of contraception, being more effective and much better tolerated than Yuzpe regimen, which contained high doses of estrogen and progesterone. At present LNG-only regimen has become the first progesterone only tablet especially developed for post-coital contraception and is approved by the United States Food and Drug Administration (USFDA) and the Drug Controller of India LNG-ECP is available as a 2-pill pack, each tablet containing 0.75 mg of LNG, and can be used as a 2-dose regimen preferably within 72 hours but not later than 120 hours of exposure. It can also be used as a single dose (1.5 mg LNG) within 72 hours but not later than 120 hours of exposure. It has been made available as an over-the-counter drug for popularizing it and is also available free of cost in most government hospitals. We conducted this open-ended questionnaire survey which was pre-validated over 100 medical students [31 interns, 61 fourth professional and 8 third professional] of Maulana Azad Medical College, New Delhi, to assess their knowledge on various aspects of emergency contraception as per a fixed questionnaire. In this medical college, obstetricians and gynecologists were taught about contraception, including emergency contraception, in the third and fourth professionals. A total of 130 interns and fourth and third professional students were requested to participate, of which 100 (76.92%) agreed to participate and 30 did not participate due to lack of time or were not interested. Age of participants was between 21 and 24 years. Out of the 100 participants, 64 were boys; and 36, girls. They were asked about the knowledge of EC, source of knowledge of EC, including their knowledge about the best method of EC, method licensed by the Government of India for EC, dosage and free availability of EC, its cost and also their opinion about popularizing EC among the general population. ...The current study clearly shows that though the medical students were aware of EC, there is still lack of awareness of LNG being the right drug for EC, its dosage and regimen and various other aspects of EC amongst medical students in a well-known teaching hospital of Delhi. The awareness is bound to be even poorer in medical students of remote regions. Questionnaires and surveys have been used to know the views of doctors and patients, and important data have been collected by their use about their knowledge of various aspects of obstetrics and gynecology, including emergency contraceptives and urogynecology. (excerpt)
Language: English
Keywords:
INDIA | RESEARCH REPORT | KAP SURVEYS | MEDICAL STUDENTS | EMERGENCY CONTRACEPTION | KNOWLEDGE | ADMINISTRATION AND DOSAGE | TIME FACTORS | COUNSELING | INFORMATION SOURCES | PRICES | MASS MEDIA | Asia, Southern | Asia | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Students | Education | Contraception | Family Planning | Sociocultural Factors | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Population Dynamics | Demographic Factors | Population | Clinic Activities | Program Activities | Programs | Organization and Administration | Information | Commerce | Macroeconomic Factors | Economic Factors | Communication
Document Number: 331006

Title: Population and the food supply.
Author: Population Council
Source: New York, New York, Population Council, 2008. [2] p.
Abstract: This fact sheet contains a bulleted list of the information presented in the Bongaarts' essay "Food and population: The return of Malthus?". Some of the issues commented on are: 1) The connection between population and food supply; 2) Reducing unnecessary consumption could improve worldwide access to food; and 3) Practical solutions for the poorest countries.
Language: English
Keywords:
DEVELOPING COUNTRIES | GLOBAL | CRITIQUE | EVALUATION | POPULATION | FOOD SUPPLY | POPULATION GROWTH | PRICES | CONSUMPTION | ENERGY SUPPLY | ENVIRONMENTAL DEGRADATION | AGRICULTURAL DEVELOPMENT | Natural Resources | Environment | Population Dynamics | Demographic Factors | Commerce | Macroeconomic Factors | Economic Factors | Rural Development
Document Number: 327695

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

6.
Peer Reviewed

Title: Microbicide acceptability: Insights for future directions from providers and policy makers.
Author: Hoffman S; Cooper D; Ramjee G; Higgins JA; Mantell JE
Source: AIDS Education and Prevention. 2008 Apr;20(2):188-202.
Abstract: To help fill the gap concerning health care providers' and policymakers' knowledge of and views concerning microbicides, we compared data from one U.S. study and two South African studies that explored these issues. Frontline providers in South Africa were enthusiastic about any method that would have the potential to slow the HIV/AIDS epidemic, whereas providers in New York City and policy makers in South Africa balanced their enthusiasm with more concerns. Across all studies, participants wanted timely and accurate scientific information, and they raised issues about safety, "messiness," and cost. Many had difficulty understanding that promoting a partially effective method can reduce risk if a client uses it more often than a highly effective method. Microbicide advocates need to effectively communicate to providers the evidence-based findings from microbicide trials and find approaches to introduce concepts such as "harm reduction" and "prevention equation" perspectives in client counseling. Developing these approaches will maximize the positive influence that providers can exert on user acceptability of microbicides once they become available. (author's)
Language: English
Keywords:
NEW YORK | SOUTH AFRICA | RESEARCH REPORT | CROSS-CULTURAL COMPARISONS | CLINICAL TRIALS | POLICYMAKERS | HEALTH PERSONNEL | MICROBICIDES | HIV PREVENTION | ADVOCACY | SAFETY | PRICES | COUNSELING | Developed Countries | United States of America | North America | Americas | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Comparative Studies | Studies | Research Methodology | Clinical Research | Administrative Personnel | Organization and Administration | Delivery of Health Care | Health | Drugs | Treatment | Medical Procedures | Medicine | Health Services | HIV Infections | Viral Diseases | Diseases | Communication | Public Health | Commerce | Macroeconomic Factors | Economic Factors | Clinic Activities | Program Activities | Programs
Document Number: 326440

Title: Hormonal implants: New, improved, and popular when available.
Author: Jacobstein R; Pile JM
Source: [New York, New York], EngenderHealth, ACQUIRE Project, 2008 Jan. [2] p.
Abstract: Hormonal implants are a highly effective, very safe, simple, convenient, and quickly reversible form of contraception that is provided easily in an outpatient setting. Implants are thin, flexible, matchstick-sized rods made of soft plastic. The rods contain progestin hormone and are surgically placed beneath the skin of a client's upper arm by a trained provider, who performs a minor surgical procedure under local anesthesia to insert or remove the rods. Three new implants, Jadelle (a two-rod system labeled as effective for five years), Sino-Implant (II) (a two-rod system labeled as effective for four years) and Implanon (a one-rod system labeled as effective for three years), are even easier to insert and remove than the previously available implant, Norplant (a six-capsule system no longer in production that was labeled as effective for seven years). Hormonal implants are an excellent contraceptive option for women at all phases of their reproductive lives, whether they want to delay, space, or limit births. Though implants are the most costly contraceptive method, their availability in programs can reduce demand on other health services because of their high effectiveness and continuation rates. (excerpt)
Language: English
Keywords:
DEVELOPING COUNTRIES | CRITIQUE | EVALUATION | WOMEN IN DEVELOPMENT | CONTRACEPTIVE IMPLANTS | TIME FACTORS | ADMINISTRATION AND DOSAGE | CONTRACEPTIVE EFFECTIVENESS | CONTRACEPTIVE MODE OF ACTION | REVERSIBILITY | CONTRACEPTIVE AGENTS, SIDE EFFECTS | CONTRACEPTIVE AVAILABILITY | CONTRACEPTION CONTINUATION | PRICES | COUNSELING | Economic Development | Economic Factors | Contraceptive Methods | Contraception | Family Planning | Population Dynamics | Demographic Factors | Population | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Contraceptive Agents | Contraceptive Usage | Commerce | Macroeconomic Factors | Clinic Activities | Program Activities | Programs | Organization and Administration
Document Number: 326798

Title: Contraceptive procurement in Peru: diversifying suppliers.
Author: Lopez-Linares R
Source: Washington, D.C., Constella Futures, Health Policy Initiative, 2008 Nov. [23] p. (USAID Contract No. GPO-I-01-05-00040-00)
Abstract: This report describes how the Government of Peru was successful in diversifying its procurement options and mechanisms for contraceptive commodities. It shows the progress made between 1999, when Peru began purchasing contraceptive supplies with public funds, and mid-2007, when important changes were made in procurement channels. Today, the Peruvian government procures contraceptives from multiple national and international suppliers and is able to negotiate for favorable prices and other terms. (Author's abstract)
Language: English
Keywords:
PERU | CRITIQUE | GOVERNMENT AGENCIES | CONTRACEPTIVE DISTRIBUTION | CONTRACEPTIVE IMPORTATION | GOVERNMENT FINANCING | LOGISTICS | PRICES | UNFPA | Developing Countries | South America, Western | South America | Latin America | Americas | Organizations | Political Factors | Sociocultural Factors | Distributional Activities | Program Activities | Programs | Organization and Administration | Family Planning Program Administration | Family Planning Programs | Family Planning | Financial Activities | Economic Factors | Management | Commerce | Macroeconomic Factors | UN | International Agencies
Document Number: 331424

10.

Peer Reviewed

Title: Out-of-pocket costs of AIDS care in China: are free antiretroviral drugs enough?
Author: Moon S; Van Leemput L; Durier N; Jambert E; Dahmane A; Jie Y; Wu G; Philips M; Hu Y; Saranchuk P
Source: AIDS Care. 2008 Sep;20(8):984-94.
Abstract: Financial access to HIV care and treatment can be difficult for many people in China, where the government provides free antiretroviral drugs but does not cover the cost of other medically necessary components, such as lab tests and drugs for opportunistic infections. This article estimates out-of-pocket costs for treatment and care that a person living with HIV/AIDS in China might face over the course of one year. Data comes from two treatment projects run by Medecins Sans Frontieres in Nanning, Guangxi Province and Xiangfan, Hubei Province. Based on the national treatment guidelines, we estimated costs for seven different patient profiles ranging from WHO Clinical Stages I through IV. We found that patients face significant financial barriers to even qualify for the free ARV program. For those who do, HIV care and treatment can be a catastrophic health expenditure, with cumulative patient contributions ranging from approximately US$200-3939/year in Nanning and US$13-1179/year in Xiangfan, depending on the patient's clinical stage of HIV infection. In Nanning, these expenses translate as up to 340% of an urban resident's annual income or 1200% for rural residents; in Xiangfan, expenses rise to 116% of annual income for city dwellers and 295% in rural areas. While providing ARV drugs free of charge is an important step, the costs of other components of care constitute important financial barriers that may exclude patients from accessing appropriate care. Such barriers can also lead to undesirable outcomes in the future, such as impoverishment of AIDS-affected households, higher ARV drug-resistance rates and greater need for complex, expensive second-line antiretroviral drugs.
Language: English
Keywords:
CHINA | RESEARCH REPORT | COMPARATIVE STUDIES | PERSONS LIVING WITH HIV/AIDS | HOUSEHOLDS | ANTIRETROVIRAL THERAPY | MICROECONOMIC FACTORS | PRICES | TREATMENT | FEES | DRUG RESISTANCE | Asia, Eastern | Asia | Developing Countries | Studies | Research Methodology | HIV Infections | Viral Diseases | Diseases | Family and Household | Sociocultural Factors | HIV | Economic Factors | Commerce | Macroeconomic Factors | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Financial Activities
Document Number: 329193

11.

Peer Reviewed

Title: Hierarchical linear modelling of smoking prevalence and frequency in China between 1991 and 2004.
Author: Pan Z; Hu D
Source: Health Policy and Planning. 2008;23(2):118-124.
Abstract: This study uses the hierarchical linear modelling (HLM) growth curve technique to explore predictors of the change in the prevalence and frequency of cigarette smoking in China between 1991 and 2004. Using nationally representative data, the study introduces a number of previously unanalysed variables at both the individual and the community level. The findings show that a number of factors are associated with the change in both the prevalence and frequency of smoking in China. In addition, there is a trend of decreasing prevalence of smoking in China after the effects of other covariates are adjusted. Finally, the free market cigarette price has an inconsistent relationship with the change in the prevalence and frequency of smoking, which further reveals the daunting task of tobacco control for public health scholars and policymakers in China. (author's)
Language: English
Keywords:
CHINA | RESEARCH REPORT | METHODOLOGICAL STUDIES | THEORETICAL MODELS | TOBACCO USE | PREVALENCE | INCIDENCE | ESTIMATION TECHNIQUES | PRICES | PUBLIC HEALTH | Asia, Eastern | Asia | Developing Countries | Research Methodology | Behavior | Measurement | Commerce | Macroeconomic Factors | Economic Factors | Health
Document Number: 324665

12.

Title: A survey of the syntheses of active pharmaceutical ingredients for antiretroviral drug combinations critical to access in emerging nations.
Author: Pinheiro ED; Antunes OA; Fortunak JM
Source: Antiviral Research. 2008 Sep;79(3):143-65.
Abstract: It has been roughly 25 years since the threat posed by human immunodeficiency virus type 1 (HIV-1) became widely known. The cumulative death toll from HIV/AIDS is now greater than 25 million. There are approximately 33 million people living worldwide with this disease, of whom about 68% (22.5 million) live in sub-Saharan Africa (http://www.avert.org/worldstats.htm). A number of antiretroviral (ARV) drugs have been approved for treatment of HIV/AIDS. Inhibitors of HIV reverse transcriptase (RTIs) include the nucleoside/nucleotide drugs zidovudine, lamivudine, abacavir, didanosine, stavudine, emtricitabine and tenofovir disoproxil fumarate. Non-nucleoside RTIs include nevirapine, efavirenz and etravirine. Inhibitors of HIV protease (PIs) include saquinavir, ritonavir, lopinavir, nelfinavir, indinavir, fosamprenavir and atazanavir. Enfuvirtide inhibits the HIV fusion protein. The CCR5 chemokine antagonist maraviroc and the integrase inhibitor raltegravir were very recently approved by the US FDA. Fixed-dose combinations (FDCs) have been formulated to increase tolerability, convenience and compliance. First-line drug combinations are offered to treatment-naive patients, while second-line drugs are reserved for those who no longer respond adequately to first-line therapy. In developing countries a modest but increasing fraction of those infected have access to ARVs. The Clinton HIV/AIDS Initiative estimates that 2.4 million of the nearly 8 million individuals needing treatment in developing nations have access to some drugs. First-line FDCs used in resource-poor settings are largely combinations of two nucleoside RTIs and a non-nucleoside RTI or PI. The effectiveness of these combinations decreases over time, requiring a switch to combinations that retain potency in the presence of viral resistance. Increasing access to second-line FDCs and new developments in first-line ARV therapy are cost challenges. In high-income countries the cost of ARV therapy is largely irrelevant, except for "advanced salvage" drugs such as enfuvirtide. In resource-poor settings cost is a huge factor that limits drug access, resulting in high rates of new infection and subsequent mortality. IP coverage, where granted, can keep access prices for essential ARVs higher than would otherwise be the case. Large, innovator companies have made drugs available at prices very close to the cost of manufacturing for "lowest income" countries. Generic providers in India and elsewhere provide the largest supply of drugs for the developing world. The recent issuance of Voluntary and Compulsory Licenses (VLs, CLs) through the World Trade Organization's TRIP (Treaty Respecting Intellectual Property) provisions arguably contribute to bringing down access prices. The utilization of improved science, pooled purchasing and intelligent procurement practices all definitely contribute to access. This work surveys the production processes for several critical ARVs. These are discussed in terms of scale up, raw material/intermediates and active pharmaceuticalingredient (API) costs. In some cases new routes to APIs or critical intermediates are needed. Based on potential new chemistries, there are significant opportunities to reduce cost for a number of critical ARVs.
Language: English
Keywords:
GLOBAL | DEVELOPING COUNTRIES | RESEARCH REPORT | PERSONS LIVING WITH HIV/AIDS | HIV | HIV INFECTIONS | DRUGS | PRICES | ANTIRETROVIRAL DRUGS | ANTIRETROVIRAL THERAPY | TREATMENT | PROGRAM ACCESSIBILITY | Viral Diseases | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Commerce | Macroeconomic Factors | Economic Factors | Program Evaluation | Programs | Organization and Administration
Document Number: 328569

13.

Peer Reviewed

Title: Patterns of condom acquisition and its association with consistent use among young men in Nigeria.
Author: Sunmola AM; Adebayo DO; Ogungbemi KO
Source: AIDS Care. 2008 Feb;20(2):270-274.
Abstract: There is limited information about the influence of condom acquisition patterns on consistent condom use. Research is required to identify the relative extent of consistent condom use among individuals who always obtain condoms free, or who always have mixed procurement of free and purchased condoms or who always purchase condoms. The study analysed condom acquisition and sexual behaviour practices of 372 young men and logistic regression was analysed to determine whether condom acquisition practice was a predictor of consistent condom use. Results showed that most participants (41%) had mixed procurement of free and purchased condoms, 31% always bought condoms while 28% always purchased condoms. Majority of individuals (71%) who always purchased condoms, 23% who had mixed procurement, and 12% who had free condoms consistently used condoms. The results also showed that having 2 or more partners and always purchasing condoms increased the likelihood of consistent condom use. It is recommended that programmes of free condom supply should also incorporate in it education that emphasizes consistent condom use with a partner whose HIV sero status is not known. (author's)
Language: English
Keywords:
NIGERIA | RESEARCH REPORT | KAP SURVEYS | CONTRACEPTIVE PREVALENCE SURVEYS | YOUTH | MEN | MULTIPLE PARTNERS | CONDOM USE | PRICES | CONTRACEPTIVE AVAILABILITY | MICROECONOMIC FACTORS | SEX BEHAVIOR | CONTRACEPTIVE DISTRIBUTION | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Surveys | Sampling Studies | Studies | Research Methodology | Family Planning Surveys | Family Planning | Age Factors | Population Characteristics | Demographic Factors | Population | Sexual Partners | Behavior | Risk Reduction Behavior | Commerce | Macroeconomic Factors | Economic Factors | Contraception | Distributional Activities | Program Activities | Programs | Organization and Administration
Document Number: 324773

14.

Peer Reviewed

Title: HPV vaccines: bring me your daughters!
Author: Thomas C
Source: South African Medical Journal. 2008 Apr;98(4):259-261.
Abstract: Our approach to cervical cancer prevention is set to change dramatically over the next decade with the advent of human papillomavirus (HPV) DNA typing, the probable demise of the PAP smear as we know it, and the registration of two highly effective vaccines against the two main HPV types (16 and 18). The latter account for about 70% of all cervical cancer cases globally and for 63% of those in South African women. HPV-45 and HPV-31 account for another 10% of cases. Except for a minority of non-mainstream, but remarkably visible and vocal, groups and individuals the general consensus worldwide is that HPV vaccines herald a new era and a phenomenal advance in the fight against cervical cancer, the most common cancer to affect women in South Africa and sub- Saharan Africa, where the established co-factors of smoking, long-term oral contraceptive use, HIV co-infection and high parity are also operative. Lesotho has the unfortunate claim of the highest rate of cervical cancer in the world, with an age standardised incidence rate of 61.6 (versus our 37.5) per 100 000 women. Women and health care providers have had to make two paradigm shifts around cervical cancer: firstly, although most HPV infections clear naturally, persistent infection with particular genotypes of a virus are responsible for most cases of cervical cancer (including the less common adenocarcinoma), and secondly, close contact (as in both penetrative and nonpenetrative sex) is the main mode of infection. (excerpt)
Language: English
Keywords:
SOUTH AFRICA | CRITIQUE | RECOMMENDATIONS | CLINICAL RESEARCH | ADOLESCENTS, FEMALE | WOMEN IN DEVELOPMENT | HPV | IMMUNIZATION | CERVICAL CANCER | PAP SMEAR | PRICES | PRIVATE SECTOR | PARENTAL CONSENT | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Viral Diseases | Diseases | Primary Health Care | Health Services | Delivery of Health Care | Health | Cancer | Neoplasms | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Commerce | Macroeconomic Factors | Political Factors | Sociocultural Factors
Document Number: 330621

15.

Title: Household demand for preventive HIV/AIDS vaccines in Thailand: do husbands' and wives' preferences differ?
Author: Whittington D; Suraratdecha C; Poulos C; Ainsworth M; Prabhu V; Tangcharoensathien V
Source: Value In Health. 2008 Sep-Oct;11(5):965-74.
Abstract: OBJECTIVES: The aims of this study were to estimate household demand in the general population of Thailand for a (hypothetical) preventive HIV vaccine; to determine whether spouses in the same household would purchase the same number of vaccines for household members and have the same demand function; to determine whether spouses would allocate vaccines to the same household members; and to estimate household and per capita average willingness to pay (WTP) for an HIV vaccine price. METHODS: The data come from a national contingent valuation survey of 2524 residents (aged 18-20 years) of 1235 households in Thailand during the period 2000 to 2001. In a subsample of 561 households, both head of household and spouse completed independent (separate) interviews. Respondents were asked whether they would purchase an HIV vaccine for themselves and for other household members if one were available at a specified price. RESULTS: For the full sample, average household WTP for the vaccine was substantial (US$610 at 50% vaccine effectiveness, US$671 at 95% effectiveness); the average per capita WTP for household members was US$220 at 50% effectiveness and US$242 at 95% effectiveness. Although spouses reported that they would purchase the same total number of vaccines, and had essentially the same demand functions, at lower vaccine prices wives were significantly more likely than husbands to allocate vaccines to their daughters than to sons. CONCLUSIONS: Because wives are more likely to allocate vaccines to daughters, vaccination programs aimed at women and girls might have different outcomes than programs directed at males or at all potential adults without regard to sex.
Language: English
Keywords:
THAILAND | RESEARCH REPORT | SAMPLING STUDIES | HOUSEHOLDS | AIDS PREVENTION | HIV PREVENTION | VACCINES | NEEDS | PRICES | RESOURCE ALLOCATION | SEX FACTORS | INTERVIEWS | Developing Countries | Asia, Southeastern | Asia | Studies | Research Methodology | Family and Household | Sociocultural Factors | AIDS | HIV Infections | Viral Diseases | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Economic Factors | Commerce | Macroeconomic Factors | Financial Activities | Population Characteristics | Demographic Factors | Population | Data Collection
Document Number: 342118

16.

Title: Caribbean (2007): Price as a barrier to condom use: a randomized controlled trial in Trinidad and Tobago and St. Vincent and the Grenadines.
Author: Population Services International [PSI]. Research and Metrics
Source: Washington, D.C., PSI, Research and Metrics, 2007. 21 p. (Social Marketing Research Series)
Abstract: This report describes the results of an experiment aimed at determining whether and how a condom price reduction in Trinidad and Tobago and St. Vincent and the Grenadines would affect condom purchase and use and the overall condom market. The study seeks answers to two questions. First, would a reduction in current condom prices result in overall higher rates of condom purchase and likelihood of use? Second, what impact would a lower priced condom have on the condom market and specific brands? The study group consisted of a representative sample of sexually active males, ages 16-21, resident in Trinidad and Tobago and St. Vincent and the Grenadines. Being sexually active is defined as those reporting having had sex in the past year. A randomized control trial was conducted with three treatment groups, one was offered the condom at $0.15 per condom in a package of three and the two others at $0.20 and $0.25 per condom in a package of three respectively. The unit of randomization was the individual, as described below. Single level trial options for sample size determination were used, resulting in a required sample size for each treatment group of 270 and a total sample size of 810. Ultimately, 819 complete interviews were conducted and used in the analysis. Once the interview was completed, respondents were offered the product to buy at one of the three price levels. The price offered to the respondents was randomly determined. The price range tested here, $0.15 to $0.25 per condom, was chosen to be significantly lower than current prices, yet high enough to make a profit based on PSI knowledge of cost of goods sold. The study finds that lower prices are causally related to purchase. The lower the price, the more likely respondents under experimental conditions to purchase the condom. Respondents reporting no condom purchases in the past month purchased condoms at lower prices, indicating that price is a barrier to purchase. (excerpt)
Language: English
Keywords:
TRINIDAD AND TOBAGO | SAINT VINCENT AND THE GRENADINES | RESEARCH REPORT | CONTROL GROUPS | CLIENTS | MEN | CONDOM USE | PRICES | POINT OF PURCHASE | CONDOMS | POPULATION CHARACTERISTICS | SOCIOECONOMIC FACTORS | INTERVENTIONS | IMPACT | Caribbean | Americas | Developing Countries | Research Methodology | Program Activities | Programs | Organization and Administration | Demographic Factors | Population | Risk Reduction Behavior | Behavior | Commerce | Macroeconomic Factors | Economic Factors | Barrier Methods | Contraceptive Methods | Contraception | Family Planning | Communication
Document Number: 327321

17.

Title: [Cost of feeding in the first year of life] Custo da alimentacao no primeiro ano de vida.
Author: Barbosa MB; Palma D; Bataglin T; Taddei JA
Source: Revista de Nutricao / Brazilian Journal of Nutrition. 2007 Jan-Feb;20(1):55-62.
Abstract: The objective was to estimate and compare the different alternatives of feeding regimens available for infants in the first year of life, considering the limitations of each option in relation to a feeding regimen adequate for the infant's growth and development and also for the family budget. In the first year of life, four alternatives of feeding regimens were calculated, in accordance with the current recommendations for the introduction of new foods for infants. The proposed costs were considered for the monthly consumption of such feeding. The resulting values were determined by the arithmetic mean of the best prices of foods quoted in each of two supermarket chains and a local market of the south zone of S�o Paulo city during a period of six months (January to June, 2004). From the calculation of the percentage cost in relation to breastfeeding plus supplementary feeding, it was observed that the use of infant formula represents a cost 3.3 times higher, and the use of cow milk 1.7 times higher than the value of breastfeeding, thus showing that the recommendation for the use of infant formula cannot be adopted by the majority of the Brazilian population due to income limitations. The development of a formula with the necessary nutrients for the infant's growth and development on the same patterns of generic medicines could be a dietary option. Such a product, costing approximately R$10.00/ kg would be twice as cheap as the formulas currently available in the market. (author's)
Spanish Abstract: Estimar e comparar os custos das diferentes alternativas de alimenta��o dispon�veis para lactentes no primeiro ano de vida, considerando as limita��es de cada op��o em rela��o ao oferecimento de uma alimenta��o adequada ao crescimento e desenvolvimento e ao or�amento da fam�lia. Foram calculadas quatro alternativas de alimenta��o no primeiro ano de vida, segundo a recomenda��o atual da introdu��o dos novos alimentos. Os custos foram propostos para o consumo mensal de tal alimenta��o. Os valores obtidos foram determinados pela coleta de pre�os dos g�neros aliment�cios praticados em duas redes de supermercado e um mercado local da zona sul de S�o Paulo, utilizando os g�neros de menor pre�o e determinando a m�dia aritm�tica desses tr�s locais no per�odo de seis meses (janeiro a junho de 2004). Observou-se que a partir do c�lculo do custo percentual em rela��o ao aleitamento materno mais alimenta��o complementar, o uso de f�rmula infantil representa custo 3,3 vezes maior, e o uso do leite de vaca 1,7 vezes maior do que o valor do custo do aleitamento materno, demonstrando, assim, que a recomenda��o de utiliza��o da f�rmula infantil n�o pode ser adotada pela maior parte da popula��o brasileira, devido �s suas limita��es de renda. O desenvolvimento de formulado, no molde dos medicamentos gen�ricos, poderia oferecer op��o alimentar com os nutrientes necess�rios para o crescimento e desenvolvimento infantil. Este produto, com custo em torno de R$10,00/kg, apresentaria pre�o menor que a metade dos valores praticados atualmente para os formulados dispon�veis no mercado. (del autor)
Language: Portuguese
Keywords:
BRAZIL | RESEARCH REPORT | ECONOMIC MODEL | INFANT | INFANT NUTRITION | HOME ECONOMICS | GROWTH | CHILD DEVELOPMENT | EXPENDITURES | PRICES | BREASTFEEDING | MILK SUBSTITUTES | INCOME | South America, Eastern | South America | Latin America | Americas | Developing Countries | Theoretical Models | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Nutrition | Health | Microeconomic Factors | Economic Factors | Biology | Financial Activities | Commerce | Macroeconomic Factors | Socioeconomic Factors
Document Number: 316397

18.

Title: Generic and branded drugs for the treatment of people living with HIV / AIDS.
Author: Bartlett JA; Muro EP
Source: Journal of the International Association of Physicians in AIDS Care. 2007;6(1):15.
Abstract: HIV/AIDS care has benefited tremendously from the availability of antiretroviral (ARV) drugs, both branded and generic. Drug discovery and innovation is the result of direct investment in the development of branded medications, a crucial process for future improvements in care. However, the cost of branded medications is too high for resource-limited countries, where most persons with HIV/AIDS live. Generic drugs dramatically lower the cost of care; however, their safety and efficacy must be ensured and maintained. Proven bioavailability and bioequivalence, in addition to satisfactory manufacturing, distribution, and administration, are keys to successfully implementing the use of qualified generic ARVs. Agencies such as the US Food and Drug Administration (FDA), European Medicines Agency (EMEA), and the World Health Organization (WHO), continue to strengthen the surveillance process through which qualified generic and branded drugs are provided worldwide. Generic drugs have the potential to cause harm if rigorous standards for their use are not followed, but those that are qualified offer great promise in the treatment of HIV/AIDS. (author's)
Language: English
Keywords:
GLOBAL | CRITIQUE | EVALUATION | PERSONS LIVING WITH HIV/AIDS | AIDS PREVENTION | ANTIRETROVIRAL DRUGS | PRICES | SAFETY | QUALITY CONTROL | PHARMACY DISTRIBUTION | MONITORING | STANDARDS | HIV Infections | Viral Diseases | Diseases | AIDS | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Commerce | Macroeconomic Factors | Economic Factors | Public Health | Organization and Administration | Nonclinical Distribution | Distributional Activities | Program Activities | Programs | Research Methodology
Document Number: 322657

19.

Title: Pricing and patents of HIV / AIDS drugs in developing countries.
Author: Borrell JR
Source: Applied Economics. 2007 Mar;39(4):505-518.
Abstract: This article provides empirical evidence on the impact of patents on drug prices across developing countries. It uses sales data on human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) drugs in a sample of 34 low- and middle-income countries between 1995 and mid-2000. The main findings are that patents do shift drug prices up, drug prices are correlated to per capita income levels and drug firms follow a skimming strategy when pricing new HIV/AIDS drugs. That is, there is across country and intertemporal price discrimination in the global drug markets. (author's)
Language: English
Keywords:
DEVELOPING COUNTRIES | RESEARCH REPORT | COMPARATIVE STUDIES | STATISTICAL REGRESSION | ANTIRETROVIRAL DRUGS | PRICING | LEGISLATION | COMMERCIAL SECTOR | PRICES | INTERNATIONAL COOPERATION | Studies | Research Methodology | Data Analysis | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Marketing | Economic Factors | Political Factors | Sociocultural Factors | Commerce | Macroeconomic Factors
Document Number: 317478

20.

Peer Reviewed

Title: Lessons learned from bednet distribution in Central Mozambique.
Author: Brentlinger PE; Correia MA; Chinhacata FS; Gimbel-Sherr KH; Stubbs B
Source: Health Policy and Planning. 2007 Mar;22(2):103-110.
Abstract: Malaria is an important cause of mortality and morbidity in sub-Saharan Africa. Use of insecticide-treated bednets (ITNs) is an important preventive intervention. Selection of the best mechanisms for distribution and promotion of ITNs to vulnerable populations is an important strategic issue. Commercial shopkeepers and groups of community leaders were trained to promote and sell ITNs in 19 sites in central Mozambique between 2000 and 2004. Pregnant women and children under 5 years of age comprised the target population. Sales records, household survey results and project experiences were examined to derive 'lessons learned'. Primary outcome: An end-of-project household survey revealed that 40.8% of households owned one or more bednets, but only 19.6% of households owned a net that had been re-treated with insecticide within the preceding 6 months. Higher levels of bednet (treated or untreated) coverage (over 50%) were achieved in urban or peri-urban sites than in rural sites (as low as 15%). Bednet ownership was significantly associated with higher socio-economic status (odds ratios for association with bednet ownership: 5.6 for highest educational level compared with no education, 0.4 for dirt floor compared with cement or other finished flooring, 2.1 for automobile ownership compared with transportation on foot), but was negatively associated with the presence of young children in the household (odds ratio 0.5). Primary output: 23 000 ITNs were sold during the course of the project. Process lessons: Nearly all of the community leader sites failed and were replaced by shopkeepers or Ministry of Health personnel. Sales were most brisk in more prosperous urban and peri-urban sites (up to 147 nets/ month) but were significantly slower in poorer, rural sites (as low as three nets/ month). Remote rural sites with slow sales were more expensive to serve. Logistical difficulties were related to tariffs, transport, management of cash, warehousing and organization of re-treatment campaigns. This project failed to achieve adequate or equitable levels of ITN coverage in a timely manner in the programme sites. However, its findings helped support a subsequent Mozambican decision to conduct targeted distribution of long-lasting nets to the neediest populations in the provinces where the project was conducted. (author's)
Language: English
Keywords:
MOZAMBIQUE | EVALUATION REPORT | HOUSEHOLDS | MALARIA PREVENTION | INTERVENTIONS | BED NETS | COMMUNITY-BASED DISTRIBUTION | SALES | PRICES | LOGISTICS | SOCIOECONOMIC STATUS | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Evaluation | Family and Household | Sociocultural Factors | Malaria | Parasitic Diseases | Diseases | Programs | Organization and Administration | Parasite Control | Public Health | Health | Nonclinical Distribution | Distributional Activities | Program Activities | Marketing | Economic Factors | Commerce | Macroeconomic Factors | Management | Socioeconomic Factors
Document Number: 315883

21.

Title: Income, food prices, and participation of fruit and vegetables in the diet.
Author: Claro RM; Carmo HC; Machado FM; Monteiro CA
Source: Revista�de Saude Publica / Journal of Public Health. 2007 Aug;41(4):557-564.
Abstract: The objective was to analyze the influence of income and food prices on household consumption of fruit and vegetables. Data from the 1998/99 Household Budget Survey were analyzed, which was conducted by the Funda��o Instituto de Pesquisas Econ�micas (Institute for Economic Research Foundation) in the city of S�o Paulo, Brazil. The influence of income and food price on the relative participation of fruit and vegetables in the total household calorie intake was studied using regression analysis to estimate elasticity coefficients. There was an increase in participation of fruit and vegetables in total household calorie purchases along with the recorded decrease in prices, increase in family income, and increase in prices of other foods. A one percent decrease in the price of fruit and vegetables would lead to a 0.2% increase in the participation of these items in the total calorie content; a 1% increase in the price of other foods would increase fruit and vegetable participation by 0.07%; and a 1% increase in family income would increase participation by 0.04%. The effect of the prices of other foods was less intense in higher income groups, and in the other two scenarios we were unable to identify consistent income-associated patterns. A reduction in the price of fruit and vegetables, which can be achieved by means of public policies, could lead to an increase in fruit and vegetable intake in households in S�o Paulo and in other cities with similar scenarios. (author's)
Language: English
Keywords:
BRAZIL | RESEARCH REPORT | QUANTITATIVE RESEARCH | SURVEYS | STATISTICAL REGRESSION | HOUSEHOLDS | DIET | PRICES | INCOME | HEALTH POLICY | ECONOMIC FACTORS | FOOD AND BEVERAGE | South America, Eastern | South America | Latin America | Americas | Developing Countries | Research Methodology | Sampling Studies | Studies | Data Analysis | Family and Household | Sociocultural Factors | Nutrition | Health | Commerce | Macroeconomic Factors | Socioeconomic Factors | Policy | Political Factors
Document Number: 319765

22.
Peer Reviewed

Title: Microbicide applicators: Understanding design preferences among women in the Dominican Republic and South Africa.
Author: Cohen JA; Steele MS; Urena FI; Beksinska ME
Source: Sexually Transmitted Diseases. 2007 Jan;34(1):15-19.
Abstract: The objectives of this study were to prioritize applicator design attributes among women in the Dominican Republic and South Africa, and to determine how preferences differed based on sociodemographic variables. The goal was to identify acceptable microbicide applicator designs in 2 low-resource settings. We surveyed 895 women, randomly sampled from clinics in the Dominican Republic (n = 449) and South Africa (n = 446), with questions on sociodemographics, applicator attribute preferences, and price/design tradeoffs. Single-use design was the most valued attribute, and reusable design and low price were the least valued attributes in both populations. Preference for single-use design was associated with concern about reusable applicators spreading germs, secondary or higher education, older age, having children, and perception of moderate to high HIV risk. Acceptability factors related to microbicide delivery mechanisms should continue to be evaluated among potential microbicide users to directly inform product development and introduction of microbicides. (author's)
Language: English
Keywords:
SOUTH AFRICA | DOMINICAN REPUBLIC | RESEARCH REPORT | CROSS-CULTURAL COMPARISONS | KAP SURVEYS | WOMEN IN DEVELOPMENT | DEMOGRAPHIC FACTORS | MICROBICIDES | PRICES | PERCEPTION | ATTITUDES | EDUCATIONAL STATUS | AGE FACTORS | HIV INFECTIONS | RISK ASSESSMENT | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Caribbean | Americas | Comparative Studies | Studies | Research Methodology | Surveys | Sampling Studies | Economic Development | Economic Factors | Population | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Commerce | Macroeconomic Factors | Psychological Factors | Behavior | Socioeconomic Status | Socioeconomic Factors | Population Characteristics | Viral Diseases | Diseases | Evaluation
Document Number: 310727

23.

Title: Regulating vaccines: Can health -- economics tools be used profitably? [editorial]
Author: Dhanasiri SK; Puliyel JM
Source: Indian Pediatrics. 2007 Jan 17;44(1):11-14.
Abstract: Direct-to-consumer vaccine advertisements are a recent phenomenon. In India a newborn can make up to 27 visits to the doctor for immunizations before his fifth birthday. The vaccines cost approximately Rs 11,000. There is a built-in incentive for doctors to prescribe the vaccines. After a market presence is established, in the next stage the equity argument is brought up. Pressure is brought to bear on Government, to bring the vaccine under the Universal Immunization Program (UIP) saying that the well-to-do are protected and it is not equitable that the poor go unprotected(2). The Government of India recently had to take out advertisements in leading newspapers cautioning the public to 'evaluate carefully the commercial claims' of various vaccines beyond the 6 UIP vaccines. Pressure is also put by international organizations like the World Health Organization (WHO) and Global Alliance for Vaccines and Immunization (GAVI). Resolution 45.17 of the World Health Assembly mandates that member countriesintegrate cost effective 'newer vaccines' into the national immunization programs. Regardless of cost-effectiveness, organizations like GAVI persuade developing countries to use new vaccines by providing donor-grants (effectively driving costs to zero in the initial stages). The full cost implications are only realized once funding is withdrawn, after the vaccine has been included in the UIP. (excerpt)
Language: English
Keywords:
INDIA | CRITIQUE | RECOMMENDATIONS | COST BENEFIT ANALYSIS | CHILDREN | POLICYMAKERS | VACCINES | IMMUNIZATION | PRICES | GOVERNMENT PROGRAMS | RISK ASSESSMENT | COST EFFECTIVENESS | PRICING | RESOURCE ALLOCATION | PROGRAM EFFICIENCY | Developing Countries | Asia, Southern | Asia | Quantitative Evaluation | Evaluation | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Administrative Personnel | Organization and Administration | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Primary Health Care | Commerce | Macroeconomic Factors | Economic Factors | Programs | Evaluation Indexes | Marketing | Financial Activities | Program Evaluation
Document Number: 315596

24.

Title: Cost-effectiveness of childhood hepatitis A vaccination in Argentina: A second dose is warranted.
Author: Ellis A; R�ttimann RW; Jacobs RJ; Meyerhoff AS; Innis BL
Source: Revista Panamericana de Salud P�blica / Pan American Journal of Public Health. 2007 Jun;21(6):345-356.
Abstract: The objectives were to investigate the cost-effectiveness of childhood vaccination against hepatitis A in the five geographic regions of Argentina, and to determine whether adding a second dose to the current one-dose schedule would provide health gains justifying its added cost. A Markov model was used to consider four immunization options for the 2005 birth cohort: (1) no vaccination; (2) vaccination at 12 months of age, (3) vaccinations at 12 and 72 months of age; or (4) vaccinations at 12 and 18 months of age. Hepatitis A costs and consequences were predicted over 50 years. The cost-effectiveness of first and second vaccine doses was assessed through a range of vaccine prices and assumptions regarding the duration of vaccine protection. Costs and health gains (measured in quality-adjusted life years) were adjusted to present values using a 3% annual discount rate. The one-dose vaccination policy is predicted to reduce each birth cohort member's 50-year probability of overt hepatitis A from 7.2% to 4.1%. A second dose would reduce the probability to between 2.0% and 2.2%. Vaccination at 12 months of age, at 12 and 72 months, or at 12 and 18 months would reduce cases among personal contacts by 82%, 87%, and 92%, respectively. The first vaccine dose would meet accepted standards of cost-effectiveness in each region, and reduce costs in the Northeast, Central, and South regions. Adding a second dose at age 18 months would be cost-effective in each region, and further reduce costs in the Cuyo region. If the duration of protection with one dose is less than anticipated, the second dose would be more cost-effective. Greater health gains are derived from the first than second hepatitis A vaccine dose. However, this analysis supports the cost-effectiveness of providing both first and second doses to Argentina's children. (author's)
Language: English
Keywords:
ARGENTINA | RESEARCH REPORT | COST BENEFIT ANALYSIS | CHILDREN | COST EFFECTIVENESS | HEPATITIS | IMMUNIZATION | ADMINISTRATION AND DOSAGE | AGE FACTORS | IMMUNIZATION SCHEDULE | PRICES | HUMAN GEOGRAPHY | South America, Southern | South America | Latin America | Americas | Developing Countries | Quantitative Evaluation | Evaluation | Youth | Population Characteristics | Demographic Factors | Population | Evaluation Indexes | Viral Diseases | Diseases | Primary Health Care | Health Services | Delivery of Health Care | Health | Drugs | Treatment | Medical Procedures | Medicine | Commerce | Macroeconomic Factors | Economic Factors | Geography | Social Sciences | Science | Sociocultural Factors
Document Number: 324229

25.
Title: AIDS briefs.
Author: Farham B
Source: CME: Your SA Journal of CPD. 2007 Jun;25(6):296-297.
Abstract: Until recently, South Africans infected with HIV have had two options for health care. Those who could afford it went to private and expensive clinics and service providers for ARV drug treatment, and generally those without financial means went to public sector clinics and took a day off work each month. Zuzimpilo (gain health) Medical Centre is situated in the Johannesburg city centre and is the first of its kind to finally give patients and their health care providers a choice. It's a private clinic that provides comprehensive HIV/AIDS care at one-third of its cost. Doctors don't have to lose their patients either as the clinic treats only HIV/AIDS. The notion of charging people for care has sparked much debate but in the context of South Africa, with its enormous requirement for HIV care, this model offers a bridge between private and public HIV care. (excerpt)
Language: English
Keywords:
AFRICA, SUB SAHARAN | PROGRESS REPORT | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | BASELINE SURVEYS | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | AIDS PREVENTION | PRICES | FEES | PREVALENCE | HIV INFECTIONS | HERPES GENITALIS | PARASITIC DISEASES | MALE CIRCUMCISION | Africa | Developing Countries | Research Methodology | Surveys | Sampling Studies | Studies | Viral Diseases | Diseases | HIV | AIDS | Commerce | Macroeconomic Factors | Economic Factors | Financial Activities | Measurement | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 318194

26.
Title: Balancing effectiveness and access to HIV treatment in the developing world [editorial]
Author: Hill A; Wood E
Source: AIDS. 2007 Jan 30;21(3):361-363.
Abstract: In Cambodia, where 78% of people earn less than US$ 2 dollars per day, UNAIDS estimates that 130 000 people are currently infected with HIV; 16 000 Cambodians have already died with HIV infection. Providing optimal treatment and care for large numbers of HIV-infected people is clearly a challenge in countries with limited resources. In this issue of AIDS, Madec and colleagues examined responses to HAART among 1735 severely immuno-compromised patients, who joined a Me�decins Sans Frontieres-sponsored treatment access programme in Phnom Penh. The median CD4 cell count at initiation of HAART was 20 cells/�l, with 75% of patients starting with fewer than 78 cells/�l. Those with CD4 cell counts below 20 cells/�l at initiation of HAART had a 2-year mortality rate of 24.7%, versus 2-year rates of 4-7% for those with higher baseline CD4 cell counts. Those with missing CD4 cell counts at baseline (i.e. those with very poor health status who did not need CD4 cell counts to decide on HAART initiation) had the highest mortality. (excerpt)
Language: English
Keywords:
CAMBODIA | PROGRESS REPORT | EVALUATION | PERSONS LIVING WITH HIV/AIDS | PROGRAM ACCESSIBILITY | DELIVERY OF HEALTH CARE | ANTIRETROVIRAL THERAPY | IMMUNITY, CELLULAR | AIDS PREVENTION | ADMINISTRATION AND DOSAGE | PRICES | Developing Countries | Asia, Southeastern | Asia | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Program Evaluation | Programs | Organization and Administration | Health | HIV | Immunity | Immune System | Physiology | Biology | AIDS | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Commerce | Macroeconomic Factors | Economic Factors
Document Number: 312186

27.

Peer Reviewed

Title: Contraceptive implants in Kenya: Current status and future prospects.
Author: Hubacher D; Kimani J; Steiner MJ; Solomon M; Ndugga MB
Source: Contraception. 2007 Jun;75(6):468-473.
Abstract: Since introducing Norplant over 20 years ago in Kenya, demand for contraceptive implants has remained high and implant costs are dropping substantially. An assessment of the Kenyan experience with implants was conducted to understand level of demand, capacity to provide services and reproductive health impact of possible increased use. Interviews were conducted with 35 key Kenyan informants. By modeling increases in national implant use (at the expense of oral contraceptives), reductions in the annual number of unintended pregnancies were estimated. Kenya has an unmet need for implants and the current network of trained providers appears ready to increase the volume of services. If 100,000 users of oral contraceptives switch to implants, then an estimated 26,000 unintended pregnancies can be averted over a 5-year period. With increased purchases of implants by international donor agencies, Kenya can reduce reliance on short-term hormonal methods and reduce the 45% prevalence rate of unintended pregnancy. (author's)
Language: English
Keywords:
KENYA | RESEARCH REPORT | QUALITATIVE RESEARCH | HEALTH PERSONNEL | FAMILY PLANNING PERSONNEL | CONTRACEPTIVE IMPLANTS | PRICES | CAPACITY BUILDING | CONTRACEPTIVE DISTRIBUTION | REPRODUCTIVE HEALTH | INTERVIEWS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Delivery of Health Care | Health | Family Planning Programs | Family Planning | Contraceptive Methods | Contraception | Commerce | Macroeconomic Factors | Economic Factors | Program Sustainability | Programs | Organization and Administration | Distributional Activities | Program Activities | Data Collection
Document Number: 313557

28.

Title: Promoting retention in care: An effective model in an antiretroviral treatment service in South Africa [letter]
Author: Lawn SD; Kaplan R; Wood R; Bekker LG
Source: Clinical Infectious Diseases. 2007 Sep 15;45(6):803.
Abstract: We read with interest the article by Giordano and colleagues regarding the difficulties of retaining HIV-infected patients within care during antiretroviral therapy (ART) in US veterans affairs hospitals and clinics. Despite few financial barriers to treatment, retention in care was poor among a substantial portion of patients, compromising survival probability. The authors highlighted the critical need to develop and implement strategies to improve retention, thereby maximizing the benefits of ART. In the accompanying editorial, Cheever described strategies that have been used successfully in other programs in the United States, whereby use of support services resulted in greater engagement of patients in their medical care and enhanced retention. (excerpt)
Language: English
Keywords:
SOUTH AFRICA | CRITIQUE | EXPERIMENTAL MODELS | PERSONS LIVING WITH HIV/AIDS | PEER EDUCATORS | COUNSELORS | USER COMPLIANCE | ANTIRETROVIRAL THERAPY | COMMUNITY HEALTH SERVICES | PRICES | COUNSELING | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | HIV Infections | Viral Diseases | Diseases | Education | Clinic Activities | Program Activities | Programs | Organization and Administration | Behavior | HIV | Primary Health Care | Health Services | Delivery of Health Care | Health | Commerce | Macroeconomic Factors | Economic Factors
Document Number: 319472