Drones and digital adherence monitoring for community-based tuberculosis control in remote Madagascar: a cost-effectiveness analysis

Continuing tuberculosis control with current approaches is unlikely to reach the World Health Organization's objective to eliminate TB by 2035. Innovative interventions such as unmanned aerial vehicles (or drones) and digital adherence monitoring technologies have the potential to enhance patient-centric quality tuberculosis care and help challenged National Tuberculosis Programs leapfrog over the impediments of conventional Directly Observed Therapy (DOTS) implementation. A bundle of innovative interventions referred to for its delivery technology as the Drone Observed Therapy System (DrOTS) was implemented in remote Madagascar. Given the potentially increased cost these interventions represent for health systems, a cost-effectiveness analysis was indicated.; A decision analysis model was created to calculate the incremental cost-effectiveness of the DrOTS strategy compared to DOTS, the standard of care, in a study population of 200,000 inhabitants in rural Madagascar with tuberculosis disease prevalence of 250/100,000. A mixed top-down and bottom-up costing approach was used to identify costs associated with both models, and net costs were calculated accounting for resulting TB treatment costs. Net cost per disability-adjusted life years averted was calculated. Sensitivity analyses were performed for key input variables to identify main drivers of health and cost outcomes, and cost-effectiveness.; Net cost per TB patient identified within DOTS and DrOTS were, respectively, $282 and$1,172. The incremental cost per additional TB patient diagnosed in DrOTS was $2,631 and the incremental cost-effectiveness ratio of DrOTS compared to DOTS was$177 per DALY averted. Analyses suggest that integrating drones with interventions ensuring highly sensitive laboratory testing and high treatment adherence optimizes cost-effectiveness.; Innovative technology packages including drones, digital adherence monitoring technologies, and molecular diagnostics for TB case finding and retention within the cascade of care can be cost effective. Their integration with other interventions within health systems may further lower costs and support access to universal health coverage

Perceptions of drones, digital adherence monitoring technologies and educational videos for tuberculosis control in remote Madagascar: A mixed-method study protocol

© 2019 Author(s). Introduction Poor road and communication infrastructure pose major challenges to tuberculosis (TB) control in many regions of the world. TB surveillance and patient support often fall to community health workers (CHWs) who may lack the time or knowledge needed for this work. To meet the End TB Strategy goal of reducing TB incidence by 90% by 2035, the WHO calls for intensified research and innovation including the rapid uptake of new tools, interventions and strategies. Technologies that â € leapfrog\u27 infrastructure challenges and support CHWs in TB control responsibilities have the potential to dramatically change TB outcomes in remote regions. Such technologies may strengthen TB control activities within challenged national tuberculosis treatment and control programmes (NTPs), and be adapted to address other public health challenges. The deployment of innovative technologies needs to be differentially adapted to context-specific factors. The Drone Observed Therapy System (DrOTS) project was launched in Madagascar in 2017 and integrates a bundle of innovative technologies including drones, digital adherence monitoring technology and mobile device-based educational videos to support TB control. Methods and analysis This mixed-methods study gathers and analyses cultural perceptions of the DrOTS project among key stakeholders: patients, community members, CHWs, village chiefs and NTP-DrOTS mobile health teams. Data from questionnaires, semistructured interviews, focus group discussions (FGD) and ethnographic observation gathered from June 2018 to June 2019 are thematically analysed and compared to identify patterns and singularities in how DrOTS stakeholders perceive and interact with DrOTS technologies, its enrolment processes, objectives and team. Ethics and dissemination Ethics approval was obtained from the National Bioethics Research Committee of Madagascar and Stony Brook University institutional review board. Study results will be submitted for peer-reviewed publication. In Madagascar, results will be presented in person to Ministry and other Malagasy decision-makers through the Institut Pasteur de Madagascar. Patient and public involvement This study is designed to foreground the voices of patients and potential patients in the DrOTS programme. CHW participants in this study also supported the design of study information sessions and recruitment strategies. One member of the mobile health team provided detailed input on the wording and content of FGD and interview guides. Study findings will be presented via a report in French and Malagasy to CHW, mobile health team and other village-level participants who have email/internet access

Repertoire Class: May 13, 1965

This is the program for the Repertoire Class recital, held on May 13, 1965. Pianist Carolyn Blazin, pianist Bill Fielding, pianist Brian Bretsnyder, soprano Nancy Justus, soprano Camille Bishop, baritone Jim Wilmoth, mezzo-soprano Linda Yeager, baritone Sam McKinney, soprano Lana Rankin, bass Robert Etters, baritone Richard Rose, soprano Paula Ray, baritone Tom Long, baritone Jim Reese, mezzo-soprano Velma Brinkley, baritone George Stevenson, soprano Dona Hatcher, pianist Susan Parr, composter Jean Balfour, pianist Jenny Boley, and pianist Bill Borland performed

Bildprogrammet på västra korväggen i Södra Råda

In November 2001 the wooden church of Södra Råda, dendrochronologically dated to the first decades of the 14th century, burnt down, the victim of arson. What was lost was a unique building, its walls covered with dated paintings, the ones in the choir from 1323, the ones in the nave from 1494. Although well known in art history, sometimes even styled the Arena Chapel of Swedish Medieval art, these paintings still contained a number of iconographically unsolved problems. The question of the identity of the donors, portrayed on the western wall of the choir, remained unan-swered. Their names (as verified in a restoration report of 1983) were never painted on the scrolls in the donor’s hands. Based on the firm dating of the paintings to 1323 and a new, thorough review of the scarce written source material, this article is an attempt to solve some of the iconographical problems in the light of the historical events of that year and of, sadly post factum, filling in the names on the donor’s scrolls. The latter, according to the author’s view, should have been those of Matts Kettilmundsson, at the time Swedish governor of Finland, and his daughter Ingrid

Kyrkorna i Klåstad: En presentation av ett pågående projekt

The churches in Klåstad. A presentation of a progressive projekt By Rikard Hedvall In 1997 an unknowed round naved churchruin was discovered in Klosterstad/Klåstad, Östergötland. The church dates approximately to the first half of the 13th century. It was destroyed in a fire between 1561 and 1567. A lot of the medieval interior was still extant. An earlier stavchurch was discovered a few meters north of the round naved church. This church dates from the 11th century and have been replaced when the round naved church was completed. Even the belltowers to both churches have been excavated. Totaly 30 pieces of limestone gravemonuments, from the same location, decorated with dragonmotives and runic inscription have been found. This type of monuments dates approximately from the 11th century to the beginning of the 12th century. Among almost 200 excavated graves one of them which belong to that early church was covered with a runic inscripted monument.&nbsp

Bi-directional drones to strengthen healthcare provision : experiences and lessons from Madagascar, Malawi and Senegal

Drones are increasingly being used globally for the support of healthcare programmes. Madagascar, Malawi and Senegal are among a group of early adopters piloting the use of bi-directional transport drones for health systems in sub-Saharan Africa. This article presents the experiences as well as the strengths, weaknesses, opportunities and threats (SWOT analysis) of these country projects. Methods for addressing regulatory, feasibility, acceptability, and monitoring and evaluation issues are presented to guide future implementations. Main recommendations for governments, implementers, drone providers and funders include (1) developing more reliable technologies, (2) thorough vetting of drone providers' capabilities during the selection process, (3) using and strengthening local capacity, (4) building in-country markets and businesses to maintain drone operations locally, (5) coordinating efforts among all stakeholders under government leadership, (6) implementing and identifying funding for long-term projects beyond pilots, and (7) evaluating impacts via standardised indicators. Sharing experiences and evidence from ongoing projects is needed to advance the use of drones for healthcare

Kepatuhan Pengobatan pada Pasien Tuberkulosis dan Faktor-Faktor yang Mempengaruhinya: Tinjauan Sistematis

Tuberkulosis (TB) merupakan penyakit menular yang disebabkan oleh bacillus mycobacterium tuberculosis. Ketidakpatuhan dalam pengobatan kerap menjadi masalah secara global, karena jika tidak mengikuti rangkaian pengobatan secara benar dapat menyebabkan resistensi obat, kambuhnya kembali penyakit, bahkan sampai kematian. Tujuan artikel ini adalah untuk mengetahui kepatuhan pengobatan pasien TB paru dan faktor-faktor yang mempengaruhinya pada studi observasional. Terdapat empat database (PubMed, Scopus, EMBASE dan MEDLINE) yang digunakan untuk menulusuri artikel. Kata kunci yang digunakan untuk pencarian diantaranya: (tuberculosis) OR (TB) AND (treatment adherence) OR (treatment compliance) OR (medication adherence) OR (medication compliance) AND (directly observed treatment shortcourse) OR (DOTS). Ditemukan sebanyak lima  artikel yang relevan digunakan untuk tinjauan dalam artikel ini. Penelusuran artikel mengacu pada PRISMA diagram. Analisis dilakukan terhadap beberapa artikel dari Asia, Afrika dan Timur Tengah. Penelitian dilakukan pada pasien TB paru dimana terdapat tiga artikel yang menggunakan desain kasus kontrol dan dua artikel menggunakan desain cross-sectional. Faktor-faktor yang mempengaruhi kepatuhan pasien TB diantaranya adalah usia, status pekerjaan, efek samping obat, jarak, pengetahuan TB, peran keluarga dalam memberikan pengawasan serta dukungan dalam menjalani pengobatan, hubungan yang baik antara dokter dan pasien serta stigma. Diperlukan upaya untuk meningkatkan kepatuhan pasien dengan pembangunan dan pengembangan dalam pemberian layanan kesehatanagar pasien dapat mengakses pelayanan kesehatan secara  maksimal, khususnya bagi pasien yang terhambat oleh jarak dan biaya. Selain itu, memberikan edukasi terkait TB, meningkatkan hubungan pasien dan dokter, dukungan keluarga baik secara fisik dan spiritual juga dibutuhkan untuk menjaga niat pasien dan memberikan kekuatan secara psikologis terhadap stigma yang mungkin diterima dari orang-orang sekitar