The cost and cost-effectiveness of alternative strategies to expand treatment to HIV-positive South Africans: scale economies and outreach costs

This repository item contains a single issue of the Health and Development Discussion Papers, an informal working paper series that began publishing in 2002 by the Boston University Center for Global Health and Development. It is intended to help the Center and individual authors to disseminate work that is being prepared for journal publication or that is not appropriate for journal publication but might still have value to readers.The South African government is currently discussing various alternative approaches to the further expansion of antiretroviral treatment (ART) in public-sector facilities. We used the EMOD-HIV model, a HIV transmission model which projects South African HIV incidence and prevalence and ARV treatment by age-group for alternative combinations of treatment eligibility criteria and testing, to generate 12 epidemiological scenarios. Using data from our own bottom-up cost analyses in South Africa, we separate outpatient cost into nonscale- dependent costs (drugs and laboratory tests) and scale-dependent cost (staff, space, equipment and overheads) and model the cost of production according to the expected future number and size of clinics. On the demand side, we include the cost of creating and sustaining the projected incremental demand for testing and treatment. Previous research with EMOD-HIV has shown that more vigorous recruitment of patients with CD4 counts less than 350 is an advantageous policy over a five-year horizon. Over 20 years, however, the model assumption that a person on treatment is 92% less infectious improves the cost-effectiveness of higher eligibility thresholds, averting HIV infections for between $1,700 and$2,800, while more vigorous expansion under the current guidelines would cost more than $7,500 per incremental HIV infection averted. Based on analysis of the sensitivity of the results to 1,728 alternative parameter combinations at each of four discount rates, we conclude that better knowledge of the behavioral elasticities could reduce the uncertainty of cost estimates by a factor of 4 to 10

Operational satellite-based temporal modelling of Aedes population in Argentina

Aedes aegypti is a vector for Chikungunya, Dengue and Zika viruses in Latin America and is therefore a large public health problem for the region. For this reason, several inter-institutional and multidisciplinary efforts have been made to support vector control actions through the use of geospatial technologies. This study presents the development of an operational system for the application of free access to remotely sensed products capable of assessing the oviposition activity of Ae. aegypti in all of Argentina?s northern region with the specific aim to improve the current Argentine National Dengue risk system. Temporal modelling implemented includes remotely sensed variables like the normalized difference vegetation index, the normalized difference water index, day and night land surface temperature and precipitation data available from NASA?s tropical rainfall measuring mission and global precipitation measurement. As a training data set, four years of weekly mosquito oviposition data from four different cities in Argentina were used. A series of satellite-generated variables was built, downloading and resampling the these products both spatially and temporally. From an initial set of 41 variables chosen based on the correlation between these products and the oviposition series, a subset of 11 variables were preserved to develop temporal forecasting models of oviposition using a lineal multivariate method in the four cities. Subsequently, a general model was generated using data from the cities. Finally, in order to obtain a model that could be broadly used, an extrapolation method using the concept of environmental distance was developed. Although the system was oriented towards the surveillance of dengue fever, the methodology could also be applied to other relevant vector-borne diseases as well as other geographical regions in Latin America.Fil: Espinosa, Manuel. Fundación Mundo Sano; ArgentinaFil: Di Fino, Eliana Marina Alvarez. Fundación Mundo Sano; Argentina. Universidad Nacional de Córdoba; ArgentinaFil: Abril, Marcelo. Fundación Mundo Sano; ArgentinaFil: Lanfri, Mario. Centro Espacial Teófilo Tabanera; ArgentinaFil: Periago, Maria Victoria. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Fundación Mundo Sano; ArgentinaFil: Scavuzzo, Carlos Marcelo. Centro Espacial Teófilo Tabanera; Argentin

Environmental change and Rift Valley fever in eastern Africa: projecting beyond HEALTHY FUTURES

Outbreaks of Rift Valley fever (RVF), a relatively recently emerged zoonosis endemic to large parts of sub-Saharan Africa that has the potential to spread beyond the continent, have profound health and socio-economic impacts, particularly in communities where resilience is already low. Here output from a new, dynamic disease model [the Liverpool RVF (LRVF) model], driven by downscaled, bias-corrected climate change data from an ensemble of global circulation models from the Inter-Sectoral Impact Model Intercomparison Project run according to two radiative forcing scenarios [representative concentration pathway (RCP)4.5 and RCP8.5], is combined with results of a spatial assessment of social vulnerability to the disease in eastern Africa. The combined approach allowed for analyses of spatial and temporal variations in the risk of RVF to the end of the current century. Results for both scenarios highlight the high-risk of future RVF outbreaks, including in parts of eastern Africa to date unaffected by the disease. The results also highlight the risk of spread from/to countries adjacent to the study area, and possibly farther afield, and the value of considering the geography of future projections of disease risk. Based on the results, there is a clear need to remain vigilant and to invest not only in surveillance and early warning systems, but also in addressing the socio-economic factors that underpin social vulnerability in order to mitigate, effectively, future impacts

Integrated Serologic Surveillance of Population Immunity and Disease Transmission.

Antibodies are unique among biomarkers in their ability to identify persons with protective immunity to vaccine-preventable diseases and to measure past exposure to diverse pathogens. Most infectious disease surveillance maintains a single-disease focus, but broader testing of existing serologic surveys with multiplex antibody assays would create new opportunities for integrated surveillance. In this perspective, we highlight multiple areas for potential synergy where integrated surveillance could add more value to public health efforts than the current trend of independent disease monitoring through vertical programs. We describe innovations in laboratory and data science that should accelerate integration and identify remaining challenges with respect to specimen collection, testing, and analysis. Throughout, we illustrate how information generated through integrated surveillance platforms can create new opportunities to more quickly and precisely identify global health program gaps that range from undervaccination to emerging pathogens to multilayered health disparities that span diverse communicable diseases

Taking the pulse of COVID-19: A spatiotemporal perspective

The sudden outbreak of the Coronavirus disease (COVID-19) swept across the world in early 2020, triggering the lockdowns of several billion people across many countries, including China, Spain, India, the U.K., Italy, France, Germany, and most states of the U.S. The transmission of the virus accelerated rapidly with the most confirmed cases in the U.S., and New York City became an epicenter of the pandemic by the end of March. In response to this national and global emergency, the NSF Spatiotemporal Innovation Center brought together a taskforce of international researchers and assembled implemented strategies to rapidly respond to this crisis, for supporting research, saving lives, and protecting the health of global citizens. This perspective paper presents our collective view on the global health emergency and our effort in collecting, analyzing, and sharing relevant data on global policy and government responses, geospatial indicators of the outbreak and evolving forecasts; in developing research capabilities and mitigation measures with global scientists, promoting collaborative research on outbreak dynamics, and reflecting on the dynamic responses from human societies.Comment: 27 pages, 18 figures. International Journal of Digital Earth (2020

Spatial epidemiology in zoonotic parasitic diseases: insights gained at the 1st International Symposium on Geospatial Health in Lijiang, China, 2007

The 1st International Symposium on Geospatial Health was convened in Lijiang, Yunnan province, People's Republic of China from 8 to 9 September, 2007. The objective was to review progress made with the application of spatial techniques on zoonotic parasitic diseases, particularly in Southeast Asia. The symposium featured 71 presentations covering soil-transmitted and water-borne helminth infections, as well as arthropod-borne diseases such as leishmaniasis, malaria and lymphatic filariasis. The work made public at this occasion is briefly summarized here to highlight the advances made and to put forth research priorities in this area. Approaches such as geographical information systems (GIS), global positioning systems (GPS) and remote sensing (RS), including spatial statistics, web-based GIS and map visualization of field investigations, figured prominently in the presentation

Assessing the Exposome with External Measures: Commentary on the State of the Science and Research Recommendations

The exposome comprises all environmental exposures that a person experiences from conception throughout the life course. Here we review the state of the science for assessing external exposures within the exposome. This article reviews (a) categories of exposures that can be assessed externally, (b) the current state of the science in external exposure assessment, (c) current tools available for external exposure assessment, and (d) priority research needs. We describe major scientific and technological advances that inform external assessment of the exposome, including geographic information systems; remote sensing; global positioning system and geolocation technologies; portable and personal sensing, including smartphone-based sensors and assessments; and self-reported questionnaire assessments, which increasingly rely on Internet-based platforms. We also discuss priority research needs related to methodological and technological improvement, data analysis and interpretation, data sharing, and other practical considerations, including improved assessment of exposure variability as well as exposure in multiple, critical life stages

An Investigation Into the Use of Geospatial Technologies as Part of Disaster Management Efforts Related to the Asian Tsunami of 2004

On the 26th of December, 2004, a tsunami impacted the countries surrounding the Indian Ocean, immediately killing over two hundred and eighty thousand people, displacing another million people, and initially causing at least US$10 billion in damage. The response by the international community was swift and massive. Disaster decision-makers who led their organization\u27s responses to the tsunami used geospatial information to support their decision-making efforts with mixed success. When describing their use of geospatial technologies during the response, a select set of disaster decision-makers provided information about how they used geospatial information, they described what worked and what did not work to support their efforts. These disaster decision-makers\u27 revelations include the need for information about the affected persons, the location and status of relief supplies and other resources, and the conditions of the terrain affected by the tsunami. Corroborated by documents produced by governments, academia, nongovernmental and international organizations, these information requirements are the basis for a logical model for a geographic information system that can be used to support a variety of disaster types