Cost, effectiveness, and cost-effectiveness of preventive chemotherapy for control of soil-transmitted helminths in Vietnam and the Philippines

School-based preventive chemotherapy (PC), the main soil-transmitted helminths (STH) control strategy, excludes adults. Mass drug administration (MDA) would benefit the entire population but requires greater investment. This thesis aims to evaluate the cost, effectiveness, and cost-effectiveness of MDA compared with school-based PC for STH control in Vietnam and the Philippines. A cost survey estimated the cost of MDA and school-based PC for hookworm control in Dak Lak, Vietnam. Effectiveness data was obtained from a trial conducted in the area. A Markov model estimated the incremental cost-effectiveness ratio (ICER) of MDA relative to school-based PC. The cost per person was $0·27 for MDA and$0·43 for school-based PC. MDA and school-based PC will cost $471,623 and$116,590, respectively, annually. Over 10 years, MDA would avert 143,546 DALYs compared to school-based PC. MDA has an ICER of $24 per DALY averted, cost-effective given a threshold is$689 per DALY averted in Vietnam. In the Philippines, a systematic review and meta-analysis estimated the effectiveness of PC for STH, schistosomiasis, and lymphatic filariasis. Prevalence of moderate-to-heavy intensity (MHI) Ascaris lumbricoides and Trichuris trichiura infections were reduced after PC (from 24% to 7%, and from 12% to 3% respectively). Overall STH prevalence reductions were only found in children. Prevalence of MHI schistosomiasis and of schistosomiasis in schoolchildren were reduced after MDA (from 3% to 0.2%, and from 31% to 1% respectively). Prevalence of lymphatic filariasis prior to MDA was 3.2%, while only 2 provinces still have prevalence above 1%. A cost survey and budget impact analysis compared MDA with expanded school-based PC, covering students ages 5 to 18 for STH control in Zamboanga Peninsula, Philippines. Annual economic cost of MDA was $809,000 or$0.22 per person, while it was $625,000 or$0.57 per person for expanded school-based PC. Over 5 years, MDA in the region will cost the government $3,128,000; which was$740,000 higher than the expanded school-based PC. This thesis provides evidence supporting MDA as a cost-effective STH control intervention in areas where the burden is concentrated in adults. In addition, considering MDA’s lower cost per person and its incremental cost over the expanded school-based targeted PC representing 0.2% of the regional Department of Health budget, implementing MDA could be key in addressing the persisting STH burden in adults in the Philippines

Establishing Competencies for a Global Health Workforce: Recommendations from the Association of Pacific Rim Universities

Background: The Association of Pacific Rim Universities Global Health Program facilitates exchange of information, knowledge and experiences in global health education and research among its 50 member universities. Despite the proliferation of global health educational programs worldwide, a lack of consensus exists regarding core competencies in global health training and how these are best taught. Methods: A workshop was convened with 30 faculty, university administrators, students, and NGO workers representing both the Global North and South to gain consensus on core competencies in masters’-level global health training. The co-authors then collaborated to refine the list of competencies, categorize them into domains, and develop a plan for how academic institutions can ensure that these competencies are effectively taught. Findings: Nineteen competencies across five domains were identified: knowledge of trends and determinants of global disease patterns; cultural competency; global health governance, diplomacy and leadership; project management; and ethics and human rights. The plan for how academic institutions can best train students on these competencies outlined five key opportunities: coursework; practicums; research opportunities; mentorship; and evaluation. The plan recommended additional institutional strategies such as maximizing collaborative research opportunities, international partnerships, capacity-building grants, and use of educational technology to support these goals. Conclusions and Recommendations: While further research on the implementation of competency-based training is warranted, this work offers a step forward in advancing competency-based global health masters’ education as identified by a globally diverse group of expert stakeholders and economies. Given the challenges facing the current global health landscape, comparable competency-based training across institutions is critical to ensure the training of competent global health professionals

Cost and cost-effectiveness analysis of mass drug administration compared to school-based targeted preventive chemotherapy for hookworm control in Dak Lak province, Vietnam

Background: School-based targeted preventive chemotherapy (PC), the main strategy for soil-transmitted helminths (STH) control, excludes other at-risk populations including adults and preschool children. Mass drug administration (MDA), covering all age groups, would bring additional health benefits but also requires greater investment. This cost survey and cost-effectiveness analysis compared MDA with school-based targeted PC for STH control in Dak Lak, Vietnam, where STH are endemic. Methods: A cost survey was conducted in 2020 to estimate the total and per person economic and financial cost of each strategy. Monte Carlo simulation accounted for uncertainty in cost estimates. The primary effectiveness measure was hookworm-related disability-adjusted life years (DALYs) averted, and secondary measures were hookworm infection-years averted and moderate-to-heavy intensity hookworm infection-years averted. A Markov model was used to determine the incremental cost-effectiveness ratio (ICER) of MDA compared to school-based targeted PC using a government payer perspective and a ten-year time horizon. One-way and probabilistic sensitivity analyses (PSA) were performed. Costs are reported in 2020 USD ($). Findings: The economic cost per person was$0.27 for MDA and $0.43 for school-based targeted PC. MDA in Dak Lak will cost$472,000 per year, while school-based targeted PC will cost $117,000. Over 10 years, MDA is estimated to avert an additional 121,465 DALYs; 4,019,262 hookworm infection-years, and 765,844 moderate-to-heavy intensity hookworm infection-years compared to school-based targeted PC. The ICER was$28.55 per DALY averted; $0.87 per hookworm infection-years averted, and$4.54 per moderate-to-heavy intensity hookworm infection-years averted. MDA was cost-effective in all PSA iterations. Interpretation: In areas where hookworm predominates and adults suffer a significant burden of infection, MDA is cost effective compared to school based targeted PC and is the best strategy to achieve global targets. \</p