Public health economics of chlamydia and other STIs : aspects of risk, prevention and resources

The overall aim of this thesis was to increase the knowledge of the public health economic aspects of chlamydia and other STIs, in terms of risk, prevention and resources. In Study I, we examined the association between demographic, socioeconomic and lifestyle factors and the risk of self-reported chlamydial infection among young adults in the Stockholm public health cohort. We found that the risk of self-reported chlamydia infection among young adults in Sweden was associated with lower age, high alcohol consumption, lower educational level and being employed or unemployed, on sick leave or pre-retired compared to being a student. In Study II, we identified potential key factors for successful regional prevention of chlamydia and other STIs by a case study including seven Swedish counties. We found that potential key factors include adequate programme- and county council investments, suitable organizational structure, strong leadership, management of regional networks, research connection, multiple local collaborations, high testing coverage and a strategic risk approach. In Study III, we analyzed the cost-effectiveness of the intervention Chlamydia Monday by estimating costs, savings and health gains generated by the intervention and analyzed whether the cost-effectiveness varied between men and women. We found that this testing intervention of a self-selected sample of individuals was cost-effective for both sexes with a discounted average cost of €8,346 per QALY. Sensitivity analyses showed consistent results for changes in parameters, and all scenarios except exclusion of contact tracing for males, generated a cost per QALY below the established threshold. In Study IV, we estimated the additional resources required to scale up adolescent- friendly health services to universal coverage in 74 low-and middle-income countries. We found that the financial costs for scaling up key adolescent-friendly health services was US$15.4 billion through 2015. The cost for STI management was approximately US$ 226.97 million of which approximately 20% constituted management of chlamydia. The estimated required resources illustrate a substantial investment gap in relation to current expenditure. In conclusion, the thesis illustrates a public health economic approach to studying STI- prevention. The findings show that chlamydia in young adults in Stockholm is associated with social and lifestyle factors, that greater consideration should be taken to the structural factors of prevention, that one of the common testing interventions implemented in many parts of Sweden is cost-effective and finally that considerable investment is required to improve quality and expand reproductive health care services to universal coverage for adolescents in the least developed countries in the world

Transmission of SARS-CoV-2 in educational settings in 2020: a review

Objectives: School closures have been used as a core non pharmaceutical intervention (NPI) during the COVID-19 pandemic. This review aims at identifying SARS-CoV-2 transmission in educational settings during the first waves of the pandemic.Methods: This literature review assessed studies published between December 2019 and April 1, 2021 in Medline and Embase, which included studies that assessed educational settings from approximately January 2020 to January 2021. The inclusion criteria were based on the PCC framework (P-Population, C-Concept, C-Context). The study Population was restricted to people 1-17 years old (excluding neonatal transmission), the Concept was to assess child-to-child and child-to-adult transmission, while the Context was to assess specifically educational setting transmission.Results: Fifteen studies met inclusion criteria, ranging from daycare centers to high schools and summer camps, while eight studies assessed the re-opening of schools in the 2020-2021 school year. In principle although there is sufficient evidence that children can both be infected by and transmit SARS-CoV-2 in school settings, the SAR remain relatively low -when NPI measures are implemented in parallel. Moreover, although the evidence was limited there was an indication that younger children may have a lower SAR than adolescents. Conclusions: Transmission in educational settings in 2020 was minimal -when NPI measures were implemented in parallel. However, with an upsurge of cases related to variants of concern, continuous surveillance and assessment of the evidence is warranted to ensure the maximum protection of the health of students and the educational workforce, while also minimising the numerous negative impacts that school closures may have on children

Systematic review of outbreaks of COVID-19 within households in the European region when the child is the index case

ObjectivesThis systematic review aims to identify the secondary attack rates (SAR) to adults and other children when children are the index cases within household settings.MethodsThis literature review assessed European-based studies published in Medline and Embase between January 2020 and January 2022 that assessed the secondary transmission of SARS-CoV-2 within household settings. The inclusion criteria were based on the Population, Exposure, Outcome framework for systematic reviews. Thus, the study population was restricted to humans within the household setting in Europe (population), in contact with paediatric index cases 1-17 years old (exposure) that led to the transmission of SARS-CoV-2 reported as either an SAR or the probability of onward infection (outcome).ResultsOf 1819 studies originally identified, 19 met the inclusion criteria. Overall, the SAR ranged from 13% to 75% in 15 studies, while there was no evidence of secondary transmission from children to other household members in one study. Evidence indicated that asymptomatic SARS-CoV-2 index cases also have a lower SAR than those with symptoms and that younger children may have a lower SAR than adolescents (>12 years old) within household settings.ConclusionsSARS-CoV-2 secondary transmission from paediatric index cases ranged from 0% to 75%, within household settings between January 2020 and January 2022, with differences noted by age and by symptomatic/asymptomatic status of the index case. Given the anticipated endemic circulation of SARS-CoV-2, continued monitoring and assessment of household transmission is necessary

A systematic review on outbreaks of COVID-19 among children within households in the European region

Objectives This systematic review aims to identify the secondary attack rates (SAR) to adults and other children when children are the index cases within household settings.Methods This literature review assessed European-based studies published in Medline and Embase between January 2020 and January 2022 that assessed the secondary transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within household settings. The inclusion criteria were based on the PEO framework (P-Population, E-Exposure, O-Outcome) for systematic reviews. Thus, the study population was restricted to humans within the household setting in Europe (population), in contact with pediatric index cases 1–17 years old (exposure) that led to the transmission of SARS-CoV-2 reported as either a SAR or the probability of onward infection (outcome).Results Of 1,819 studies originally identified, 25 met the inclusion criteria. Overall, the SAR ranged from 13% to 75% in 23 studies, while there was no evidence of secondary transmission from children to other household members in two studies. Evidence indicated that asymptomatic SARS-CoV-2 index cases also have a lower SAR than those with symptoms and that younger children may have a lower SAR than adolescents (>12 years old) within household settings.Conclusions SARS-CoV-2 secondary transmission from paediatric index cases ranged from 0% to 75%, within household settings between January 2020 and January 2022, with differences noted by age and by symptomatic/asymptomatic status of the index case. Given the anticipated endemic circulation of SARS-CoV-2, continued monitoring and assessment of household transmission is necessary

What must be done to tackle vaccine hesitancy and barriers to COVID-19 vaccination in migrants?

Migrants have been disproportionately impacted by COVID-19 and emerging evidence suggests they may face barriers to COVID-19 vaccination. Participatory approaches and engagement strategies are urgently needed to strengthen uptake, alongside innovative delivery mechanisms and sharing of best practice, to ensure migrants are better consider within countries’ existing vaccine priority structures

The cost of the COVID-19 pandemic vs the cost-effectiveness of mitigation strategies in EU/UK/OECD: a systematic review

Objectives: The economic burden of COVID-19 pandemic is substantial, with both direct and indirect costs playing a significant role. Design: A systematic literature review was conducted to estimate the cost of the COVID-19 pandemic and the cost-effectiveness of pharmaceutical or non-pharmaceutical interventions. All cost data were adjusted to the 2021 Euro, and interventions compared with null.Data Sources: Ovid Medline and EMBASE were searched from January 2020 through 22nd of April 2021. Eligibility Criteria: Studies regarding COVID-19 outbreak or public health preparedness measures or interventions with outcome measures related to the direct and indirect costs for disease and preparedness and/or response for the EU/EEA/UK and OECD countries of all relevant epidemiological designs which estimate cost within the selected timeframe.Data extraction and synthesis: Studies were searched, screened, and coded independently by two reviewers with high measure of inter-rater agreement. Data were extracted to a predefined data extraction sheet. The risk of bias was assessed using the Consensus on Health Economic Criteria checklist.Results: We included data from 41 economic studies. Ten studies evaluated the cost of the COVID-19 pandemic, while 31 assessed the cost-benefit of public health surveillance, preparedness, and response measures. Overall, the economic burden of the COVID-19 pandemic was found to be substantial. Community screening, bed provision policies, investing in personal-protective-equipment and vaccination strategies were cost-effective. Physical distancing measures were associated with health benefits; however, their cost-effectiveness was dependent on the duration, compliance and the phase of the epidemic in which it was implemented. Conclusions: COVID-19 pandemic is associated with substantial short-term and long-term economic costs to healthcare systems, payers, and societies, while interventions including testing and screening policies, vaccination and physical distancing policies were identified as those presenting cost-effective options to deal with the pandemic, dependent on population vaccination and the Re at the stage of the pandemic

Having a child without wanting to? : Estimates and contributing factors from a population-based survey in Sweden

Aims: The aims of the current study were to identify the prevalence of unwanted childbirth (UC), to explore the association with sociodemographic factors and to identify possible contributing factors such as psychosomatic health, contraceptive use, experiences of induced abortion and sexual violence. Methods: We used Swedish data from the randomised population-based study SRHR2017 on sexual and reproductive health and rights (SRHR), based on self-administered surveys, linked to nationwide registers. The national sample consisted of 14,537 women and men aged between 16 and 84 years. With logistic regression, we examined differences in self-reported experience of UC, stratified by sex, in relation to socio-economic factors, as well as several possible contributing factors. Results: Despite advances in SRHR and fertility control, 6% of women and men in Sweden reported UC. This experience tends to be unevenly distributed in the population according to age, country of birth and, to some extent, income and educational attainment. Previous experience of induced abortion, sexual violence and threat from a partner were significantly associated with UC, whereas self-reported good health was protective. Conclusions: Mechanisms behind unintended, unplanned, unwanted or mistimed pregnancies are complex. Current results focus on the role of individual factors and personal experiences. In addition, in line with previous understanding, there is a need for adopting a broader socio-ecological perspective on fertility intentions

Are Men Who Buy Sex Different from Men Who Do Not? : Exploring Sex Life Characteristics Based on a Randomized Population Survey in Sweden

The buying and selling of sex is a topic of frequent discussion and a relevant public health issue. Studies of sex workers are available, while studies addressing the demand side of sex are scarce, especially based on robust population data. The current study provides national estimates of the prevalence of and factors associated with having paid for sex among men in Sweden. We used a randomized population-based survey on sexual and reproductive health and rights among ages 16-84 years, linked to nationwide registers. The sample consisted of 6048 men. With a logistic regression, we analyzed what sex life factors were associated with ever having paid for or given other types of compensation for sex. A total of 9.5% of male respondents reported ever having paid for sex. An increased probability of having paid for sex was identified in men who were dissatisfied with their sex life (aOR: 1.72; 95% CI: 1.34-2.22), men reporting having had less sex than they would have liked to (aOR: 2.78; 95% CI: 2.12-3.66), men who had ever looked for or met sex partners online (aOR: 5.07; 95% CI: 3.97-6.46), as well as frequent pornography users (aOR: 3.02; 95% CI: 2.28-3.98) Associations remained statistically significant after adjustment for age, income, and educational attainment. Sex life characteristics such as poor sex life satisfaction, high online sex activity, and frequent pornography use are strongly associated with sex purchase. These findings can help guide and support counselling and prevention activities targeting sex buyers

Rätten till hälsa : Hur normer och strukturer inverkar på transpersoners upplevelser av sexuell hälsa

Denna rapport handlar om transpersoners upplevelser och beskrivningar av sexuell hälsa och baseras på en kvalitativ intervjustudie. Utgångspunkten för studien är Folkhälsomyndighetens arbete med nationella strategin mot hiv och aids och vissa andra smittsamma sjukdomar (proposition 2005/06:60) samt uppföljningen av hälsan bland trans-personer inom regeringens strategi för lika möjligheter och rättigheter oavsett sexuell läggning, könsidentitet eller könsuttryck. Resultatet innehåller transpersoners egna beskrivningar och utsagor kring möjligheter och hinder till sexuell hälsa samt berör sexuellt risktagande och erfarenheter av möten med personal inom hälso- och sjukvården. Resultaten visar att respekt är centralt för upplevelsen av sexuell hälsa– respekt för sig själv, sin kropp och sina känslor samt respekt från andra i intima relationer och relationer med personal inom hälso- och sjukvården. Rapporten riktar sig till främst till personal inom hälso- och sjukvården, kommuner landsting, relevanta myndigheter och ideella organisationer inom området. Förhoppningen är att rapporten kan bidra med insikt och kunskap om transpersoners livssituation i relation till sexualitet, sexuell hälsa och sexuellt risktagande samt ge underlag avseende hälsofrämjande och sjukdomsförebyggande arbete.Ur förordet: "Studien har genomförts av Malin Lindroth vid Centrum för sexologi och sexualitetsstudier på Malmö högskola, i samarbete med Folkhälso­myndigheten (Malin Lindroth arbetar numera på Högskolan i Jönköping). Rapporten har sammanställts av utredaren Charlotte Deogan och enhets­chefen Louise Mannheimer, Folkhälsomyndigheten."</p