<b>Table 1.</b> ARV regimens for HIV prevention and treatment of mothers and children compared in the analysis - Current Practice 2010, WHO Option A, WHO Option B and Malawi's Option B+.

<p><b>Table 1.</b> ARV regimens for HIV prevention and treatment of mothers and children compared in the analysis - Current Practice 2010, WHO Option A, WHO Option B and Malawi's Option B+.</p

Results from sensitivity analyses on input parameters affecting outcomes in HIV-infected mothers; USperlifeyeargained(comparedtothecurrentpractice)andpaediatricoutcomes;US per life year gained (compared to the current practice) and paediatric outcomes; US per DALY averted.

<p>Results from sensitivity analyses on input parameters affecting outcomes in HIV-infected mothers; US$per life year gained (compared to the current practice) and paediatric outcomes; US$ per DALY averted.</p

Tornado diagram for the ICER of Option B+, base case is $455 per life year gained shown with the dotted line.

<p>Tornado diagram for the ICER of Option B+, base case is $455 per life year gained shown with the dotted line.</p

Abbreviated decision tree summarizing the analytical approach, policy options and results.

<p>Abbreviated decision tree summarizing the analytical approach, policy options and results.</p

Input parameters and plausible ranges used for sensitivity analysis and relevant references for the Malawi analysis (US $ 2010).

<p>Input parameters and plausible ranges used for sensitivity analysis and relevant references for the Malawi analysis (US $ 2010).</p

Voluntary Medical Male Circumcision for HIV Prevention in Malawi: Modeling the Impact and Cost of Focusing the Program by Client Age and Geography

<div><p>Background</p><p>In 2007, the World Health Organization (WHO) recommended scaling up voluntary medical male circumcision (VMMC) in priority countries with high HIV prevalence and low male circumcision (MC) prevalence. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), an estimated 5.8 million males had undergone VMMC by the end of 2013. Implementation experience has raised questions about the need to refocus VMMC programs on specific subpopulations for the greatest epidemiological impact and programmatic effectiveness. As Malawi prepared its national operational plan for VMMC, it sought to examine the impacts of focusing on specific subpopulations by age and region.</p><p>Methods</p><p>We used the Decision Makers’ Program Planning Toolkit, Version 2.0, to study the impact of scaling up VMMC to different target populations of Malawi. National MC prevalence by age group from the 2010 Demographic and Health Survey was scaled according to the MC prevalence for each district and then halved, to adjust for over-reporting of circumcision. In-country stakeholders advised a VMMC unit cost of $100, based on implementation experience. We derived a cost of$451 per patient-year for antiretroviral therapy from costs collected as part of a strategic planning exercise previously conducted in- country by UNAIDS.</p><p>Results</p><p>Over a fifteen-year period, circumcising males ages 10–29 would avert 75% of HIV infections, and circumcising males ages 10–34 would avert 88% of infections, compared to the current strategy of circumcising males ages 15–49. The Ministry of Health’s South West and South East health zones had the lowest cost per HIV infection averted. Moreover, VMMC met WHO’s definition of cost-effectiveness (that is, the cost per disability-adjusted life-year [DALY] saved was less than three times the per capita gross domestic product) in all health zones except Central East. Comparing urban versus rural areas in the country, we found that circumcising men in urban areas would be both cost-effective and cost-saving, with a VMMC cost per DALY saved of $120 USD and with 15 years of VMMC implementation resulting in lifetime HIV treatment costs savings of$331 million USD.</p><p>Conclusions</p><p>Based on the age analyses and programmatic experience, Malawi’s VMMC operational plan focuses on males ages 10–34 in all districts in the South East and South West zones, as well as Lilongwe (an urban district in the Central zone). This plan covers 14 of the 28 districts in the country.</p></div

Costs and paediatric outcomes from preventing mother to child transmission programmatic interventions for 18 months of prophylaxis and treatment^* (US $ 2010).

*<p>Assumes 663,000 pregnant women, 66,500 HIV-infected pregnant women annually, and 90% (59,850) of those women reached by Option A, B and B+.</p>**<p>Assumes no needed CD4 to start ART under the Malawi Option B+ approach; however, in practice some HIV-infected pregnant women will have access to CD4 testing as part of staging and response to treatment</p>***<p>Background infections if no ARV interventions = 20,681</p

Cost effectiveness of various strategies for the prevention of new pediatric infections and the treatment of HIV-infected mothers in Malawi.

<p>Current practice represents our base case scenario or the status quo in 2010. The next set of scenarios highlight the cost effectiveness of incrementally expanding program implementation and service delivery coverage, and ranges from PMTCT only to the addition of integrated ART-ANC services for eligible pregnant women, both identified immediately and at a later time. Universal coverage implies the availability of HIV services for mother and children at any point of needing treatment. Option B+ offers ART to pregnant women regardless of CD4 count.</p

Atropa belladonna L.

原著和名: ベラドンナ科名: ナス科 = Solanaceae採集地: 千葉県 千葉市 千葉大学 (下総 千葉市 千葉大学)採集日: 1963/8/7採集者: 萩庭丈壽整理番号: JH036908国立科学博物館整理番号: TNS-VS-98690

Impact and cost of VMMC scale-up by target age group, 2015–2029.

<p>Impact and cost of VMMC scale-up by target age group, 2015–2029.</p