Cost-effectiveness of voluntary HIV-1 counseling and testing in reducing sexual transmission of HIV-1 in Kenya and Tanzania.

Background Access to HIV-1 voluntary counseling and testing (VCT) is severely limited in less-developed countries. We undertook a multisite trial of HIV-1 VCT to assess its impact, cost, and cost-effectiveness in less-developed country settings.\ud Methods\ud The cost-effectiveness of HIV-1 VCT was estimated for a hypothetical cohort of 10 000 people seeking VCT in urban east Africa. Outcomes were modelled based on results from a randomised controlled trial of HIV-1 VCT in Tanzania and Kenya. Our main outcome measures included programme cost, number of HIV-1 infections averted, cost per HIV-1 infection averted, and cost per disability-adjusted life-year (DALY) saved. We also modelled the impact of targeting VCT by HIV-1 prevalence of the client population, and the proportion of clients who receive VCT as a couple compared with as individuals. Sensitivity analysis was done on all model parameters.\ud Findings\ud HIV-1 VCT was estimated to avert 1104 HIV-1 infections in Kenya and 895 in Tanzania during the subsequent year. The cost per HIV-1 infection averted was US$249 and$346, respectively, and the cost per DALY saved was $12·77 and$17·78. The intervention was most cost-effective for HIV-1-infected people and those who received VCT as a couple. The cost-effectiveness of VCT was robust, with a range for the average cost per DALY saved of $5·16-27·36 in Kenya, and$6·58-45·03 in Tanzania. Analysis of targeting showed that increasing the proportion of couples to 70% reduces the cost per DALY saved to $10·71 in Kenya and$13·39 in Tanzania, and that targeting a population with HIV-1 prevalence of 45% decreased the cost per DALY saved to $8·36 in Kenya and$11·74 in Tanzania.\ud Interpretation\ud HIV-1 VCT is highly cost-effective in urban east African settings, but slightly less so than interventions such as improvement of sexually transmitted disease services and universal provision of nevirapine to pregnant women in high-prevalence settings. With the targeting of VCT to populations with high HIV-1 prevalence and couples the cost-effectiveness of VCT is improved significantly

Heterogeneous Batch Distillation Processes: Real System Optimisation

In this paper, optimisation of batch distillation processes is considered. It deals with real systems with rigorous simulation of the processes through the resolution full MESH differential algebraic equations. Specific software architecture is developed, based on the BatchColumn® simulator and on both SQP and GA numerical algorithms, and is able to optimise sequential batch columns as long as the column transitions are set. The efficiency of the proposed optimisation tool is illustrated by two case studies. The first one concerns heterogeneous batch solvent recovery in a single distillation column and shows that significant economical gains are obtained along with improved process conditions. Case two concerns the optimisation of two sequential homogeneous batch distillation columns and demonstrates the capacity to optimize several sequential dynamic different processes. For such multiobjective complex problems, GA is preferred to SQP that is able to improve specific GA solutions

9 Park-and-Ride Accessibility: Experience from a Pilot Study for the Island of Trinidad

Kleine Inselstaaten gehören zu den Gebieten, die am stärksten vom Meeresspiegelanstieg betroffenen sind. Eine nachhaltige Verkehrsentwicklung ist daher für eine Transformation zu mehr Resilienz entscheidend. Die besonderen räumlichen Gegebenheiten, die Insellage, die geografische Abgeschiedenheit, die geringe Bevölkerungszahl und die kleinen Volkswirtschaften der Inselstaaten führen jedoch zu hohen Transportkosten und einer Abhängigkeit vom Auto. Das Buch löst sich von der herkömmlichen Fokussierung auf städtische Gebiete im Globalen Norden und dem Tourismus. Es bietet eine andere Perspektive auf nachhaltigen Verkehr, Reisen und Pendeln in der Karibik und in Europa. Die Autorinnen und Autoren liefern forschungsbasierte Erkenntnisse, zeigen den Stand der Technik und zukünftige Ansätze für politische Entscheidungsträger:innen, Wissenschaftler:innen und Praktizierende auf. Fachübergreifend bietet das Buch einen innovativen Ausblick.Small island states are one of the most affected areas by sea-level rise, and sustainable transport development is crucial to their transition towards resiliency. However, their special spatial situations, insularity, geographic remoteness, small populations, and small economies resulted in high transport costs and car dependencies. The book moves away from the conventional focus on urban areas in the Global North and tourism. It gives a different perspective on sustainable transport, travelling, and commuting in the Caribbean and Europe. The authors provide research-based insights and show the state-of-the-art and future approaches for policy-makers, academics, and practitioners. Even beyond small island state research, the book offers an innovative outlook

Culturally-adapted and audio-technology assisted HIV/AIDS awareness and education program in rural Nigeria: a cohort study

Background: HIV-awareness programs tailored toward the needs of rural communities are needed. We sought to quantify change in HIV knowledge in three rural Nigerian villages following an integrated culturally adapted and technology assisted educational intervention. Methods: A prospective 14-week cohort study was designed to compare short-term changes in HIV knowledge between seminar-based education program and a novel program, which capitalized on the rural culture of small-group oral learning and was delivered by portable digital-audio technology. Results: Participants were mostly Moslem (99%), male (53.5%), with no formal education (55%). Baseline HIV knowledge was low (\u3c 80% correct answers for 9 of the 10 questions). Knowledge gain was higher (p \u3c 0.0001 for 8 of 10 questions) in the integrated culturally adapted and technology-facilitated (n = 511) compared with the seminar-based (n = 474) program. Conclusions: Baseline HIV-awareness was low. Culturally adapted, technology-assisted HIV education program is a feasible cost-effective method of raising HIV awareness among low-literacy rural communities

Contributors

Kleine Inselstaaten gehören zu den Gebieten, die am stärksten vom Meeresspiegelanstieg betroffenen sind. Eine nachhaltige Verkehrsentwicklung ist daher für eine Transformation zu mehr Resilienz entscheidend. Die besonderen räumlichen Gegebenheiten, die Insellage, die geografische Abgeschiedenheit, die geringe Bevölkerungszahl und die kleinen Volkswirtschaften der Inselstaaten führen jedoch zu hohen Transportkosten und einer Abhängigkeit vom Auto. Das Buch löst sich von der herkömmlichen Fokussierung auf städtische Gebiete im Globalen Norden und dem Tourismus. Es bietet eine andere Perspektive auf nachhaltigen Verkehr, Reisen und Pendeln in der Karibik und in Europa. Die Autorinnen und Autoren liefern forschungsbasierte Erkenntnisse, zeigen den Stand der Technik und zukünftige Ansätze für politische Entscheidungsträger:innen, Wissenschaftler:innen und Praktizierende auf. Fachübergreifend bietet das Buch einen innovativen Ausblick.Small island states are one of the most affected areas by sea-level rise, and sustainable transport development is crucial to their transition towards resiliency. However, their special spatial situations, insularity, geographic remoteness, small populations, and small economies resulted in high transport costs and car dependencies. The book moves away from the conventional focus on urban areas in the Global North and tourism. It gives a different perspective on sustainable transport, travelling, and commuting in the Caribbean and Europe. The authors provide research-based insights and show the state-of-the-art and future approaches for policy-makers, academics, and practitioners. Even beyond small island state research, the book offers an innovative outlook

Towards Sustainable Transport and Mobility

Kleine Inselstaaten gehören zu den Gebieten, die am stärksten vom Meeresspiegelanstieg betroffenen sind. Eine nachhaltige Verkehrsentwicklung ist daher für eine Transformation zu mehr Resilienz entscheidend. Die besonderen räumlichen Gegebenheiten, die Insellage, die geografische Abgeschiedenheit, die geringe Bevölkerungszahl und die kleinen Volkswirtschaften der Inselstaaten führen jedoch zu hohen Transportkosten und einer Abhängigkeit vom Auto. Das Buch löst sich von der herkömmlichen Fokussierung auf städtische Gebiete im Globalen Norden und dem Tourismus. Es bietet eine andere Perspektive auf nachhaltigen Verkehr, Reisen und Pendeln in der Karibik und in Europa. Die Autorinnen und Autoren liefern forschungsbasierte Erkenntnisse, zeigen den Stand der Technik und zukünftige Ansätze für politische Entscheidungsträger:innen, Wissenschaftler:innen und Praktizierende auf. Fachübergreifend bietet das Buch einen innovativen Ausblick.Small island states are one of the most affected areas by sea-level rise, and sustainable transport development is crucial to their transition towards resiliency. However, their special spatial situations, insularity, geographic remoteness, small populations, and small economies resulted in high transport costs and car dependencies. The book moves away from the conventional focus on urban areas in the Global North and tourism. It gives a different perspective on sustainable transport, travelling, and commuting in the Caribbean and Europe. The authors provide research-based insights and show the state-of-the-art and future approaches for policy-makers, academics, and practitioners. Even beyond small island state research, the book offers an innovative outlook

Optimal operation of unconventional batch distillation columns.

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