Cost of Community Integrated Prevention Campaign for Malaria, HIV, and Diarrhea in Rural Kenya

BACKGROUND: Delivery of community-based prevention services for HIV, malaria, and diarrhea is a major priority and challenge in rural Africa. Integrated delivery campaigns may offer a mechanism to achieve high coverage and efficiency. METHODS: We quantified the resources and costs to implement a large-scale integrated prevention campaign in Lurambi Division, Western Province, Kenya that reached 47,133 individuals (and 83% of eligible adults) in 7 days. The campaign provided HIV testing, condoms, and prevention education materials; a long-lasting insecticide-treated bed net; and a water filter. Data were obtained primarily from logistical and expenditure data maintained by implementing partners. We estimated the projected cost of a Scaled-Up Replication (SUR), assuming reliance on local managers, potential efficiencies of scale, and other adjustments. RESULTS: The cost per person served was $41.66 for the initial campaign and was projected at$31.98 for the SUR. The SUR cost included 67% for commodities (mainly water filters and bed nets) and 20% for personnel. The SUR projected unit cost per person served, by disease, was $6.27 for malaria (nets and training),$15.80 for diarrhea (filters and training), and $9.91 for HIV (test kits, counseling, condoms, and CD4 testing at each site). CONCLUSIONS: A large-scale, rapidly implemented, integrated health campaign provided services to 80% of a rural Kenyan population with relatively low cost. Scaling up this design may provide similar services to larger populations at lower cost per person

HIV prevention costs and program scale: data from the PANCEA project in five low and middle-income countries

<p>Abstract</p> <p>Background</p> <p>Economic theory and limited empirical data suggest that costs per unit of HIV prevention program output (unit costs) will initially decrease as small programs expand. Unit costs may then reach a nadir and start to increase if expansion continues beyond the economically optimal size. Information on the relationship between scale and unit costs is critical to project the cost of global HIV prevention efforts and to allocate prevention resources efficiently.</p> <p>Methods</p> <p>The "Prevent AIDS: Network for Cost-Effectiveness Analysis" (PANCEA) project collected 2003 and 2004 cost and output data from 206 HIV prevention programs of six types in five countries. The association between scale and efficiency for each intervention type was examined for each country. Our team characterized the direction, shape, and strength of this association by fitting bivariate regression lines to scatter plots of output levels and unit costs. We chose the regression forms with the highest explanatory power (R²).</p> <p>Results</p> <p>Efficiency increased with scale, across all countries and interventions. This association varied within intervention and within country, in terms of the range in scale and efficiency, the best fitting regression form, and the slope of the regression. The fraction of variation in efficiency explained by scale ranged from 26% – 96%. Doubling in scale resulted in reductions in unit costs averaging 34.2% (ranging from 2.4% to 58.0%). Two regression trends, in India, suggested an inflection point beyond which unit costs increased.</p> <p>Conclusion</p> <p>Unit costs decrease with scale across a wide range of service types and volumes. These country and intervention-specific findings can inform projections of the global cost of scaling up HIV prevention efforts.</p

Integrated HIV Testing, Malaria, and Diarrhea Prevention Campaign in Kenya: Modeled Health Impact and Cost-Effectiveness

Efficiently delivered interventions to reduce HIV, malaria, and diarrhea are essential to accelerating global health efforts. A 2008 community integrated prevention campaign in Western Province, Kenya, reached 47,000 individuals over 7 days, providing HIV testing and counseling, water filters, insecticide-treated bed nets, condoms, and for HIV-infected individuals cotrimoxazole prophylaxis and referral for ongoing care. We modeled the potential cost-effectiveness of a scaled-up integrated prevention campaign.We estimated averted deaths and disability-adjusted life years (DALYs) based on published data on baseline mortality and morbidity and on the protective effect of interventions, including antiretroviral therapy. We incorporate a previously estimated scaled-up campaign cost. We used published costs of medical care to estimate savings from averted illness (for all three diseases) and the added costs of initiating treatment earlier in the course of HIV disease.Per 1000 participants, projected reductions in cases of diarrhea, malaria, and HIV infection avert an estimated 16.3 deaths, 359 DALYs and $85,113 in medical care costs. Earlier care for HIV-infected persons adds an estimated 82 DALYs averted (to a total of 442), at a cost of$37,097 (reducing total averted costs to $48,015). Accounting for the estimated campaign cost of$32,000, the campaign saves an estimated $16,015 per 1000 participants. In multivariate sensitivity analyses, 83$20.A mass, rapidly implemented campaign for HIV testing, safe water, and malaria control appears economically attractive

Australian Aboriginal Ethnometeorology and Seasonal Calendars

This paper uses a cultural anthropological approach to investigate an indigenous Australian perspective on atmospheric phenomena and seasons, using data gained from historical records and ethnographic fieldwork. Aboriginal people believe that the forces driving the weather are derived from Creation Ancestors and spirits, asserting that short term changes are produced through ritual. By recognizing signals such as wind direction, rainfall, temperature change, celestial movements, animal behaviour and the flowering of plants, Aboriginal people are able to divide the year into seasons. Indigenous calendars vary widely across Australia and reflect annual changes within Aboriginal lifestyles

Corrida em piscina funda: limites e possibilidades para o alto desempenho Velocidad en piscina de profundidad: límites y posibilidades para un alto desempeño Deep water running: limits and possibilities for high performance

O objetivo deste estudo foi analisar os limites e possibilidades da utilização da corrida em piscina funda no treinamento de corredores de rendimento. Além disso, são discutidas as respostas agudas submáximas, máximas e crônicas, do ponto de vista fisiológico e biomecânico entre a corrida em terra e em piscina funda. As respostas máximas de freqüência cardíaca e consumo de oxigênio são menores no exercício aquático do que na corrida terrestre. Dados experimentais sugerem o uso do treinamento de corrida em piscina funda para corredores de rendimento; contudo, essas evidências são limitadas para treinamentos de até 10 semanas.<br>El objetivo de este estudio ha sido el de analizar los límites y posibilidades de la utilización de carreras de velocidad en piscina de profundidad durante el entrenamiento de velocista de rendimiento. Además de esto, son discutidas las respuestas agudas submáximas, máximas y crónicas, bajo el punto de vista fisiológico y biomecánico entre la carrera en tierra y en piscina profunda. Las respuestas máximas de frecuencia cardíaca y consumo de oxígeno son menores en el ejercicio acuático que en la de tierra. Datos experimentales sugieren el uso de entrenamiento de carrera en piscina profunda para velocistas de rendimiento, sin embargo estas evidencias son limitadas a entrenamientos de hasta 10 semanas.<br>The purpose of this study was to analyze the limits and possibilities of deep water running on training of performance runners. Besides, it has been discussed the submaximal acute, maximal acute and chronical responses, following physiological and biomechanical aspects between running on land and deep water running. Heart rate and oxygen uptake's maximal responses are lower in aquatic exercise than in running on land. Experimental evidences suggest the deep water running training for performance athletes, but these studies are limited in training program until ten weeks