Outputs, cost and efficiency of public sector centres for prevention of mother to child transmission of HIV in Andhra Pradesh, India

<p>Abstract</p> <p>Background</p> <p>Prevention of mother to child transmission (PMTCT) is an important part of the effort to control HIV. PMTCT services are mostly provided at public sector government hospitals in India. Systematic data on the cost and efficiency of providing PMTCT services in India are not available readily for further planning.</p> <p>Methods</p> <p>Cost and output data were collected at 16 sampled PMTCT centres in the south Indian state of Andhra Pradesh using standardized methods. The services provided were analysed, and the relation of unit cost of services with scale was assessed.</p> <p>Results</p> <p>In the 2005–2006 fiscal year, 125,073 pregnant women received PMTCT services at the 16 centres (range 2,939 to 20,896, median 5,679). The overall HIV positive rate among those tested was 1.67%. Of the total economic cost, the major components were personnel (47.3%) and recurrent goods (31.7%). For the 16 PMTCT centres, the average economic cost per post-HIV-test counselled pregnant woman was Indian Rupees (INR) 98.9 (US$2.23), ranging 2.7-fold from INR 71.4 (US$ 1.61) to INR 189.9 (US$4.29). The economic cost per mother-neonate pair who received nevirapine had a higher variation, ranging 41-fold for the 16 centres from INR 4,354 (US$ 98) to INR 179,175 (US$4,047), average INR 10,210 (US$ 231), with very high unit cost at some centres where HIV prevalence among pregnant women and the total volume of services were both low. Scale had a significant inverse relation with both of the unit costs, per post-HIV-test counselled pregnant woman and per mother-neonate pair who received nevirapine. In addition, HIV prevalence among pregnant women had a significant inverse relation with unit cost per mother-neonate pair who received nevirapine.</p> <p>Conclusion</p> <p>Although the variation between PMTCT centres for unit cost per post-HIV-test counselled pregnant woman was modest that per mother-neonate pair receiving nevirapine was over 40-fold. The extremely high unit cost for each mother-neonate pair receiving nevirapine at some centres suggests that the new approach of combining PMTCT services with voluntary counselling and testing services that has recently been started in India could potentially offer better efficiency.</p

Major dietary patterns of young and middle aged women : results from a prospective Australian cohort study

Objective: The aim of this study was to assess the major dietary patterns of two age cohorts of women, to determine to the extent to which the dietary patterns differ between the cohorts and to assess whether they vary according to sociodemographic and behavioural characteristics and patterns of nutrient intake.Method: Dietary intake was assessed using an 80-item food frequency questionnaire for women aged 50&ndash;55 years (n=10&thinsp;150; &lsquo;middle age&rsquo;) in 2001 and aged 25&ndash;30 years (n=7371; &lsquo;young&rsquo;) in 2003, from the Australian Longitudinal Study on Women\u27s Health. Factor analysis using principal component extraction was used to identify dietary patterns, and a pattern score was calculated from the consumption of the food items identified with each dietary pattern. Associations between the dietary pattern scores and sociodemographic and behavioural characteristics and nutrient intakes were investigated using regression analysis.Results: Six dietary patterns were identified and were labelled: cooked vegetables; fruit; Mediterranean-style; processed meat, meat and takeaway; reduced fat dairy; and high-fat and sugar foods. Regression analysis revealed that healthier dietary patterns were significantly associated with other favourable health-related behaviours, higher socioeconomic status and living in urban areas (P-values &lt;0.05).Conclusions: In spite of differences in the level of consumption of individual food items, the similarity in dietary patterns across two generations of women suggests that policies and interventions to improve diet should focus on social and economic factors and general health-related behaviour rather than different age groups.<br /