Identification of publicly available data sources to inform the conduct of Health Technology Assessment in India

Background: Health technology assessment (HTA) provides a globally-accepted and structured approach to synthesising evidence for cost and clinical effectiveness alongside ethical and equity considerations to inform evidence-based priorities. India is one of the most recent countries to formally commit to institutionalising HTA as an integral component of the heath resource allocation decision-making process. The effective conduct of HTA depends on the availability of reliable data. Methods: We draw from our experience of collecting, synthesizing, and analysing health-related datasets in India and internationally, to highlight the complex requirements for undertaking HTA, and explore the availability of such data in India. We first outlined each of the core data components required for the conduct of HTA, and their availability in India, drawing attention to where data can be accessed, and different ways in which researchers can overcome the challenges of missing or low quality data. Results: We grouped data into the following categories: clinical efficacy; cost; epidemiology; quality of life; service use/consumption; and equity. We identified numerous large local data sources containing epidemiological information. There was a marked absence of other locally-collected data necessary for informing HTA, particularly data relating to cost, service use, and quality of life. Conclusions: The introduction of HTA into the health policy space in India provides an opportunity to comprehensively assess the availability and quality of health data capture across the country. While epidemiological information is routinely collected across India, other data inputs necessary for HTA are not readily available. This poses a significant bottleneck to the efficient generation and deployment of HTA into the health decision space. Overcoming these data gaps by strengthening the routine collection of comprehensive and verifiable health data will have important implications not only for embedding economic analyses into the priority setting process, but for strengthening the health system as a whole

Sequence History Analysis (SHA) : Estimating the Effect of Past Trajectories on an Upcoming Event

In this article, we propose an innovative method which is a combination of Sequences Analysis and Event History Analysis. We called this method Sequence History Analysis (SHA). We start by identifying typical past trajectories of individuals over time by using Sequence Analysis. We then estimate the effect of these typical past trajectories on the event under study using discrete-time models. The aim of this approach is to estimate the effect of past trajectories on the chances of experiencing an event. We apply the proposed methodological approach to an original study of the effect of past childhood co-residence structures on the chances of leaving the parental home in Switzerland. The empirical research was based on the LIVES Cohort study, a panel survey that started in autumn 2013 in Switzerland. Analyses show that it is not only the occurrence of an event that increases the risk of experiencing another event, but also the order in which various states occurred. What is more, it seems that two features have a significant influence on departure from the parental home: the co-residence structures and the arrival or departure of siblings from the parental home

Efficient Production of HIV-1 Virus-Like Particles from a Mammalian Expression Vector Requires the N-Terminal Capsid Domain

It is now well accepted that the structural protein Pr55Gag is sufficient by itself to produce HIV-1 virus-like particles (VLPs). This polyprotein precursor contains different domains including matrix, capsid, SP1, nucleocapsid, SP2 and p6. In the present study, we wanted to determine by mutagenesis which region(s) is essential to the production of VLPs when Pr55Gag is inserted in a mammalian expression vector, which allows studying the protein of interest in the absence of other viral proteins. To do so, we first studied a minimal Pr55Gag sequence called Gag min that was used previously. We found that Gag min fails to produce VLPs when expressed in an expression vector instead of within a molecular clone. This failure occurs early in the cell at the assembly of viral proteins. We then generated a series of deletion and substitution mutants, and examined their ability to produce VLPs by combining biochemical and microscopic approaches. We demonstrate that the matrix region is not necessary, but that the efficiency of VLP production depends strongly on the presence of its basic region. Moreover, the presence of the N-terminal domain of capsid is required for VLP production when Gag is expressed alone. These findings, combined with previous observations indicating that HIV-1 Pr55Gag-derived VLPs act as potent stimulators of innate and acquired immunity, make the use of this strategy worth considering for vaccine development

Legal Empowerment and Horizontal Inequalities after Conflict

This article explores whether legal empowerment can address horizontal inequalities in post-conflict settings, and, if so, how. It argues that legal empowerment has modest potential to reduce these inequalities. Nevertheless, there are risks that legal empowerment might contribute to a strengthening of group identities, reduction of social cohesion, and, in the worst case, triggering of conflict. It looks at how two legal empowerment programmes in Liberia navigated the tensions between equity and peace