Cost effectiveness of potential ART adherence monitoring interventions in sub-saharan Africa

Background Interventions based around objective measurement of adherence to antiretroviral drugs for HIV have potential to improve adherence and to enable differentiation of care such that clinical visits are reduced in those with high adherence. It would be useful to understand the approximate upper limit of cost that could be considered for such interventions of a given effectiveness in order to be cost effective. Such information can guide whether to implement an intervention in the light of a trial showing a certain effectiveness and cost. Methods An individual-based model, calibrated to Zimbabwe, which incorporates effects of adherence and resistance to antiretroviral therapy, was used to model the potential impact of adherence monitoring-based interventions on viral suppression, death rates, disability adjusted life years and costs. Potential component effects of the intervention were: enhanced average adherence when on ART, reduced risk of ART discontinuation, and reduced risk of resistance acquisition. We considered a situation in which viral load monitoring is not available and one in which it is. In the former case, it was assumed that care would be differentiated based on the adherence level, with fewer clinic visits in those demonstrated to have high adherence. In the latter case, care was assumed to be primarily differentiated according to viral load level. The maximum intervention cost required to be cost effective was calculated based on a cost effectiveness threshold of $500 per DALY averted. Findings In the absence of viral load monitoring, an adherence monitoring-based intervention which results in a durable 6$50 per person-year on ART, mainly driven by the cost savings of differentiation of care. In the presence of viral load monitoring availability, an intervention with a similar effect on viral load suppression was cost-effective when costing $23-$32 per year, depending on whether the adherence intervention is used to reduce the level of need for viral load measurement. Conclusion The cost thresholds identified suggest that there is clear scope for adherence monitoringbased interventions to provide net population health gain, with potential cost-effective use in situations where viral load monitoring is or is not available. Our results guide the implementation of future adherence monitoring interventions found in randomized trials to have health benefit

Disappointment expression evokes collective action: The moderating role of legitimacy appraisal and the mediating role of collective guilt after wartime

Research on intergroup emotions has largely focused on the experience of emotions and surprisingly little attention has been given to the expression of emotions. Drawing on the social-functional approach to emotions, we argue that in the context of intergroup conflicts, outgroup members’ expression of disappointment with one’s ingroup induces the complementary emotion of collective guilt and correspondingly a collective action protesting ingroup actions against the outgroup. In Study 1 conducted immediately after the 2014 Gaza war, Jewish-Israeli participants received information about outgroup’s (Palestinians) expression of emotions (disappointment, fear, or none). As predicted, outgroup’s expression of disappointment increased collective guilt and willingness to participate in collective action, but only among those who saw the intergroup situation as illegitimate. Moreover, collective guilt mediated the relationship between disappointment expression and collective action, moderated, again, by legitimacy perception. In Study 2, we replicated these results in the context of racial tension between Black and White Americans in the US. We discuss the theoretical and applied implications of the findings

The application of warfare ecology to belligerent occupations

Insofar as warfare ecology aims to examine all war-related conditions, belligerent occupations are a necessary stage in its broad taxonomy. Under international law, belligerent occupations are covered by a distinctive subset of jus in bello (humanitarian law), which is imprecise regarding ecological changes. This chapter examines the potential role of warfare ecology in studying belligerent occupations, highlighting the multiple, often indirect, means by which such occupations shape ecological processes. Particular attention is paid to the Israeli occupation of Palestinian territory, due to its protracted duration, although also discussed are environmental effects associated with the US and UK occupation of Iraq. The onus on the occupying power, under international humanitarian law, to protect the conditions of life for civilians can plausibly be applied to the environmental resources of the resident population. It is argued that warfare ecology can make a significant contribution both to assessing the effects of occupations and, through the generation of policy advice, to promote conflict outcomes more sensitive towards ecological processes

Impact of COVID-19 pandemic on the physical, mental and social health of the suburban and rural adult population in Bangladesh

Background and objectives: The COVID-19 pandemic caused a significant impact on health worldwide. Adverse effect of COVID-19 on health-related quality of life is significant. This study aimed to find out the impact of COVID-19 on the physical, mental and social health of suburban and rural adult population in Bangladesh. Methods: A suburban and a rural community were purposively selected. The suburban and rural areas were located about 40 km and 130 km north and north-east of Dhaka city respectively. People aged ≥20 years in the selected communities were enrolled in the study. The investigation procedure included socio-demographic and clinical history, anthropometry, and clinical examination and laboratory investigations. Depression, Anxiety and Stress Scale-21 (DASS-21) and 36-Item Short Form Health Survey (SF-36) questionnaires were used for assessing mental and social health respectively. Knowledge, attitude and practice (KAP) regarding the prevention and transmission of COVID-19 was assessed by a validated questionnaire and interview. Results: Total 385 individuals (suburban=201, rural=184) were enrolled in the study. Out of 385, 116 and 269 were male and female, respectively. Out of total 385 participants, depression, anxiety and stress were present in 113 (29.4%), 144 (37.4%) and 70 (18.2%) respectively, while 210 (54.5%) were normal. Extremely severe depression, anxiety and stress were present in 3.6%, 6% and 0.5%, respectively. Depression and anxiety did not differ between suburban and rural populations, though stress was significantly higher among the suburban (p<0.05) population. Social functioning was limited in more than 50% as opposed to excellent (5.5%) or good (39.8%). Almost 60% of the participants had to cut-down schedule of heavy work. Moderate to minimal physical activities were less affected, though weakness and nervousness predominantly hindered socialization. About the prevention and transmission of COVID-19, awareness and attitude were found satisfactory (≥45%), though practice was neglected (<30%). Conclusions: This is the first study in Bangladesh to report the impact of the COVID-19 pandemic on the physical, mental, and social health of adult suburban and rural populations. Physical and mental disabilities were evident among the studied people. Social functioning was affected by COVID-19 equally in suburban and rural participants. A well-designed cohort study is needed to obtain a real picture of the impact of COVID-19 pandemic on human health and society. IMC J Med Sci. 2024; 18(1):007. DOI: https://doi.org/10.55010/imcjms.18.007 *Correspondence: MA Sayeed, Department of Community Medicine and Public Health, Ibrahim Medical College, 1/A Ibrahim Sarani, Segunbagicha, Dhaka 1000, Bangladesh; Email: [email protected]