When an emerging disease becomes endemic.

Epidemics, such as HIV in the early 1980s and Ebola in 2014, inspire decisive government investment and action, and individual and societal concern, sometimes bordering on panic. By contrast, endemic diseases, such as HIV in 2017 and tuberculosis, struggle to maintain the same attention. For many, the paradox is that endemic disease, in its totality, continues to impose a far higher public health burden than epidemic disease. Overall, the swift political response to epidemics has resulted in success. It has proven possible to eradicate epidemic diseases, often without the availability of vaccines and other biomedical technologies. In recent times, only HIV has made the transition from epidemic to endemic, but diseases that have existed for centuries continue to cause most of the infectious disease burden

From Haiti to the ESL Class: Working with Adult Haitian ESL Learners in the US

This project provides the person unfamiliar with Haiti and its inhabitants with some background information on the country - politically, economically, socially. It also gives a perspective on why Haitians leave Haiti to come to the US, and the stages they must go through in order to do so. Teachers are given some insight into what to expect from their students in an ESL class, given their background and experiences. Finally, factual information is provided on Haiti - i.e. holidays, major cities, etc. - for the interest of the reader. It also serves to help the teacher make the ESL class more relevant to the student

An Empirical Analysis of Synergies and Tradeoffs between Sustainable Development Goals

The UN Sustainable Development Goals (SDGs) represent a universal agenda that nations have committed to achieving by 2030. The challenge is substantial, with no country excelling across all SDGs. Using global UN data, we assess patterns of positive and negative correlations between indicators of SDG status and progress. For nearly 70% of SDG indicators, status is positively associated with GDP/capita. Progress on SDG indicators, however, occurs in both poorer and wealthier countries. When GDP/capita is controlled for, positive associations remain between health, environment and energy usage indicators. Economic growth is negatively associated with changes in some health and environment indicators. For SDGs targets to be achieved, major opportunities and conflicts will need to be identified, prioritized and acted upon

Higher cost of implementing Xpert(®) MTB/RIF in Ugandan peripheral settings: implications for cost-effectiveness.

SETTING: Initial cost-effectiveness evaluations of Xpert(®) MTB/RIF for tuberculosis (TB) diagnosis have not fully accounted for the realities of implementation in peripheral settings. OBJECTIVE: To evaluate costs and diagnostic outcomes of Xpert testing implemented at various health care levels in Uganda. DESIGN: We collected empirical cost data from five health centers utilizing Xpert for TB diagnosis, using an ingredients approach. We reviewed laboratory and patient records to assess outcomes at these sites and10 sites without Xpert. We also estimated incremental cost-effectiveness of Xpert testing; our primary outcome was the incremental cost of Xpert testing per newly detected TB case. RESULTS: The mean unit cost of an Xpert test was US$21 based on a mean monthly volume of 54 tests per site, although unit cost varied widely (US$16-58) and was primarily determined by testing volume. Total diagnostic costs were 2.4-fold higher in Xpert clinics than in non-Xpert clinics; however, Xpert only increased diagnoses by 12%. The diagnostic costs of Xpert averaged US$119 per newly detected TB case, but were as high as US$885 at the center with the lowest volume of tests. CONCLUSION: Xpert testing can detect TB cases at reasonable cost, but may double diagnostic budgets for relatively small gains, with cost-effectiveness deteriorating with lower testing volumes

Estimators Used in Multisite Healthcare Costing Studies in Low- and Middle-Income Countries: A Systematic Review and Simulation Study.

BACKGROUND: In low- and middle-income countries, multisite costing studies are increasingly used to estimate healthcare program costs. These studies have employed a variety of estimators to summarize sample data and make inferences about overall program costs. OBJECTIVE: We conducted a systematic review and simulation study to describe these estimation methods and quantify their performance in terms of expected bias and variance. METHODS: We reviewed the published literature through January 2017 to identify multisite costing studies conducted in low- and middle-income countries and extracted data on analytic approaches. To assess estimator performance under realistic conditions, we conducted a simulation study based on 20 empirical cost data sets. RESULTS: The most commonly used estimators were the volume-weighted mean and the simple mean, despite theoretical reasons to expect bias in the simple mean. When we tested various estimators in realistic study scenarios, the simple mean exhibited an upward bias ranging from 12% to 113% of the true cost across a range of study sample sizes and data sets. The volume-weighted mean exhibited minimal bias and substantially lower root mean squared error. Further gains were possible using estimators that incorporated auxiliary information on delivery volumes. CONCLUSIONS: The choice of summary estimator in multisite costing studies can significantly influence study findings and, therefore, the economic analyses they inform. Use of the simple mean to summarize the results of multisite costing studies should be considered inappropriate. Our study demonstrates that several alternative better-performing methods are available

Cost of point-of-care lateral flow urine lipoarabinomannan antigen testing in HIV-positive adults in South Africa

Aaron S. Karat - ORCID 0000-0001-9643-664X https://orcid.org/0000-0001-9643-664XINTRODUCTION: The World Health Organization recommends point-of-care (POC) lateral flow urine lipoarabinomannan (LF-LAM) for tuberculosis (TB) diagnosis in selected human immunodeficiency virus (HIV) positive people. South Africa had 438 000 new TB episodes in 2016, 58.9% of which were contributed by HIV-positive people. LF-LAM is being considered for scale-up in South Africa.METHODS: We estimated the costs of using LF-LAM in HIV-positive adults with CD4 counts 6 150 cells/ll enrolled in the TB Fast Track Trial in South Africa. We also estimated costs of POC haemoglobin (Hb), as this was used in the study algorithm. Data on clinic-level (10 intervention clinics) and above-clinic-level costs were collected.RESULTS: A total of 1307 LF-LAM tests were performed at 10 clinics over 24 months. The mean cliniclevel costs were US$12.80 per patient for LF-LAM and POC Hb; LF-LAM costs were US$11.49 per patient. The mean above-clinic-level unit costs for LF-LAM were US$12.06 for clinic preparation, training, coordination and mentoring. The mean total cost of LF-LAM was US$23.55 per patient.CONCLUSION: At clinic level, the cost of LF-LAM was comparable to other TB diagnostics in South Africa. It is important to consider above-clinic-level costs for POC tests, as these may be required to support roll-out and ensure successful implementation.The trial sponsor was the London School of Hygiene & Tropical Medicine, London, UK. The study was funded by Joint Global Health Trials (UK Medical Research Council, UK Department for International Development, Wellcome Trust). This UK-funded award is part of the EDCTP2 programme supported by the European Union. Alere donated materials for quality control of their LAM assay. The funder and study sponsor had no role in the study design or in the execution of the study, analysis and interpretation of data, or decision to submit results for publication.https://doi.org/10.5588/ijtld.18.004622pubpub

Estimating unbiased economies of scale of HIV prevention projects: A case study of Avahan

Governments and donors are investing considerable resources on HIV prevention in order to scale up these services rapidly. Given the current economic climate, providers of HIV prevention services increasingly need to demonstrate that these investments offer good ‘value for money’. One of the primary routes to achieve efficiency is to take advantage of economies of scale (a reduction in the average cost of a health service as provision scales-up), yet empirical evidence on economies of scale is scarce. Methodologically, the estimation of economies of scale is hampered by several statistical issues preventing causal inference and thus making the estimation of economies of scale complex. In order to estimate unbiased economies of scale when scaling up HIV prevention services, we apply our analysis to one of the few HIV prevention programmes globally delivered at a large scale: the Indian Avahan initiative. We costed the project by collecting data from the 138 Avahan NGOs and the supporting partners in the first four years of its scale-up, between 2004 and 2007. We develop a parsimonious empirical model and apply a system Generalized Method of Moments (GMM) and fixed-effects Instrumental Variable (IV) estimators to estimate unbiased economies of scale. At the programme level, we find that, after controlling for the endogeneity of scale, the scale-up of Avahan has generated high economies of scale. Our findings suggest that average cost reductions per person reached are achievable when scaling-up HIV prevention in low and middle income countries