Scale-up of radiotherapy for cervical cancer in the era of human papillomavirus vaccination in low-income and middle-income countries: a model-based analysis of need and economic impact

Cervical cancer incidence and mortality have decreased in high-income countries, but low- and middle-income countries continue to bear a significant burden from the disease. Human papillomavirus (HPV) vaccines are a promising alternative for disease control; however, their introduction is slow in settings with greater need. We conducted a review of HPV vaccine efficacy and effectiveness reported in clinical trials and population-based studies. Efficacy of HPV vaccines is close to 100% when using a three-dose schedule in HPV-negative young women (<25 years old) for protection against persistent infection and HPV vaccine-type associated pre-cancerous lesions. Furthermore, sustained protection for up to 12 years of follow-up has been demonstrated; cross-protection against non-vaccine types is particularly observed for the bivalent vaccine, and preliminary data regarding impact on invasive cancer have emerged. Given its lower efficacy, catch-up vaccination beyond 19 years of age and proposals for vaccinating adult women deserve careful evaluation in accurately designed studies and economic analyses. Despite positive results regarding immunogenicity and post-hoc analysis for cervical intra-epithelial neoplasia in clinical trials, population-based data for prime and booster two-dose schedules are not available. Evaluation of vaccine safety from surveillance systems in immunization programs that have already distributed more than 270 million doses found no association of HPV vaccination with serious side effects. The introduction of HPV vaccination in national immunization programs remains the main challenge in tackling the burden of cervical cancer (up to 2018, only 89 countries have introduced vaccination worldwide, and most of these are high-income countries). Access models and technical capacity require further development to help low- and middle-income countries to increase the pace of vaccine delivery. Alternative approaches such as one-dose schedules and vaccination at younger ages may help reduce the programmatic and economic challenges to adolescent vaccination.

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Establishing Global School Feeding Program Targets: How Many Poor Children Globally Should Be Prioritized, and What Would Be the Cost of Implementation?

Frontiers in Public Health ◽

10.3389/fpubh.2020.530176 ◽

2020 ◽

Vol 8 ◽

Author(s):

Lesley J. Drake ◽

Nail Lazrak ◽

Meena Fernandes ◽

Kim Chu ◽

Samrat Singh ◽

...

Keyword(s):

Low Income ◽

School Health ◽

Scale Up ◽

Good Health ◽

Global Strategy ◽

Low Income Countries ◽

School Age Children ◽

Middle Income ◽

Middle Income Countries ◽

School Feeding

The creation of Human Capital is dependent upon good health and education throughout the first 8,000 days of life, but there is currently under-investment in health and nutrition after the first 1,000 days. Working with governments and partners, the UN World Food Program is leading a global scale up of investment in school health, and has undertaken a strategic analysis to explore the scale and cost of meeting the needs of the most disadvantaged school age children and adolescents in low and middle-income countries globally. Of the 663 million school children enrolled in school, 328 million live where the current coverage of school meals is inadequate (<80%), of these, 251 million live in countries where there are significant nutrition deficits (>20% anemia and stunting), and of these an estimated 73 million children in 60 countries are also living in extreme poverty (<USD 1.97 per day). 62.7 million of these children are in Africa, and more than 66% live in low income countries, with a substantial minority in pockets of poverty in middle-income countries. The estimated overall financial requirement for school feeding is USD 4.7 billion, increasing to USD 5.8 billion annually if other essential school health interventions are included in the package. The DCP3 (Vol 8) school feeding edition and the global coverage numbers were launched in Tunis, 2018 by the WFP Executive Director, David Beasley. These estimates continue to inform the development of WFP's global strategy for school feeding.

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Assessing the value of human papillomavirus vaccination in Gavi-eligible low-income and middle-income countries

BMJ Global Health ◽

10.1136/bmjgh-2020-003006 ◽

2020 ◽

Vol 5 (10) ◽

pp. e003006

Author(s):

Jessica Ochalek ◽

Kaja Abbas ◽

Karl Claxton ◽

Mark Jit ◽

James Lomas

Keyword(s):

Human Papillomavirus ◽

Low Income ◽

Hpv Vaccination ◽

Cost Effective ◽

Health Impact ◽

Healthcare Intervention ◽

Human Papillomavirus Vaccination ◽

Middle Income ◽

Maximum Price ◽

Healthcare Interventions

IntroductionEstimating the value of providing effective healthcare interventions in a country requires an assessment of whether the improvement in health outcomes they offer exceeds the improvement in health that would have been possible if the resources required had, instead, been made available for other healthcare activities in that country. This potential alternative use of the same resources represents the health opportunity cost of providing the intervention. Without such assessments, there is a danger that blanket recommendations made by international organisations will lead to the adoption of healthcare interventions that are not cost effective in some countries, even given existing donor mechanisms intended to support their affordability.MethodsWe assessed the net health impact to 46 Gavi-eligible countries of achieving one of the WHO’s proposed 90-70-90 targets for cervical cancer elimination, which includes 90% coverage of human papillomavirus (HPV) vaccination among girls by 15 years of age, using published estimates of the expected additional benefits and costs in each country and estimates of the marginal productivity of each healthcare system. We calculated the maximum price each country could afford to pay for HPV vaccination to be cost effective by assessing the net health impact that would be expected to be generated at different potential prices.ResultsAt Gavi negotiated prices, HPV vaccination offers net health benefits across most Gavi-eligible countries included in this study. However, if Gavi-eligible countries faced the average price faced by non-Gavi eligible countries, providing HPV vaccination would result in reduced overall population health in most countries.ConclusionEstimates of the net health impact of providing a healthcare intervention can be used to assess the benefit (or lack of) to countries of adhering to global guidance, inform negotiations with donors, as well as pricing negotiations and the value of developing new healthcare interventions.

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Cost of scaling up mental healthcare in low-and middle-income countries

The British Journal of Psychiatry ◽

10.1192/bjp.bp.107.038463 ◽

2007 ◽

Vol 191 (6) ◽

pp. 528-535 ◽

Cited By ~ 62

Author(s):

Dan Chisholm ◽

Crick Lund ◽

Shekhar Saxena

Keyword(s):

Low Income ◽

Scale Up ◽

Mental Healthcare ◽

Scaling Up ◽

Psychosocial Treatment ◽

Economic Evaluations ◽

Middle Income ◽

Middle Income Countries ◽

Per Capita ◽

Low And Middle Income

BackgroundNo systematic attempt has been made to calculate the costs of scaling up mental health services in low-and middle-income countries.AimsTo estimate the expenditures needed to scale up the delivery of an essential mental healthcare package over a 10-year period (2006–2015).MethodA core package was defined, comprising pharmacological and/or psychosocial treatment of schizophrenia, bipolar disorder, depression and hazardous alcohol use. Current service levels in 12 selected low-and middle-income countries were established using the WHO–AIMS assessment tool. Target-level resource needs were derived from published need assessments and economic evaluations.ResultsThe cost per capita of providing the core package attarget coverage levels (in US dollars) ranged from $1.85 to $2.60 per year in low-income countries and $3.20 to $6.25 per year in lower-middle-income countries, an additional annual investment of $0.18–0.55 per capita.ConclusionsAlthough significant new resources need to be invested, the absolute amount is not large when considered at the population level and against other health investment strategies.

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Modern possibilities of using immunotherapy in the treatment of cervical cancer

Tumors of female reproductive system ◽

10.17650/1994-4098-2021-17-2-104-111 ◽

2021 ◽

Vol 17 (2) ◽

pp. 104-111

Author(s):

A. V. Tarasova ◽

K. A. Ganina ◽

M. A. Meshkova ◽

Yu. V. Solovyeva ◽

E. E. Ivanova ◽

...

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

Clinical Case ◽

Control Points ◽

Special Group ◽

Middle Income ◽

Vaccination Programs ◽

Middle Income Countries ◽

Common Cancer ◽

Preventive Vaccination

Cervical cancer (CC) is the fourth most common cancer in women worldwide. Every year, more than 500,000 women are diagnosed with CC, and the disease leads to more than 300,000 deaths worldwide. Infection with the human papillomavirus is the cause of CC in most cases. The disease is largely preventable through preventive vaccination. Approximately 90 % of CC cases are diagnosed in low-and middle-income countries where there are no organized human papillomavirus screening and vaccination programs. A special group in this disease consists of patients who develop recurrent / metastatic CC. To date, the most promising direction of drug treatment for this pathology is drugs that act on the control points of immunity – the PD-1 receptor / PD-L1 ligand, which are used by the tumor to block the immune system. The article presents a clinical case demonstrating the efficacy of the PD-1 inhibitor pembrolizumab for the treatment of recurrent / metastatic CC.

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Innovative financing to fund surgical systems and expand surgical care in low-income and middle-income countries

BMJ Global Health ◽

10.1136/bmjgh-2020-002375 ◽

2020 ◽

Vol 5 (6) ◽

pp. e002375 ◽

Cited By ~ 1

Author(s):

Ché L Reddy ◽

Alexander W Peters ◽

Desmond Tanko Jumbam ◽

Luke Caddell ◽

Blake C Alkire ◽

...

Keyword(s):

Health Systems ◽

Low Income ◽

Critical Role ◽

Scale Up ◽

Surgical Care ◽

Healthcare Intervention ◽

Strengthen Health System ◽

Middle Income ◽

Middle Income Countries ◽

Fiscal Space

Strong surgical systems are necessary to prevent premature death and avoidable disability from surgical conditions. The epidemiological transition, which has led to a rising burden of non-communicable diseases and injuries worldwide, will increase the demand for surgical assessment and care as a definitive healthcare intervention. Yet, 5 billion people lack access to timely, affordable and safe surgical and anaesthesia care, with the unmet demand affecting predominantly low-income and middle-income countries (LMICs). Rapid surgical care scale-up is required in LMICs to strengthen health system capabilities, but adequate financing for this expansion is lacking. This article explores the critical role of innovative financing in scaling up surgical care in LMICs. We locate surgical system financing by using a modified fiscal space analysis. Through an analysis of published studies and case studies on recent trends in the financing of global health systems, we provide a conceptual framework that could assist policy-makers in health systems to develop innovative financing strategies to mobilise additional investments for scale-up of surgical care in LMICs. This is the first time such an analysis has been applied to the funding of surgical care. Innovative financing in global surgery is an untapped potential funding source for expanding fiscal space for health systems and financing scale-up of surgical care in LMICs.

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Screening for Human Papillomavirus in a Low- and Middle-Income Country

Journal of Global Oncology ◽

10.1200/jgo.18.00233 ◽

2019 ◽

pp. JGO.18.00233 ◽

Cited By ~ 2

Author(s):

Aaron E. Atkinson ◽

Carlos Alberto Matute Mandujano ◽

Suyapa Bejarano ◽

Linda S. Kennedy ◽

Gregory J. Tsongalis

Keyword(s):

Cervical Cancer ◽

Polymerase Chain Reaction ◽

Human Papillomavirus ◽

Chain Reaction ◽

Middle Income ◽

Middle Income Countries ◽

Hpv Genotypes ◽

Polymerase Chain ◽

High Risk Hpv ◽

Low And Middle Income

PURPOSE Low- and middle-income countries have high incidences of cervical cancer linked to human papillomavirus (HPV), and without resources for cancer screenings these countries bear 85% of all cervical cancer cases. To address some of these needs, brigade-style screening combined with sensitive polymerase chain reaction–based HPV testing to detect common high-risk HPV genotypes may be necessary. METHODS We deployed an inexpensive DNA extraction technique and a real-time polymerase chain reaction–based HPV genotyping assay, as well as Papanicolaou testing, in a factory in San Pedro Sula, Honduras, where 1,732 women were screened for cervical cancer. RESULTS We found that 28% of participants were positive for high-risk HPV, with 26% of HPV-positive participants having more than one HPV infection. Moreover, the most common HPV genotypes detected were different than those routinely found in the United States. CONCLUSION This work demonstrates a deployable protocol for HPV screening in low- and middle-income countries with limited resources to perform cytopathology assessment of Pap smears.

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