Estimating the impact of antiretroviral therapy on HIV-TB co-infection: Optimal strategy prediction

2020 ◽  
pp. 2150004
Author(s):  
Tanvi ◽  
Rajiv Aggarwal
Keyword(s):  
Optimal Control ◽  
Equilibrium Point ◽  
Treatment Strategies ◽  
Hiv Treatment ◽  
Time Dependent ◽  
Control Parameters ◽  
Treatment Rate ◽  
Tb Treatment ◽  
The Cost ◽  
The Impact

In this paper, a nonlinear population model for HIV-TB co-infection has been proposed. The model is incorporated with the effect of early and late initiation of HIV treatment in co-infectives already on TB treatment, on the occurrence of Immune Reconstitution Inflammatory syndrome (IRIS). A 15-dimensional (15D) mathematical model has been developed in this study. We begin with considering constant treatment rates and thereafter, proceed to time-dependent treatment rates for co-infectives as control parameters. The basic reproduction number, a threshold quantity, corresponding to each HIV and TB sub-model has been computed in case of constant controls. With constant values of control parameters, mathematical analysis shows the existence and local stability of the disease-free equilibrium point and the endemic equilibrium point for the model. Together with time-dependent parameters, an optimal control problem is introduced and solved using Pontryagin’s maximum principle with an objective to minimize the number of infectives and disease induced deaths along with the cost of treatment. Numerical simulations are performed to examine the effect of reproduction numbers on control profiles and to identify, the ideal combination of treatment strategies which provides minimum burden on a society. Numerical results imply that if both HIV and TB are endemic in the population, then in order to bring in minimum burden from the co-infection, optimal control efforts must be enforced rather than constant treatment rate.

Dynamical analysis of a class of hepatitis C virus infection models with application of optimal control

2016 ◽  
Vol 09 (03) ◽  
pp. 1650038 ◽  
Author(s):  
Aida Mojaver ◽  
Hossein Kheiri
Keyword(s):  
Optimal Control ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Deterministic Model ◽  
Treatment Strategies ◽  
Dynamical Analysis ◽  
Existence And Stability ◽  
Direct Cell ◽  
Infected Cells ◽  
The Impact

In this paper, we deal with the problem of optimal control of a deterministic model of hepatitis C virus (HCV). In the first part of our analysis, a mathematical modeling of HCV dynamics which can be controlled by antiretroviral therapy as fixed controls has been presented and analyzed which incorporates two mechanisms: infection by free virions and the direct cell-to-cell transmission. Basic reproduction number is calculated and the existence and stability of equilibria are investigated. In the second part, the optimal control problem representing drug treatment strategies of the model is explored considering control parameters as time-dependent in order to minimize not only the population of infected cells but also the associated costs. At the end of the paper, the impact of combination of the strategies in the control of HCV and their effectiveness are compared by numerical simulation.

scholarly journals Modeling the Effects of Helminth Infection on the Transmission Dynamics of Mycobacterium tuberculosis under Optimal Control Strategies

2020 ◽  
Vol 2020 ◽  
pp. 1-21
Author(s):  
Aristide G. Lambura ◽  
Gasper G. Mwanga ◽  
Livingstone Luboobi ◽  
Dmitry Kuznetsov
Keyword(s):  
Optimal Control ◽  
Equilibrium Point ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Helminth Infection ◽  
Reproduction Number ◽  
Control Strategies ◽  
Active Tuberculosis ◽  
Control Measures ◽  
The Impact

A deterministic mathematical model for the transmission and control of cointeraction of helminths and tuberculosis is presented, to examine the impact of helminth on tuberculosis and the effect of control strategies. The equilibrium point is established, and the effective reproduction number is computed. The disease-free equilibrium point is confirmed to be asymptotically stable whenever the effective reproduction number is less than the unit. The analysis of the effective reproduction number indicates that an increase in the helminth cases increases the tuberculosis cases, suggesting that the control of helminth infection has a positive impact on controlling the dynamics of tuberculosis. The possibility of bifurcation is investigated using the Center Manifold Theorem. Sensitivity analysis is performed to determine the effect of every parameter on the spread of the two diseases. The model is extended to incorporate control measures, and Pontryagin’s Maximum Principle is applied to derive the necessary conditions for optimal control. The optimal control problem is solved numerically by the iterative scheme by considering vaccination of infants for Mtb, treatment of individuals with active tuberculosis, mass drug administration with regular antihelminthic drugs, and sanitation control strategies. The results show that a combination of educational campaign, treatment of individuals with active tuberculosis, mass drug administration, and sanitation is the most effective strategy to control helminth-Mtb coinfection. Thus, to effectively control the helminth-Mtb coinfection, we suggest to public health stakeholders to apply intervention strategies that are aimed at controlling helminth infection and the combination of vaccination of infants and treatment of individuals with active tuberculosis.

scholarly journals Is tuberculosis elimination a feasible goal in Colombia by 2050?

2019 ◽  
Author(s):  
Lucelly López ◽  
Yoav Keynan ◽  
Diana Marin ◽  
Cielo Yaneth Ríos-Hincapie ◽  
Fernando Montes ◽  
...  
Keyword(s):  
Treatment Adherence ◽  
Ecological Study ◽  
Treatment Strategies ◽  
Status Quo ◽  
World Health ◽  
Treatment Rate ◽  
Tb Treatment ◽  
Incidence And Mortality ◽  
Health Organization ◽  
Case Notification

Abstract Colombia has an underreporting of 30% of the total cases, according to World Health Organization (WHO) estimations. In 2016, successful tuberculosis (TB) treatment rate was 70%, and the mortality rate ranged between 3.5% and 10%. In 2015, Colombia adopted and adapted the End TB strategy and set a target of 50% reduction in incidence and mortality by 2035 compared with 2015. The aims of this study were: To evaluate whether Colombia will be able to achieve the goals of TB incidence and mortality by 2050, using the current strategies; and whether the implementation of new screening, diagnosis and TB treatment strategies will allow to achieve those WHO targets. An ecological study was conducted using TB case-notification, successful treatment and mortality rates from the last 8 years (2009–17). System dynamics analysis was performed using simulated scenarios: (1) continuation with the same trends following the trajectory of the last 8 years (Status quo) and (2) modification of the targets between 2017 through 2050, assuming the implementation of multimodal strategies to increase the screening, to improve the early diagnosis and to improve the treatment adherence. Following the current strategies, it is projected that Colombia will not achieve the End TB strategy targets. Achieving the goal of TB incidence of 10/100 000 by 2050 will only be possible by implementing combined strategies for increasing screening of people with respiratory symptoms, improving access to rapid diagnostic tests and improving treatment adherence. Therefore, it is necessary to design and implement simultaneous strategies according to the population needs and resources, in order to stride towards the End TB targets.

scholarly journals Measuring the in-hospital costs of Pseudomonas aeruginosa pneumonia: methodology and results from a German teaching hospital

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Klaus Kaier ◽  
Thomas Heister ◽  
Tim Götting ◽  
Martin Wolkewitz ◽  
Nico T. Mutters
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Teaching Hospital ◽  
Financial Burden ◽  
Hospital Costs ◽  
Multidrug Resistant ◽  
Time Dependent ◽  
Sensitivity Analyses ◽  
The Cost ◽  
Hospital Acquired ◽  
The Impact

Abstract Background Pseudomonas aeruginosa-related pneumonia is an ongoing healthcare challenge. Estimating its financial burden is complicated by the time-dependent nature of the disease. Methods Two hundred thirty-six cases of Pseudomonas aeruginosa-related pneumonia were recorded at a 2000 bed German teaching hospital between 2011 and 2014. Thirty-five cases (15%) were multidrug-resistant (MDR) Pseudomonas aeruginosa. Hospital- and community-acquired cases were distinguished by main diagnoses and exposure time. The impact of Pseudomonas aeruginosa-related pneumonia on the three endpoints cost, reimbursement, and length of stay was analyzed, taking into account (1) the time-dependent nature of exposure, (2) clustering of costs within diagnostic groups, and (3) additional confounders. Results Pseudomonas aeruginosa pneumonia is associated with substantial additional costs that are not fully reimbursed. Costs are highest for hospital-acquired cases (€19,000 increase over uninfected controls). However, community-acquired cases are also associated with a substantial burden (€8400 when Pseudomonas aeruginosa pneumonia is the main reason for hospitalization, and €6700 when not). Sensitivity analyses for hospital-acquired cases showed that ignoring or incorrectly adjusting for time-dependency substantially biases results. Furthermore, multidrug-resistance was rare and only showed a measurable impact on the cost of community-acquired cases. Conclusions Pseudomonas aeruginosa pneumonia creates a substantial financial burden for hospitals. This is particularly the case for nosocomial infections. Infection control interventions could yield significant cost reductions. However, to evaluate the potential effectiveness of different interventions, the time-dependent aspects of incremental costs must be considered to avoid introduction of bias.

scholarly journals Modelling Optimal Control of In-Host HIV Dynamics Using Different Control Strategies

2018 ◽  
Vol 2018 ◽  
pp. 1-18 ◽  
Author(s):  
Purity Ngina ◽  
Rachel Waema Mbogo ◽  
Livingstone S. Luboobi
Keyword(s):  
Optimal Control ◽  
Deterministic Model ◽  
Control Strategies ◽  
Treatment Strategies ◽  
Optimal Strategies ◽  
Hiv Treatment ◽  
Sub Saharan Africa ◽  
System Control ◽  
Hiv Dynamics

HIV is one of the major causes of deaths, especially in Sub-Saharan Africa. In this paper, an in vivo deterministic model of differential equations is presented and analyzed for HIV dynamics. Optimal control theory is applied to investigate the key roles played by the various HIV treatment strategies. In particular, we establish the optimal strategies for controlling the infection using three treatment regimes as the system control variables. We have applied Pontryagin’s Maximum Principle in characterizing the optimality control, which then has been solved numerically by applying the Runge-Kutta forth-order scheme. The numerical results indicate that an optimal controlled treatment strategy would ensure significant reduction in viral load and also in HIV transmission. It is also evident from the results that protease inhibitor plays a key role in virus suppression; this is not to underscore the benefits accrued when all the three drug regimes are used in combination.

scholarly journals Influence Re-weighted G-Estimation

2016 ◽  
Vol 12 (1) ◽  
pp. 157-177
Author(s):  
Benjamin Rich ◽  
Erica E. M. Moodie ◽  
David A. Stephens
Keyword(s):  
Individualized Medicine ◽  
Treatment Strategies ◽  
Treatment Regimens ◽  
Dynamic Treatment Regime ◽  
Dynamic Treatment ◽  
Optimal Dynamic ◽  
Data Adaptive ◽  
Doubly Robust ◽  
The Cost ◽  
The Impact

Abstract Individualized medicine is an area that is growing, both in clinical and statistical settings, where in the latter, personalized treatment strategies are often referred to as dynamic treatment regimens. Estimation of the optimal dynamic treatment regime has focused primarily on semi-parametric approaches, some of which are said to be doubly robust in that they give rise to consistent estimators provided at least one of two models is correctly specified. In particular, the locally efficient doubly robust g-estimation is robust to misspecification of the treatment-free outcome model so long as the propensity model is specified correctly, at the cost of an increase in variability. In this paper, we propose data-adaptive weighting schemes that serve to decrease the impact of influential points and thus stabilize the estimator. In doing so, we provide a doubly robust g-estimator that is also robust in the sense of Hampel (15).

scholarly journals Modeling the impact of campaign program on the prevalence of anemia in children under five

2021 ◽  
Vol 2 (3) ◽  
pp. 29-40
Author(s):  
Md. Azmir Ibne Islam
Keyword(s):  
Equilibrium Point ◽  
Time Dependent ◽  
Children Under Five ◽  
Under Five ◽  
Blood Disorder ◽  
Child Patients ◽  
The Stability ◽  
The Impact ◽  
Global Health Problem ◽  
Prevalence Of Anemia

Anemia, a global health problem, is increasing worldwide and affecting both developed and developingcountries. Being a blood disorder, anemia may occur in any stages of life but it is quite common in childrenunder the age of five. Globally, iron deficiency is the supreme contributor towards the onset of anemia. In thispaper, a general model based on the dynamics of anemia among children under five is formulated. The populationis divided in three classes such as susceptible, affected and treated. A time-dependent control measurenamely campaign program is considered. The model has an equilibrium point and the stability of the pointis analyzed. Moreover, sensitivity of the equilibrium point is also performed to discover the critical parameters.Numerical simulations are carried out to observe the dynamic behavior of the model. Results showthat campaign program is effective in minimizing the disease progression. The number of child patients andyearly deaths significantly decrease with accelerated campaign program that is implemented earlier whereastermination of the applied measure may upturn the burden. Findings also reveal that application of controlmeasure helps to reduce the prevalence of anemia but may not eliminate the disease.

scholarly journals A co-infection model for Oncogenic HPV and TB with Optimal Control and Cost-Effectiveness Analysis

2020 ◽  
Author(s):  
Andrew Omame ◽  
Daniel Okuonghae
Keyword(s):  
Optimal Control ◽  
Cost Effectiveness ◽  
Reproduction Number ◽  
Intervention Strategy ◽  
Cost Effectiveness Analysis ◽  
Infection Model ◽  
Tb Treatment ◽  
Effectiveness Analysis ◽  
The Impact ◽  
Oncogenic Hpv

A co-infection model for oncogenic Human papillomavirus (HPV) and Tuberculosis (TB), with optimal control and cost-effectiveness analysis is studied and analyzed to assess the impact of controls against incident infection and against infection with HPV by TB infected individuals as well as optimal TB treatment in reducing the burden of the co-infection of the two diseases in a population. The co-infection model is shown to exhibit the dynamical property of backward bifurcation when the associated reproduction number is less than unity. Furthermore, it is shown that TB and HPV re-infection parameters (ϕp ≠ 0 and σT ≠ 0) as well as TB exogenous re-infection term (ϵ1 ≠ 0) oncogenic HPV-TB co-infection model. The global asymptotic stability of the disease-free equilibrium of the co-infection model is also proven not to exist, when the associated reproduction number is below unity. The necessary conditions for the existence of optimal control and the optimality system for the co-infection model is established using the Pontryagin's Maximum Principle. Uncertainty and global sensitivity analysis are also carried out to determine the top ranked parameters that drive the dynamics of the co-infection model, when the associated reproduction numbers as well as the infected populations are used as response functions. Numerical simulations of the optimal control model reveal that the intervention strategy which combines and implements control against HPV infection by TB infected individuals as well as TB treatment control for dually infected individuals is the most cost-effective of all the control strategies for the control and management of the burden of oncogenic HPV and TB co-infection.

scholarly journals The burden of osteoporosis in Brazil

2014 ◽  
Vol 58 (5) ◽  
pp. 434-443 ◽  
Author(s):  
Bruna Coelho Galvão Marinho ◽  
Luiza Paulino Guerra ◽  
Juliana Beaudette Drummond ◽  
Barbara C. Silva ◽  
Maria Marta Sarquis Soares
Keyword(s):  
Cost Effectiveness ◽  
Financial Burden ◽  
Scientific Evidence ◽  
Treatment Strategies ◽  
Indirect Costs ◽  
Osteoporotic Fractures ◽  
Fragility Fractures ◽  
Treatment Of Osteoporosis ◽  
The Cost ◽  
The Impact

Osteoporotic fractures impose severe physical, psychosocial, and financial burden both to the patient and the society. Studies on the prevalence of osteoporosis and fragility fractures in Brazil show a wide variation, due to differences in sample size, the population studied, and methodologies. Few studies have been conducted in Brazil about the cost-effectiveness analyses of different intervention options aimed at the diagnosis and treatment of osteoporosis. Investigation and treatment strategies based on cost-effectiveness and scientific evidence are essential in the preparation of public health policies with the ultimate goal of reducing the incidence of fractures and, consequently, the direct and indirect costs associated with them. This article reviews the Brazilian burden of osteoporosis in terms of the prevalence and fractures attributable to the disease, the costs related to the investigation and management, as well as the impact of osteoporosis on the population as a whole and on affected individuals.

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