scholarly journals Achieving a “step change” in the tuberculosis epidemic through comprehensive community-wide intervention: a model-based analysis

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Sourya Shrestha ◽  
Emily A. Kendall ◽  
Rebekah Chang ◽  
Roy Joseph ◽  
Parastu Kasaie ◽  
...  
Keyword(s):  
Health System ◽  
Adult Population ◽  
Preventive Therapy ◽  
Step Change ◽  
Health System Strengthening ◽  
World Health ◽  
Unsuccessful Treatment ◽  
Incidence And Mortality ◽  
Epidemiological Impact ◽  
The Impact

Abstract Background Global progress towards reducing tuberculosis (TB) incidence and mortality has consistently lagged behind the World Health Organization targets leading to a perception that large reductions in TB burden cannot be achieved. However, several recent and historical trials suggest that intervention efforts that are comprehensive and intensive can have a substantial epidemiological impact. We aimed to quantify the potential epidemiological impact of an intensive but realistic, community-wide campaign utilizing existing tools and designed to achieve a “step change” in the TB burden. Methods We developed a compartmental model that resembled TB transmission and epidemiology of a mid-sized city in India, the country with the greatest absolute TB burden worldwide. We modeled the impact of a one-time, community-wide screening campaign, with treatment for TB disease and preventive therapy for latent TB infection (LTBI). This one-time intervention was followed by the strengthening of the tuberculosis-related health system, potentially facilitated by leveraging the one-time campaign. We estimated the tuberculosis cases and deaths that could be averted over 10 years using this comprehensive approach and assessed the contributions of individual components of the intervention. Results A campaign that successfully screened 70% of the adult population for active and latent tuberculosis and subsequently reduced diagnostic and treatment delays and unsuccessful treatment outcomes by 50% was projected to avert 7800 (95% range 5450–10,200) cases and 1710 (1290–2180) tuberculosis-related deaths per 1 million population over 10 years. Of the total averted deaths, 33.5% (28.2–38.3) were attributable to the inclusion of preventive therapy and 52.9% (48.4–56.9) to health system strengthening. Conclusions A one-time, community-wide mass campaign, comprehensively designed to detect, treat, and prevent tuberculosis with currently existing tools can have a meaningful and long-lasting epidemiological impact. Successful treatment of LTBI is critical to achieving this result. Health system strengthening is essential to any effort to transform the TB response.

scholarly journals Mixed methods systematic review and metasummary about barriers and facilitators for the implementation of cotrimoxazole and isoniazid - preventive therapies for people living with HIV.

2021 ◽  
Author(s):  
Pia Muller ◽  
Luis Velez Lapao
Keyword(s):  
Health System ◽  
Opportunistic Infections ◽  
Stakeholder Involvement ◽  
Preventive Therapy ◽  
Health System Strengthening ◽  
World Health ◽  
People Living With Hiv ◽  
Therapy Regimen ◽  
Similarities And Differences ◽  
Health Organization

Background: Cotrimoxazole and isoniazid preventive therapy (CPT, IPT) have been shown to be efficacious therapies for the prevention of opportunistic infections and tuberculosis (TB) among people living with human immunodeficiency virus (HIV). Despite governments' efforts to translate World Health Organization recommendations into practice, implementation remains challenging. This review aimed to explore and compare CPT and IPT with respect to similarities and differences of barriers identified across high TB/HIV burden countries. A secondary objective was to identify facilitators for implementing both preventive therapies. Methods: We searched MEDLINE, Web of Science and SCOPUS databases for peer-reviewed literature published before September 2020. We extracted and synthesized our findings using Maxqda software. We applied framework synthesis in conjunction with metasummary to compare both therapies with respect to similarities and differences of barriers identified across seven health system components (in line with the modified WHO's Framework for action). Protocol registration: PROSPERO (CRD42019137778). Findings: We identified four hundred and eighty-two papers, of which we included forty for review. Although most barrier themes were identical for both preventive therapies, we identified seven intervention-specific themes. Like for CPT, barriers identified for IPT were most frequently classified as 'service delivery-related barriers' and 'patient & community-related barriers'. 'Health provider-related barriers' played an additional important role for implementing of IPT. Most facilitators identified referred to health system strengthening activities. Conclusions: For researchers with limited working experience in high TB/HIV burden countries, this review can provide valuable insights about barriers that may arise at different levels of the health system. For policymakers in high TB/HIV burden countries, this review offers strategies for improving the delivery of IPT (or any newer therapy regimen) for the prevention of TB. Based on our findings, we suggest initial and continuous stakeholder involvement, a focus on the efficient use and reinforcement of existing resources for health.

scholarly journals The Impact of Conflict on Immunisation Coverage in 16 Countries

2018 ◽  
Vol 8 (4) ◽  
pp. 211-221 ◽  
Author(s):  
John Grundy ◽  
Beverley-Ann Biggs
Keyword(s):  
Health System ◽  
Disease Incidence ◽  
National Policy ◽  
Disease Outbreaks ◽  
Health System Strengthening ◽  
World Health ◽  
Immunisation Coverage ◽  
Global Alliance ◽  
Middle Income ◽  
The Impact

Background: Military conflict has been an ongoing determinant of inequitable immunisation coverage in many low- and middle-income countries, yet the impact of conflict on the attainment of global health goals has not been fully addressed. This review will describe and analyse the association between conflict, immunisation coverage and vaccine-preventable disease (VPD) outbreaks, along with country specific strategies to mitigate the impact in 16 countries. Methods: We cross-matched immunisation coverage and VPD data in 2014 for displaced and refugee populations. Data on refugee or displaced persons was sourced from the United Nations High Commissioner for Refugees (UNHCR) database, and immunisation coverage and disease incidence data from World Health Organization (WHO) databases. Demographic and Health Survey (DHS) databases provided additional data on national and sub-national coverage. The 16 countries were selected because they had the largest numbers of registered UNHCR "persons of interest" and received new vaccine support from Global Alliance for Vaccine and Immunisation (GAVI), the Vaccine Alliance. We used national planning and reporting documentation including immunisation multiyear plans, health system strengthening strategies and GAVI annual progress reports (APRs) to assess the impact of conflict on immunisation access and coverage rates, and reviewed strategies developed to address immunisation program shortfalls in conflict settings. We also searched the peer-reviewed literature for evidence that linked immunisation coverage and VPD outbreaks with evidence of conflict. Results: We found that these 16 countries, representing just 12% of the global population, were responsible for 67% of global polio cases and 39% of global measles cases between 2010 and 2015. Fourteen out of the 16 countries were below the global average of 85% coverage for diphtheria, pertussis, and tetanus (DPT3) in 2014. We present data from countries where the onset of conflict has been associated with sudden drops in national and sub-national immunisation coverage. Tense security conditions, along with damaged health infrastructure and depleted human resources have contributed to infrequent outreach services, and delays in new vaccine introductions and immunisation campaigns. These factors have in turn contributed to pockets of low coverage and disease outbreaks in sub-national areas affected by conflict. Despite these impacts, there was limited reference to the health needs of conflict affected populations in immunisation planning and reporting documents in all 16 countries. Development partner investments were heavily skewed towards vaccine provision and working with partner governments, with comparatively low levels of health systems support or civil partnerships. Conclusion: Global and national policy and planning focus is required on the service delivery needs of conflict affected populations, with increased investment in health system support and civil partnerships, if persistent immunisation inequities in conflict affected areas are to be addressed.

scholarly journals Regulatory standards and processes for over-the-counter availability of hormonal contraception and drugs for medical abortion in five countries in the Eastern Mediterranean Region

2021 ◽  
Vol 19 (S1) ◽  
Author(s):  
Anne Ammerdorffer ◽  
Mark Laws ◽  
Arinze Awiligwe ◽  
Florence Erb ◽  
Wallada Im-Amornphong ◽  
...  
Keyword(s):  
Reproductive Health ◽  
Health System ◽  
Emergency Contraception ◽  
Sexual And Reproductive Health ◽  
Self Care ◽  
Medical Abortion ◽  
Health System Strengthening ◽  
World Health ◽  
Over The Counter ◽  
Regulatory Status

AbstractThe World Health Organization 2019 WHO consolidated guideline on self-care interventions for health: sexual and reproductive health and rights includes recommendations on self-administration of injectable contraception, over-the-counter (OTC) oral contraception and self-management of medical abortion. A review of the regulatory status of these two self-care interventions can highlight processes required to ensure that the quality of the medicines and safety of individuals are safeguarded in the introduction and scale-up in countries. This review outlines the legal regulatory status of prescription-only medicine (POM) and OTC contraceptives, including emergency contraception, and drugs for medical abortion in Egypt, Jordan, Lebanon, Morocco and Tunisia using information obtained from internet searches, regulatory information databases and personal contacts. In addition, the review examines whether the national medicines regulatory authorities have documented procedures available to allow for a change in status from a POM to OTC to allow for increased accessibility, availability and uptake of self-care interventions recommended by WHO. Egypt, Jordan and Lebanon have a documented national OTC list available. The only contraceptive product mentioned in the OTC lists across all five countries is ellaOne (ulipristal acetate for emergency contraception), which is publicly registered in Lebanon. None of the five countries has an official documented procedure to apply for the change of POM to OTC. Informal procedures exist, such as the ability to apply to the national medicines regulatory authority for OTC status if the product has OTC status in the original country of manufacture. However, many of these procedures are not officially documented, highlighting the need for establishing sound, affordable and effective regulation of medical products as an important part of health system strengthening. From a public health perspective, it would be advantageous for licensed products to be available OTC. This is particularly the case for settings where the health system is under-resourced or over-stretched due to health emergencies. Readiness of national regulatory guidelines and OTC procedures could lead to increased access, availability and usage of essential self-care interventions for sexual and reproductive health and rights.

scholarly journals Association between leisure-time physical activity and the risk of chronic diseases

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
A Dedele ◽  
A Miskinyte
Keyword(s):  
Physical Activity ◽  
Chronic Diseases ◽  
High Intensity ◽  
Leisure Time ◽  
Leisure Time Physical Activity ◽  
Adult Population ◽  
World Health ◽  
Health Study ◽  
Moderate Intensity ◽  
The Impact

Abstract Background According to the World Health Organization, non-communicable diseases or chronic diseases, account for 71 percent of all deaths globally, affecting individuals of all age groups and countries. Epidemiological studies have shown an association between a lack of physical activity (PA) and the risk of raised blood pressure, increased body mass index and obesity that can lead to chronic diseases. Methods The aim of the study was to assess the relationship between leisure-time PA and the risk of chronic diseases among adult population. We conducted a cross-sectional study of 470 men and 641 women who participated in “The Impact of Sustainable Mobility, Physical Activity and Environmental Factors on Urban Population Health Study (ISMA)” in Lithuania. Leisure-time PA was self-reported and divided into three levels: low, moderate and high. Logistic regression was used to estimate adjusted odds ratios (ORs) of chronic diseases according to leisure-time PA. Results More than half (55%) of the study population engaged in a moderate intensity PA and 12% of participants engaged in a high intensity leisure-time PA. Men 1.6 times more often than women reported engaging in a high intensity PA in leisure time (p = 0.004). Adults who engaged in low intensity leisure-time PA had almost 3 times (OR = 2.91; 95% confidence interval (CI) 1.62-5.24) higher risk of chronic diseases, whereas those adults who reported moderate intensity leisure-time PA had an OR of 1.63 (95% CI 0.92-2.87) compared to individuals who engaged in a high-level PA. Conclusions Our findings suggest that high levels of leisure-time PA could reduce the risk of chronic diseases and this effect was significantly stronger in men. Key messages Global decline in PA is related to inaction during leisure time and sedentary behaviour at work and at home that has a major health impact worldwide. High levels of leisure-time PA are important factor for chronic disease prevention.

scholarly journals The impact of joining the Eurozone on nutrition habits in Lithuania

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
V Dobrovolskij
Keyword(s):  
Vegetable Oil ◽  
Eating Habits ◽  
Adult Population ◽  
Food Prices ◽  
World Health ◽  
Consumer Prices ◽  
Fresh Vegetables ◽  
Health Organization ◽  
The Impact ◽  
Nutrition Habits

Abstract Background Increases in the cost of food often leads to changes in the quantity and type of foods that are purchased. World Health Organization estimates that today’s global food prices rose to the highest level. Numerous research results show that the effect of the conversion of national currencies to the euro on the growth of consumer prices in euro area countries was generally mild and one-off. The aim - to explore the eating habits in 2019 of the Lithuanian population and compare it with results of an eating habits research which was made before the joining euro zone in 2013. Methods The sample under the survey included 1007 of the Lithuania’s population. The interviewing under a questionnaire was carried out in March 2019 using the questionnaire developed for this purpose. Statistical analysis was performed using SPSS program package. The results were compared with nutritional habits of the survey done in 2013. Results The results showed that only one-fifth of the Lithuanian adult population thinks about food choices for health benefits - 22 % (in 2013 - 21 %). Food choice is affected by the taste - 37 % (in 2013 - 28%), to a lesser extent - the food price, which represents 24 % (in 2013 - 37%). 67% of the Lithuanian population (in 2013 - 43%) do not always eat at the same time. 59% (in 2013 - 59%) of the adult population eats three times a day. The majority - 98% (in 2013 - 92.9%) of the respondents had a snack between main meals. It is recommended to eat fresh vegetables every day, but this recommendation is shared by 55% (in 2013 - 40%). The milk and milk products are used each day by 51% (37% in 2013) of the population. The majority - 42% (in 2013 - 82%) of adult Lithuanian population most frequently used vegetable oil. Conclusions More people started to choose food by taste, and a decreased number of those who choose by price. There is increased number of people who eat fresh vegetables every day and decreased number of people who use vegetable oil. Key messages There are differents in nutrition habits among Lithuania population before and after joining Eurozone. The study showed the impact of joining the Eurozone on the diet of the population.

scholarly journals A review of the impact of financing mechanisms on maternal health care in Australia

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Haylee Fox ◽  
Stephanie M. Topp ◽  
Emily Callander ◽  
Daniel Lindsay
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Health System ◽  
Search Engine ◽  
Grey Literature ◽  
Maternal Health Care ◽  
World Health ◽  
Google Search ◽  
The Impact ◽  
Out Of Pocket Costs

Abstract Background The World Health Organization states there are three interrelated domains that are fundamental to achieving and maintaining universal access to care - raising sufficient funds for health care, reducing financial barriers to access by pooling funds in a way that prevents out-of-pocket costs, and allocating funds in a way that promotes quality, efficiency and equity. In Australia, a comprehensive account of the mechanisms for financing the health system have not been synthesised elsewhere. Therefore, to understand how the maternal health system is financed, this review aims to examine the mechanisms for funding, pooling and purchasing maternal health care and the influence these financing mechanisms have on the delivery of maternal health services in Australia. Methods We conducted a scoping review and interpretative synthesis of the financing mechanisms and their impact on Australia’s maternal health system. Due to the nature of the study question, the review had a major focus on grey literature. The search was undertaken in three stages including; searching (1) Google search engine (2) targeted websites and (3) academic databases. Executive summaries and table of contents were screened for grey literature documents and Titles and Abstracts were screened for journal articles. Screening of publications’ full-text followed. Data relating to either funding, pooling, or purchasing of maternal health care were extracted for synthesis. Results A total of 69 manuscripts were included in the synthesis, with 52 of those from the Google search engine and targeted website (grey literature) search. A total of 17 articles we included in the synthesis from the database search. Conclusion Our study provides a critical review of the mechanisms by which revenues are raised, funds are pooled and their impact on the way health care services are purchased for mothers and babies in Australia. Australia’s maternal health system is financed via both public and private sources, which consequentially creates a two-tiered system. Mothers who can afford private health insurance – typically wealthier, urban and non-First Nations women - therefore receive additional benefits of private care, which further exacerbates inequity between these groups of mothers and babies. The increasing out of pocket costs associated with obstetric care may create a financial burden for women to access necessary care or it may cause them to skip care altogether if the costs are too great.

scholarly journals The potential impact of urine-LAM diagnostics on tuberculosis incidence and mortality: A modelling analysis

PLoS Medicine ◽  
2020 ◽  
Vol 17 (12) ◽  
pp. e1003466
Author(s):  
Saskia Ricks ◽  
Claudia M. Denkinger ◽  
Samuel G. Schumacher ◽  
Timothy B. Hallett ◽  
Nimalan Arinaminpathy
Keyword(s):  
Population Level ◽  
Credible Interval ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Country Level ◽  
Incidence And Mortality ◽  
The Status ◽  
Epidemiological Impact ◽  
Incident Cases ◽  
The Impact

Background Lateral flow urine lipoarabinomannan (LAM) tests could offer important new opportunities for the early detection of tuberculosis (TB). The currently licensed LAM test, Alere Determine TB LAM Ag (‘LF-LAM’), performs best in the sickest people living with HIV (PLHIV). However, the technology continues to improve, with newer LAM tests, such as Fujifilm SILVAMP TB LAM (‘SILVAMP-LAM’) showing improved sensitivity, including amongst HIV-negative patients. It is important to anticipate the epidemiological impact that current and future LAM tests may have on TB incidence and mortality. Methods and findings Concentrating on South Africa, we examined the impact that widening LAM test eligibility would have on TB incidence and mortality. We developed a mathematical model of TB transmission to project the impact of LAM tests, distinguishing ‘current’ tests (with sensitivity consistent with LF-LAM), from hypothetical ‘future’ tests (having sensitivity consistent with SILVAMP-LAM). We modelled the impact of both tests, assuming full adoption of the 2019 WHO guidelines for the use of these tests amongst those receiving HIV care. We also simulated the hypothetical deployment of future LAM tests for all people presenting to care with TB symptoms, not restricted to PLHIV. Our model projects that 2,700,000 (95% credible interval [CrI] 2,000,000–3,600,000) and 420,000 (95% CrI 350,000–520,000) cumulative TB incident cases and deaths, respectively, would occur between 2020 and 2035 if the status quo is maintained. Relative to this comparator, current and future LAM tests would respectively avert 54 (95% CrI 33–86) and 90 (95% CrI 55–145) TB deaths amongst inpatients between 2020 and 2035, i.e., reductions of 5% (95% CrI 4%–6%) and 9% (95% CrI 7%–11%) in inpatient TB mortality. This impact in absolute deaths averted doubles if testing is expanded to include outpatients, yet remains <1% of country-level TB deaths. Similar patterns apply to incidence results. However, deploying a future LAM test for all people presenting to care with TB symptoms would avert 470,000 (95% CrI 220,000–870,000) incident TB cases (18% reduction, 95% CrI 9%–29%) and 120,000 (95% CrI 69,000–210,000) deaths (30% reduction, 95% CrI 18%–44%) between 2020 and 2035. Notably, this increase in impact arises largely from diagnosis of TB amongst those with HIV who are not yet in HIV care, and who would thus be ineligible for a LAM test under current guidelines. Qualitatively similar results apply under an alternative comparator assuming expanded use of GeneXpert MTB/RIF (‘Xpert’) for TB diagnosis. Sensitivity analysis demonstrates qualitatively similar results in a setting like Kenya, which also has a generalised HIV epidemic, but a lower burden of HIV/TB coinfection. Amongst limitations of this analysis, we do not address the cost or cost-effectiveness of future tests. Our model neglects drug resistance and focuses on the country-level epidemic, thus ignoring subnational variations in HIV and TB burden. Conclusions These results suggest that LAM tests could have an important effect in averting TB deaths amongst PLHIV with advanced disease. However, achieving population-level impact on the TB epidemic, even in high-HIV-burden settings, will require future LAM tests to have sufficient performance to be deployed more broadly than in HIV care.

scholarly journals Enhanced comparisons of COVID-19 mortality across populations

2020 ◽  
Author(s):  
Chalapati Rao ◽  
Suhail A. Doi ◽  
Gail Williams
Keyword(s):  
Health System ◽  
Age Distribution ◽  
Case Fatality ◽  
The South ◽  
South Korean ◽  
Age Variations ◽  
Incidence And Mortality ◽  
System Factors ◽  
The Impact ◽  
Age Structures

AbstractBackgroundThe reported crude case fatality rate (CFR) for COVID-19 varies considerably across countries. Crude CFRs could by biased by larger proportions of older COVID-19 cases in population data, who are also at increased mortality risk. Such distorted age case structures are a common feature of selective COVID 19 testing strategies in many countries, and they potentially mask underlying differences arising from other important factors such as health system burden.MethodsWe used the method of direct case-age standardisation to evaluate the effects of age variations on CFRs. Data on cases and death by age from Italy, Spain, China, Australia and South Korea were analysed to derive standardised CFRs. Findings were compared across different case age distribution references as standards.ResultsUsing the South Korean case age distribution as a standard, the fivefold higher crude CFR for Italy is reduced to less than two-fold after adjustment, while the crude CFR difference for Spain is virtually eliminated. The adjusted CFR for Australia is the lowest among all countries.DiscussionMortality differences based on crude CFRs are exaggerated by age structures, which are effectively controlled by case age standardization. Residual CFR differences could be attributed to health and health system factors. The South Korean case age distribution is an appropriate reference standard, given its robust case detection and contact tracing program. Till reliable population level indicators of incidence and mortality are available, the age-standardized CFR could be a viable option for international comparison of the impact of the COVID 19 epidemic.SummaryThe knownThere are intense debates around the magnitude of and reasons for wide variations in observed case fatality rates (CFRs) from COVID 19 across countries. Age is commonly speculated as a reason, but this has not been technically quantified or explained.The newThe technique of direct standardization using reference distributions of case age structures eliminates the effects of age on CFR, thus enhancing the comparability as well as understanding of differentialsThe implicationsResidual differences between adjusted CFRs can be used to infer health and health system factors that influence mortality in COVID 19 cases in different populations

scholarly journals Integrating sexual and reproductive health into health system strengthening in humanitarian settings: a planning workshop toolkit to transition from minimum to comprehensive services in the Democratic Republic of Congo, Bangladesh, and Yemen

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Nguyen Toan Tran ◽  
Alison Greer ◽  
Brigitte Kini ◽  
Hassan Abdi ◽  
Kariman Rajeh ◽  
...  
Keyword(s):  
Reproductive Health ◽  
Health System ◽  
Collaborative Design ◽  
Sexual And Reproductive Health ◽  
Democratic Republic ◽  
Democratic Republic Of Congo ◽  
Health System Strengthening ◽  
World Health ◽  
Republic Of Congo ◽  
Humanitarian Settings

Abstract Background Planning to transition from the Minimum Initial Service Package for Sexual and Reproductive Health (SRH) toward comprehensive SRH services has been a challenge in humanitarian settings. To bridge this gap, a workshop toolkit for SRH coordinators was designed to support effective planning. This article aims to describe the toolkit design, piloting, and final product. Methods Anchored in the Health System Building Blocks Framework of the World Health Organization, the design entailed two complementary and participatory strategies. First, a collaborative design phase with iterative feedback loops involved global partners with extensive operational experience in the initial toolkit conception. The second phase engaged stakeholders from three major humanitarian crises to participate in pilot workshops to contextualize, evaluate, validate, and improve the toolkit using qualitative interviews and end-of-workshop evaluations. The aim of this two-phase design process was to finalize a planning toolkit that can be utilized in and adapted to diverse humanitarian contexts, and efficiently and effectively meet its objectives. Pilots occurred in the Democratic Republic of Congo for the Kasai region crisis, Bangladesh for the Rohingya humanitarian response in Cox’s Bazar, and Yemen for selected Governorates. Results Results suggest that the toolkit enabled facilitators to foster a systematic, participatory, interactive, and inclusive planning process among participants over a two-day workshop. The approach was reportedly effective and time-efficient in producing a joint work plan. The main planning priorities cutting across settings included improving comprehensive SRH services in general, healthcare workforce strengthening, such as midwifery capacity development, increasing community mobilization and engagement, focusing on adolescent SRH, and enhancing maternal and newborn health services in terms of quality, coverage, and referral pathways. Recommendations for improvement included a dedicated and adequately anticipated pre-workshop preparation to gather relevant data, encouraging participants to undertake preliminary study to equalize knowledge to partake fully in the workshop, and enlisting participants from marginalized and underserved populations. Conclusion Collaborative design and piloting efforts resulted in a workshop toolkit that could support a systematic and efficient identification of priority activities and services related to comprehensive SRH. Such priorities could help meet the SRH needs of communities emerging from acute humanitarian situations while strengthening the overall health system.

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