scholarly journals Costs and outcomes of active and passive case detection for visceral leishmaniasis (Kala-Azar) to inform elimination strategies in Bihar, India

2021 ◽  
Vol 15 (2) ◽  
pp. e0009129
Author(s):  
Natalie J. Dial ◽  
Graham F. Medley ◽  
Simon L. Croft ◽  
Tanmay Mahapatra ◽  
Khushbu Priyamvada ◽  
...  
Keyword(s):  
Visceral Leishmaniasis ◽  
Index Case ◽  
Unit Cost ◽  
Scale Up ◽  
Scaling Up ◽  
Case Detection ◽  
Health Authorities ◽  
Passive Case Detection ◽  
The Cost ◽  
Case Based

Background Effective case identification strategies are fundamental to capturing the remaining visceral leishmaniasis (VL) cases in India. To inform government strategies to reach and sustain elimination benchmarks, this study presents costs of active- and passive- case detection (ACD and PCD) strategies used in India’s most VL-endemic state, Bihar, with a focus on programme outcomes stratified by district-level incidence. Methods Expenditure analysis was complemented by onsite micro-costing to compare the cost of PCD in hospitals alongside index case-based ACD and a combination of blanket (house-to-house) and camp ACD from January to December 2018. From the provider’s perspective, a cost analysis evaluated the overall programme cost of each activity, the cost per case detected, and the cost of scaling up ACD. Results During 2018, index case-based ACD, blanket and camp ACD, and PCD reported 1,497, 131, and 1,983 VL-positive cases at a unit cost of $522.81, $4,186.81, and $246.79, respectively. In high endemic districts, more VL cases were identified through PCD while in meso- and low-endemic districts more cases were identified through ACD. The cost of scaling up ACD to identify 3,000 additional cases ranged from $1.6–4 million, depending on the extent to which blanket and camp ACD was relied upon. Conclusion Cost per VL test conducted (rather than VL-positive case identified) may be a better metric estimating unit costs to scale up ACD in Bihar. As more VL cases were identified in meso-and low-endemic districts through ACD than PCD, health authorities in India should consider bolstering ACD in these areas. Blanket and camp ACD identified fewer cases at a higher unit cost than index case-based ACD. However, the value of detecting additional VL cases early outweighs long-term costs for reaching and sustaining VL elimination benchmarks in India.

scholarly journals Effectiveness and Feasibility of Active and Passive Case Detection in the Visceral Leishmaniasis Elimination Initiative in India, Bangladesh, and Nepal

2010 ◽  
Vol 83 (3) ◽  
pp. 507-511 ◽  
Author(s):  
Siddhivinayak Hirve ◽  
Megha Raj Banjara ◽  
Axel Kroeger ◽  
Shri Prakash Singh ◽  
Suman Rijal ◽  
...  
Keyword(s):  
Visceral Leishmaniasis ◽  
Case Detection ◽  
Passive Case Detection

scholarly journals Passive case detection for canine visceral leishmaniasis control in urban Brazil: Determinants of population uptake

2021 ◽  
Vol 15 (10) ◽  
pp. e0009818
Author(s):  
João Gabriel G. Luz ◽  
Amanda G. de Carvalho ◽  
João Victor L. Dias ◽  
Luis Claudio L. Marciano ◽  
Sake J. de Vlas ◽  
...  
Keyword(s):  
Visceral Leishmaniasis ◽  
Negative Binomial ◽  
Clinical Manifestations ◽  
Time Dependent ◽  
Case Detection ◽  
Canine Visceral Leishmaniasis ◽  
Serological Screening ◽  
Passive Case Detection ◽  
Dog Owners ◽  
Screening Site

Background In Brazil, the transmission of Leishmania infantum in urban settings is closely related to infection among dogs, with occasional transmission to humans. Serological screening of dogs for Leishmania spp. infection on requests of their owners (passive case detection) represents a frequent, but little studied, practice within the scope of Brazilian public health. This study identified factors associated with canine visceral leishmaniasis (CVL) diagnosis-seeking behavior of dog owners in Rondonópolis (236,000 inhabitants), a municipality in Central-Western Brazil where VL is endemic. Also, we evaluated the profile of dog owners and their animals screened on free demand. Methodology/Principal findings Using mixed effects negative binomial regression, we modelled the number of dogs screened for Leishmania infection on free demand per neighborhood from 2011 to 2016 as a function of time-dependent predictors (current or recent canine seropositivity and human VL incidence), distance to the screening site, and demographic variables. We assessed potential delays in the effect of time-dependent predictors on the outcome. Among 12,536 dogs screened for Leishmania infection, 64.2% were tested during serosurveys and 35.8% were tested on free demand. Of these, 63.9% were positive. Uptake of screening under free demand was strongly associated with higher levels of canine seropositivity in the neighborhood (current or recent) and decreasing distance to the screening site. A subsample of dog owners (n = 93) who sought CVL screening between 2016 and 2017 were interviewed in more detail. Owners with better socioeconomic status and dogs with apparent CVL clinical manifestations prevailed among them. Conclusions/Significance To support timely CVL management, passive case detection along with awareness activities aimed at dog owners should be encouraged in endemic areas. Screening sites should be prioritized in accessible zones, as well as in socio-economically disadvantage areas. In parallel, CVL active case detection should be continued as a surveillance tool to guide control actions.

scholarly journals Reducing regional inequality in community-based treatment of childhood pneumonia in Ethiopia: A sub-national distributional cost-effectiveness analysis

2020 ◽  
Author(s):  
Maria Olsen ◽  
Ole F. Norheim ◽  
Solomon Tessema Memirie
Keyword(s):  
Cost Effectiveness ◽  
Scenario Analysis ◽  
Scale Up ◽  
Scaling Up ◽  
Community Based ◽  
Childhood Pneumonia ◽  
Under Five ◽  
Geographical Inequalities ◽  
The Cost ◽  
Universal Scale

Abstract Background Scaling up coverage of community-based treatment of childhood pneumonia (CCM) is part of the strategy to promote equity and reduce under-five mortality rate (U5MR) in Ethiopia. However, urban children with symptoms of pneumonia are still more than twice as likely to receive treatment compared with rural children having similar symptoms. There are no sub-national cost-effectiveness analyses available to inform decision makers on the most equitable scale-up strategy. Objectives To model sub-national cost-effectiveness and inequality impacts of scaling up coverage of CCM in each of the 11 Ethiopian regions. We also explore three different scale-up strategies: reducing geographical inequalities, health maximization and universal scale-up. Methods For each region, we developed a Markov model and estimated the cost-effectiveness of scaling up coverage to 90 percent. Data inputs were collected through literature review. Effects were modeled as life years gained and under-five deaths averted. Inputs on unit costs were adjusted to the proportions of rural and urban population in each region. In scenario analysis, we estimated costs, health effects and, by the use of the Gini measure applied to health, the inequality impacts of three different scale-up strategies: 1) maximizing health by prioritizing the regions where the intervention was the most cost-effective, 2) reducing geographical inequality by prioritizing the regions with the highest baseline U5MR and 3) universally scaling up to 90% coverage in all the regions. Results Universal scale-up of CCM would cost about 1.3 billion USD and prevent about 90,000 under-five deaths. This is less than 15,000 USD per life saved and translates to an increase in life expectancy at birth of 1.6 years across Ethiopia. The regional incremental-cost effectiveness ratio (ICER) of scaling up the intervention coverage varied from 26 USD per life year gained in Addis to 199 USD per life year gained in the SNNP region. In scenario analysis, we found that prioritizing regions with high U5MR is effective in reducing geographical inequalities, although at the cost of some fewer lives saved. Conclusions Our model results illustrate a trade-off between maximizing health and reducing health inequalities, two common policy-aims in low-income settings.

scholarly journals From Patañjali to the “Gospel of Sweat”: Yoga’s Remarkable Transformation from a Sacred Movement into a Thriving Global Market

2021 ◽  
pp. 000183922199347
Author(s):  
Kamal Munir ◽  
Shahzad (Shaz) Ansari ◽  
Deborah Brown
Keyword(s):  
Market Economy ◽  
Scale Up ◽  
Extreme Case ◽  
Scaling Up ◽  
Moral Values ◽  
Global Market ◽  
Market Mechanism ◽  
Key Aspects ◽  
The Cost ◽  
Collective Goals

Movements seeking to infuse markets with moral values often end up utilizing the market mechanism and support from mainstream actors to scale up, even if it comes at the cost of diluting their founding ethos. But this process can be particularly challenging for movements that are explicitly opposed to using a market mechanism as a means of scaling up. Our analysis of yoga between 1975 and 2016 reveals how a countercultural movement fundamentally opposed to a capitalist market economy but seeking to grow can paradoxically become syncretic with or infiltrated by concepts and beliefs that are core to the market system but incompatible with the movement’s original ethos. We show how, before such a movement can be commodified, it must be de-essentialized, a process that requires stripping away key aspects of its history, context, and religious commitments and transforming collective goals into individual ones. This process involves not only external entrepreneurs looking to mine the movement but also movement leaders seeking wider enrollment of resource-rich actors to scale the movement up. We show how codes borrowed from parallel movements and templates borrowed from markets can be instrumental in driving such a movement’s transformation. Through this extreme case of the yoga movement, we advance understandings of how movements can become syncretic with values and practices they fundamentally oppose.

Marginal assessment of the cost and benefits of aphasia treatment: Evidence from community-based telerehabilitation treatment for aphasia

2021 ◽  
pp. 1357633X2098277
Author(s):  
Molly Jacobs ◽  
Patrick M Briley ◽  
Heather Harris Wright ◽  
Charles Ellis
Keyword(s):  
Cost Effectiveness ◽  
Economies Of Scale ◽  
Reference Group ◽  
Unit Cost ◽  
Community Based ◽  
Face To Face ◽  
Conduction Aphasia ◽  
Aphasia Treatment ◽  
The Cost ◽  
The Relationship

Introduction Few studies have reported information related to the cost-effectiveness of traditional face-to-face treatments for aphasia. The emergence and demand for telepractice approaches to aphasia treatment has resulted in an urgent need to understand the costs and cost-benefits of this approach. Methods Eighteen stroke survivors with aphasia completed community-based aphasia telerehabilitation treatment, utilizing the Language-Oriented Treatment (LOT) delivered via Webex videoconferencing program. Marginal benefits to treatment were calculated as the change in Western Aphasia Battery-Revised (WAB-R) score pre- and post-treatment and marginal cost of treatment was calculated as the relationship between change in WAB-R aphasia quotient (AQ) and the average cost per treatment. Controlling for demographic variables, Bayesian estimation evaluated the primary contributors to WAB-R change and assessed cost-effectiveness of treatment by aphasia type. Results Thirteen out of 18 participants experienced significant improvement in WAB-R AQ following telerehabilitation delivered therapy. Compared to anomic aphasia (reference group), those with conduction aphasia had relatively similar levels of improvement whereas those with Broca’s aphasia had smaller improvement. Those with global aphasia had the largest improvement. Each one-point of improvement cost between US$89 and US$864 for those who improved (mean = US$200) depending on aphasia type/severity. Discussion Individuals with severe aphasia may have the greatest gains per unit cost from treatment. Both improvement magnitude and the cost per unit of improvement were driven by aphasia type, severity and race. Economies of scale to aphasia treatment–cost may be minimized by treating a variety of types of aphasia at various levels of severity.

scholarly journals Strategies for involving patients and the public in scaling-up initiatives in health and social services: protocol for a scoping review and Delphi survey

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Ali Ben Charif ◽  
◽  
Karine V. Plourde ◽  
Sabrina Guay-Bélanger ◽  
Hervé Tchala Vignon Zomahoun ◽  
...  
Keyword(s):  
Social Services ◽  
Scoping Review ◽  
Delphi Study ◽  
Public Involvement ◽  
Scale Up ◽  
Scaling Up ◽  
Delphi Survey ◽  
The Public ◽  
Health And Social Services ◽  
Scoping Reviews

Abstract Background The scale-up of evidence-based innovations is required to reduce waste and inequities in health and social services (HSS). However, it often tends to be a top-down process initiated by policy makers, and the values of the intended beneficiaries are forgotten. Involving multiple stakeholders including patients and the public in the scaling-up process is thus essential but highly complex. We propose to identify relevant strategies for meaningfully and equitably involving patients and the public in the science and practice of scaling up in HSS. Methods We will adapt our overall method from the RAND/UCLA Appropriateness Method. Following this, we will perform a two-prong study design (knowledge synthesis and Delphi study) grounded in an integrated knowledge translation approach. This approach involves extensive participation of a network of stakeholders interested in patient and public involvement (PPI) in scaling up and a multidisciplinary steering committee. We will conduct a systematic scoping review following the methodology recommended in the Joanna Briggs Institute Reviewers Manual. We will use the following eligibility criteria: (1) participants—any stakeholder involved in creating or testing a strategy for PPI; (2) intervention—any PPI strategy proposed for scaling-up initiatives; (3) comparator—no restriction; (4) outcomes: any process or outcome metrics related to PPI; and (5) setting—HSS. We will search electronic databases (e.g., Medline, Web of Science, Sociological Abstract) from inception onwards, hand search relevant websites, screen the reference lists of included records, and consult experts in the field. Two reviewers will independently select and extract eligible studies. We will summarize data quantitatively and qualitatively and report results using the PRISMA extension for Scoping Reviews (PRISMA-ScR) checklist. We will conduct an online Delphi survey to achieve consensus on the relevant strategies for PPI in scaling-up initiatives in HSS. Participants will include stakeholders from low-, middle-, and high-income countries. We anticipate that three rounds will allow an acceptable degree of agreement on research priorities. Discussion Our findings will advance understanding of how to meaningfully and equitably involve patients and the public in scaling-up initiatives for sustainable HSS. Systematic review registration We registered this protocol with the Open Science Framework on August 19, 2020 (https://osf.io/zqpx7/).

scholarly journals Estimating the programmatic cost of targeted mass drug administration for malaria in Myanmar

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shwe Sin Kyaw ◽  
Gilles Delmas ◽  
Tom L. Drake ◽  
Olivier Celhay ◽  
Wirichada Pan-ngum ◽  
...  
Keyword(s):  
Drug Administration ◽  
Mass Drug Administration ◽  
Malaria Elimination ◽  
Unit Cost ◽  
Financial Data ◽  
Research Activities ◽  
High Incidence ◽  
Implementation Costs ◽  
The Cost ◽  
Greater Mekong Subregion

Abstract Background Mass drug administration (MDA) has received growing interest to accelerate the elimination of multi-drug resistant malaria in the Greater Mekong Subregion. Targeted MDA, sometimes referred to as focal MDA, is the practice of delivering MDA to high incidence subpopulations only, rather than the entire population. The potential effectiveness of delivering targeted MDA was demonstrated in a recent intervention in Kayin State, Myanmar. Policymakers and funders need to know what resources are required if MDA, targeted or otherwise, is to be included in elimination packages beyond existing malaria interventions. This study aims to estimate the programmatic cost and the unit cost of targeted MDA in Kayin State, Myanmar. Methods We used financial data from a malaria elimination initiative, conducted in Kayin State, to estimate the programmatic costs of the targeted MDA component using a micro-costing approach. Three activities (community engagement, identification of villages for targeted MDA, and conducting mass treatment in target villages) were evaluated. We then estimated the programmatic costs of implementing targeted MDA to support P. falciparum malaria elimination in Kayin State. A costing tool was developed to aid future analyses. Results The cost of delivering targeted MDA within an integrated malaria elimination initiative in eastern Kayin State was approximately US$ 910,000. The cost per person reached, distributed among those in targeted and non-targeted villages, for the MDA component was US$ 2.5. Conclusion This cost analysis can assist policymakers in determining the resources required to clear malaria parasite reservoirs. The analysis demonstrated the value of using financial data from research activities to predict programmatic implementation costs of targeting MDA to different numbers of target villages.

scholarly journals Promoting Scale-Up Across a Global Project Platform: Lessons from the Evidence to Action Project

2021 ◽  
Author(s):  
Laura Ghiron ◽  
Eric Ramirez-Ferrero ◽  
Rita Badiani ◽  
Regina Benevides ◽  
Alexis Ntabona ◽  
...  
Keyword(s):  
Family Planning ◽  
Scale Up ◽  
Scaling Up ◽  
Sub Saharan Africa ◽  
Health System Strengthening ◽  
Country Level ◽  
Look Ahead ◽  
Republic Of The Congo ◽  
Sub Saharan ◽  
Multi Stakeholder

AbstractThe USAID-funded flagship family planning service delivery project named Evidence to Action (E2A) worked from 2011 to 2021 to improve family planning and reproductive health for women and girls across seventeen nations in sub-Saharan Africa using a “scaling-up mindset.” The paper discusses three key lessons emerging from the project’s experience with applying ExpandNet’s systematic approach to scale up. The methodology uses ExpandNet/WHO’s scaling-up framework and guidance tools to design and implement pilot or demonstration projects in ways that look ahead to their future scale-up; develop a scaling-up strategy with local stakeholders; and then strategically manage the scaling-up process. The paper describes how a scaling-up mindset was engendered, first within the project’s technical team in Washington and then how they subsequently sought to build capacity at the country level to support scale-up work throughout E2A’s portfolio of activities. The project worked with local multi-stakeholder resource teams, often led by government officials, to equip them to lead the scale-up of family planning and health system strengthening interventions. Examples from project experience in the Democratic Republic of the Congo, Kenya, Nigeria, and Uganda illustrating key concepts are discussed. E2A also established a community of practice on systematic approaches to scale up as a platform for sharing learning across a variety of technical agencies engaged in scale-up work and to create learning opportunities for interacting with thought leaders around critical scale-up issues.

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