Cost-effectiveness of routine provider-initiated testing and counseling for children with undiagnosed HIV in South Africa

Background We compared cost-effectiveness of pediatric provider-initiated HIV testing and counseling (PITC) versus no PITC in a range of clinical care settings in South Africa. Methods We used the CEPAC-Pediatric model to simulate a cohort of children, aged 2-10 years, presenting for care in four settings (outpatient, malnutrition, inpatient, tuberculosis clinic) with varying prevalence of undiagnosed HIV (1.0%, 15.0%, 17.5%, 50.0%, respectively). We compared “PITC” (routine testing offered to all patients; 97% acceptance and 71% linkage to care after HIV diagnosis) to no PITC. Model outcomes included life expectancy, lifetime costs, and incremental cost-effectiveness ratios (ICERs) from the healthcare system perspective, and the proportion of children living with HIV (CLWH) diagnosed, on ART, and virally suppressed. We assumed a threshold of $3,200/YLS to determine cost-effectiveness. Sensitivity analyses varied the age distribution of children seeking care and costs for PITC, HIV care, and ART. Results PITC improved the proportion of CLWH diagnosed (45.2% to 83.2%), on ART (40.8% to 80.4%), and virally suppressed (32.6% to 63.7%) at one year in all settings. PITC increased life expectancy by 0.1-0.7 years for children seeking care (including those with and without HIV). In all settings, the ICER of PITC versus no PITC was very similar, ranging from $710-1,240/YLS. PITC remained cost-effective unless undiagnosed HIV prevalence was <0.2%. Conclusions Routine testing improves HIV clinical outcomes and is cost-effective in South Africa, if prevalence of undiagnosed HIV among children exceeds 0.2%. These findings support current recommendations for PITC in outpatient, inpatient, tuberculosis, and malnutrition clinical settings.

A full-factorial randomized controlled trial of adjunct couples HIV testing and counseling components addressing drug use and communication skills among sexual minority male couples

Background The past decade has seen increasing attention directed to the development of HIV prevention interventions for male couples, driven by epidemiological data indicating that main or primary – rather than causal – partnerships account for a substantial number of HIV infections in this population. Couples HIV testing and counseling (CHTC) has emerged as a standard of care in the US. This protocol describes a study that aims to evaluate the efficacy of two adjunct components to CHTC – communication training (CT) videos and a substance use module (SUM) – to reduce drug use and sexual HIV transmission risk behavior. Methods Eligible couples must include one participant who is aged 17-29, HIV-negative, and reports recent drug use. Both partners must be aged 17 or older, identify as cismale (assigned male sex at birth and currently identify as male gender), and communicate in English. Couples are randomized post-baseline to one of four conditions (CHTC as usual, CHTC plus CT video; CHTC + SUM and CHTC + CT video + SUM) in a full-factorial design. Follow up assessments are completed at 3-, 6-, 9- and 12-months post baseline. Discussion Results of this trial will enhance the application of CHTC. If found effective, adjunct components would comprise a brief and scalable drug use intervention that could be readily integrated into existing HIV testing settings. Trial registration ClinicalTrials.gov Protocol Registration; NCT05000866; completed August 3, 2021; https://register.clinicaltrials.gov/ Protocol version 1.0; September 1, 2021.

Optimal Control in Stochastic Model with Short Message Service to HIV/AIDS patients under ARV

In this paper, we treat an application of a optimal control problem to the stochastic dynamic system in epidemic. We consider a HIV/AIDS stochastic dynamic model with anti retro viral (ARV)-therapy. This model is formulated and is analyzed previously in [11]. Our objective is to minimize the newly infection cases. ARV-therapy is a curative measure of HIV/AIDS patients. It presents until there the therapeutic effect efficient, even in the cases of resistances. This treatment measure associated to the preventive measures as HIV-Testing and Counseling (HTC), i.e. test technology and education, sensitization campaign on change sexual behavior among people that run the risk, especially, the strategy of quick-alert by Short Message Service (SMS) to patients by the care service, for to ensure that these take their treatment effectively, are again the optimal strategies of the control that permits to reduce the new cases of infection. Thus, we introduce three additional variables in a stochastic dynamic proposed in [11] to act on the proportions of HIV/AIDS patients under ARV by the optimal strategies for the purpose to reduce the prevalence and the incidence. A minimization problem of newly infection cases of HIV/AIDS is formulated and solved analytically and numerically via Bellman’s principle. The numerical results of this controlled dynamics are also described.

Mapping the Diverse and Inclusive Future of Parkinson’s Disease Genetics and Its Widespread Impact

Over the last decades, genetics has been the engine that has pushed us along on our voyage to understand the etiology of Parkinson’s disease (PD). Although a large number of risk loci and causative mutations for PD have been identified, it is clear that much more needs to be done to solve the missing heritability mystery. Despite remarkable efforts, as a field, we have failed in terms of diversity and inclusivity. The vast majority of genetic studies in PD have focused on individuals of European ancestry, leading to a gap of knowledge on the existing genetic differences across populations and PD as a whole. As we move forward, shedding light on the genetic architecture contributing to PD in non-European populations is essential, and will provide novel insight into the generalized genetic map of the disease. In this review, we discuss how better representation of understudied ancestral groups in PD genetics research requires addressing and resolving all the challenges that hinder the inclusion of these populations. We further provide an overview of PD genetics in the clinics, covering the current challenges and limitations of genetic testing and counseling. Finally, we describe the impact of worldwide collaborative initiatives in the field, shaping the future of the new era of PD genetics as we advance in our understanding of the genetic architecture of PD.

Assessing comprehensive care deficits in United States (U.S.) ovarian cancer programs to inform quality improvement initiatives.

256 Background: Ovarian cancer is the leading cause of gynecologic cancer mortality in the US. Given the high burden of disease and complexities in the provision of quality care, a multidisciplinary team approach is critical to optimal care delivery. In 2019, the Association of Community Cancer Centers (ACCC) launched a multiphase, stakeholder-driven initiative to improve care for this patient population. Results of a national survey of cancer programs to identify the needs of patients are reported here. Methods: A 20 question survey was developed by an expert steering committee including gynecologic oncologists, pathologists, genetic counselors, a nurse navigator, and cancer center administrators. The instrument was designed to collect data about cancer programs, key ovarian cancer patient needs, and barriers to and opportunities for improving ovarian cancer care. The online survey was open for participation for 4 weeks using the Qualtrics platform and distributed via email to ACCC and Society of Gynecologic Oncology members. Results: We received 26 total responses from Comprehensive Community (26%), NCI-Designed Comprehensive (22%), Academic Comprehensive (22%), and Integrated Network (13%) Cancer Programs. Annual ovarian cancer cases ranged from 22 to 190 (median: 50.5). 85% of programs has a multidisciplinary team for ovarian cancer and 61% were part of a referral network. On average, programs has 1.5 phase II and 2 phase III clinical trials currently available for ovarian cancer (all programs had at least 1 trial available). Palliative care and comprehensive symptom management was integrated into the first appointment (15%), integrated at the time of recurrence (4%), and most frequently, available by consult (81%). We assessed genetic testing practices at each program. Aggregated across programs, 79% of patients received germline multipanel testing, 71% germline BRCA only, 50% somatic multigene, and 51% somatic BRCA only. The frequency of consultations included: genetic counseling (75%), nurse navigation (75%), social work (50%), dietetics (40%), financial counseling (25%). Genetic evaluations were typically ordered by Gynecologic Oncology (88%), genetic counseling (4%), or both (8%). When asked what topic they would choose for a quality improvement project, genetic testing and counseling was the most frequent choice (46%), followed by clinical trials enrollment and availability (23%), multidisciplinary team care (19%), education on best practices (15%), palliative care (15%), and ancillary services (15%). Conclusions: Multidisciplinary care for ovarian cancer was common across a range of cancer programs but integration of palliative care, social work, dietetics, and financial counseling could be improved. Expanding clinical trials and genetic testing and counseling were the most frequently identified opportunities to improve ovarian cancer care.

Adelia Risa P

The focus of the study was to identify and analyzed the policy implementation HIV testing and counseling program in Teladan health center in order to achieve the SDG’s target by using interactive issues of GeorgeCEdward III such as communication, resources, disposition, bereaucratic structure, that has a role in policy implemetation.These fourth issues was meaningful due to policy implemetation and designed by qualitative method through descriptive analysis and object was Medan Health Department, Teladan Health Center and Community Health Center In working area.The result showed that the implementation HIV testing and counseling program in Teladan Health Center for achieving the SDG’s target was qualify through not perfect yet.

Does facility readiness promote high-quality of provider-initiated HIV testing and counseling to pregnant women? A national survey for improving policy of prevention of mother-to-child transmission of HIV in Tanzania

Background Provider-initiated HIV testing and counseling (PITC) is a recommended approach to screen for HIV to all pregnant women during antenatal care (ANC) visits, and all with HIV positive results have to be enrolled into prevention of mother-to-child transmission of HIV (PMTCT) program. However, little is known about the relationship between facility readiness and the uptake of PITC to pregnant women attending ANC in Tanzania. Therefore, this study assessed whether the facility readiness promotes the uptake of PITC to the pregnant women attending ANC for the purpose of improving the PMTCT interventions in Tanzania. Methods This study analyzed data for health facilities obtained from the 2014–2015 Tanzania service provision assessment survey. The Primary outcome measure was a composite variable (with score of 0–5) in which its higher scores indicates provision of high-quality of PITC. Also, facilities scored higher in the PMTCT service readiness index were considered to have high readiness to provide PMTCT services. In Poisson regression analyses, a series of models were fitted to assess whether there is an association between provision of high-quality of PITC and facility readiness. In all statistical analysis, a P < 0.05 was considered significant. Results Out of 1853 included first-visit ANC consultations, only about one-third of pregnant women received all five components required for PITC. The mean percentage of PMTCT readiness score was moderate 63.96 [61.32–66.59]%. In adjusted model, we found that facility with high readiness to provide PMTCT services was significantly associated with the provision of high-quality of PITC (model 2: [β = 0.075, P = 0.00]). Conclusion In order to increase high-quality of PITC services, efforts should be made to improve the PMTCT facility readiness by increasing availability of trained staffs, diagnostic tools, and ARTs among health facilities in Tanzania.