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1.
Background
How should HIV and AIDS resources be allocated to achieve the greatest possible impact? This paper begins with a theoretical discussion of this issue, describing the key elements of an "evidence-based allocation strategy". While it is noted that the quality of epidemiological and economic data remains inadequate to define such an optimal strategy, there do exist tools and research which can lead countries in a way that they can make allocation decisions. Furthermore, there are clear indications that most countries are not allocating their HIV and AIDS resources in a way which is likely to achieve the greatest possible impact. For example, it is noted that neighboring countries, even when they have a similar prevalence of HIV, nonetheless often allocate their resources in radically different ways.These differing allocation patterns appear to be attributable to a number of different issues, including a lack of data, contradictory results in existing data, a need for overemphasizing a multisectoral response, a lack of political will, a general inefficiency in the use of resources when they do get allocated, poor planning and a lack of control over the way resources get allocated.Methods
There are a number of tools currently available which can improve the resource-allocation process. Tools such as the Resource Needs Model (RNM) can provide policymakers with a clearer idea of resource requirements, whereas other tools such as Goals and the Allocation by Cost-Effectiveness (ABCE) models can provide countries with a clearer vision of how they might reallocate funds.Results
Examples from nine different countries provide information about how policymakers are trying to make their resource-allocation strategies more "evidence based". By identifying the challenges and successes of these nine countries in making more informed allocation decisions, it is hoped that future resource-allocation decisions for all countries can be improved.Conclusion
We discuss the future of resource allocation, noting the types of additional data which will be required and the improvements in existing tools which could be made.2.
Background
This paper discusses the practices of organisations that cross the boundary between research and politics, to promote evidence-based policies and programmes.Methods
It uses the experience of a network of organisations in Africa to describe the methodology, challenges and successes of efforts to promote utilisation of research on the inter-connections between HIV/AIDS, food security and nutrition in South Africa. It emphasises that crossing the boundary between science and politics can be done systematically and is inevitable for any attempt that seeks influence policy making.Results
The paper reveals the complexity of the research-policy making interface and identifies key lessons for the practice of networking and engaging policy and decision-makers.Conclusion
The concept of boundary organisation is a helpful means to understand the methodological underpinnings of efforts to get research into policy and practice and to understand the ‘messy’ process of doing so.3.
Diego F. Cuadros Benn Sartorius Chris Hall Adam Akullian Till Bärnighausen Frank Tanser 《International journal of health geographics》2018,17(1):27
Background
Large geographical variations in the intensity of the HIV epidemic in sub-Saharan Africa call for geographically targeted resource allocation where burdens are greatest. However, data available for mapping the geographic variability of HIV prevalence and detecting HIV ‘hotspots’ is scarce, and population-based surveillance data are not always available. Here, we evaluated the viability of using clinic-based HIV prevalence data to measure the spatial variability of HIV in South Africa and Tanzania.Methods
Population-based and clinic-based HIV data from a small HIV hyper-endemic rural community in South Africa as well as for the country of Tanzania were used to map smoothed HIV prevalence using kernel interpolation techniques. Spatial variables were included in clinic-based models using co-kriging methods to assess whether cofactors improve clinic-based spatial HIV prevalence predictions. Clinic- and population-based smoothed prevalence maps were compared using partial rank correlation coefficients and residual local indicators of spatial autocorrelation.Results
Routinely-collected clinic-based data captured most of the geographical heterogeneity described by population-based data but failed to detect some pockets of high prevalence. Analyses indicated that clinic-based data could accurately predict the spatial location of so-called HIV ‘hotspots’ in?>?50% of the high HIV burden areas.Conclusion
Clinic-based data can be used to accurately map the broad spatial structure of HIV prevalence and to identify most of the areas where the burden of the infection is concentrated (HIV ‘hotspots’). Where population-based data are not available, HIV data collected from health facilities may provide a second-best option to generate valid spatial prevalence estimates for geographical targeting and resource allocation.4.
Background
There has been a sudden increase in the amount of money donors are willing to spend on the worldwide HIV/AIDS epidemic. Present plans are to hold most of the money in reserve and spend it slowly. However, rapid spending may be the best strategy for halting this disease.Methods
We develop a mathematical model that predicts eradication or persistence of HIV/AIDS on a world scale. Dividing the world into regions (continents, countries etc), we develop a linear differential equation model of infectives which has the same eradication properties as more complex models.Results
We show that, even if HIV/AIDS can be eradicated in each region independently, travel/immigration of infectives could still sustain the epidemic. We use a continent-level example to demonstrate that eradication is possible if preventive intervention methods (such as condoms or education) reduced the infection rate to two fifths of what it is currently. We show that, for HIV/AIDS to be eradicated within five years, the total cost would be ≈ $63 billion, which is within the existing $60 billion (plus interest) amount raised by the donor community. However, if this action is spread over a twenty year period, as currently planned, then eradication is no longer possible, due to population growth, and the costs would exceed $90 billion.Conclusion
Eradication of AIDS is feasible, using the tools that we have currently to hand, but action needs to occur immediately. If not, then HIV/AIDS will race beyond our ability to afford it.5.
Background
South-Asian countries are considered to be a potential breeding ground for HIV epidemic. Although the prevalence of this incurable disease is low in Bangladesh, women still have been identified as more vulnerable group. The aim of this study is to assess the knowledge about HIV/AIDS: its trends and associated factors among the women in Bangladesh.Methods
We analysed the nationally representative repeatedly cross-sectional Bangladesh Demographic and Health Surveys (BDHSs) data: 2007, 2011, and 2014. These data were clustered in nature due to the sampling design and the generalized mixed effects model is appropriate to examine the association between the outcome and the explanatory variables by adjusting for the cluster effect.Results
Overall, women’s knowledge about HIV/AIDS has been decreasing over the years. Education plays the leading role and secondary-higher educated women are 6.6 times more likely to have HIV/AIDS knowledge. The likelihood of knowledge is higher among the women who had media exposure (OR: 1.6) and knowledge on family planning (OR: 2.3). A rural-urban gap is noticed in women’s knowledge about HIV/AIDS and significant improvement has been observed among the rural and media exposed women. Results reveal that age, region, religion, socio-economic status, education, contraceptive use have significant (p<0.01) effects on women’s knowledge about HIV/AIDS.Conclusion
This study recommends to emphasis more on women’s education, media exposure, and family planning knowledge in strengthening women’s knowledge about HIV/AIDS. In addition, residence specific programs regarding HIV/AIDS awareness also need to be prioritized.6.
Background
Swaziland is experiencing the world’s worst HIV and AIDS epidemic. Prevalence rose from four percent of antenatal clinic attendees in 1992 to 42.6 percent in 2004. The Report ‘Reviewing ‘Emergencies’ for Swaziland: Shifting the Paradigm in a New Era’ published in 2007 bought together social and economic indicators. It built a picture of the epidemic as a humanitarian emergency, requiring urgent action from international organisations, donors, and governments. Following a targeted communications effort, the report was believed to have raised the profile of the issue and Swaziland - a success story for HIV and AIDS research.Methods
Keen to understand how, where and why the report had an impact, Health Economics and HIV/AIDS Research Division commissioned an assessment to track and evaluate the influence of the research. This tapped into literature on the significance of understanding the research-to-policy interface. This paper outlines the report and its impact. It explores key findings from the assessment and suggests lessons for future research projects.Results
The paper demonstrates that, although complex, and not without methodological issues, impact assessment of research can be of real value to researchers in understanding the research-to-policy interface.Conclusion
Only by gaining insight into this process can researchers move forward in delivering effective research.7.
Crane Paul K. Gibbons Laura E. Ocepek-Welikson Katja Cook Karon Cella David Narasimhalu Kaavya Hays Ron D. Teresi Jeanne A. 《Quality of life research》2007,16(1):69-84
Background
Several techniques have been developed to detect differential item functioning (DIF), including ordinal logistic regression (OLR). This study compared different criteria for determining whether items have DIF using OLR.Objectives
To compare and contrast findings from three different sets of criteria for detecting DIF using OLR. General distress and physical functioning items were evaluated for DIF related to five covariates: age, marital status, gender, race, and Hispanic origin.Research design
Cross-sectional study.Subjects
1,714 patients with cancer or HIV/AIDS.Measures
A total of 23 items addressing physical functioning and 15 items addressing general distress were selected from a pool of 154 items from four different health-related quality of life questionnaires.Results
The three sets of criteria produced qualitatively and quantitatively different results. Criteria based on statistical significance alone detected DIF in almost all the items, while alternative criteria based on magnitude detected DIF in far fewer items. Accounting for DIF by using demographic-group specific item parameters had negligible effects on individual scores, except for race.Conclusions
Specific criteria chosen to determine whether items have DIF have an impact on the findings. Criteria based entirely on statistical significance may detect small differences that are clinically negligible.8.
9.
Introduction
The long average incubation time from HIV infection to AIDS makes it difficult to estimate the recent tendencies of HIV from AIDS incidence data. The objective of this study was to investigate the effects of three temporal components in AIDS incidence in the state of Rio de Janeiro, Brazil - age, period, and cohort.Methods
Age-specific AIDS incidence rates per 100,000 from Rio de Janeiro (Brazil) were calculated for both sexes using five-year age classes from 1985 to 2009 based on reported data from the Notifiable Disease Information System of the Brazilian Ministry of Health and from census population counts. Multivariate negative binomial models were used to analyze the risk of AIDS by age, period, and birth cohort.Results
From 1985 to 2009, AIDS incidence initially increased with age in each birth cohort and then decreased (except for individuals born from 1971–1979 to 1986–1994). High peaks in the rates in each birth cohort were detected in 1995–1999 for males and in 2000–2004 for females. Multivariate analysis showed the maximum risk of AIDS in the 30–34 age group and 1958–1962 birth cohort.Conclusion
Age, birth cohort, and period effects all may have influenced the AIDS incidence rates over the period investigated. From 1985 to 1999, comparison of the tendencies (by age) of the period with the birth cohort revealed opposing tendencies in individuals older than 29 years and in the youngest age groups (0 to 14 years). From 2000 to 2009, a strong age effect can be observed in both sexes. Consistent changes in period tendency curves suggest the occurrence of period effects. A reduction in the intensity of the risk of AIDS can be observed after 2000–2004.10.
Beate Blättner Katharina Ponomarew Katharina Kraemer Sabrina Griesel Stefanie Roß-Stabernack Kerstin Krüger 《Pr?vention und Gesundheitsf?rderung》2018,13(2):146-150
Background
Nursing care insurance should stimulate healthy organizational development processes in order to strengthen the health resources of people who are in need of in-patient care. The perceptions of decision-makers in the nursing homes were of interest.Methods
Between July and September 2016, 17 business directors and 4 nursing managers of different sponsorships and size were interviewed.Results
Decision-makers hoped for an improvement of the financial situation in the homes. They view the possibility of universal prevention and the participation of inhabitants as unrealistic. They also see the presentation of such a process administrated through nursing care insurance rather skeptically.Discussion
More optimistic perceptions of committed decision-makers of other nursing homes can be possible and changes are likely. However, arguments of why managers of nursing facilities should support such a process are still lacking. This could become easier with the thorough inclusion of workplace health promotion.11.
Veronika?J?Wirtz Steven?Forsythe Atanacio?Valencia-Mendoza Sergio?Bautista-Arredondo 《BMC public health》2009,9(Z1):S6
Background
Antiretroviral medicines (ARVs) are one of the most costly parts of HIV/AIDS treatment. Many countries are struggling to provide universal access to ARVs for all people living with HIV and AIDS. Although substantial price reductions of ARVs have occurred, especially between 2002 and 2008, achieving sustainable access for the next several decades remains a major challenge for most low- and middle-income countries. The objectives of the present study were twofold: first, to analyze global ARV prices between 2005 and 2008 and associated factors, particularly procurement methods and key donor policies on ARV procurement efficiency; second, to discuss the options of procurement processes and policies that should be considered when implementing or reforming access to ARV programs.Methods
An ARV-medicines price-analysis was carried out using the Global Price Reporting Mechanism from the World Health Organization. For a selection of 12 ARVs, global median prices and price variation were calculated. Linear regression models for each ARV were used to identify factors that were associated with lower procurement prices. Logistic regression models were used to identify the characteristics of those countries which procure below the highest and lowest direct manufactured costs.Results
Three key factors appear to have an influence on a country's ARV prices: (a) whether the product is generic or not; (b) the socioeconomic status of the country; (c) whether the country is a member of the Clinton HIV/AIDS Initiative. Factors which did not influence procurement below the highest direct manufactured costs were HIV prevalence, procurement volume, whether the country belongs to the least developed countries or a focus country of the United States President's Emergency Plan For AIDS Relief.Conclusion
One of the principal mechanisms that can help to lower prices for ARV over the next several decades is increasing procurement efficiency. Benchmarking prices could be one useful tool to achieve this.12.
Matsubayashi T Manabe YC Etonu A Kyegombe N Muganzi A Coutinho A Peters DH 《BMC international health and human rights》2011,11(Z1):S9
Background
HIV/AIDS is a major public health concern in Uganda. There is widespread consensus that weak health systems hamper the effective provision of HIV/AIDS services. In recent years, the ways in which HIV/AIDS-focused programs interact with the delivery of other health services is often discussed, but the evidence as to whether HIV/AIDS programs strengthen or distort overall health services is limited. The aim of this study was to examine the effect of a PEPFAR-funded HIV/AIDS program on six government-run general clinics in Kampala.Methods
Longitudinal information on the delivery of health services was collected at each clinic. Monthly changes in the volume of HIV and non-HIV services were analyzed by using multilevel models to examine the effect of an HIV/AIDS program on health service delivery. We also conducted a cross-sectional survey utilizing patient exit interviews to compare perceptions of the experiences of patients receiving HIV care and those receiving non-HIV care.Results
All HIV service indicators showed a positive change after the HIV program began. In particular, the number of HIV lab tests (10.58, 95% Confidence Interval (C.I.): 5.92, 15.23) and the number of pregnant women diagnosed with HIV tests (0.52, 95%C.I.: 0.15, 0.90) increased significantly after the introduction of the project. For non-HIV/AIDS health services, TB lab tests (1.19, 95%C.I.: 0.25, 2.14) and diagnoses (0.34, 95%C.I.: 0.05, 0.64) increased significantly. Noticeable increases in trends were identified in pediatric care, including immunization (52.43, 95%C.I.: 32.42, 74.43), malaria lab tests (1.21, 95%C.I.: 0.67, 1.75), malaria diagnoses (7.10, 95%C.I.: 0.73, 13.46), and skin disease diagnoses (4.92, 95%C.I.: 2.19, 7.65). Patients’ overall impressions were positive in both the HIV and non-HIV groups, with more than 90% responding favorably about their experiences.Conclusions
This study shows that when a collaboration is established to strengthen existing health systems, in addition to providing HIV/AIDS services in a setting in which other primary health care is being delivered, there are positive effects not only on HIV/AIDS services, but also on many other essential services. There was no evidence that the HIV program had any deleterious effects on health services offered at the clinics studied.13.
Elisa Knebel Nancy Puttkammer Adrien Demes Ruth Devirois Mona Prismy 《Human resources for health》2008,6(1):17
Background
Preparing health workers to confront the HIV/AIDS epidemic is an urgent challenge in Haiti, where the HIV prevalence rate is 2.2% and approximately 10 100 people are taking antiretroviral treatment. There is a critical shortage of doctors in Haiti, leaving nurses as the primary care providers for much of the population. Haiti's approximately 1000 nurses play a leading role in HIV/AIDS prevention, care and treatment. However, nurses do not receive sufficient training at the pre-service level to carry out this important work.Methods
To address this issue, the Ministry of Health and Population collaborated with the International Training and Education Center on HIV over a period of 12 months to create a competency-based HIV/AIDS curriculum to be integrated into the 4-year baccalaureate programme of the four national schools of nursing.Results
Using a review of the international health and education literature on HIV/AIDS competencies and various models of curriculum development, a Haiti-based curriculum committee developed expected HIV/AIDS competencies for graduating nurses and then drafted related learning objectives. The committee then mapped these learning objectives to current courses in the nursing curriculum and created an 'HIV/AIDS Teaching Guide' for faculty on how to integrate and achieve these objectives within their current courses. The curriculum committee also created an 'HIV/AIDS Reference Manual' that detailed the relevant HIV/AIDS content that should be taught for each course.Conclusion
All nursing students will now need to demonstrate competency in HIV/AIDS-related knowledge, skills and attitudes during periodic assessment with direct observation of the student performing authentic tasks. Faculty will have the responsibility of developing exercises to address the required objectives and creating assessment tools to demonstrate that their graduates have met the objectives. This activity brought different administrators, nurse leaders and faculty from four geographically dispersed nursing schools to collaborate on a shared goal using a process that could be easily replicated to integrate any new topic in a resource-constrained pre-service institution. It is hoped that this experience provided stakeholders with the experience, skills and motivation to strengthen other domains of the pre-service nursing curriculum, improve the synchronization of didactic and practical training and develop standardized, competency-based examinations for nursing licensure in Haiti.14.
Background
This paper will determine whether expanding Insite (North America’s first and only supervised injection facility) to more locations in Canada such as Montreal, cost less than the health care consequences of not having such expanded programs for injection drug users.Methods
By analyzing secondary data gathered in 2012, this paper relies on mathematical models to estimate the number of new HIV and Hepatitis C (HCV) infections prevented as a result of additional SIF locations in Montreal.Results
With very conservative estimates, it is predicted that the addition of each supervised injection facility (up-to a maximum of three) in Montreal will on average prevent 11 cases of HIV and 65 cases of HCV each year. As a result, there is a net cost saving of CDN$0.686 million (HIV) and CDN$0.8 million (HCV) for each additional supervised injection site each year. This translates into a net average benefit-cost ratio of 1.21: 1 for both HIV and HCV.Conclusions
Funding supervised injection facilities in Montreal appears to be an efficient and effective use of financial resources in the public health domain.15.
Cook Karon F. Teal Cayla R. Bjorner Jakob B. Cella David Chang Chih-Hung Crane Paul K. Gibbons Laura E. Hays Ron D. McHorney Colleen A. Ocepek-Welikson Katja Raczek Anastasia E. Teresi Jeanne A. Reeve Bryce B. 《Quality of life research》2007,16(1):121-132
Background
In June 2004, the National Cancer Institute and the Drug Information Association co-sponsored the conference, “Improving the Measurement of Health Outcomes through the Applications of Item Response Theory (IRT) Modeling: Exploration of Item Banks and Computer-Adaptive Assessment.” A component of the conference was presentation of a psychometric and content analysis of a secondary dataset.Objectives
A thorough psychometric and content analysis was conducted of two primary domains within a cancer health-related quality of life (HRQOL) dataset.Research design
HRQOL scales were evaluated using factor analysis for categorical data, IRT modeling, and differential item functioning analyses. In addition, computerized adaptive administration of HRQOL item banks was simulated, and various IRT models were applied and compared.Subjects
The original data were collected as part of the NCI-funded Quality of Life Evaluation in Oncology (Q-Score) Project. A total of 1,714 patients with cancer or HIV/AIDS were recruited from 5 clinical sites.Measures
Items from 4 HRQOL instruments were evaluated: Cancer Rehabilitation Evaluation System–Short Form, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Functional Assessment of Cancer Therapy and Medical Outcomes Study Short-Form Health Survey.Results and conclusions
Four lessons learned from the project are discussed: the importance of good developmental item banks, the ambiguity of model fit results, the limits of our knowledge regarding the practical implications of model misfit, and the importance in the measurement of HRQOL of construct definition. With respect to these lessons, areas for future research are suggested. The feasibility of developing item banks for broad definitions of health is discussed.16.
17.
Background
Despite a large body of evidence globally demonstrating that the criminalization of sex workers increases HIV/STI risks, we know far less about the impact of criminalization and policing of managers and in-call establishments on HIV/STI prevention among sex workers, and even less so among migrant sex workers.Methods
Analysis draws on ethnographic fieldwork and 46 qualitative interviews with migrant sex workers, managers and business owners of in-call sex work venues in Metro Vancouver, Canada.Results
The criminalization of in-call venues and third parties explicitly limits sex workers’ access to HIV/STI prevention, including manager restrictions on condoms and limited onsite access to sexual health information and HIV/STI testing. With limited labour protections and socio-cultural barriers, criminalization and policing undermine the health and human rights of migrant sex workers working in –call venues.Conclusions
This research supports growing evidence-based calls for decriminalization of sex work, including the removal of criminal sanctions targeting third parties and in-call venues, alongside programs and policies that better protect the working conditions of migrant sex workers as critical to HIV/STI prevention and human rights.18.
Z. F. Zhai L. J. Cheng C. J. Zhou Z. Q. Song H. Yang Zhu Shen 《Zeitschrift fur Gesundheitswissenschaften》2016,24(6):505-511
Aims
To explore HIV-related facial skin disorders among HIV-positive outpatients and the role in identifying HIV infection and/or AIDS.Subjects and methods
We retrospectively evaluated records from all HIV-positive patients who initially presented at our Dermatology and Venereology Department (Southwest Hospital, Chongqing, China) between January 2009 and March 2016. We also compared the prevalences of facial skin disorders among HIV-positive and HIV-negative outpatients.Results
We identified 827 HIV-positive patients, who included 150 patients who initially presented with 1 of 14 different facial skin disorders. Noninfectious/inflammatory dermatosis was the most common diagnosis (109/150, 72.7 %), and infectious dermatosis was diagnosed in 41 cases (27.3 %). Most facial skin disorders exhibited a higher proportion of HIV-positive patients, compared to HIV-negative patients. Herpes zoster was the most common disorder, and psoriasis and eczema or neurodermatitis were secondary disorders. Some disorders, such as seborrheic dermatitis, exhibited a severe and refractory clinical manifestation. Photosensitive dermatoses were significantly more common among HIV-positive patients, compared to HIV-negative patients (1.9 % vs. 0.0 %). No malignancies were diagnosed.Conclusions
There is a wide spectrum of facial skin disorders among HIV-positive patients in southwest China, and some of these disorders may provide the first clinical indication of HIV infection and/or AIDS. However, these findings require confirmation using immunological data.19.
Richard?Gordon Natalie?K?Bj?rklund Robert?J?Smith Eluemuno?R?Blyden 《BMC public health》2009,9(Z1):S13
Background
A major deficit of all approaches to epidemic modelling to date has been the need to approximate or guess at human behaviour in disease-transmission-related contexts. Avatars are generally human-like figures in virtual computer worlds controlled by human individuals.Methods
We introduce the concept of a "havatar", which is a (human, avatar) pairing. Evidence is mounting that this pairing behaves in virtual contexts much like the human in the pairing might behave in analogous real-world contexts.Results
We propose that studies of havatars, in a virtual world, may give a realistic approximation of human behaviour in real-world contexts. If the virtual world approximates the real world in relevant details (geography, transportation, etc.), virtual epidemics in that world could accurately simulate real-world epidemics. Havatar modelling of epidemics therefore offers a complementary tool for tackling how best to halt epidemics, including perhaps HIV/AIDS, since sexual behaviour is a significant component of some virtual worlds, such as Second Life.Conclusion
Havatars place the control parameters of an epidemic in the hands of each individual. By providing tools that everyone can understand and use, we could democratise epidemiology.20.
Yujiro?Sano Roger?Antabe Kilian?Nasung?Atuoye Lucia?Kafui?Hussey Jason?Bayne Sylvester?Zackaria?Galaa