1
|
Lambach P, Silal S, Sbarra AN, Koh M, Aggarwal R, Farooqui HH, Flasche S, Hogan AB, Kim SY, Leung K, Moss WJ, Munywoki PK, Portnoy A, Sheel M, Wang XY. Report from the World Health Organization's immunization and vaccines-related implementation research advisory committee (IVIR-AC) meeting, virtual gathering, 26 February-1 March 2024. Vaccine 2024:S0264-410X(24)00494-8. [PMID: 38704250 DOI: 10.1016/j.vaccine.2024.04.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 04/19/2024] [Indexed: 05/06/2024]
Abstract
The Immunization and Vaccine-related Implementation Research Advisory Committee (IVIR-AC) is the World Health Organization's key standing advisory body to conduct an independent review of research, particularly of transmission and economic modeling analyses that estimate the impact and value of vaccines. From 26th February-1st March 2024, at its first of two semi-annual meetings, IVIR-AC provided feedback and recommendations across four sessions; this report summarizes the proceedings and recommendations from that meeting. Session topics included modeling of the impact and cost-effectiveness of the R21/Matrix-M malaria vaccine, meta-analysis of economic evaluations of vaccines, a global analysis estimating the impact of vaccination over the last 50 years, and modeling the impact of different RTS,S malaria vaccine dose schedules in seasonal settings.
Collapse
Affiliation(s)
- Philipp Lambach
- Immunizations, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Sheetal Silal
- Modelling and Simulation Hub, Africa, University of Cape Town, Cape Town, South Africa; Centre for Global Health, Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
| | - Alyssa N Sbarra
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
| | - Mitsuki Koh
- Immunizations, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Rakesh Aggarwal
- Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | | | | | - Alexandra B Hogan
- School of Population Health, University of New South Wales, Sydney, Australia
| | | | - Kathy Leung
- School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region
| | - William J Moss
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Patrick K Munywoki
- Kenya Medical Research Institute, Centre for Global Health Research, Nairobi, Kenya
| | - Allison Portnoy
- Department of Global Health, Boston University School of Public Health, Boston, United States; Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, United States
| | - Meru Sheel
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Xuan-Yi Wang
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China
| |
Collapse
|
2
|
Lambach P, Orenstein W, Silal S, Sbarra AN, Koh M, Aggarwal R, Hasan Farooqui H, Flasche S, Hogan A, Kim SY, Leask J, Luz PM, Lyimo DC, Moss WJ, Pitzer VE, Wang XY, Wu J. Report from the World Health Organization's immunization and vaccines related implementation research advisory committee (IVIR-AC) meeting, Geneva, 11-13 September 2023. Vaccine 2024; 42:1424-1434. [PMID: 38326131 PMCID: PMC10953699 DOI: 10.1016/j.vaccine.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/02/2024] [Indexed: 02/09/2024]
Abstract
Evaluating vaccine-related research is critical to maximize the potential of vaccination programmes. The WHO Immunization and Vaccine-related Implementation Research Advisory Committee (IVIR-AC) provides an independent review of research that estimates the performance, impact and value of vaccines, with a particular focus on transmission and economic modelling. On 11-13 September 2023, IVIR-AC was convened for a bi-annual meeting where the committee reviewed research and presentations across eight different sessions. This report summarizes the background information, proceedings and recommendations from that meeting. Sessions ranged in topic from timing of measles supplementary immunization activities, analyses of conditions necessary to meet measles elimination in the South-East Asia region, translating modelled evidence into policy, a risk-benefit analysis of dengue vaccine, COVID-19 scenario modelling in the African region, therapeutic vaccination against human papilloma virus, the Vaccine Impact Modelling Consortium, and the Immunization Agenda 2030 vaccine impact estimates.
Collapse
Affiliation(s)
- Philipp Lambach
- Immunizations, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | | | - Sheetal Silal
- Modelling and Simulation Hub, Africa, University of Cape Town, Cape Town, South Africa; Centre for Global Health, Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
| | - Alyssa N Sbarra
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom.
| | - Mitsuki Koh
- Immunizations, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Rakesh Aggarwal
- Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | | | - Stefan Flasche
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Julie Leask
- School of Public Health, University of Sydney Sydney, Australia
| | - Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - William J Moss
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | - Xian-Yi Wang
- Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Joseph Wu
- School of Public Health, The University of Hong Kong, Hong Kong
| |
Collapse
|
3
|
Jamieson L, Van Schalkwyk C, Nichols BE, Meyer-Rath G, Silal S, Pulliam J, Blumberg L, Cohen C, Moultrie H, Jassat W. Differential in-hospital mortality and intensive care treatment over time: Informing hospital pathways for modelling COVID-19 in South Africa. PLOS Glob Public Health 2023; 3:e0001073. [PMID: 37195977 DOI: 10.1371/journal.pgph.0001073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 02/15/2023] [Indexed: 05/19/2023]
Abstract
There are limited published data within sub-Saharan Africa describing hospital pathways of COVID-19 patients hospitalized. These data are crucial for the parameterisation of epidemiological and cost models, and for planning purposes for the region. We evaluated COVID-19 hospital admissions from the South African national hospital surveillance system (DATCOV) during the first three COVID-19 waves between May 2020 and August 2021. We describe probabilities and admission into intensive care units (ICU), mechanical ventilation, death, and lengths of stay (LOS) in non-ICU and ICU care in public and private sectors. A log-binomial model was used to quantify mortality risk, ICU treatment and mechanical ventilation between time periods, adjusting for age, sex, comorbidity, health sector and province. There were 342,700 COVID-19-related hospital admissions during the study period. Risk of ICU admission was 16% lower during wave periods (adjusted risk ratio (aRR) 0.84 [0.82-0.86]) compared to between-wave periods. Mechanical ventilation was more likely during a wave overall (aRR 1.18 [1.13-1.23]), but patterns between waves were inconsistent, while mortality risk in non-ICU and ICU were 39% (aRR 1.39 [1.35-1.43]) and 31% (aRR 1.31 [1.27-1.36]) higher during a wave, compared to between-wave periods, respectively. If patients had had the same probability of death during waves vs between-wave periods, we estimated approximately 24% [19%-30%] of deaths (19,600 [15,200-24,000]) would not have occurred over the study period. LOS differed by age (older patients stayed longer), ward type (ICU stays were longer than non-ICU) and death/recovery outcome (time to death was shorter in non-ICU); however, LOS remained similar between time periods. Healthcare capacity constraints as inferred by wave period have a large impact on in-hospital mortality. It is crucial for modelling health systems strain and budgets to consider how input parameters related to hospitalisation change during and between waves, especially in settings with severely constrained resources.
Collapse
Affiliation(s)
- Lise Jamieson
- Health Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Medical Microbiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
- The South African Department of Science and Innovation/National Research Foundation Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, Republic of South Africa
| | - Cari Van Schalkwyk
- The South African Department of Science and Innovation/National Research Foundation Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, Republic of South Africa
| | - Brooke E Nichols
- Health Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Medical Microbiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts, United States of America
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Gesine Meyer-Rath
- Health Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- The South African Department of Science and Innovation/National Research Foundation Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, Republic of South Africa
- Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts, United States of America
| | - Sheetal Silal
- Modelling and Simulation Hub, Africa, Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Juliet Pulliam
- The South African Department of Science and Innovation/National Research Foundation Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, Republic of South Africa
| | - Lucille Blumberg
- National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
- Right to Care, Centurion, South Africa
| | - Cheryl Cohen
- National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Harry Moultrie
- National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Waasila Jassat
- National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
- Right to Care, Centurion, South Africa
| |
Collapse
|
4
|
Morton A, Bish E, Megiddo I, Zhuang W, Aringhieri R, Brailsford S, Deo S, Geng N, Higle J, Hutton D, Janssen M, Kaplan EH, Li J, Oliveira MD, Prinja S, Rauner M, Silal S, Song J. Introduction to the special issue: Management Science in the Fight Against Covid-19. Health Care Manag Sci 2021; 24:251-252. [PMID: 34129134 PMCID: PMC8204067 DOI: 10.1007/s10729-021-09569-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/19/2021] [Indexed: 01/29/2023]
Affiliation(s)
- Alec Morton
- University of Strathclyde London, 16 Richmond St, Glasgow, G1 1XQ, UK.
| | - Ebru Bish
- The University of Alabama, AL, Tuscaloosa, 35487, USA
| | - Itamar Megiddo
- University of Strathclyde London, 16 Richmond St, Glasgow, G1 1XQ, UK
| | - Weifen Zhuang
- Xiamen University, 422 Siming S Rd, Siming District, Fujian, Xiamen, China
| | - Roberto Aringhieri
- Computer Science Dept, University of Turin, Corso Svizzera. 185, TO, 10149, Torino, Italy
| | - Sally Brailsford
- University of Southampton, SO17 1BJ, Southampton, United Kingdom
| | - Sarang Deo
- Indian School of Business, Telangana, 500111, Hyderabad, India
| | - Na Geng
- Shanghai Jiao Tong University, Minhang District, 200240, Shanghai, China
| | - Julie Higle
- University of Southern California, CA, 90007, Los Angeles, United States
| | - David Hutton
- University of Michigan, 500 S State St, MI, 48109, Ann Arbor, United States
| | | | - Edward H Kaplan
- Yale School of Management, Yale School of Public Health, Yale School of Engineering and Applied Science, 165 Whitney Avenue, New Haven, CT, 06511, New Haven, United States
| | - Jianbin Li
- Huazhong University of Science and Technology, 1037 Luoyu Rd, Hubei, 430074, Wuhan, China
| | - Mónica D Oliveira
- Centre for Management Studies of Instituto Superior Técnico (CEG-IST), Institute for Bioengineering and Biosciences, and Institute for Health and Bioeconomy - i4HB Associate Laboratory, University to Lisboa, Institute for Bioengineering and Biosciences, and Institute for Health and Bioeconomy - i4HB Associate Laboratory, 1649-001, Lisboa, Portugal
| | - Shankar Prinja
- Post Graduate Institute of Medical Education & Research (PGIMER), Madhya Marg, Sector 12, 160012, Chandigarh, India
| | - Marion Rauner
- University of Vienna, Faculty of Business, Economics, and Statistics Department of Business Decisions and Analytics Oskar-Morgenstern-Platz 1, A-1090, Vienna, Austria
| | - Sheetal Silal
- Modelling and Simulation Hub, Africa (MASHA), University of Cape Town, Cape Town, 7700, Rondebosch, South Africa
| | - Jie Song
- Peking University, 5 Yiheyuan Rd, Haidian District, 100871, Beijing, China
| |
Collapse
|
5
|
Nichols BE, Jamieson L, Zhang SRC, Rao GA, Silal S, Pulliam JRC, Sanne I, Meyer-Rath G. The Role of Remdesivir in South Africa: Preventing COVID-19 Deaths Through Increasing Intensive Care Unit Capacity. Clin Infect Dis 2021; 72:1642-1644. [PMID: 32628744 PMCID: PMC7454458 DOI: 10.1093/cid/ciaa937] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/02/2020] [Indexed: 11/14/2022] Open
Abstract
Countries such as South Africa have limited intensive care unit (ICU) capacity to handle the expected number of patients with COVID-19 requiring ICU care. Remdesivir can prevent deaths in countries such as South Africa by decreasing the number of days people spend in ICU, therefore freeing up ICU bed capacity.
Collapse
Affiliation(s)
- Brooke E Nichols
- Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts, USA.,Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lise Jamieson
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sabrina R C Zhang
- Massachusetts College of Pharmacy and Health Sciences, Boston, Massachusetts, USA
| | - Gabriella A Rao
- Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Sheetal Silal
- Modelling and Simulation Hub, Africa, Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Juliet R C Pulliam
- South African Department of Science and Innovation-National Research Foundation Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Ian Sanne
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gesine Meyer-Rath
- Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts, USA.,Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
6
|
Jo Y, Jamieson L, Edoka I, Long L, Silal S, Pulliam JRC, Moultrie H, Sanne I, Meyer-Rath G, Nichols BE. Cost-effectiveness of Remdesivir and Dexamethasone for COVID-19 Treatment in South Africa. Open Forum Infect Dis 2021; 8:ofab040. [PMID: 33732750 PMCID: PMC7928624 DOI: 10.1093/ofid/ofab040] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/24/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Dexamethasone and remdesivir have the potential to reduce coronavirus disease 2019 (COVID)-related mortality or recovery time, but their cost-effectiveness in countries with limited intensive care resources is unknown. METHODS We projected intensive care unit (ICU) needs and capacity from August 2020 to January 2021 using the South African National COVID-19 Epi Model. We assessed the cost-effectiveness of (1) administration of dexamethasone to ventilated patients and remdesivir to nonventilated patients, (2) dexamethasone alone to both nonventilated and ventilated patients, (3) remdesivir to nonventilated patients only, and (4) dexamethasone to ventilated patients only, all relative to a scenario of standard care. We estimated costs from the health care system perspective in 2020 US dollars, deaths averted, and the incremental cost-effectiveness ratios of each scenario. RESULTS Remdesivir for nonventilated patients and dexamethasone for ventilated patients was estimated to result in 408 (uncertainty range, 229-1891) deaths averted (assuming no efficacy [uncertainty range, 0%-70%] of remdesivir) compared with standard care and to save $15 million. This result was driven by the efficacy of dexamethasone and the reduction of ICU-time required for patients treated with remdesivir. The scenario of dexamethasone alone for nonventilated and ventilated patients requires an additional $159 000 and averts 689 [uncertainty range, 330-1118] deaths, resulting in $231 per death averted, relative to standard care. CONCLUSIONS The use of remdesivir for nonventilated patients and dexamethasone for ventilated patients is likely to be cost-saving compared with standard care by reducing ICU days. Further efforts to improve recovery time with remdesivir and dexamethasone in ICUs could save lives and costs in South Africa.
Collapse
Affiliation(s)
- Youngji Jo
- Section of Infectious Disease, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Lise Jamieson
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ijeoma Edoka
- SAMRC Centre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lawrence Long
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Sheetal Silal
- Modelling and Simulation Hub, Africa, Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Juliet R C Pulliam
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Harry Moultrie
- Division of the National Health Laboratory Service, National Institute for Communicable Diseases (NICD), Johannesburg, South Africa
| | - Ian Sanne
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gesine Meyer-Rath
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Brooke E Nichols
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts, USA
| |
Collapse
|
7
|
Kuodi P, Patterson J, Silal S, Hussey GD, Kagina BM. Characterisation of the environmental presence of hepatitis A virus in low-income and middle-income countries: a systematic review and meta-analysis. BMJ Open 2020; 10:e036407. [PMID: 32988941 PMCID: PMC7523219 DOI: 10.1136/bmjopen-2019-036407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To characterise the environmental presence of hepatitis A virus (HAV) in low- and middle-income countries (LMICs). DESIGN Systematic review and meta-analysis. DATA SOURCES EBSCOhost, PubMed, Scopus, ScienceDirect, Clinical Key and Web of Science were searched. Grey literature was sourced by searching the following electronic databases: Open Grey, National Health Research Database and Mednar. ELIGIBILITY CRITERIA FOR INCLUDING STUDIES Cross-sectional and ecological studies reporting HAV environmental presence and conducted in LMICs between January 2005 and May 2019, irrespective of language of publication. DATA EXTRACTION AND DATA SYNTHESIS Relevant data were extracted from articles meeting the inclusion criteria, and two reviewers independently assessed the studies for risk of bias. High heterogeneity of the extracted data led to the results being reported narratively. RESULTS A total of 2092 records were retrieved, of which 33 met the inclusion criteria. 21 studies were conducted in Tunisia, India and South Africa, and the rest were from Philippines, Pakistan, Morocco, Chad, Mozambique, Kenya and Uganda. In Tunisian raw sewage samples, the prevalence of HAV ranged from 12% to 68%, with an estimated average detection rate of 50% (95% CI 25 to 75), whereas HAV detection in treated sewage in Tunisia ranged from 23% to 65%, with an estimated average detection rate of 38% (95% CI 20 to 57). The prevalence of HAV detection in South African treated sewage and surface water samples ranged from 4% to 37% and from 16% to 76%, with an estimated average detection rates of 15% (95% CI 1 to 29) and 51% (95% CI 21 to 80), respectively. Over the review period, the estimated average detection rate of environmental HAV presence appeared to have declined by 10%. CONCLUSION The quality of included studies was fair, but sampling issues and paucity of data limited the strength of the review findings. PROSPERO REGISTRATION NUMBER CRD42019119592.
Collapse
Affiliation(s)
- Paul Kuodi
- Faculty of Health Sciences, Department of Public Health, Lira University, Lira, Uganda
- School of Public Health and Family Medicine, University of Cape Town, Rondebosch, South Africa
| | - Jenna Patterson
- School of Public Health and Family Medicine, University of Cape Town, Rondebosch, South Africa
- Vaccines for Africa Initiative, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
| | - Sheetal Silal
- Department of Statistical Sciences, University of Cape Town, Rondebosch, South Africa
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Gregory D Hussey
- Vaccines for Africa Initiative, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
| | - Benjamin M Kagina
- School of Public Health and Family Medicine, University of Cape Town, Rondebosch, South Africa
- Vaccines for Africa Initiative, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
| |
Collapse
|
8
|
Jo Y, Jamieson L, Edoka I, Long L, Silal S, Pulliam JRC, Moultrie H, Sanne I, Meyer-Rath G, Nichols BE. Cost-effectiveness of remdesivir and dexamethasone for COVID-19 treatment in South Africa. medRxiv 2020. [PMID: 32995824 DOI: 10.1101/2020.09.24.20200196] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background South Africa recently experienced a first peak in COVID-19 cases and mortality. Dexamethasone and remdesivir both have the potential to reduce COVID-related mortality, but their cost-effectiveness in a resource-limited setting with scant intensive care resources is unknown. Methods We projected intensive care unit (ICU) needs and capacity from August 2020 to January 2021 using the South African National COVID-19 Epi Model. We assessed cost-effectiveness of 1) administration of dexamethasone to ventilated patients and remdesivir to non-ventilated patients, 2) dexamethasone alone to both non-ventilated and ventilated patients, 3) remdesivir to non-ventilated patients only, and 4) dexamethasone to ventilated patients only; all relative to a scenario of standard care. We estimated costs from the healthcare system perspective in 2020 USD, deaths averted, and the incremental cost effectiveness ratios of each scenario. Results Remdesivir for non-ventilated patients and dexamethasone for ventilated patients was estimated to result in 1,111 deaths averted (assuming a 0-30% efficacy of remdesivir) compared to standard care, and save $11.5 million. The result was driven by the efficacy of the drugs, and the reduction of ICU-time required for patients treated with remdesivir. The scenario of dexamethasone alone to ventilated and non-ventilated patients requires additional $159,000 and averts 1,146 deaths, resulting in $139 per death averted, relative to standard care. Conclusions The use of dexamethasone for ventilated and remdesivir for non-ventilated patients is likely to be cost-saving compared to standard care. Given the economic and health benefits of both drugs, efforts to ensure access to these medications is paramount.
Collapse
|
9
|
Abstract
OBJECTIVES The aetiology and burden of viral-induced acute liver failure remains unclear globally. It is important to understand the epidemiology of viral-induced ALF to plan for clinical case management and case prevention. PARTICIPANTS This systematic review was conducted to synthesize data on the relative contribution of different viruses to the aetiology of viral-induced acute liver failure in an attempt to compile evidence that is currently missing in the field. EBSCOhost, PubMed, ScienceDirect, Scopus and Web of Science were searched for relevant literature published from 2009 to 2019. The initial search was run on 9 April 2019 and updated via PubMed on 30 September 2019 with no new eligible studies to include. Twenty-five eligible studies were included in the results of this review. RESULTS This systematic review estimated the burden of acute liver failure after infection with hepatitis B virus, hepatitis A virus, hepatitis C virus, hepatitis E virus, herpes simplex virus/human herpesvirus, cytomegalovirus, Epstein-Barr virus and parvovirus B19. Data were largely missing for acute liver failure after infection with varicella-zostervirus, human parainfluenza viruses, yellow fever virus, coxsackievirus and/or adenovirus. The prevalence of hepatitis A-induced acute liver failur was markedly lower in countries with routine hepatitis A immunisation versus no routine hepatitis A immunisation. Hepatitis E virus was the most common aetiological cause of viral-induced acute liver failure reported in this review. In addition, viral-induced acute liver failure had poor outcomes as indicated by high fatality rates, which appear to increase with poor economic status of the studied countries. CONCLUSIONS Immunisation against hepatitis A and hepatitis B should be prioritised in low-income and middle-income countries to prevent high viral-induced acute liver failure mortality rates, especially in settings where resources for managing acute liver failure are lacking. The expanded use of hepatitis E immunisation should be explored as hepatitis E virus was the most common cause of acute liver failure. REGISTRATION PROSPERO registration number: CRD42017079730.
Collapse
Affiliation(s)
- Jenna Patterson
- Vaccines for Africa Initiative, School of Public Health and Family Medicine, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
| | - Hannah Sophia Hussey
- Vaccines for Africa Initiative, School of Public Health and Family Medicine, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
| | - Sheetal Silal
- Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa
- Nuffield Department of Medicine, University of Oxford, Oxford, Oxfordshire, UK
| | - Liz Goddard
- Department of Paediatrics, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Mashiko Setshedi
- Department of Medicine, Division of Gastroenterology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Wendy Spearman
- Department of Medicine, Division of Hepatology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Gregory D Hussey
- Vaccines for Africa Initiative, School of Public Health and Family Medicine, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
| | - Benjamin M Kagina
- Vaccines for Africa Initiative, School of Public Health and Family Medicine, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
| | - Rudzani Muloiwa
- Vaccines for Africa Initiative, School of Public Health and Family Medicine, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
- Department of Pediatrics & Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
10
|
Patterson J, Hussey HS, Abdullahi LH, Silal S, Goddard L, Setshedi M, Spearman W, Hussey GD, Kagina B, Muloiwa R. The global epidemiology of viral-induced acute liver failure: a systematic review protocol. BMJ Open 2019; 9:e029819. [PMID: 31473618 PMCID: PMC6720318 DOI: 10.1136/bmjopen-2019-029819] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION The burden of viral-induced acute liver failure (ALF) around the world still remains unclear, with little to no data collected regarding the disease incidence in general and synthesised data on the relative contribution of different viruses to the aetiology of ALF is missing in the field. The aim of this review is to estimate the burden (prevalence, incidence, mortality, hospitalisation) of ALF following infection HAV, HBV, HCV, HDV, HEV, EBV), HSV1, HSV2, VZV, parvo-virus B19, HPIVs, YFV, HVV-6, CMV, CA16 and/or HAdVs. Establishing the common aetiologies of viral-induced ALF, which vary geographically, is important so that: (1) treatment can be initiated quickly, (2) contraindications to liver transplant can be identified, (3) prognoses can be deterined more accurately, and most importantly, (4) vaccination against viral ALF aetiologies can be prioritised especially in under-resourced regions with public health risks associated with the relevant attributable diseases. METHODS AND ANALYSIS EBSCOhost, PubMed, ScienceDirect, Scopus and Web of Science databases will be searched for relevant literature published and grey literature from 2009 up to 2019. Published cross-sectional and cohort studies will be eligible for inclusion in this review. Qualifying studies will be formally assessed for quality and risk of bias using a standardised scoring tool. Following standardised data extraction, meta-analyses will be carried out using STATA. Depending on characteristics of included studies, subgroup analyses and meta-regression analyses will be performed. This review will be reported according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. ETHICS AND DISSEMINATION No ethics approval is required as the systematic review will use only published data already in the public domain. Findings will be disseminated through publication in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42018110309.
Collapse
Affiliation(s)
- Jenna Patterson
- Vaccines for Africa Initiative, University of Cape Town, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Hannah Sophia Hussey
- Vaccines for Africa Initiative, University of Cape Town, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Leila Hussein Abdullahi
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Somaliland Country Office, Save the Children International, Nairobi, Kenya
| | - Sheetal Silal
- Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa
- Modelling and Simulation Hub Africa, University of Cape Town, Cape Town, South Africa
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Liz Goddard
- Department of Paediatrics, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Mashiko Setshedi
- Department of Medicine, Division of Gastroenterology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Wendy Spearman
- Department of Medicine, Division of Hepatology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Gregory D Hussey
- Vaccines for Africa Initiative, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Benjamin Kagina
- Vaccines for Africa Initiative, University of Cape Town, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Rudzani Muloiwa
- Vaccines for Africa Initiative, University of Cape Town, Cape Town, South Africa
- Department of Paediatrics, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
11
|
Shretta R, Silal S, White LJ, Maude RJ. Predicting the cost of malaria elimination in the Asia-Pacific. Wellcome Open Res 2019; 4:73. [PMID: 31080895 PMCID: PMC6484453 DOI: 10.12688/wellcomeopenres.15166.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2019] [Indexed: 11/21/2022] Open
Abstract
Over the past decade, the countries of the Asia-Pacific region have made significant progress towards the goal of malaria elimination by the year 2030. It is widely accepted that for the region to meet this goal, an intensification of efforts supported by sustained funding is required. However, robust estimates are needed for the optimal coverage and components of malaria elimination packages and the resources required to implement them. In this collection, a multispecies mathematical and economic modelling approach supported by the estimated burden of disease is used to make preliminary estimates for the cost of elimination and develop an evidence-based investment case for the region.
Collapse
Affiliation(s)
- Rima Shretta
- Global Health Group, University of California, San Francisco, San Francisco, CA 94158, USA
- Swiss Tropical and Public Health Institute, Basel 4002, Switzerland
- University of Basel, Basel 4001, Switzerland
| | - Sheetal Silal
- Modelling and Simulation Hub, Africa (MASHA), Department of Statistical Sciences, University of Cape Town, Rondebosch, Cape Town 7700, South Africa
- South African DST-NRF Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University, Cape Town, South Africa
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, Oxfordshire, UK
| | - Lisa J. White
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, Oxfordshire, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Bangkok 10400, Thailand
| | - Richard J. Maude
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, Oxfordshire, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Bangkok 10400, Thailand
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| |
Collapse
|
12
|
Cleary S, Birch S, Chimbindi N, Silal S, McIntyre D. Investigating the affordability of key health services in South Africa. Soc Sci Med 2012; 80:37-46. [PMID: 23415590 DOI: 10.1016/j.socscimed.2012.11.035] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 11/20/2012] [Accepted: 11/29/2012] [Indexed: 11/19/2022]
Abstract
This paper considers the affordability of using public sector health services for three tracer conditions (obstetric care, tuberculosis treatment and antiretroviral treatment for HIV-positive people), based on research undertaken in two urban and two rural sites in South Africa. We understand affordability as the 'degree of fit' between the costs of seeking health care and a household's ability-to-pay. Exit interviews were conducted with over 300 patients for each of the three tracer conditions in each of the four sites (i.e. a total sample of over 3600). Total direct costs for the service used at the time of the interview, as well as other health related costs incurred during the preceding month either for self-care or the use of plural providers were assessed, as were a range of indicators of ability-to-pay. The percentage of households incurring direct costs exceeding 10% of household consumption expenditure and those borrowing money or selling assets as a mechanism for coping with the burden of direct costs were calculated. Logistic regressions were also conducted to identify factors that were significantly associated with these indicators of affordability. There were significant differences in affordability between rural and urban sites; costs were higher, ability-to-pay was lower and there was a greater proportion of households selling assets or borrowing money in rural areas. There were also significant differences across tracers, with a higher percentage of households receiving tuberculosis and antiretroviral treatment borrowing money or selling assets than those using obstetric services. As these conditions require expenses to be incurred on an ongoing basis, the sustainability of such coping strategies is questionable. Policy makers need to explore how to reduce direct costs for users of these key health services in the context of the particular characteristics of different treatment types. Affordability needs to be considered in relation to the dynamic aspects of the costs of treating different conditions and the timing of treatment in relation to diagnosis. The frequently high transport costs associated with treatments involving multiple consultations can be addressed by initiatives that provide close-to-client services and subsidised patient transport for referrals.
Collapse
Affiliation(s)
- Susan Cleary
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, South Africa.
| | | | | | | | | |
Collapse
|
13
|
Cleary S, Silal S, Birch S, Carrara H, Pillay-van Wyk V, Rehle T, Schneider H. Equity in the use of antiretroviral treatment in the public health care system in urban South Africa. Health Policy 2010; 99:261-6. [PMID: 21075470 DOI: 10.1016/j.healthpol.2010.10.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Revised: 10/15/2010] [Accepted: 10/18/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The scaling up of antiretroviral treatment (ART) for HIV-infected adults requires a sizeable investment of resources in the South African public health care system. It is important that these resources are used productively and in ways that reach those in need, irrespective of social status or personal characteristics. In this study we evaluate whether the distribution of ART services in the public system reflects the distribution of need among adults in the urban population. METHODS Data from a 2008 national survey were used to estimate the distribution of socioeconomic status (SES) and sex in HIV-positive adults in urban areas. These findings were compared to SES and sex distributions in 635 ART users within 6 urban public ART facilities. RESULTS Close to 40% of those with HIV are in the lowest SES quintile, while 67% are women. The distributions in users of ART are similar to these distributions in HIV-positive people. CONCLUSIONS Patterns of ART use in study settings correspond to patterns of HIV in the urban population at the national level. This suggests that the South African ART programme is on track to ensure equitable delivery of treatment services in urban settings.
Collapse
Affiliation(s)
- Susan Cleary
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, 7925, Observatory Cape Town, South Africa.
| | | | | | | | | | | | | |
Collapse
|