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Konda KA, Qquellon J, Torres TS, Vega-Ramirez EH, Elorreaga O, Guillén-Díaz-Barriga C, Diaz-Sosa D, Hoagland B, Guanira JV, Benedetti M, Pimenta C, Vermandere H, Bautista-Arredondo S, Veloso VG, Grinsztejn B, Caceres CF. Awareness of U = U among Sexual and Gender Minorities in Brazil, Mexico, and Peru: Differences According to Self-reported HIV Status. AIDS Behav 2024:10.1007/s10461-024-04336-9. [PMID: 38662277 DOI: 10.1007/s10461-024-04336-9] [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] [Accepted: 03/29/2024] [Indexed: 04/26/2024]
Abstract
The slogan Undetectable equals Untransmittable (U = U) communicates that people living with HIV (PLHIV) who are on antiretroviral therapy (ART) will not transmit HIV to their sexual partners. We describe awareness of U = U among sexual and gender minorities (SGM) living in Brazil, Mexico, and Peru by self-reported HIV status (PLHIV, negative, unknown) during 2021 using an online survey. We estimated two models using Poisson regression for each population group: Model A including socio-demographic factors (country, gender, age, race, education, and income), and then Model B including taking ART (for PLHIV) or risk behavior, ever-taking PrEP, and HIV risk perception (for HIV-negative or of unknown HIV status). A total of 21,590 respondents were included (Brazil: 61%, Mexico: 30%, Peru: 9%). Among HIV-negative (74%) and unknown status (12%), 13% ever used PrEP. Among PLHIV (13%), 93% reported current use of ART. Awareness of U = U was 89% in both Brazil and Mexico, which was higher than in Peru 64%. Awareness of U = U was higher among PLHIV (96%) than HIV-negative (88%) and HIV-unknown (70%). In multivariate models, PLHIV with lower education were less aware of U = U, while those taking ART were more aware. Among HIV-negative, non-cisgender, lower income, and those with lower education had lower awareness of U = U, while individuals ever using PrEP had higher awareness. In conclusion, awareness of U = U varied by HIV status, socio-demographic characteristics, and HIV risk behavior. The concept of U = U should be disseminated through educational strategies and include a focus on SGM to combat HIV stigma.
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Affiliation(s)
- K A Konda
- Keck School of Medicine, University of Southern California, 1845 N Soto St, Los Angeles, CA, 90032, USA.
- Centro de Investigación Interdisciplinaria en Sexualidad, Universidad Peruana Cayetano Heredia, SIDA y Sociedad, Lima, Peru.
| | - J Qquellon
- Centro de Investigación Interdisciplinaria en Sexualidad, Universidad Peruana Cayetano Heredia, SIDA y Sociedad, Lima, Peru
| | - T S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - E H Vega-Ramirez
- Instituto Nacional de Psiquiatria Ramon de la Fuente Muñiz, Mexico City, Mexico
| | - O Elorreaga
- Centro de Investigación Interdisciplinaria en Sexualidad, Universidad Peruana Cayetano Heredia, SIDA y Sociedad, Lima, Peru
| | - C Guillén-Díaz-Barriga
- Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - D Diaz-Sosa
- Instituto Nacional de Psiquiatria Ramon de la Fuente Muñiz, Mexico City, Mexico
| | - B Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - J V Guanira
- Centro de Investigación Interdisciplinaria en Sexualidad, Universidad Peruana Cayetano Heredia, SIDA y Sociedad, Lima, Peru
| | - M Benedetti
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - C Pimenta
- Departmento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissiveis, Brazilian Ministry of Health, Rio de Janeiro, Brazil
| | - H Vermandere
- Instituto Nacional de Salud Pública (INSP), Mexico City, Mexico
| | | | - V G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - B Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - C F Caceres
- Centro de Investigación Interdisciplinaria en Sexualidad, Universidad Peruana Cayetano Heredia, SIDA y Sociedad, Lima, Peru
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Cruz-Bañares A, Rojas-Carmona A, Aguilera-Mijares S, Martínez-Dávalos A, Bautista-Arredondo S, Vermandere H. Pre-exposure prophylaxis and telemedicine during coronavirus (COVID-19): a qualitative study of the experiences of health care professionals in Mexico. Sex Health 2024; 21:SH23206. [PMID: 38648372 DOI: 10.1071/sh23206] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 04/03/2024] [Indexed: 04/25/2024]
Abstract
Background Telemedicine, which involves utilising technologies for remote health care delivery, proved useful to continue offering certain health services during the coronavirus disease 2019 (COVID-19) lockdown. However, the extent of its effectiveness in delivering pre-exposure prophylaxis services for HIV prevention remains underexplored from the viewpoint of health care providers. Therefore, this study aimed to assess the experiences of health care professionals in Mexico who utilised telemedicine for delivering pre-exposure prophylaxis services during the COVID-19 contingency. Methods A qualitative study was performed: 15 virtual interviews with health care professionals were conducted, transcribed and coded in ATLAS.ti. Results The results indicate that telemedicine effectively mitigated COVID-19 exposure, facilitated users' access to pre-exposure prophylaxis counselling, minimised waiting times and enhanced health care professionals' perceived control during sessions. While implementing remote services, certain organisational challenges, which were somewhat latent before the pandemic, became more apparent: colleagues recognised the necessity for more formal communication channels to disseminate information effectively. Additionally, there was a recognised need for electronic patient files to streamline data-sharing processes. An optimal approach would involve a blend of face-to-face and virtual services, contingent upon the availability of essential infrastructure, well-defined implementation protocols and comprehensive training programs. Conclusions Telemedicine streamlined certain processes, garnered positive acceptance from healthcare professionals and holds promise as a valuable post-pandemic tool for improving retention among pre-exposure prophylaxis users.
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Affiliation(s)
- A Cruz-Bañares
- Center for Evaluation Research and Surveys, National Institute of Public Health of Mexico, Cuernavaca, Mexico
| | - A Rojas-Carmona
- Center for Evaluation Research and Surveys, National Institute of Public Health of Mexico, Cuernavaca, Mexico
| | - S Aguilera-Mijares
- Center for Evaluation Research and Surveys, National Institute of Public Health of Mexico, Cuernavaca, Mexico
| | - A Martínez-Dávalos
- Center for Evaluation Research and Surveys, National Institute of Public Health of Mexico, Cuernavaca, Mexico
| | - S Bautista-Arredondo
- Center for Evaluation Research and Surveys, National Institute of Public Health of Mexico, Cuernavaca, Mexico
| | - H Vermandere
- Center for Evaluation Research and Surveys, National Institute of Public Health of Mexico, Cuernavaca, Mexico
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Colchero MA, Gómez R, Bautista-Arredondo S. A systematic review of the literature on the impact of the Seguro Popular. Health Res Policy Syst 2022; 20:42. [PMID: 35436938 PMCID: PMC9014564 DOI: 10.1186/s12961-022-00839-w] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/09/2022] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND The Seguro Popular (SP) was launched in 2004 to increase access to healthcare and reduce catastrophic expenditures among the Mexican population. To document the evidence on its effectiveness, we conducted a systematic review of impact evaluations of the SP. METHODS We included papers using rigorous quasi-experimental designs to assess the effectiveness of the SP. We evaluated the quality of each study and presented the statistical significance of the effects by outcome category. RESULTS We identified 26 papers that met the inclusion criteria. Sixteen studies that evaluated the impact of SP on financial protection found consistent and statistically significant positive effects in 55% of the 65 outcomes analyzed. Nine studies evaluating utilization of health services for the general and infant populations found effectiveness on 40% of 30 outcomes analyzed. Concerning screening services for hypertension, diabetes, and cervical and prostate cancer, we found three studies evaluating 14 outcomes and finding significant effects on 50% of them. Studies looking at the impact of SP on diabetes, hypertension, and general health care and treatment evaluated 19 outcomes and found effects on 21% of them. One study assessed five diabetes monitoring services and found positive effects on four of them. The only study on morbidity and mortality found positive results on three of the four outcomes of interest. CONCLUSION We found mixed evidence on the impact of SP on financial protection, healthcare utilization, morbidity and mortality. In the 26 studies included in this review, researchers found positive effects in roughly half of the outcomes and null results on the rest.
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Affiliation(s)
- M A Colchero
- Center for Health Systems Research, Instituto Nacional de Salud Pública, Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, C.P. 62100, Cuernavaca, Morelos, Mexico
| | - R Gómez
- Center for Health Systems Research, Instituto Nacional de Salud Pública, Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, C.P. 62100, Cuernavaca, Morelos, Mexico
| | - S Bautista-Arredondo
- Center for Health Systems Research, Instituto Nacional de Salud Pública, Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, C.P. 62100, Cuernavaca, Morelos, Mexico.
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Colchero MA, Barrientos-Gutiérrez T, Guerrero-López CM, Bautista-Arredondo S. Corrigendum to "Density of alcohol-selling outlets and prices are associated with frequent binge drinking in Mexico" [Preventive Medicine 154 (2022) 106921]. Prev Med 2022; 155:106953. [PMID: 35067411 DOI: 10.1016/j.ypmed.2022.106953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- M Arantxa Colchero
- Center for Health Systems Research, National Institute of Public Health, Mexico.
| | | | - C M Guerrero-López
- Center for Health Systems Research, National Institute of Public Health, Mexico
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Vergara-Ortega DN, López-Gatell H, Bautista-Arredondo S, Colchero A, Sosa-Rubí SG, Morales-Vazquez M, Herrera-Ortiz A, Olamendi-Portugal M, García-Cisneros S, Sevilla-Reyes EE, Hernández-Avila M, Sánchez-Alemán MA. Regional disparity of HIV incidence and prevalence among men who have sex with men. BMC Infect Dis 2021; 21:917. [PMID: 34488671 PMCID: PMC8419902 DOI: 10.1186/s12879-021-06582-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 08/09/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND HIV incidence can be estimated with cross-sectional studies using clinical, serological, and molecular data. Worldwide, HIV incidence data in only men who have sex with men (MSM) are scarce and principally focus on those with healthcare or under treatment. However, better estimates can be obtained through studies with national representativeness. The objective was to estimate the prevalence, incidence, and factors associated with acquiring HIV in a national sample of MSM who attend meeting places, considering geographical regions. METHODS A nationally representative survey of MSM attending meeting places was performed in Mexico. Participants answered a questionnaire, and a dried blood spot (DBS) was collected. Samples were classified as recent infections using an algorithm with HIV status, antiretroviral therapy, and the result of BED-EIA assay. Parameters were analysed considering regions and demographic and sexual behaviour characteristics. RESULTS The national HIV prevalence was 17.4% with regional differences; the highest prevalence (20.7%) was found in Mexico City, and the lowest prevalence was found in the West region (11.5%). The incidence was 9.4 per 100 p/y, with regional values from 6.2 to 13.2 for the Northeast and the Centre regions, respectively. Age, age at sexual debut, low wealth index, and rewarded sex were associated with HIV prevalence. Centre region, use of private clinics as health services, and having sex exclusively with men were associated with recent HIV infections. CONCLUSIONS The incidence and prevalence showed regional differences, suggesting a difference in the dynamics of HIV transmission; some regions have a greater case accumulation, and others have a greater rate of new infections. Understanding this dynamic will allow developing health programs focused on HIV prevention or treating people already living with HIV.
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Affiliation(s)
- D N Vergara-Ortega
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Av. Universidad No.655, Col. Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - H López-Gatell
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Av. Universidad No.655, Col. Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - S Bautista-Arredondo
- Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - A Colchero
- Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - S G Sosa-Rubí
- Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - M Morales-Vazquez
- Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - A Herrera-Ortiz
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Av. Universidad No.655, Col. Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - M Olamendi-Portugal
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Av. Universidad No.655, Col. Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - S García-Cisneros
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Av. Universidad No.655, Col. Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico
| | - E E Sevilla-Reyes
- Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - M Hernández-Avila
- Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - M A Sánchez-Alemán
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Av. Universidad No.655, Col. Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico.
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Siapka M, Vassall A, Cunnama L, Pineda C, Cerecero D, Sweeney S, Bautista-Arredondo S, Bollinger L, Cameron D, Levin C, Gomez GB. Cost of tuberculosis treatment in low- and middle-income countries: systematic review and meta-regression. Int J Tuberc Lung Dis 2021; 24:802-810. [PMID: 32912385 DOI: 10.5588/ijtld.19.0694] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Despite a scarcity of tuberculosis (TB) cost data, a substantial body of evidence has been accumulating for drug-susceptible TB (DS-TB) treatment. In this study, we review unit costs for DS-TB treatment from a provider´s perspective. We also examine factors driving cost variations and extrapolate unit costs across low- and middle-income countries (LMICs).METHODS: We searched published and grey literature for any empirically collected TB cost estimates. We selected a subgroup of estimates looking at DS-TB treatment. We extracted information on activities and inputs included. We standardised costs into an average per person-month, fitted a multi-level regression model and cross-validated country-level predictions. We then extrapolated estimates for facility-based, directly observed DS-TB treatment across countries.RESULTS: We included 95 cost estimates from 28 studies across 17 countries. Costs predictions were sensitive to characteristics such as delivery mode, whether hospitalisation was included, and inputs accounted for, as well as gross domestic product per capita. Extrapolation results are presented with uncertainty intervals (UIs) for LMICs. Predicted median costs per 6 months of treatment were US$315.30 (95% CI US$222.60-US$417.20) for low-income, US$527.10 (95% CI US$395.70-US$743.70) for lower middle-income and US$896.40 (95% CI US$654.00-US$1214.40) for upper middle-income countries.CONCLUSIONS: Our study provides country-level DS-TB treatment cost estimates suitable for priority setting. These estimates, while not standing as a substitute for local high-quality primary data, can inform global, regional and national exercises.
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Affiliation(s)
- M Siapka
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - A Vassall
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - L Cunnama
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - C Pineda
- National Institute of Public Health (INSP), Mexico City, Mexico
| | - D Cerecero
- National Institute of Public Health (INSP), Mexico City, Mexico
| | - S Sweeney
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - D Cameron
- University of California, Berkeley, CA
| | - C Levin
- University of Washington, Seattle, WA, USA
| | - G B Gomez
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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Ochoa-Moreno I, Bautista-Arredondo S, McCoy SI, Buzdugan R, Mangenah C, Padian NS, Cowan FM. Costs and economies of scale in the accelerated program for prevention of mother-to-child transmission of HIV in Zimbabwe. PLoS One 2020; 15:e0231527. [PMID: 32433715 PMCID: PMC7239451 DOI: 10.1371/journal.pone.0231527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 03/25/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Despite a growing body of literature on HIV service costs in sub-Saharan Africa, only a few studies have estimated the facility-level cost of prevention of Mother-to-Child Transmission (PMTCT) services, and even fewer provide insights into the variation of PMTCT costs across facilities. In this study, we present the first empirical costs estimation of the accelerated program for the prevention of mother-to-child transmission of HIV in Zimbabwe and investigate the determinants of heterogeneity of the facility-level average cost per service. To understand such variation, we explored the association between average costs per service and supply-and demand-side characteristics, and quality of services. One aspect of the supply-side we explore carefully is the scale of production-which we define as the annual number of women tested or the yearly number of HIV-positive women on prophylaxis. METHODS We collected rich data on the costs and PMTCT services provided by 157 health facilities out of 699 catchment areas in five provinces in Zimbabwe for 2013. In each health facility, we measured total costs and the number of women covered with PMTCT services and estimated the average cost per woman tested and the average cost per woman on either ARV prophylaxis or ART. We refer to these facility-level average costs per service as unitary costs. We also collected information on potential determinants of the variation of unitary costs. On the supply-side, we gathered data on the scale of production, staff composition and on the types of antenatal and family planning services provided. On the demand side, we measured the total population at the catchment area and surveyed eligible pairs of mothers and infants about previous use of HIV testing and prenatal care, and on the HIV status of both mothers and infants. We explored the determinants of unitary cost variation using a two-stage linear regression strategy. RESULTS The average annual total cost of the PMTCT program per facility was US$16,821 (median US$8,920). The average cost per pregnant woman tested was US$80 (median US$47), and the average cost per HIV-positive pregnant woman initiated on ARV prophylaxis or treatment was US$786 annually (median US$420). We found substantial heterogeneity of unitary costs across facilities regardless of facility type. The scale of production was a strong predictor of unitary costs variation across facilities, with a negative and statistically significant correlation between the two variables (p<0.01). CONCLUSIONS These findings are the first empirical estimations of PMTCT costs in Zimbabwe. Unitary costs were found to be heterogeneous across health facilities, with evidence consistent with economies of scale.
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Affiliation(s)
- I. Ochoa-Moreno
- National Institute of Public Health, Cuernavaca, Mexico
- University of York, York, England, United Kingdom
| | - S. Bautista-Arredondo
- National Institute of Public Health, Cuernavaca, Mexico
- University of California, Berkeley, California, United States of America
| | - S. I. McCoy
- University of California, Berkeley, California, United States of America
| | - R. Buzdugan
- University of California, Berkeley, California, United States of America
| | - C. Mangenah
- Centre for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe
| | - N. S. Padian
- University of California, Berkeley, California, United States of America
| | - F. M. Cowan
- Liverpool School of Tropical Medicine, Liverpool, England, United Kingdom
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Bautista-Arredondo S, Nance N, Salas-Ortiz A, Akeju D, Oluwayinka AG, Ezirim I, Anenih J, Chima C, Amanze O, Omoregie G, Ogungbemi K, Aliyu SH. The role of management on costs and efficiency in HIV prevention interventions for female sex workers in Nigeria: a cluster-randomized control trial. Cost Eff Resour Alloc 2018; 16:37. [PMID: 30386184 PMCID: PMC6199740 DOI: 10.1186/s12962-018-0107-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/05/2018] [Indexed: 01/20/2023] Open
Abstract
Background While the world has made much global progress toward the reduction of new HIV infections, HIV continues to be an important public health problem. In the face of constantly constrained resources, donors and grantees alike must seek to optimize resources and deliver HIV services as efficiently as possible. While there is evidence that management practices can affect efficiency, this has yet to be rigorously tested in the context of HIV service delivery. Methods The present protocol describes the design of a cluster-randomized control trial to estimate the effect of management practices on efficiency. Specifically, we will evaluate the impact of an intervention focused on improving management practices among community-based organizations (CBOs), on the costs of HIV prevention services for female sex workers (FSW) in Nigeria. To design the intervention, we used a qualitative, design thinking-informed methodology that allowed us to understand management in its organizational context better and to develop a user-centered solution. After designing the suite of management tools, we randomly assigned 16 CBOs to the intervention group, and 15 CBOs to the control group. The intervention consisted of a comprehensive management training and a management “toolkit” to support better planning and organization of their work and better communication between CBOs and community volunteers. Both treatment and control groups received training to record data on efficiency—inputs used, and outputs produced. Both groups will be prospectively followed through to the end of the study, at which point we will compare the average unit cost per FSW served between the two groups using a quasi-experimental “difference-in-differences” (DiD) strategy. This approach identifies the effect of the intervention by examining differences between treatment and control groups, before and after the intervention thus accounting for time-constant differences between groups. Despite the rigorous randomization procedure, the small sample size and diversity in the country may still cause unobservable characteristics linked to efficiency to unbalanced between treatment and control groups at baseline. In anticipation of this possibility, using the quasi-experimental DiD approach allows any baseline differences to be “differenced out” when measuring the effect. Discussion This study design will uniquely add to the literature around management practices by building rigorous evidence on the relationship between management skills and practices and service delivery efficiency. We expect that management will positively affect efficiency. This study will produce valuable evidence that we will disseminate to key stakeholders, including those integral to the Nigerian HIV response. Trial registration This trial has been registered in Clinical Trials (NCT03371914). Registered 13 December 2018 Electronic supplementary material The online version of this article (10.1186/s12962-018-0107-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Bautista-Arredondo
- 1National Institute of Public Health, Mexico (INSP), Cuernavaca, Mexico.,2University of California, Berkeley, School of Public Health (UCB), Berkeley, USA
| | - N Nance
- 1National Institute of Public Health, Mexico (INSP), Cuernavaca, Mexico
| | - A Salas-Ortiz
- 1National Institute of Public Health, Mexico (INSP), Cuernavaca, Mexico
| | - D Akeju
- 3University of Lagos (UNILAG), Lagos, Nigeria
| | | | - I Ezirim
- 5National Agency for the Control of AIDS (NACA), Abuja, Nigeria
| | - J Anenih
- 5National Agency for the Control of AIDS (NACA), Abuja, Nigeria
| | - C Chima
- 4Society for Family Health (SFH), Abuja, Nigeria
| | - O Amanze
- 5National Agency for the Control of AIDS (NACA), Abuja, Nigeria
| | - G Omoregie
- 4Society for Family Health (SFH), Abuja, Nigeria
| | - K Ogungbemi
- 5National Agency for the Control of AIDS (NACA), Abuja, Nigeria
| | - S H Aliyu
- 5National Agency for the Control of AIDS (NACA), Abuja, Nigeria
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Medina C, Janssen I, Barquera S, Bautista-Arredondo S, González ME, González C. Occupational and leisure time physical inactivity and the risk of type II diabetes and hypertension among Mexican adults: A prospective cohort study. Sci Rep 2018; 8:5399. [PMID: 29599426 PMCID: PMC5876361 DOI: 10.1038/s41598-018-23553-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 03/14/2018] [Indexed: 01/09/2023] Open
Abstract
There is a lack of longitudinal data linking physical inactivity and chronic diseases among Mexicans. Objective. To examine the relationship between total, leisure and occupational moderate-to-vigorous physical activity (MVPA) and incidence of type II diabetes (T2D) and hypertension in the Mexico City Diabetes Study. Study design and population. A prospective cohort study was conducted from 1989 to 2009 among 2282 men and non-pregnant women residing in six low-income neighborhoods in Mexico City. Main outcome. Incidence of T2D and hypertension. Results. After controlling for confounders, <1 MET/min/week of MVPA during leisure time was associated with higher risk of hypertension (HR 1.29, CI 95% 1.01, 1.66) and T2D (HR 1.31 CI 95% 1.00, 1.74). In addition, accumulating <1 MET/min/week of occupational MVPA was associated with higher risk of hypertension (HR 1.47, CI 95% 1.13, 1.90). Conclusion. The absence of leisure and occupational MVPA was associated with an increased risk of hypertension. However, no associations were found between occupational MVPA and T2D.
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Affiliation(s)
- C Medina
- Mexican National Institute of Public Health, Health and Nutrition Research Center, Cuernavaca, Mexico.,Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - I Janssen
- Queen's University, School of Kinesiology and Health Studies, Kingston, Canada
| | - S Barquera
- Mexican National Institute of Public Health, Health and Nutrition Research Center, Cuernavaca, Mexico
| | - S Bautista-Arredondo
- Mexican National Institute of Public Health, Division of Health Economics, Cuernavaca, Mexico
| | - M E González
- Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - C González
- Mexican National Institute of Public Health, Unit for Research in Diabetes and Cardiovascular Risk, Cuernavaca, Mexico. .,Centro de Estudios en Diabetes, Mexico City, Mexico.
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Minnis AM, Dommelen-Gonzalez EV, Luecke E, Cheng H, Dow W, Bautista-Arredondo S, Padian NS. O12.4 Design and Feasibility of Yo Puedo, a Combined Conditional Cash Transfer and Life Skills Sexual Health Intervention For Adolescents in San Francisco, California: Results of a Randomised Study. Sex Transm Infect 2013. [DOI: 10.1136/sextrans-2013-051184.0152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Juarez-Figueroa L, Iracheta P, Conde-Glez C, Bautista-Arredondo S, Gonzalez-Rodriguez A. P3-S6.01 Validation of a treponemic antibodies quimioluminiscence automated test for syphilis detection among inmates of Mexico City. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Burgos JL, Kahn JG, Strathdee SA, Valencia-Mendoza A, Bautista-Arredondo S, Laniado-Laborin R, Castañeda R, Deiss R, Garfein RS. Targeted screening and treatment for latent tuberculosis infection using QuantiFERON-TB Gold is cost-effective in Mexico. Int J Tuberc Lung Dis 2009; 13:962-968. [PMID: 19723375 PMCID: PMC2763545] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE To assess the cost-effectiveness of screening for latent tuberculosis infection (LTBI) using a commercially available detection test and treating individuals at high risk for human immunodeficiency virus (HIV) infection in a middle-income country. DESIGN We developed a Markov model to evaluate the cost per LTBI case detected, TB case averted and quality-adjusted life year (QALY) gained for a cohort of 1000 individuals at high risk for HIV infection over 20 years. Baseline model inputs for LTBI prevalence were obtained from published literature and cross-sectional data from tuberculosis (TB) screening using QuantiFERON-TB Gold In-Tube (QFT-GIT) testing among sex workers and illicit drug users at high risk for HIV recruited through street outreach in Tijuana, Mexico. Costs are reported in 2007 US dollars. Future costs and QALYs were discounted at 3% per year. Sensitivity analyses were performed to evaluate model robustness. RESULTS Over 20 years, we estimate the program would prevent 78 cases of active TB and 55 TB-related deaths. The incremental cost per case of LTBI detected was US$730, cost per active TB averted was US$529 and cost per QALY gained was US$108. CONCLUSIONS In settings of endemic TB and escalating HIV incidence, targeting LTBI screening and treatment among high-risk groups may be highly cost-effective.
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Affiliation(s)
- J L Burgos
- Division of Global Public Health, School of Medicine, University of California San Diego, San Diego, California 92093-0507, USA.
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