Regional and temporal trends in malaria commodity costs: an analysis of Global Fund data for 79 countries

BACKGROUND: Although procurement consumes nearly 40% of Global Fund’s money, no analyses have been published to show how costs vary across regions and time. This paper presents an analysis of malaria-related commodity procurement data from 79 countries, as reported through the Global Fund’s price and quality reporting (PQR) system for the 2005–2012 period. METHODS: Data were analysed for the three most widely procured commodities for prevention, diagnosis and treatment of malaria. These were long-lasting insecticide-treated nets (LLINs), malaria rapid diagnostic tests (RDTs) and the artemether/lumefantrine (AL) combination treatment. Costs were compared across time (2005–2012), regions, and between individual procurement reported through the PQR and pooled procurement reported through the Global Fund’s voluntary pooled procurement (VPP) system. All costs were adjusted for inflation and reported in US dollars. RESULTS: The data included 1,514 entries reported from 79 countries over seven years. Of these, 492 entries were for LLINs, 330 for RDTs and 692 for AL. Considerable variations were seen by commodity, although none showed an increase in cost. The costs for LLINs, RDTs and AL all dropped significantly over the period of analysis. Regional variations were also seen, with the cost for all three commodities showing significant variations. The median cost for a single LLIN ranged from USD 4.3 in East Asia to USD 5.0 in West and Central Africa. The cost of a single RDT was lowest in West and Central Africa at US$0.57, and highest in the Latin American region at US$ 1.1. AL had the narrowest margin of between US$0.06 per tablet in sub-Saharan Africa and South Asia, and US$ 0.08 in the Latin American and Eastern Europe regions. CONCLUSION: This paper concludes that global procurement costs do vary by region and have reduced overall over time. This suggests a mature market is operating when viewed from the global level, but regional variation needs further attention. Such analyses should be done more often to identify and correct market insufficiencies

TB STIGMA – MEASUREMENT GUIDANCE

TB is the most deadly infectious disease in the world, and stigma continues to play a significant role in worsening the epidemic. Stigma and discrimination not only stop people from seeking care but also make it more difficult for those on treatment to continue, both of which make the disease more difficult to treat in the long-term and mean those infected are more likely to transmit the disease to those around them. TB Stigma – Measurement Guidance is a manual to help generate enough information about stigma issues to design and monitor and evaluate efforts to reduce TB stigma. It can help in planning TB stigma baseline measurements and monitoring trends to capture the outcomes of TB stigma reduction efforts. This manual is designed for health workers, professional or management staff, people who advocate for those with TB, and all who need to understand and respond to TB stigma

Sex differences in survival in patients with a hospital admission for acute myocardial infarction in Scotland 1990-2000

Background Acute myocardial infarction (AMI) is an important cause of morbidity and mortality in men and women. Much of the existing literature has either focussed on men or has examined men and women together. There is a growing evidence to suggest that men and women represent distinct entities in terms of the epidemiology of AMI. This study therefore aims to examine and compare the baseline characteristics, burden of disease and survival of men and women hospitalised between 1990 and 2000 following a first and second AMI and also to determine factors that influence survival in men and women. Methods The Scottish Linked Morbidity Record Database was used to identify all patients hospitalised with a first and a second AMI between 1990 and 2000. Baseline characteristics including demographics, comorbid diagnoses and the burden of disease (including incidence, length of stay and revascularisation rates) were examined in men and women. Sex specific case fatality was calculated at a number of time points from 30 days to five years. Multivariate modelling was then used to examine factors affecting prognosis in different age groups and determine trends over time in men and women separately. Results Between 1990 and 2000, a total of 110, 226 individuals were hospitalised with a first AMI (41% women) and 9,664 individuals (40%) were hospitalised with a second AMI. Comorbid diagnoses were coded in almost half of all men and women with a first AMI and two thirds of those with a second AMI. Between 1990 and 2000, first AMI incidence declined by about one half in men and by one third in women whilst hospitalisation rates for second AMI halved. Thus, burden of disease (incidence and length of stay) fell whilst revascularisation rates increased. Unadjusted short and longer term survival was greater in men than in women. After adjusting for age and other factors women with a first AMI fared worse than men in the short term but better than men in the longer term. Short term sex differences were restricted to younger age groups. In the multivariate analyses men and women had similar short and longer term outcomes following a second AMI. Between 1990 and 2000, short term case fatality declined by approximately half in men and by one third in women over the study period. These improvements were more evident following a first AMI and in younger age groups. Conclusions Younger women hospitalised with a first AMI have high levels of comorbid disease and a worse short term prognosis than men. However women fare better than men in the longer term. Sex differences are not apparent in survival following a second AMI. This may reflect differences in treatment and in secondary prevention, and merits further research

Overcoming barriers to engaging socio-economically disadvantaged populations in CHD primary prevention: a qualitative study

<p><b>Background:</b> Preventative medicine has become increasingly important in efforts to reduce the burden of chronic disease in industrialised countries. However, interventions that fail to recruit socio-economically representative samples may widen existing health inequalities. This paper explores the barriers and facilitators to engaging a socio-economically disadvantaged (SED) population in primary prevention for coronary heart disease (CHD).</p> <p><b>Methods:</b> The primary prevention element of Have a Heart Paisley (HaHP) offered risk screening to all eligible individuals. The programme employed two approaches to engaging with the community: a) a social marketing campaign and b) a community development project adopting primarily face-to-face canvassing. Individuals living in areas of SED were under-recruited via the social marketing approach, but successfully recruited via face-to-face canvassing. This paper reports on focus group discussions with participants, exploring their perceptions about and experiences of both approaches.</p> <p><b>Results:</b> Various reasons were identified for low uptake of risk screening amongst individuals living in areas of high SED in response to the social marketing campaign and a number of ways in which the face-to-face canvassing approach overcame these barriers were identified. These have been categorised into four main themes: (1) processes of engagement; (2) issues of understanding; (3) design of the screening service and (4) the priority accorded to screening. The most immediate barriers to recruitment were the invitation letter, which often failed to reach its target, and the general distrust of postal correspondence. In contrast, participants were positive about the face-to-face canvassing approach. Participants expressed a lack of knowledge and understanding about CHD and their risk of developing it and felt there was a lack of clarity in the information provided in the mailing in terms of the process and value of screening. In contrast, direct face-to-face contact meant that outreach workers could explain what to expect. Participants felt that the procedure for uptake of screening was demanding and inflexible, but that the drop-in sessions employed by the community development project had a major impact on recruitment and retention.</p> <p><b>Conclusion:</b> Socio-economically disadvantaged individuals can be hard-to-reach; engagement requires strategies tailored to the needs of the target population rather than a population-wide approach.</p&gt

Exploring masculinities, sexual health and wellbeing across areas of high deprivation in Scotland: the depth of the challenge to improve understandings and practices

Within and across areas of high deprivation, we explored constructions of masculinity in relation to sexual health and wellbeing, in what we believe to be the first UK study to take this approach. Our sample of 116 heterosexual men and women age 18–40 years took part in individual semi-structured interviews (n = 35) and focus group discussions (n = 18), across areas in Scotland. Drawing on a socio-ecological framework, findings revealed experience in places matter, with gender practices rooted in a domestically violent milieu, where localised, socio-cultural influences offered limited opportunities for more egalitarian performances of masculinity. We discuss the depths of the challenge in transforming masculinities in relation to sexual health and wellbeing in such communities

Pregnant or positive: Adolescent childbearing and HIV risk in South Africa

In communities where early age of childbearing is common and HIV prevalence is high, adolescent boys and girls may place themselves at risk of HIV to realize their childbearing preferences. In this paper, we analyze survey data from Kwa-Zulu-Natal province that explores whether an association exists between pregnancy preferences and behavioral and perceptual measures of HIV risk among adolescents in South Africa. Our analysis is based on data from 1,426 sexually active respondents aged 14-22 who participated in wave 1 of the “Transitions to Adulthood in the Context of AIDS in South Africa” study. We use logistic regression to model the probability of reporting that pregnancy would be a problem, using measures of HIV risk together with controls for individual and community measures that are also likely to affect pregnancy preferences. We find that educational and employment opportunities affect fertility preferences but also that the HIV pandemic, specifically adults’ perception of HIV risk for the young in the community and peer opinions about HIV risk, affect fertility preferences. Some significant differences by sex emerge concerning the influence of the perceptions of HIV risk. The analysis suggests that although individual and structural factors remain important, for some adolescents-and for girls more than for boys-the danger of HIV infection is becoming part of their calculus of the desirability of pregnancy. For both boys and girls, the unprotected sex required for conception puts them at danger of HIV transmission. For girls, the environment of risk may be particularly influential because the double threat of pregnancy and HIV infection carries an additional risk of HIV transmission to the infant, as well as the possibility of learning one’s serostatus at an antenatal clinic during pregnancy

Interventions to reduce HIV/AIDS stigma: What have we learned?

Stigma is a common human reaction to disease. Throughout history many diseases have carried considerable stigma, including leprosy, tuberculosis, cancer, mental illness, and many sexually transmitted diseases. HIV/AIDS is only the latest disease to be stigmatized. This paper reviews 21 interventions that have explicitly attempted to decrease AIDS stigma both in the developed and developing countries and 9 studies that aim to decrease stigma related with other diseases. The studies selected met stringent evaluation criteria in order to draw common lessons for future development of interventions to combat stigma. This paper assesses published and reported studies through comparison of audiences, types of interventions, and methods used to measure change. Target audiences include both those living with or suspected of living with a disease and perpetrators of stigma. All interventions reviewed target subgroups within these broad categories. Types of programs include general information-based programs, contact with affected groups, coping skills acquisition, and counseling approaches. A limited number of scales and indices were used as indicators of change in AIDS stigma