Journal Article > ResearchFull Text
J Viral Hepat. 2020 November 4; Volume 28 (Issue 2); 268-278.; DOI:10.1111/jvh.13422
Mafirakureva N, Lim AG, Khalid GG, Aslam K, Campbell L, et al.
J Viral Hepat. 2020 November 4; Volume 28 (Issue 2); 268-278.; DOI:10.1111/jvh.13422
Despite the availability of effective direct-acting antiviral (DAA) treatments for Hepatitis C virus (HCV) infection, many people remain undiagnosed and untreated. We assessed the cost-effectiveness of a Médecins Sans Frontières (MSF) HCV screening and treatment programme within a primary health clinic in Karachi, Pakistan. A health state transition Markov model was developed to estimate the cost-effectiveness of the MSF programme. Programme cost and outcome data were analysed retrospectively. The incremental cost-effectiveness ratio (ICER) was calculated in terms of incremental cost (2016 US$) per disability-adjusted life year (DALY) averted from the provider's perspective over a lifetime horizon. The robustness of the model was evaluated using deterministic and probabilistic sensitivity analyses (PSA). The ICER for implementing testing and treatment compared to no programme was US$450/DALY averted, with 100% of PSA runs falling below the per capita Gross Domestic Product threshold for cost-effective interventions for Pakistan (US$1,422). The ICER increased to US$532/DALY averted assuming national HCV seroprevalence (5.5% versus 33% observed in the intervention). If the cost of liver disease care was included (adapted from resource use data from Cambodia which has similar GDP to Pakistan), the ICER dropped to US$148/DALY, while it became cost-saving if a recently negotiated reduced drug cost of $75/treatment course was assumed (versus $282 in base-case) in addition to cost of liver disease care. In conclusion, screening and DAA treatment for HCV infection are expected to be highly cost-effective in Pakistan, supporting the expansion of similar screening and treatment programmes across Pakistan.
Journal Article > ResearchFull Text
Society. 2020 June 29; Volume 117 (Issue 2); 411-424.; DOI:10.1111/add.15630
Mafirakureva N, Stone J, Fraser H, Nzomukunda Y, Maina A, et al.
Society. 2020 June 29; Volume 117 (Issue 2); 411-424.; DOI:10.1111/add.15630
BACKGROUND AND AIMS
Hepatitis C virus (HCV) treatment is essential for eliminating HCV in people who inject drugs (PWID), but has limited coverage in resource-limited settings. We measured the cost-effectiveness of a pilot HCV screening and treatment intervention using directly observed therapy among PWID attending harm reduction services in Nairobi, Kenya.
DESIGN
We utilized an existing model of HIV and HCV transmission among current and former PWID in Nairobi to estimate the cost-effectiveness of screening and treatment for HCV, including prevention benefits versus no screening and treatment. The cure rate of treatment and costs for screening and treatment were estimated from intervention data, while other model parameters were derived from literature. Cost-effectiveness was evaluated over a life-time horizon from the health-care provider's perspective. One-way and probabilistic sensitivity analyses were performed.
SETTING
Nairobi, Kenya.
POPULATION
PWID.
MEASUREMENTS
Treatment costs, incremental cost-effectiveness ratio (cost per disability-adjusted life year averted).
FINDINGS
The cost per disability-adjusted life-year averted for the intervention was $975, with 92.1% of the probabilistic sensitivity analyses simulations falling below the per capita gross domestic product for Kenya ($1509; commonly used as a suitable threshold for determining whether an intervention is cost-effective). However, the intervention was not cost-effective at the opportunity cost-based cost-effectiveness threshold of $647 per disability-adjusted life-year averted. Sensitivity analyses showed that the intervention could provide more value for money by including modelled estimates for HCV disease care costs, assuming lower drug prices ($75 instead of $728 per course) and excluding directly-observed therapy costs.
CONCLUSIONS
The current strategy of screening and treatment for hepatitis C virus (HCV) among people who inject drugs in Nairobi is likely to be highly cost-effective with currently available cheaper drug prices, if directly-observed therapy is not used and HCV disease care costs are accounted for.
Hepatitis C virus (HCV) treatment is essential for eliminating HCV in people who inject drugs (PWID), but has limited coverage in resource-limited settings. We measured the cost-effectiveness of a pilot HCV screening and treatment intervention using directly observed therapy among PWID attending harm reduction services in Nairobi, Kenya.
DESIGN
We utilized an existing model of HIV and HCV transmission among current and former PWID in Nairobi to estimate the cost-effectiveness of screening and treatment for HCV, including prevention benefits versus no screening and treatment. The cure rate of treatment and costs for screening and treatment were estimated from intervention data, while other model parameters were derived from literature. Cost-effectiveness was evaluated over a life-time horizon from the health-care provider's perspective. One-way and probabilistic sensitivity analyses were performed.
SETTING
Nairobi, Kenya.
POPULATION
PWID.
MEASUREMENTS
Treatment costs, incremental cost-effectiveness ratio (cost per disability-adjusted life year averted).
FINDINGS
The cost per disability-adjusted life-year averted for the intervention was $975, with 92.1% of the probabilistic sensitivity analyses simulations falling below the per capita gross domestic product for Kenya ($1509; commonly used as a suitable threshold for determining whether an intervention is cost-effective). However, the intervention was not cost-effective at the opportunity cost-based cost-effectiveness threshold of $647 per disability-adjusted life-year averted. Sensitivity analyses showed that the intervention could provide more value for money by including modelled estimates for HCV disease care costs, assuming lower drug prices ($75 instead of $728 per course) and excluding directly-observed therapy costs.
CONCLUSIONS
The current strategy of screening and treatment for hepatitis C virus (HCV) among people who inject drugs in Nairobi is likely to be highly cost-effective with currently available cheaper drug prices, if directly-observed therapy is not used and HCV disease care costs are accounted for.
Journal Article > ResearchFull Text
BMC Health Serv Res. 2020 September 21; Volume 20 (Issue 1); DOI:10.1186/s12913-020-05735-z
Gils T, Laxmeshwar C, Duka M, Malakyan K, Siomak OV, et al.
BMC Health Serv Res. 2020 September 21; Volume 20 (Issue 1); DOI:10.1186/s12913-020-05735-z
BACKGROUND
Ukraine has a high burden of drug-resistant tuberculosis (DR-TB). Mental health problems, including alcohol use disorder, are common co-morbidities. One in five DR-TB patients has human immunodeficiency virus (HIV). As part of health reform, the country is moving from inpatient care to ambulatory primary care for tuberculosis (TB). In Zhytomyr oblast, Médecins Sans Frontières (MSF) is supporting care for DR-TB patients on all-oral short DR-TB regimens. This study describes the preparedness of ambulatory care facilities in Zhytomyr oblast, Ukraine, to provide good quality ambulatory care.
METHODS
This is a retrospective analysis of routinely collected programme data. Before discharge of every patient from the hospital, MSF teams assess services available at outpatient facilities using a standardised questionnaire. The assessment evaluates access, human resources, availability of medicines, infection control measures, laboratory and diagnostic services, and psychosocial support.
RESULTS
We visited 68 outpatient facilities in 22 districts between June 2018 and September 2019. Twenty-seven health posts, 24 TB-units, 13 ambulatories, two family doctors and one polyclinic, serving 30% of DR-TB patients in the oblast by September 2019, were included. All facilities provided directly observed treatment, but only seven (10%) provided weekend-services. All facilities had at least one medical staff member, but TB-training was insufficient and mostly limited to TB-doctors. TB-treatment and adequate storage space were available in all facilities, but only five (8%) had ancillary medicines. HIV-positive patients had to visit a separate facility to access HIV-care. Personal protective equipment was unavailable in 32 (55%) facilities. Basic laboratory services were available in TB-units, but only four (17%) performed audiometry. Only ten (42%) TB-units had psychosocial support available, and nine (38%) offered psychiatric support.
CONCLUSION
Outpatient facilities in Zhytomyr oblast are not yet prepared to provide comprehensive care for DR-TB patients. Capacity of all facilities needs strengthening with trainings, infection control measures and infrastructure. Integration of psychosocial services, treatment of co-morbidities and adverse events at the same facility are essential for successful decentralisation. The health reform is an opportunity to establish quality, patient-centred care.
Ukraine has a high burden of drug-resistant tuberculosis (DR-TB). Mental health problems, including alcohol use disorder, are common co-morbidities. One in five DR-TB patients has human immunodeficiency virus (HIV). As part of health reform, the country is moving from inpatient care to ambulatory primary care for tuberculosis (TB). In Zhytomyr oblast, Médecins Sans Frontières (MSF) is supporting care for DR-TB patients on all-oral short DR-TB regimens. This study describes the preparedness of ambulatory care facilities in Zhytomyr oblast, Ukraine, to provide good quality ambulatory care.
METHODS
This is a retrospective analysis of routinely collected programme data. Before discharge of every patient from the hospital, MSF teams assess services available at outpatient facilities using a standardised questionnaire. The assessment evaluates access, human resources, availability of medicines, infection control measures, laboratory and diagnostic services, and psychosocial support.
RESULTS
We visited 68 outpatient facilities in 22 districts between June 2018 and September 2019. Twenty-seven health posts, 24 TB-units, 13 ambulatories, two family doctors and one polyclinic, serving 30% of DR-TB patients in the oblast by September 2019, were included. All facilities provided directly observed treatment, but only seven (10%) provided weekend-services. All facilities had at least one medical staff member, but TB-training was insufficient and mostly limited to TB-doctors. TB-treatment and adequate storage space were available in all facilities, but only five (8%) had ancillary medicines. HIV-positive patients had to visit a separate facility to access HIV-care. Personal protective equipment was unavailable in 32 (55%) facilities. Basic laboratory services were available in TB-units, but only four (17%) performed audiometry. Only ten (42%) TB-units had psychosocial support available, and nine (38%) offered psychiatric support.
CONCLUSION
Outpatient facilities in Zhytomyr oblast are not yet prepared to provide comprehensive care for DR-TB patients. Capacity of all facilities needs strengthening with trainings, infection control measures and infrastructure. Integration of psychosocial services, treatment of co-morbidities and adverse events at the same facility are essential for successful decentralisation. The health reform is an opportunity to establish quality, patient-centred care.
Journal Article > Meta-AnalysisFull Text
Hepatol Commun. 2018 October 1; Volume 2 (Issue 10); 1160-1167.; DOI:10.1002/hep4.1247
Ford NP, Scourse R, Lemoine M, Hutin Y, Bulterys M, et al.
Hepatol Commun. 2018 October 1; Volume 2 (Issue 10); 1160-1167.; DOI:10.1002/hep4.1247
Successful treatment outcomes for chronic hepatitis B virus (HBV) infection requires high levels of adherence to treatment. We searched three databases and abstracts from two conferences up to January 2018 for studies reporting the proportion of patients who were adherent to HBV antiviral therapy and pooled data using random effects meta-analysis. We included 30 studies, providing data for 23,823 patients. Overall, adherence to treatment was 74.6% (95% confidence interval [CI] 67.1%-82.1%). Adherence was similar in high-income settings (75.1%; 95% CI, 65.4%-85.0%) and in low-income and middle-income settings (72.9%; 95% CI, 57.8%-88.0%). Reported barriers to adherence included forgetting, limited understanding of the importance of adherence, and change to routine.
CONCLUSION
There is a need to reinforce assessment and reporting of adherence as a routine part of HBV care and to assess the extent to which evidence-based interventions to improve adherence to medication for human immunodeficiency virus [HIV] and other chronic diseases are effective for HBV infection.
CONCLUSION
There is a need to reinforce assessment and reporting of adherence as a routine part of HBV care and to assess the extent to which evidence-based interventions to improve adherence to medication for human immunodeficiency virus [HIV] and other chronic diseases are effective for HBV infection.
Journal Article > ResearchFull Text
J Infect Dev Ctries. 2021 September 29; Volume 15 (Issue 9.1); 25S-33S.; DOI: 10.3855/jidc.13827
Plokhykh V, Duka M, Cassidy L, Chen CY, Malakyan K, et al.
J Infect Dev Ctries. 2021 September 29; Volume 15 (Issue 9.1); 25S-33S.; DOI: 10.3855/jidc.13827
INTRODUCTION
Despite concerted efforts, Ukraine is challenged by increasing rates of multidrug and rifampicin-resistant tuberculosis (MDR/RR-TB) comorbid with alcohol use disorder (AUD). This study describes a cohort of RR-TB patients with high alcohol consumption treated in MSF Zhytomyr Project, Ukraine.
METHODOLOGY
We used programmatic data for 73 RR-TB patients screened with the AUD Identification Test March-July 2019 and followed-up for culture conversion/TB treatment outcome till 31 January 2020. We described socio-demographic, behavioral, and clinical characteristics, the level of depressive symptoms, and TB treatment outcomes in three groups: 1) patients with AUD who received mental health interventions (MHI); 2) patients with AUD who did not receive MHI; 3) patients with no AUD. We also found three potential contributors to declining to receive MHI.
RESULTS
Main characteristics of the study groups did not differ substantially. Those receiving MHI (mean: nine sessions) were rated for alcohol consumption as 'hazardous' (41%), 'harmful' (43%) and 'dependence' (36%) and had higher depression scores versus the second (p=0.009) and third (p=0.095) groups at baseline. Depressive symptoms declined at 9-month follow-up for all patients. Culture conversion was seen at 77%, 73%, and 83% for each group respectively. We also found three reasons for declining from MHI.
CONCLUSIONS
We detected little differences across the groups. However, our study cohort demonstrated substantially higher adherence rates, culture conversion and reduction of depressive symptoms than reported globally. We recommend further research on the effectiveness of MHI in changing the drinking habits, quality of life and/or TB treatment outcomes of patients with AUD.
Despite concerted efforts, Ukraine is challenged by increasing rates of multidrug and rifampicin-resistant tuberculosis (MDR/RR-TB) comorbid with alcohol use disorder (AUD). This study describes a cohort of RR-TB patients with high alcohol consumption treated in MSF Zhytomyr Project, Ukraine.
METHODOLOGY
We used programmatic data for 73 RR-TB patients screened with the AUD Identification Test March-July 2019 and followed-up for culture conversion/TB treatment outcome till 31 January 2020. We described socio-demographic, behavioral, and clinical characteristics, the level of depressive symptoms, and TB treatment outcomes in three groups: 1) patients with AUD who received mental health interventions (MHI); 2) patients with AUD who did not receive MHI; 3) patients with no AUD. We also found three potential contributors to declining to receive MHI.
RESULTS
Main characteristics of the study groups did not differ substantially. Those receiving MHI (mean: nine sessions) were rated for alcohol consumption as 'hazardous' (41%), 'harmful' (43%) and 'dependence' (36%) and had higher depression scores versus the second (p=0.009) and third (p=0.095) groups at baseline. Depressive symptoms declined at 9-month follow-up for all patients. Culture conversion was seen at 77%, 73%, and 83% for each group respectively. We also found three reasons for declining from MHI.
CONCLUSIONS
We detected little differences across the groups. However, our study cohort demonstrated substantially higher adherence rates, culture conversion and reduction of depressive symptoms than reported globally. We recommend further research on the effectiveness of MHI in changing the drinking habits, quality of life and/or TB treatment outcomes of patients with AUD.