Journal Article > ResearchSubscription Only
Society. 2022 January 31; 103107.; DOI:10.1016/j.pce.2022.103107
Takavada I, Hoko Z, Gumindoga W, Mhiza A, Nuttinck JY, et al.
Society. 2022 January 31; 103107.; DOI:10.1016/j.pce.2022.103107
Zimbabwe is projected to suffer water stress by 2025. Water availability is decreasing in the capital Harare, particularly in high density settlements where people rely mainly on boreholes. Anthropogenic pollution and poorly constructed boreholes lead to high levels of bacteriological contamination of borehole water sources, posing an increased risk of diarrheal disease for beneficiaries. To mitigate the risk of recurrent diarrheal outbreaks, Médecins Sans Frontiers piloted the incorporation of borehole sanitary seal in accordance with the local geology while drilling new boreholes in Harare. This study compared physical, chemical and bacteriological parameters between boreholes with two different sanitary seal types and no sanitary seal in Harare's Mbare suburb. 14 boreholes were classified into three categories based on the installed sanitary seal. Water quality analysis were conducted to describe physical, chemical and bacteriological parameters across three categories. The three categories included 4 boreholes with no seal, 6 with 3–6 m seal (random seal) and 4 with 18–25 m seal (proper seal; done in accordance with local geology). Water samples were collected between February 2019 to January 2020 in 3 sampling periods and analysed according to APHA standards. Groundwater vulnerability assessment to map pollution risk of the study areas showed 80% of the study area had high vulnerability. Results of water quality analysis revealed that only boreholes with 18–25m sanitary seal satisfied the WHO guidelines for drinking water. This study suggests that local geology should be considered to install borehole sanitary seals for contaminated shallow water aquifers in urban settlements.
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 > LetterFull Text
Society. 2016 January 11; Volume 53 (Issue 1); 8-12.; DOI:10.1007/s12115-015-9965-4
Delaunay S
Society. 2016 January 11; Volume 53 (Issue 1); 8-12.; DOI:10.1007/s12115-015-9965-4