Lancet Global Health最新文献

{"title":"Lived experience and global health architecture reform: from afterthought to cornerstone.","authors":"Johanna Ralston,Lavanya Vijayasingham,Chikhulupiliro Stanley Ng'ombe,Lucia Feito Allonca,Prisca Githuka,Nupur Lalvani,Ratna Devi","doi":"10.1016/j.langlo.2026.103999","DOIUrl":"https://doi.org/10.1016/j.langlo.2026.103999","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"22 1","pages":"103999"},"PeriodicalIF":34.3,"publicationDate":"2027-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148400840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sustaining progress in HIV care in Africa with a transition to enabled self-care: a modelling study.","authors":"Andrew N Phillips,Kenly Sikwese,Valentina Cambiano,Loveleen Bansi-Matharu,Jennifer Smith,Euphemia Sibanda,Cheryl Johnson,Brooke E Nichols,Edinah Mudimu,Frances M Cowan,Paul Revill","doi":"10.1016/s2214-109x(26)00088-4","DOIUrl":"https://doi.org/10.1016/s2214-109x(26)00088-4","url":null,"abstract":"BACKGROUNDThe funding crisis for HIV services in east, central, southern, and west Africa means that innovative strategies for continuing prevention and care for HIV are needed. One such strategy is enabled self-care: the provision of free HIV self-tests, pre-exposure prophylaxis (PrEP), tenofovir-lamivudine-dolutegravir for post-exposure prophylaxis (PEP), and antiretroviral therapy (ART) provided in local pharmacies and by community-based health workers. We modelled the introduction of a policy of transition to enabled self-care compared with continuation of current service provision.METHODSWe used an established individual-based model (HIV Synthesis) to simulate HIV epidemics in 1000 setting scenarios representing diversity in setting characteristics across east, central, southern, and west Africa, and uncertainty in parameter values. For each setting scenario, we simulated 100 000 people aged ≥15 years between 1989 and 2076. The model incorporates ART access informed by studies of barriers to accessing clinics. Our main outcomes included the number of adults testing for HIV in a 3-month period, PrEP and PEP use, coverage of people on ART, HIV-related deaths, HIV incidence, perinatal transmission, disability-adjusted life-years (DALYs), and costs. We chose a 50-year time horizon to capture the full effects of the policies. For each setting scenario, we performed three replicate runs for each of the two policies and for each policy took the mean across the three runs.FINDINGSOur model estimated that transitioning to enabled self-care would lead to increases in testing from a median of 5·0% (90% range 2·3-11·5) of adults testing per 3 months to 12·7% (6·6-21·1), an increase in PrEP and PEP use (+0·5% of adults [0·0-2·2]), and an increase in ART coverage for people with diagnosed HIV (+1% [0-3]) with enhanced benefits in those previously without access to PrEP and testing services. Enabled self-care was predicted to result in a median 18% (90% range 4-33) fewer HIV deaths, and a relative rate of 0·73 (0·52-0·94) in terms of HIV incidence per 100 person-years over 10 years. Overall, over a 50-year time horizon, enabled self-care was predicted to cut discounted programme costs by US$6·0 million (5·6-6·5; a 7% decrease), avert 34 000 (32 200 to 36 000) DALYS, and be cost-effective (at a cost-effectiveness threshold of $300 per DALY averted) in 95% of setting scenarios. The mean undiscounted annual cost per adult in the population per year across setting scenarios was $12 (median $11 [90% range 6-22]). The higher the HIV prevalence was in a setting scenario, the more cost-effective the policy was found to be (odds ratio 1·41 [95% CI 1·25-1·60] per 1% higher HIV prevalence).INTERPRETATIONIntroduction of community access to self-tests and antiretroviral drugs through a transition to enabled self-care is very likely to be cost-effective in most settings in east, central, southern, and west Africa; enable incidence declines to be sustained at reduced cos","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"40 1","pages":"103943"},"PeriodicalIF":34.3,"publicationDate":"2027-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148349219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enabled self-care for HIV infection: an inflection point for sustainable epidemic control.","authors":"Dvora Joseph Davey","doi":"10.1016/j.langlo.2026.103970","DOIUrl":"https://doi.org/10.1016/j.langlo.2026.103970","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"1 1","pages":"103970"},"PeriodicalIF":34.3,"publicationDate":"2027-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148349222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accountability for pandemic financing decisions.","authors":"Shuhei Nomura","doi":"10.1016/j.langlo.2026.104105","DOIUrl":"https://doi.org/10.1016/j.langlo.2026.104105","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"104105"},"PeriodicalIF":22.5,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence-supported diabetic retinopathy screening in Tanzania: a randomised controlled trial.","authors":"Charles R Cleland, Covadonga Bascaran, William U Makupa, Bernadetha Shilio, Justus Rwiza, Lusekelo Nyale, Edith Macha, Fatima Mumba, Franki Sandi, Heiko Philippin, Ana P Marques, Louis Bolter, John Anderson, Catherine Egan, Adnan Tufail, Pearse A Keane, Alastair K Denniston, David Macleod, Matthew J Burton","doi":"10.1016/j.langlo.2026.104062","DOIUrl":"https://doi.org/10.1016/j.langlo.2026.104062","url":null,"abstract":"<p><strong>Background: </strong>Non-attendance after referral from screening is one of the major challenges for diabetic retinopathy screening programmes in Africa. Artificial intelligence (AI) systems for the identification of diabetic retinopathy can provide point-of-screening results and therefore enable immediate counselling. We aimed to investigate whether AI-supported diabetic retinopathy screening, with a point-of-screening result and face-to-face counselling, increased the proportion of people with true referable diabetic retinopathy who attended the central ophthalmology referral clinic when compared with standard diabetic retinopathy screening with deferred human grading and telephone counselling.</p><p><strong>Methods: </strong>This two-arm, parallel-group, individually randomised controlled trial was conducted at non-communicable disease or diabetic clinics in 24 hospitals in the Kilimanjaro and Arusha regions of Tanzania. Eligible participants (aged ≥18 years) had diabetes and attended diabetic retinopathy screening. Participants were randomly assigned (1:1) to receive either AI-supported diabetic retinopathy screening with a point-of-screening result and face-to-face counselling (the AI-intervention group) or standard-of-care diabetic retinopathy screening with deferred human retinal image assessment and telephone counselling (the standard-of-care group). Participants had retinal photographs taken of both eyes. Images from the AI-intervention group were submitted to the AI software, and these participants were given their screening result (non-referable, referable, or ungradable) plus face-to-face counselling before leaving the photography room, with a referral to the central ophthalmology clinic if the AI output was referable or ungradable. Participants in the standard-of-care group received their screening result, along with appropriate counselling, by telephone a few weeks later. The primary outcome was attendance at the central ophthalmology clinic within 8 weeks of screening among participants classified by masked UK-certified graders as having true referable diabetic retinopathy. This trial was registered with the ISRCTN Registry, ISRCTN18317152, and is complete.</p><p><strong>Findings: </strong>Between March 8, 2023, and Aug 31, 2024, 2439 participants were assessed for eligibility and 2378 were enrolled, of whom 1192 were randomly assigned to the AI-intervention group and 1186 to the standard-of-care group. 904 participants had true referable diabetic retinopathy, comprising 437 in the AI-intervention group and 467 in the standard-of-care group. Of the participants in the AI-intervention group, 157 (35·9%) of 437 attended the central ophthalmology clinic within 8 weeks, compared with 85 (18·2%) of 467 in the standard-of-care group, an absolute difference of 17·7 percentage points (95% CI 12·0-23·4; odds ratio 2·52 [95% CI 1·86-3·42]; p<0·0001).</p><p><strong>Interpretation: </strong>AI-supported screening, with a point-of-sc","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"104062"},"PeriodicalIF":22.5,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Informing an mpox stockpile investment case: epidemiological modelling and cost-benefit analysis.","authors":"Dionne Mitcham, Richard Bruns, Hannah Goodtree, Elizabeth Campbell, Alison Kelly, Oluremilekun Oyefolu, Haley Wellham, Fatima N Ameaka, Sarah Gillani, Sarah Schneider-Firestone, Amanda Hart, Caitlin Rivers, Nivedita Saksena, Ignacio Esteban, Lassané Kaboré, Simon Allan, Allyson L Russell, Francisco J Luquero, Neil J Saad Duque, Crystal R Watson","doi":"10.1016/j.langlo.2026.104069","DOIUrl":"https://doi.org/10.1016/j.langlo.2026.104069","url":null,"abstract":"<p><strong>Background: </strong>In response to ongoing mpox outbreaks, Gavi, the Vaccine Alliance, was considering funding the establishment of an mpox vaccine stockpile. To support their decision making, Gavi commissioned the Center for Outbreak Response Innovation at the Johns Hopkins Bloomberg School of Public Health to estimate the optimal size, impact, health benefits, and monetised net benefits of different mpox vaccine stockpile sizes for an effective global stockpile to support outbreak containment and prevention of widespread mpox transmission. We aimed to quantify the potential impact of vaccination on future mpox outbreaks to inform Gavi's decision making for investing in an effective mpox vaccine stockpile.</p><p><strong>Methods: </strong>A deterministic compartmental model of mpox transmission with vaccine interventions was developed, including intervening rapidly-at 20 cases reported-versus at 100 cases reported. The model was used to assess potential vaccine-based mitigation strategies for mpox outbreaks in Gavi-eligible countries by simulating mpox transmission and control dynamics, given two vaccination strategies (one dose and two doses) compared with no intervention in high-risk groups and contacts of cases, across four distinct subpopulations: (1) children younger than 5 years, (2) men who have sex with men, (3) female sex workers, and (4) the remaining general population. The findings from this model were incorporated into a Monte Carlo cost-benefit analysis of different stockpile sizes.</p><p><strong>Findings: </strong>Rapid response (ie, intervening at 20 cases reported) using a single-dose vaccination strategy provided the greatest benefits relative to costs compared with a two-dose strategy. Using a one-dose strategy, expected net benefits were estimated to be over US$81 million to $220 million higher when responding to outbreaks rapidly than when responding after 100 cases. Furthermore, the total cost per disability-adjusted life-year (DALY) averted with rapid response using a one-dose vaccine strategy responding at 20 cases was 18% to 53% lower than a one-dose strategy introduced at 100 cases. A stockpile of 1 000 000 doses had the highest ratio of benefits to costs.</p><p><strong>Interpretation: </strong>A stockpile calibrated to attain a high ratio of benefits to costs can be effective in controlling outbreaks and reducing overall negative health impacts. The cost-effectiveness of mpox vaccine stockpiles could be further maximised with reduced vaccine pricing and dose-sparing strategies.</p><p><strong>Funding: </strong>Gavi, the Vaccine Alliance.</p>","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"104069"},"PeriodicalIF":22.5,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital-based prevalence of culture-confirmed melioidosis among high-risk patients in India, 2023-25: a multicentre prospective study.","authors":"Nitin Gupta, Mohammed Ashiq, Tirlangi Praveen Kumar, Venkat Abhiram Earny, K E Vandana, Muralidhar Varma, Saurav Jyoti Patgiri, Ayush Gupta, Bijayini Behera, Chimanjita Phukan, Clarissa J Lyngdoh, Lalrempuii, Luna Adhikari, Mamta Devi, Margaret Yhome, Mika Umpo, Pradip Kumar Das, Rushika Saksena, Vibhor Tak, Anil Kumar, Pooja Kumari, Harpreet Kaur, Chiranjay Mukhopadhyay","doi":"10.1016/j.langlo.2026.104072","DOIUrl":"https://doi.org/10.1016/j.langlo.2026.104072","url":null,"abstract":"<p><strong>Background: </strong>Melioidosis is not a nationally notifiable disease in India, and the absence of systematic surveillance has contributed to substantial under-recognition and fragmented epidemiological data. We aimed to determine the hospital-based prevalence of culture-confirmed melioidosis among hospitalised adults at high risk of melioidosis in India.</p><p><strong>Methods: </strong>We conducted a prospective, multicentre, hospital-based prevalence study between Jan 1, 2023, and Dec 31, 2025, across 15 tertiary care centres in India. Adults (aged ≥18 years) hospitalised with predefined community-acquired infectious syndromes and diabetes or chronic kidney disease were enrolled. Melioidosis was defined by culture confirmation. The primary outcome was hospital-based prevalence. Prespecified secondary analyses assessed geographical, syndrome-specific, and seasonal variation; factors associated with melioidosis; and clinical characteristics and in-hospital outcomes.</p><p><strong>Findings: </strong>Among 2953 patients, 262 (8·9% [95% CI 7·9-10·0]) had culture-confirmed melioidosis, with marked geographical heterogeneity. Prevalence was highest in Odisha, Madhya Pradesh, and Karnataka, and among patients presenting with extrapulmonary abscesses and bone and joint infections. Cases clustered during the monsoon months. Factors independently associated with melioidosis included monsoon admission (adjusted odds ratio 1·40 [95% CI 1·08-1·83]), male sex (2·33 [1·64-3·32]), outdoor high-risk occupation (1·94 [1·47-2·56]), and groundwater as the primary drinking-water source (3·25 [2·48-4·26]). Bacteraemia occurred in 152 (58%) of 262 patients with melioidosis, and 50 (19%) died in hospital.</p><p><strong>Interpretation: </strong>Melioidosis is a frequent and severe infection among high-risk hospitalised adults in India, with substantial geographical variation and strong environmental and seasonal associations. These findings support targeted diagnostic testing and heightened clinical awareness among high-risk patients.</p><p><strong>Funding: </strong>Indian Council of Medical Research.</p>","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"104072"},"PeriodicalIF":22.5,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expression of concern-Effect of Brazil's national human papillomavirus vaccination programme on the incidence of cervical cancer and cervical intraepithelial neoplasia grade 3 in women aged 20-24 years: a population-based study.","authors":"The Editors Of The Lancet Global Health","doi":"10.1016/j.langlo.2026.104113","DOIUrl":"https://doi.org/10.1016/j.langlo.2026.104113","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"104113"},"PeriodicalIF":22.5,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond geography: conflict, displacement, and structural vulnerability in noma distribution in Nigeria.","authors":"John Adeoye, Ramat Oyebunmi Braimah, Abubakar Abdullahi Bello","doi":"10.1016/j.langlo.2026.104060","DOIUrl":"10.1016/j.langlo.2026.104060","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"104060"},"PeriodicalIF":22.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148800011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to Health in times of uncertainty in the eastern Mediterranean region, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet Glob Health 2016; 4: e704-13.","authors":"","doi":"10.1016/j.langlo.2026.104085","DOIUrl":"10.1016/j.langlo.2026.104085","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"104085"},"PeriodicalIF":22.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}