Lancet Global Health最新文献

{"title":"Clinical impact and cost-effectiveness of the WHO-recommended advanced HIV disease package of care.","authors":"Emily P Hyle, Thulani Maphosa, Ajay Rangaraj, Mary Feser, Geoffrey C Singini, Prakriti Shrestha, Amir Shroufi, Krishna P Reddy, Eddie Matiya, Rosalia Dambe, Virginia R Talbot, Rachel Chamanga, C Robert Horsburgh, Milton C Weinstein, Rose K Nyirenda, Nathan Ford, Appolinaire Tiam, Andrew Phillips, Kenneth A Freedberg","doi":"10.1016/S2214-109X(25)00190-1","DOIUrl":"10.1016/S2214-109X(25)00190-1","url":null,"abstract":"<p><strong>Background: </strong>In sub-Saharan Africa, 20-40% of people living with HIV present with advanced HIV disease (AHD), which can be diagnosed, treated, and prevented using a package of care recommended by WHO. We aimed to project the cost-effectiveness and budget impact of the WHO-recommended AHD package in Malawi.</p><p><strong>Methods: </strong>Using the Cost-Effectiveness of Preventing AIDS Complications-International model, we simulated a cohort of non-hospitalised people living with HIV (aged >19 years) initiating antiretroviral therapy (ART), 25% of whom had AHD (CD4 count <200 cells per μL and/or WHO stage 3 or 4 disease). We assessed 13 increasingly comprehensive strategies, ranging from ART only to the WHO-recommended AHD package, including tuberculosis diagnostics (ie, sputum Xpert and urine lipoarabinomannan), tuberculosis preventive therapy, serum cryptococcal antigen (CrAg) screening with pre-emptive fluconazole treatment if CrAg-positive, and co-trimoxazole to prevent bacterial infections. Model outcomes included 1 year survival, life expectancy, costs, and incremental cost-effectiveness ratios (ICERs, US$ per quality-adjusted life-year [QALY]); we considered a strategy cost-effective if the ICER was less than $600 per QALY (based on 2023 Malawi per capita gross domestic product).</p><p><strong>Findings: </strong>ART only resulted in life expectancy of 17·45 undiscounted QALYs and discounted lifetime costs of $1450. All other strategies would increase both QALYs and costs. The WHO-recommended AHD package would result in the greatest life expectancy (19·30 undiscounted QALYs) and be cost-effective (ICER $580 per QALY). AHD prevalence and intervention efficacy had the greatest influence on ICERs; however, the WHO-recommended AHD package would remain cost-effective over a wide range of estimates.</p><p><strong>Interpretation: </strong>The WHO-recommended AHD package of care at ART initiation would provide substantial clinical benefits and be cost-effective in Malawi. This package for AHD should be made widely available in Malawi and similar settings.</p><p><strong>Funding: </strong>WHO, the HIV Modelling Consortium within the Institute for Global Health at University College London, the Bill & Melinda Gates Foundation, the National Institute of Allergy and Infectious Diseases, the Massachusetts General Hospital Jerome and Celia Reich Endowed Scholar in HIV/AIDS Research Award, and the Steve and Deborah Gorlin Massachusetts General Hospital Research Scholars Award.</p><p><strong>Translation: </strong>For the Chichewa translation of the abstract see Supplementary Materials section.</p>","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 8","pages":"e1436-e1447"},"PeriodicalIF":19.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12286912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to Lancet Glob Health 2015; 3: e196.","authors":"","doi":"10.1016/S2214-109X(25)00200-1","DOIUrl":"10.1016/S2214-109X(25)00200-1","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"e1348"},"PeriodicalIF":19.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143976","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":"Effective refractive error coverage in adults: a systematic review and meta-analysis of updated estimates from population-based surveys in 76 countries modelling the path towards the 2030 global target.","authors":"Rupert Richard Alexander Bourne, Maria Vittoria Cicinelli, David A Selby, Tabassom Sedighi, Ian H Tapply, Ian McCormick, Jost B Jonas, Mohammad H Abdianwall, Mukharram M Bikbov, Tasanee Braithwaite, Matthew J Burton, Vera Carneiro, Robert J Casson, Ching-Yu Cheng, Nathan G Congdon, Catherine Creuzot-Garcher, Leon B Ellwein, Mohammad Hassan Emamian, Akbar Fotouhi, Timothy R Fricke, David S Friedman, João M Furtado, Ronnie George, Noopur Gupta, Xiaotong Han, Hassan Hashemi, Mingguang He, Abba Hydara, Aiko Iwase, Gyulli Kazakbaeva, Rajiv B Khandekar, Rohit C Khanna, Fatima Kyari, Luisa C Luque, Srinivas Marmamula, Andreas Müller, Vinay Nangia, Kovin S Naidoo, Jacqueline Ramke, Paisan Ruamviboonsuk, Solange R Salomão, Hugh R Taylor, Yih C Tham, Fotis Topouzis, Rohit Varma, Lingam Vijaya, Ningli Wang, Ya Xing Wang, Tien Y Wong, Hua Yan, Seth R Flaxman, Stuart Keel, Serge Resnikoff","doi":"10.1016/S2214-109X(25)00194-9","DOIUrl":"10.1016/S2214-109X(25)00194-9","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In 2024, WHO included effective refractive error coverage (eREC) into the results framework of the 14th General Programme of Work, which sets a road map for global health and guides WHO's work between 2025 and 2028. eREC is a measure of both the availability and quality of refractive correction in a population. This study aimed to model global and regional estimates of eREC as of 2023 and evaluate progress towards the WHO global target of a 40 percentage-point absolute increase in eREC by 2030.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;For this systematic review and meta-analysis, the Vision Loss Expert Group analysed data from 237 population-based eye surveys conducted in 76 countries since 2000, comprising 815 273 participants, to calculate eREC (met need / met need + undermet need + unmet need]) and the relative quality gap between eREC and REC ([REC - eREC] / REC × 100, where REC = [met + undermet need] / [met need + undermet need + unmet need]). An expert elicitation process was used to choose covariates for a Bayesian logistic regression model used to estimate eREC by country-age-sex grouping among adults aged 50 years and older. Country-age-sex group estimates were aggregated to provide estimates according to Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) super-regions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Global eREC was estimated to be 65·8% (95% uncertainty interval [UI] 64·7-66·8) in 2023, 6 percentage points higher than in 2010 (eREC 59·8% [59·4-60·2]). There were marked differences in eREC between GBD super-regions in 2023, ranging from 84·0% (95% UI 83·0-85·0) in high-income countries to 28·3% (26·4-30·4) in sub-Saharan Africa. In all super-regions, eREC was lower in females than males, and decreased with increasing age among adults aged ≥50 years. Since 2000, the relative increase in eREC was 60·2% in sub-Saharan Africa, 45·7% in North Africa and the Middle East, 41·5% in southeast Asia, east Asia and Oceania, 40·3% in south Asia, 16·2% in Latin America and the Caribbean, 8·3% in central Europe, eastern Europe and central Asia, and 6·8% in the high-income super-region. The relative quality gap ranged from 2·9% to 78·3% across studies, with larger gaps characteristically in regions of lower eREC. Globally, the percentage of those with a refractive need that was undermet reduced between 2000 and 2023, from 10·0% (95% UI 9·5-10·5) to 5·3% (5·1-5·5).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;The current trajectory of improvement in eREC and the relative quality gap are insufficient to meet the 2030 target. Global efforts to equitably increase spectacle coverage, such as the WHO SPECS 2030 initiative, and to address equity failings associated with geography, age, and sex, are crucial to accelerating progress towards the 2030 targets. No region is close to achieving universal coverage.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Funding: &lt;/strong&gt;WHO, Sightsavers, The Fred Hollows Foundation, Fondation Thea, University of Heidelberg,","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"e1396-e1405"},"PeriodicalIF":19.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209996","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 Lancet Glob Health 2025; 13: e995–1005","authors":"","doi":"10.1016/s2214-109x(25)00277-3","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00277-3","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"12 1","pages":""},"PeriodicalIF":34.3,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144669831","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":"The potential impact of reductions in international donor funding on tuberculosis in low-income and middle-income countries: a modelling study","authors":"Rebecca A Clark PhD, C Finn McQuaid PhD, Alexandra S Richards PhD, Roel Bakker PhD, Tom Sumner PhD, Tomos O Prŷs-Jones PhD, Prof Rein M G J Houben PhD, Prof Richard G White PhD, Katherine C Horton PhD","doi":"10.1016/s2214-109x(25)00232-3","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00232-3","url":null,"abstract":"Tuberculosis programmes in many settings rely heavily on international donor funding. In 2025, the United States Agency for International Development (USAID) was dismantled, and other countries announced cuts to overseas development assistance. We quantified the potential epidemiological impacts on the tuberculosis burden attributable to these reductions in funding.","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"7 1","pages":""},"PeriodicalIF":34.3,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144622585","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":"Mpox in Africa: funding cuts and delayed global actions fuelling new epicentres.","authors":"Victor Saidi Mithi","doi":"10.1016/s2214-109x(25)00241-4","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00241-4","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"107 1","pages":""},"PeriodicalIF":34.3,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613025","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":"Global, regional, and national health-care inefficiency and associated factors in 201 countries, 1995-2022: a stochastic frontier meta-analysis for the Global Burden of Disease Study 2023.","authors":"Amy Lastuka,Michael R Breshock,Simon I Hay,Kayla V Taylor,Stephen S Lim,Christopher J L Murray,Joseph L Dieleman","doi":"10.1016/s2214-109x(25)00178-0","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00178-0","url":null,"abstract":"BACKGROUNDAll governments face pressure to maximise the impact of their health budget. We aimed to measure health spending inefficiency for 201 countries from 1995 to 2022, estimate the cost of one additional year of healthy life, and assess contextual factors associated with health spending inefficiency.METHODSWe extracted data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2023 and the Financing Global Health 2024 project to estimate health spending inefficiency using a non-linear stochastic frontier meta-analysis model designed to assess health-adjusted life expectancy (HALE). This model produced a frontier that represents the best possible HALE for a given level of health spending. Inefficiency scores were measured as the distance between a country's HALE and the frontier at that country's level of spending. We used the slope of the frontier to estimate the cost of one additional year of healthy life, and we regressed inefficiency scores on contextual factors and policy variables to measure their association with health spending inefficiency.FINDINGSThe relationship between health spending and HALE was positive for all levels of spending, although health spending inefficiency existed in most countries. Globally, health spending inefficiency decreased from 1995 to 2019, increased considerably in 2020 and 2021 due to the COVID-19 pandemic, and recovered substantially in 2022. We found decreasing returns to additional health spending, with the cost of one additional health-adjusted life-year varying from US$92 (95% uncertainty interval 43-239) per capita for a country spending $100 per capita to $11 213 (8031-57 754) per capita for a country spending $5000 per capita. More efficient spending was associated with better governance, having a higher percentage of health expenditure from the government, infrastructure that facilitates access to and delivery of health care, and higher uptake of preventive care measures.INTERPRETATIONExpanding government-provided health-care coverage would decrease the inefficiency of the health-care system. Countries should also focus on strengthening democracy, building infrastructure, and increasing the use of, and access to, preventive care.FUNDINGBill & Melinda Gates Foundation.","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"109 1","pages":""},"PeriodicalIF":34.3,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144664275","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":"PrEParing for HIV prevention among men who have sex with men in China: challenges and solutions.","authors":"Hongbo Jiang,Huachun Zou","doi":"10.1016/s2214-109x(25)00234-7","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00234-7","url":null,"abstract":"Although pre-exposure prophylaxis (PrEP) has been implemented globally, in China, engagement with the PrEP care continuum is overall low among men who have sex with men (MSM). The large population of MSM and the high proportion of PrEP-eligible individuals, coupled with low PrEP uptake and adherence, underscore the urgent need for initiatives to address barriers and facilitate uptake in this population. Based on the social ecological framework, low PrEP uptake and adherence among MSM in China can be attributed to multiple factors at the individual, interpersonal and community, and policy levels, which require a comprehensive and multifaceted approach to address. Tailored combinations of strategies need to be developed to increase PrEP awareness, acceptance, adherence, and persistence among individuals, health-care providers, and the MSM communities. Reducing stigma and discrimination towards PrEP and the MSM community is crucial to the successful implementation of PrEP. Additionally, policies that promote PrEP uptake and ensure access to appropriate regimens for eligible MSM should be in place. Solutions proposed in this Viewpoint have implications for other low-income and middle-income countries facing similar challenges against PrEP implementation.","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"37 1","pages":""},"PeriodicalIF":34.3,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613021","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":"Zinc-iron interactions in the treatment of children with mild-to-moderate anaemia - Authors' reply.","authors":"Ranadip Chowdhury,Ravi Prakash Upadhyay,Sudarshan Mundra,Sunita Taneja,Nita Bhandari","doi":"10.1016/s2214-109x(25)00259-1","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00259-1","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"38 1","pages":""},"PeriodicalIF":34.3,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604026","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":"Zinc-iron interactions in the treatment of children with mild-to-moderate anaemia.","authors":"Bingwen Eugene Fan","doi":"10.1016/s2214-109x(25)00217-7","DOIUrl":"https://doi.org/10.1016/s2214-109x(25)00217-7","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"107 1","pages":""},"PeriodicalIF":34.3,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144603802","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}