PLOS global public health最新文献

{"title":"Implementation strategies to improve outcomes in patients with established cardiovascular disease in sub-Saharan Africa: A systematic review.","authors":"Leah A Sanga, Jonathan A Hudson, Alexander D Perkins, Adrianna Murphy, Anthony Etyang, Pablo Perel, Anoop S V Shah","doi":"10.1371/journal.pgph.0004544","DOIUrl":"https://doi.org/10.1371/journal.pgph.0004544","url":null,"abstract":"<p><strong>Systematic review registration: </strong>The protocol was registered in PROSPERO prior to the study implementation (ID: CRD42023465781). The protocol can be accessed at crd.york.ac.uk/PROSPERO/display_record.php?RecordID=465781.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 5","pages":"e0004544"},"PeriodicalIF":0.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and facilitators of primary care management of type II diabetes mellitus in the West African sub-region: A scoping review.","authors":"Abdul-Basit Abdul-Samed, Yasmin Jahan, Veronika Reichenberger, Ellen Barnie Peprah, Mary Pomaa Agyekum, Henry Lawson, Dina Balabanova, Tolib Mirzoev, Irene Akua Agyepong","doi":"10.1371/journal.pgph.0003733","DOIUrl":"https://doi.org/10.1371/journal.pgph.0003733","url":null,"abstract":"<p><p>The prevalence of diabetes is rising rapidly across West Africa, posing a significant public health challenge. Effective diabetes management through accessible and quality primary healthcare is crucial, yet multiple barriers persist. This review aimed to synthesise the available evidence on factors influencing access, utilisation, and quality of diabetes primary care in West Africa. Following Arksey and O'Malley's framework and PRISMA-ScR guidelines, we searched four electronic databases (PubMed, Scopus, Google Scholar, CAIRN Info) and grey literature sources. Eligibility criteria included: peer-reviewed studies published between 2000-2023 in English or French; primary research focusing on adult type II diabetes care in West African countries; and studies reporting on factors affecting access, utilisation, or quality of primary healthcare. Data were extracted using a standardised form and analysed through framework synthesis integrating the WHO Primary Health Care Framework, Social Determinants of Health model, and Innovative Care for Chronic Conditions model. Twelve studies were included from Nigeria (n=7), Ghana (n=4), and Senegal (n=1). Key barriers to access, utilisation, and quality were identified as health system deficiencies, including inadequate infrastructure, workforce shortages, supply gaps, fragmented coordination of care, absence of standardised guidelines, high costs of care, and inefficient leadership/governance for chronic disease management. Broader determinants of health, such as poverty, gender, cultural beliefs, reliance on traditional medicine, and health policy gaps, significantly influenced access to and utilisation of care. Individual-level barriers like psychological distress and delays in care-seeking were also significant. Family/social support systems emerged as potential facilitators of accessing and utilising PHC services. Our review identified that to improve diabetes care, West Africa needs context-specific models that align indigenous healing practices with PHC, strengthen health systems, and address sociocultural determinants. Future research should focus on developing and evaluating culturally resonant interventions that can navigate both biomedical and sociocultural factors shaping diabetes management in resource-constrained settings.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 5","pages":"e0003733"},"PeriodicalIF":0.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring landscape of drug abuse trends in Pakistan: A decade and a half of clinical laboratory big data analysis.","authors":"Yousra Sarfaraz, Lena Jafri, Hafsa Majid, Nadeem Ullah Khan, Ayesha Sadiqa, Aysha Habib Khan, Imran Siddiqui, Sibtain Ahmed","doi":"10.1371/journal.pgph.0004424","DOIUrl":"https://doi.org/10.1371/journal.pgph.0004424","url":null,"abstract":"<p><p>The utilization of urine testing for drugs of abuse has emerged as a valuable tool in discerning the evolving landscape of drug abuse patterns. The objective of this study was to determine the patterns of drug of abuse within the Pakistani population, incorporating demographic factors such as age, gender, and location. This observational study was conducted at the Department of Pathology and Laboratory Medicine, Aga Khan University from January 2008 to December 2022. A review of drugs of abuse screening data extracted from laboratory information system was carried out. The panel includes screening of common drugs, amphetamine (AMP), benzodiazepine (BZO), barbiturates (BAR), cannabinoids (THC), cocaine (COC), and opioids (OPI) as well as blood alcohol (ALC) levels. Mean, standard deviation, percentage and frequency were calculated by using STATA version 13.Over a period of 15 years, a total of 130, 859 tests were performed, with 89.5% being male and mean age of 32.4 ± 11.3 years, while seventy-seven percent of the specimens (n = 101, 648) came from the province of Sindh. Of the total 6270 (4.8%) were screened positive for at least one drug, THC (n = 3626, 57.8%) was the most frequently positive test, followed by OPI (n = 1000, 16%), ALC (n = 671, 10.7%), COC (n = 31, 0.5%), AMP (n = 45, 0.7%), BAR (n = 35, 0.6%) and BZO (n = 862, 13.7%). Yearly trend analysis shows an increasing number of THC tests requested over time, with THC exhibiting the highest positivity rate, followed by BZO, OPI, and ALC.The 15-year patterns depict the rising prevalence of drug consumption which is subsequently increasing the demand for drug screening tests. The study highlights Pakistan's growing drug prevalence and calls for targeted policies to address its use, including strengthened prevention programs, improved regulation and better management and rehabilitation access.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 5","pages":"e0004424"},"PeriodicalIF":0.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Organization of services for severe chronic Noncommunicable diseases at first-level hospitals in nine lower-income countries: Results from a Baseline assessment of PEN-Plus initiation.","authors":"Chantelle Boudreaux, Emily B Wroe, Ada Thapa, Natnael A Abebe, Ann R Akiteng, Laura Drown, Abhijit Gadewar, Biraj M Karmacharya, Sandeepa Karki, Maryam Mansoor, Reuben Mutagaywa, Bavin Mulenga, Alvern Mutengerere, Laura Nollino, Devashri Salvi, Wubaye Walelgne Dagnaw, Gene Bukhman, Ana O Mocumbi, Alma Adler","doi":"10.1371/journal.pgph.0004552","DOIUrl":"https://doi.org/10.1371/journal.pgph.0004552","url":null,"abstract":"<p><p>Severe chronic noncommunicable diseases pose a significant health burden and challenges for health systems globally. This study aims to advance our understanding of the current organization of care for these conditions in low and lower-middle-income countries. The study was conducted as part of a baseline assessment of facilities prior to the initiation of the Package of Essential NCD Interventions -Plus (PEN-Plus) strategy, which is designed to enhance outpatient care for conditions including rheumatic and congenital heart disease, sickle cell disease, type 1 diabetes, severe asthma, and advanced chronic kidney disease. We employed a cross-sectional survey methodology to collect baseline data from 16 hospitals in nine LLMICs. The survey assessed the organization of common and severe NCD services, focusing on the availability and management of severe NCDs, organized into domains of integrated services. Data were analyzed using summary statistics and heatmaps to evaluate care patterns. We document gaps in the availability of services for both common and severe NCDs. We find that the majority of NCD care occurs in the general outpatient settings, with a smaller proportion provided in specialized internal medicine wards. Despite some hospitals implementing specialized clinics and teams, limitations in specialist access, variability in service fees, and inconsistent definitions of patient follow-up were prominent issues affecting patient care access and continuity. Despite the spectrum of strategies employed by these hospitals to cater to chronically and severely ill patients, notable gaps in care persist, particularly for diagnostic and treatment options that require specialist training or equipment. The sustainable decentralization of effective care for individuals with severe chronic NCDs will require integrated teams and customized systems to ensure seamless and comprehensive care through the entire care continuum-from screening and diagnosis to care linkage, ongoing management, handling of complications, uninterrupted supply of medicines and commodities and maintaining patient retention.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 5","pages":"e0004552"},"PeriodicalIF":0.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wastewater-integrated pathogen surveillance dashboards enable real-time, transparent, and interpretable public health risk assessment and dissemination.","authors":"Nosihle S Msomi, Joshua I Levy, Nathaniel L Matteson, Nkosenhle Ndlovu, Phindile Ntuli, Adam Baer, Dylan Pilz, Victor Mabasa, Sipho Gwala, Natasha Singh, Kathleen Subramoney, Emmanuel Phalane, Mokgaetji Macheke, Mantshali Motloung, Thabo Mangena, Lethabo Monametsi, Lebohang Rabotapi, Sibonginkosi Maposa, Amanda Birmingham, Mark Zeller, Smruthi Karthikeyan, Peter De Hoff, Simon Harris, Rob Knight, Louise C Laurent, Kristian G Andersen, Kerrigan McCarthy, Mukhlid Yousif","doi":"10.1371/journal.pgph.0004443","DOIUrl":"https://doi.org/10.1371/journal.pgph.0004443","url":null,"abstract":"<p><p>Timely pathogen surveillance and reporting is essential for effective public health guidance. Web dashboards have become a key tool for communicating public health information to stakeholders, health care workers, and the broader community. Over the SARS-CoV-2 pandemic, wastewater surveillance has increasingly been incorporated into public health workflows for outbreak monitoring and response, enabling community-representative and low-cost monitoring to supplement clinical surveillance. However, the methods used for visualization and dissemination of clinical and wastewater surveillance data differ across programs, and best practices are yet to be defined. In this work, we demonstrate data workflows and dashboards used to perform wastewater-based public health surveillance in tandem with clinical data across local and national scales, leveraging custom-built, reproducible, and open-source software. Using a centralized data aggregation and analysis hub approach, we establish multiple data pipelines for data storage, wrangling, and standardized analyses, and deploy custom-built web dashboards that allow for immediate public release. We find that our approach is effective across scales, computing architectures, and dissemination strategies, and provides an adaptable model to incorporate additional pathogens and epidemiological data.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 5","pages":"e0004443"},"PeriodicalIF":0.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating community health workers to sustain malaria services in the Greater Mekong Subregion: Findings from implementer case studies.","authors":"Laura Buback, Kyle Daniels, Tiese Etim-Inyang, Monnaphat Jongdeepaisal, Massaya Sirimatayanant, Panarasri Khonputsa, Naomi Beyeler, Richard J Maude","doi":"10.1371/journal.pgph.0004528","DOIUrl":"https://doi.org/10.1371/journal.pgph.0004528","url":null,"abstract":"<p><p>Many countries in the Asia Pacific rely on community health workers (CHWs) to care for various health needs. In the Greater Mekong Subregion (GMS), malaria CHWs have been an essential component of malaria elimination. Yet as the malaria burden declines, the role of malaria CHWs in local health systems and communities is changing. There is a need to expand malaria CHW roles to take on the provision of health services beyond malaria. This study sought to understand the process and experience of this role expansion including implementation, financing, policy, and sustainability within the Asia Pacific region. We documented malaria CHW programs that included health services in addition to malaria. We conducted 21 key-stakeholder interviews from thirteen programs in eight countries throughout the Asia Pacific region virtually in English and findings were analyzed using rapid-matrix analysis. Participants were recruited by an online landscaping survey, with an inclusion criterion of five + years' work experience and English speaking. Governments ran five of the thirteen programs; six were international non-governmental organizations (INGOs), and two were academic. Senior staff from programs that have expanded roles of malaria CHWs or integrated CHW programs explained expansion processes, challenges, and opportunities. We found that integration can occur in multiple program domains and does not necessarily occur in all domains simultaneously. We identified entry points for role expansion: integrated policy and financing, planning, assessments, and research. Operational entry points included the selection, training, motivation, management, supervision, and monitoring of CHWs. Enabling factors included decentralized management structures, health system linkages, commodity provision and referral procedures, and community engagement. While there is not a linear or unique path towards integration, we provide considerations for the policy level, practical implementation steps, and enabling factors for countries in the GMS to consider as they move towards sustainable, integrated malaria CHWs.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 5","pages":"e0004528"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12047754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Conducting tobacco control surveys among schoolchildren in Bangladesh, India and Pakistan: A feasibility study.","authors":"Masuma Pervin Mishu, Cath Jackson, Ann McNeill, Suneela Garg, Amod Borle, Chetana Deshmukh, M Meghachandra Singh, Nidhi Bhatnagar, Ravi Kaushik, Rumana Huque, Fariza Fieroze, Sushama Kanan, S M Abdullah, Laraib Mazhar, Zohaib Akhter, Khalid Rehman, Safat Ullah, Lu Han, Anne Readshaw, Aziz Sheikh, Paramjit Gill, Kamran Siddiqi, Mona Kanaan, Romaina Iqbal","doi":"10.1371/journal.pgph.0004602","DOIUrl":"https://doi.org/10.1371/journal.pgph.0004602","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1371/journal.pgph.0003784.].</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 5","pages":"e0004602"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12047818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using an analogue-digital hybrid clinical data management platform during a two-dose preventive Ebola virus vaccine trial in Goma, the Democratic Republic of the Congo.","authors":"Hannah E Brindle, Darius Tetsa-Tata, Tansy Edwards, Edward Man-Lik Choi, Kambale Kasonia, Soumah Aboubacar, Grace Mambula, Hugo Kavunga-Membo, Rebecca Grais, John Johnson, Daniel G Bausch, Jean-Jacques Muyembe-Tamfum, Ibrahim Seyni Ama, Shelley Lees, Deborah Watson-Jones, Anton Camacho, Chrissy H Roberts","doi":"10.1371/journal.pgph.0004487","DOIUrl":"https://doi.org/10.1371/journal.pgph.0004487","url":null,"abstract":"<p><p>Clinical trials in settings with intermittent or non-existent internet and power connectivity, for example during humanitarian emergencies, present challenges in the synchronisation of data across different sites, in addition to accessing a centralised database in real-time. To overcome these, we designed a novel hybrid analogue/digital data management system which was deployed during the rapid implementation of a Phase III evaluation of a two-dose preventative vaccine for Ebola virus disease in Goma, Democratic Republic of the Congo, from 2019 to 2022. We provided study participants with an Enhanced Participant Record Card (EPRC) that served as eligibility for, and confirmation of, vaccination and was used in combination with Open Data Kit (ODK) electronic case report forms to create an off-grid study participant management system. To understand the utility of the EPRC, we analysed data from 15,327 study participants who received both vaccines and various types of prompts or reminders to return for dose 2, including home visits, telephone calls, or short messaging service (SMS). A total of 53% participants referred to the date on the EPRC as a prompt to return for dose 2 and 36.1% mentioned this as the only prompt. A multivariable generalised linear mixed-effects model showed that those who were not working, those aged 45-64 years or who had a chronic medical condition identified prior to receiving dose 2 were more likely to use the date on the EPRC as a prompt. Our findings demonstrate the utility of this system in the facilitation of decentralised data collection in off-grid locations that may be useful for future trials in complex humanitarian settings. Clinical Trials Registration Number: ClinicalTrials.gov NCT01128790.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 5","pages":"e0004487"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12047755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of prenatal lead, mercury, cadmium, and arsenic exposure on children's neurodevelopment in an artisanal small-scale gold mining area in Northwestern Tanzania using a multi-chemical exposure model.","authors":"Elias C Nyanza, Raphael J Mhana, Moses Asori, Deborah S K Thomas, Agapiti P Kisoka","doi":"10.1371/journal.pgph.0004577","DOIUrl":"https://doi.org/10.1371/journal.pgph.0004577","url":null,"abstract":"<p><p>An estimated 250 million children under five fail to reach their cognitive development potential in Africa. Growing evidence suggests reduced neurodevelopments for children from environmental exposures, yet research on this topic in Sub-Saharan Africa remains limited. This study examined the effects of multi-chemical prenatal exposure to heavy metals on developmental milestones for children aged 3-4 in artisanal and small gold mining areas in northwestern Tanzania. This longitudinal follow-up study of children whose mothers were enrolled in the Tanzania Mining and Health Cohort in Geita District in 2015 were assessed at 3-4 years of age for the current study between June 2019 - June 2020. Developmental outcomes (cognitive, social, motor, and language skills) were assessed using the Malawi Developmental Assessment Tool (MDAT). A quantile g-computation model evaluated the linkage between multi-chemical exposures and developmental milestones. Of the 310 children in the follow-up, a majority had at least one form of developmental impairment (50.7%; n = 157) across four domains: gross motor (20.3%), fine motor (23.9%), language (28.3%), and social skill (16.2%). Increased Pb, Hg, Cd, and As exposure jointly reduced gross motor by 17.78% (aPR = 0.822; 95% CI: 0.6994, 0.966). Joint exposure to these heavy metals decreased language ability by 55.36% (aPR = 0.446; 95% CI: 0.313, 0.636) and decreased general developmental milestones by 13.36% (aPR = 0.866; 95% CI: 0.747,1.005). However, the combined effect on the fine motor (aPR = 0.943; 95% CI: 0.754, 1.180) and social skills 6.71% (aPR = 1.067; 95% CI: 0.694, 1.641) were not statistically significant. Exposure to heavy metals while in utero reduced children neurodevelopmental milestones at 3-4 years of age. The cumulative impact of Pb, Hg, Cd, and As was significant for gross motor, language ability, and general impairment. The independent effects of Pb and Hg were amplified beyond what would be expected under the additive assumption with Cd and As, suggesting synergistic effects.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 4","pages":"e0004577"},"PeriodicalIF":0.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost and cost-effectiveness of pediatric home-based versus facility-based TB Preventive Treatment in Ethiopia (CHIP-TB).","authors":"Akash Malhotra, Ahmed Bedru, Fiseha Mulatu, Bareng A S Nonyane, Silvia Cohn, Christiaan Mulder, Samuel Bayu, Stephanie Borsboom, Gidea Conradie, Jonathan E Golub, Richard E Chaisson, Gavin Churchyard, David W Dowdy, Hojoon Sohn, Nicole Salazar-Austin","doi":"10.1371/journal.pgph.0004466","DOIUrl":"https://doi.org/10.1371/journal.pgph.0004466","url":null,"abstract":"<p><p>Tuberculosis preventive treatment (TPT) is an essential intervention recommended for all child contacts in Ethiopia under 15 years who are at risk of tuberculosis (TB) infection. We conducted a cost and cost-effectiveness analysis of home-based versus facility-based TPT provision for child contacts in Ethiopia. As part of the CHIP TB trial, a pragmatic, cluster-randomized trial conducted at eighteen clinics in Ethiopia, clinics were randomized to either a home-based model (intervention arm), administered by community health workers, or a facility-based model (standard of care) for managing child contacts. Cost data were collected from both a health service perspective and a household perspective, capturing all costs relevant to TPT. Costs were evaluated on a per-household basis, with the primary outcome being the difference in median costs per household initiating TPT. A secondary outcome assessed the cost-effectiveness as the incremental cost per additional child contact starting TPT. Probabilistic sensitivity analyses (PSA) were conducted to examine the robustness of findings. At an average cost of US$18.92 per household managed, Home-based contact management, including TPT delivery was cost-saving compared to facility-based TPT delivery (US$27.24 per household managed) assessed based on the partial-societal perspectives, largely due to reductions in household out-of-pocket costs. The home-based strategy was both less costly and had increased TPT initiation in 61.5% of the scenarios assessed in the PSA. Home-based contact management is a cost-saving alternative for households and provides comparable initiation rates to facility-based care, making it a feasible approach to improve TB preventive treatment accessibility. Although it does not entirely replace facility-based care, a hybrid model that respects household preferences and allows flexibility in delivery could enhance TB care access for socio-economically disadvantaged households, potentially reducing health inequities. The trial was registered on clinicaltrials.gov NCT04369326 on April 30, 2020. https://clinicaltrials.gov/study/NCT04369326.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"5 4","pages":"e0004466"},"PeriodicalIF":0.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}