BMJ Global Health最新文献

{"title":"Beyond COVID-19, the case for collecting, analysing and using sex-disaggregated data and gendered data to inform outbreak response: a scoping review.","authors":"McKinzie Gales, Emelie Love Yonally Phillips, Leah Zilversmit Pao, Christine Dubray, Clara Rodriguez Ribas Elizalde, Shirin Heidari, Marie-Amelie Degail, Marie Meudec, M Ruby Siddiqui, Simone E Carter","doi":"10.1136/bmjgh-2024-015900","DOIUrl":"10.1136/bmjgh-2024-015900","url":null,"abstract":"<p><strong>Introduction: </strong>Understanding sex and gender differences during outbreaks is critical to delivering an effective response. Although recommendations and minimum requirements exist, the incorporation of sex-disaggregated data and gender analysis into outbreak analytics and response for informed decision-making remains infrequent. A scoping review was conducted to provide an overview of the extent of sex-disaggregated data and gender analysis in outbreak response within low- and middle-income countries (LMICs).</p><p><strong>Methods: </strong>Five databases were searched for peer-reviewed literature examining sex- and gender-specific outcomes for communicable disease outbreaks published in English between 1 January 2012 and 12 April 2022. An adapted version of the WHO's Gender Analysis Matrix was used to synthesise evidence, which was then mapped across four phases of the outbreak timeline: prevention, detection, treatment/management and recovery.</p><p><strong>Results: </strong>71 articles met inclusion criteria and were included in this review. Sex-, gender-, and pregnancy-related disparities were identified throughout all four phases of the outbreak timeline. These disparities encompassed a wide range of risk factors for disease, vulnerability, access to and use of services, health-seeking behaviour, healthcare options, as well as experiences in healthcare settings and health and social outcomes and consequences.</p><p><strong>Conclusion: </strong>Significant gender-evidence gaps remain in outbreak response. Evidence that is available illustrates that sex and gender disparities in outbreaks vary by disease, setting and population, and these differences play significant roles in shaping outbreak dynamics. As such, failing to collect, analyse or use sex-disaggregated data and gendered data during outbreaks results in less effective responses, differential adverse health outcomes, increased vulnerability among certain groups and insufficient evidence for effective prevention and response efforts. Systematic sex- and gender-based analyses to ensure gender-responsive outbreak prevention, detection, treatment/management and recovery are urgently needed.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acceptability and effectiveness of a study information video in improving the research consent process for youth: a non-inferiority trial.","authors":"Tinashe Cynthia Mwaturura, Victoria Simms, Ethel Dauya, Som Kumar Shrestha, Salmaan Ferrand, Talent Shavani, Chido Dziva Chikwari, Constance R S Mackworth-Young, Tsitsi Bandason, Constancia Mavodza, Mandikudza Tembo, Katharina Kranzer, Sarah Bernays, Rashida Abbas Ferrand","doi":"10.1136/bmjgh-2023-014481","DOIUrl":"10.1136/bmjgh-2023-014481","url":null,"abstract":"<p><strong>Introduction: </strong>Obtaining informed consent for research includes the use of information sheets, which are often long and may be difficult for participants to understand. We conducted a trial to investigate whether consent procedures using a study information video coupled with electronic consent were non-inferior to standard consent procedures using participant information sheets (PIS) among youth aged 18-24 years in Zimbabwe.</p><p><strong>Methods: </strong>The trial was nested within an endline population-based survey for a cluster-randomised trial from October 2021 to June 2022. Randomisation of participants to video or paper-based consent was at household level. We assessed non-inferiority in comprehension of the study using a questionnaire. The video method was accepted as non-inferior to standard consent procedures if the 95% CIs of the mean difference did not fall below the prespecified margin of 1.98. Thematic analysis was conducted on brief qualitative discussions with randomly selected youth to explore the acceptability of video and PIS within consent methods.</p><p><strong>Results: </strong>Overall, 921 participants were enrolled (54% female). The median age was 20 (IQR 18-24) years. The mean comprehension score was 25.4/30 in both arms. The mean difference in comprehension between arms was -0.02 (95% CI -0.51 to 0.47) showing non-inferiority of the intervention in comprehension of study information. Youth (N=90) described both consent methods as interactive and inclusive. Those in the video consent arm felt it was exciting and youth focused. The use of imagery to explain procedures strengthened the perceived trustworthiness of the research. However, the high volume of information in both arms reduced acceptability.</p><p><strong>Conclusion: </strong>Comprehension of study information using an information video is non-inferior to a paper-based consent method. Using information videos for consent processes shows promise as a person-centred and context-sensitive approach to enhance the informed consent process and should be encouraged by ethics committees.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Linda Kizazi study: a comparison of morbidity and mortality from birth to 2 years between children who are HIV-unexposed and HIV-exposed, uninfected in the era of universal antiretroviral therapy.","authors":"Emily R Begnel, Ednah Ojee, Judy Adhiambo, Eliza Mabele, Brenda Wandika, Vincent Ogweno, Efrem S Lim, Soren Gantt, John Kinuthia, Dara A Lehman, Jennifer Slyker, Dalton Wamalwa","doi":"10.1136/bmjgh-2024-015841","DOIUrl":"10.1136/bmjgh-2024-015841","url":null,"abstract":"<p><strong>Background: </strong>Historically, children who are HIV-exposed, uninfected (CHEU) have been found to have greater morbidity and mortality than children who are HIV-unexposed, uninfected (CHUU). To assess whether this difference persists in the era of universal antiretroviral therapy (ART), we conducted a cohort study to compare the risk of acute diarrhoea, respiratory tract infections (RTI), malaria, hospitalisation, and all-cause mortality between Kenyan CHEU and CHUU from birth to 2 years.</p><p><strong>Methods: </strong>From December 2018 to March 2020 at Mathare North Health Centre in Nairobi, we recruited pregnant women living with HIV on ART for ≥6 months and pregnant women without HIV from the same community. We followed the mother-infant pairs for 2 years post partum and collected data on symptoms of illness, clinical visits and diagnoses, and infant feeding every 3 months; a self-selected subset of participants also received weekly data collection for up to 1 year. We compared the risk of each outcome between CHEU versus CHUU using HRs from Andersen-Gill (recurrent morbidity outcomes) and Cox proportional hazards (mortality) regression models adjusted for maternal age, marital status and education level.</p><p><strong>Results: </strong>Among 187 mother-infant pairs with postpartum data, 86 (46%) infants were CHEU and 101 (54%) were CHUU. All initiated breastfeeding, and 88% of CHEU and 57% of CHUU were exclusively breastfed (EBF) for ≥6 months. There was no significant difference in risk of diarrhoea (HR=0.79, 95% CI 0.52 to 1.22), malaria (HR=0.44, 95% CI 0.16 to 1.21), hospitalisation (HR=1.11, 95% CI 0.30 to 4.14), or mortality (HR=1.87, 95% CI 0.17 to 20.5). However, CHEU had lower risk of any RTI (HR=0.60, 95% CI 0.44 to 0.82) and pneumonia (HR=0.29, 95% CI 0.091 to 0.89).</p><p><strong>Conclusions: </strong>CHEU born to women on effective long-term ART experienced similar overall morbidity and mortality as CHUU. However, CHEU had substantially lower risk of pneumonia and other RTI, possibly due to longer EBF in this group.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of gross domestic product with equitable access to childhood vaccines in 195 countries: a systematic review and meta-analysis.","authors":"Jerome Nyhalah Dinga, Jones Soladoye Akinbobola, Funmilayo Ibitayo Deborah Afolayan, Andreas Ateke Njoh, Tesfaye Kassa, David Dazhia Lazarus, Yakhya Dieye, Gezahegne Mamo Kassa, Kwabena Obeng Duedu, Nefefe Tshifhiwa, Mustapha Oumouna","doi":"10.1136/bmjgh-2024-015693","DOIUrl":"10.1136/bmjgh-2024-015693","url":null,"abstract":"<p><strong>Introduction: </strong>Gross domestic product (GDP) has been shown to affect government spending on various budget heads including healthcare and the purchase and distribution of vaccines. This vulnerable situation has been exacerbated by the COVID-19 pandemic which disrupted and exposed the fragile nature of equitable access to vaccines for childhood immunisation globally. A systematic review and meta-analysis to assess the association of country income status and GDP with vaccination coverage of vaccines for childhood immunisation and other major infectious diseases around the globe will inform global and national policy on equity in living standards and vaccine uptake. This study was carried out to identify factors influenced by GDP that affect access, distribution, and uptake of childhood vaccines around the world using a systematic review and meta-analysis approach.</p><p><strong>Methods: </strong>Data were extracted for the burden of major infectious diseases of childhood immunisation programmes, factors affecting access to vaccines, vaccine procurement platforms, vaccination coverage and percentage of GDP used for the procurement of vaccines. Factors influencing the global vaccination coverage rate were also assessed. The protocol was registered on PROSPERO (ID: CRD42022350418) and carried out using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.</p><p><strong>Results: </strong>Data from 195 countries showed that the following infectious diseases had the highest burden; human papillomavirus (HPV), measles, Ebola and yellow fever. Low-income and some lower-middle-income countries (LMICs) used COVAX and UNICEF for vaccine procurement while high-income countries (HICs) preferred national and regional public tenders. Global vaccination coverage for tuberculosis, diphtheria/tetanus/pertussis, hepatitis B, <i>Haemophilus influenzae</i> type b, measles, polio, meningitis and HPV had a significantly higher coverage than COVID-19. Being an HIC and having coverage data collected from 1985 to 2015 as the most current data were associated with high vaccination coverage. The percentage of GDP spent on vaccine procurement did not influence vaccination coverage.</p><p><strong>Conclusion: </strong>Low-income countries and LMICs should prioritise vaccine research and improve on development capacity. Countries worldwide should share data on vaccine expenditure, vaccination coverage, and the development and introduction of new vaccines and technologies to facilitate equitable vaccine access.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing whose interests? Corporate strategy and risks to food systems transformation and public health nutrition through academic partnerships in Africa.","authors":"Safura Abdool Karim, Busiso Moyo, Helen Walls","doi":"10.1136/bmjgh-2024-016049","DOIUrl":"10.1136/bmjgh-2024-016049","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Doctors taking bribes from pharmaceutical companies is common and not substantially reduced by an educational intervention: a pragmatic randomised controlled trial in Pakistan.","authors":"Mishal Khan, Muhammad Naveed Noor, Afifah Rahman-Shepherd, Amna Rehana Siddiqui, Sabeen Sharif Khan, Nina van der Mark, Afshan Khurshid Isani, Ahson Q Siddiqi, Charles Opondo, Faisal Ziauddin, Faiza Bhutto, Iqbal Azam, Johanna Hanefeld, Natasha Ali, Robyna Irshad Khan, Syed Ahmed Raza Kazmi, Virginia Wiseman, Wafa Aftab, Zafar Mirza, Zainab Hasan, Sameen Siddiqi, Rumina Hasan, Sadia Shakoor","doi":"10.1136/bmjgh-2024-016055","DOIUrl":"10.1136/bmjgh-2024-016055","url":null,"abstract":"<p><strong>Introduction: </strong>Incentive-linked prescribing, which is when healthcare providers accept incentives from pharmaceutical companies for prescribing promoted medicines, is a form of bribery that harms patients and health systems globally. We developed a novel method using data collectors posing as pharmaceutical company sales representatives to evaluate private doctors' engagement in incentive-linked prescribing and the impact of a multifaceted educational intervention on reducing this practice in Karachi, Pakistan.</p><p><strong>Methods: </strong>We made a sampling frame of all doctors running for-profit, primary-care clinics and randomly allocated participants to control and intervention groups (1:1). The intervention group received a multifaceted seminar on ethical prescribing and reinforcement messages over 6 weeks. The control group attended a seminar without mention of ethical prescribing. The primary outcome was the proportion of participants agreeing to accept incentives in exchange for prescribing promoted medicines from data collectors posing as pharmaceutical company representatives, 3 months after the seminars.</p><p><strong>Results: </strong>We enrolled 419 of 440 eligible participants. Of 210 participants randomly allocated to the intervention group, 135 (64%) attended the intervention seminar and of 209 participants allocated to the control group, 132 (63%) attended the placebo seminar. The primary outcome was assessed in 130 (96%) and 124 (94%) of intervention and control participants, respectively. No participants detected the covert data collectors. 52 control group doctors (41.9%) agreed to accept incentives as compared with 42 intervention group doctors (32.3%). After adjusting for doctors' age, sex and clinic district, there was no evidence of the intervention's impact on the primary outcome (OR 0.70 [95% CI 0.40 to 1.20], p=0.192).</p><p><strong>Conclusions: </strong>This first study to covertly assess deal-making between doctors and pharmaceutical company representatives demonstrated that the practice is strikingly widespread in the study setting and suggested that substantial reductions are unlikely to be achieved by educational interventions alone. Our novel method provides an opportunity to generate evidence on deal-making between doctors and pharmaceutical companies elsewhere.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"9 12","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wildlife policy, the food system and One Health: a complex systems analysis of unintended consequences for the prevention of emerging zoonoses in China, the Democratic Republic of the Congo and the Philippines.","authors":"Chloe Clifford Astbury, Anastassia Demeshko, Russel Aguilar, Mala Ali Mapatano, Angran Li, Kathleen Chelsea Togño, Zhilei Shi, Zhuoyu Wang, Cary Wu, Marc K Yambayamba, Hélène Carabin, Janielle Clarke, Valentina De Leon, Shital Desai, Eduardo Gallo-Cajiao, Kirsten Melissa Lee, Krishihan Sivapragasam, Mary Wiktorowicz, Tarra L Penney","doi":"10.1136/bmjgh-2024-016313","DOIUrl":"10.1136/bmjgh-2024-016313","url":null,"abstract":"<p><strong>Introduction: </strong>Evolving human-wildlife interactions have contributed to emerging zoonoses outbreaks, and pandemic prevention policy for wildlife management and conservation requires enhanced consideration from this perspective. However, the risk of unintended consequences is high. In this study, we aimed to assess how unrecognised complexity and system adaptation can lead to policy failure, and how these dynamics may impact zoonotic spillover risk and food system outcomes.</p><p><strong>Methodology: </strong>This study focused on three countries: China, the Democratic Republic of the Congo (DRC) and the Philippines. We combined evidence from a rapid literature review with key informant interviews to develop causal loop diagrams (CLDs), a form of systems map representing causal theory about system factors and interconnections. We analysed these CLDs using the 'fixes that fail' (FTF) systems archetype, a conceptual tool used to understand and communicate how system adaptation can lead to policy failure. In each country, we situated the FTF in the wider system of disease ecology and food system factors to highlight how zoonotic risk and food system outcomes may be impacted.</p><p><strong>Results: </strong>We interviewed 104 participants and reviewed 303 documents. In each country, we identified a case of a policy with the potential to become an FTF: wildlife farming in China, the establishment of a new national park in the DRC, and international conservation agenda-setting in the Philippines. In each country, we highlighted context-specific impacts of the FTF on zoonotic spillover risk and key food system outcomes.</p><p><strong>Conclusion: </strong>Our use of systems thinking highlights how system adaptation may undermine prevention policy aims, with a range of unintended consequences for food systems and human, animal and environmental health. A broader application of systems-informed policy design and evaluation could help identify instruments approporiate for the disruption of system traps and improve policy success. A One Health approach may also increase success by supporting collaboration, communication and trust among actors to imporove collective policy action.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing fragmentation of primary healthcare financing for more equitable, people-centred primary healthcare.","authors":"Agnes Gatome-Munyua, Susan Sparkes, Gemini Mtei, Martin Sabignoso, Prastuti Soewondo, Pierre Yameogo, Kara Hanson, Cheryl Cashin","doi":"10.1136/bmjgh-2024-015088","DOIUrl":"10.1136/bmjgh-2024-015088","url":null,"abstract":"<p><p>Despite primary healthcare (PHC) being recognised in global declarations-Alma Ata in 1978 and Astana in 2018-and prioritised in national health strategies, chronic under-resourcing of PHC persists in most low-income and middle-income countries. More public spending is needed for PHC, but macrofiscal and political constraints often limit the ability of governments to allocate more public resources to PHC. Under-resourcing has been compounded by fragmented and rigid funding flows, which are inefficient and may erode equity, quality of care and public trust in PHC.This article explores the drivers of fragmentation in PHC financing-low public spending, which results in over-reliance on external sources to fund critical health interventions, and the proliferation of new financing schemes that do not take a system-wide view or adhere to the principles of universality. It then highlights some of the possible consequences of this fragmentation for the efficiency, equity and effectiveness of service delivery.Four countries-Argentina, Burkina Faso, Indonesia and Tanzania-are used to illustrate practical steps that may be taken to minimise the consequences of fragmentation in PHC financing: (1) consolidating multiple coverage schemes, (2) avoiding further fragmentation, (3) harmonising health purchasing functions and (4) streamlining funding flows to the provider level.The country examples reveal lessons for policy-makers grappling with the consequences of fragmented PHC financing. The paper concludes with a research agenda to generate additional evidence on what works to address fragmentation.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disparities in dolutegravir utilisation in children, adolescents and young adults (0-24 years) living with HIV. An analysis of the IeDEA Pediatric West African cohort.","authors":"Sophie Desmonde, Joycelyn Dame, Karen Malateste, Agatha David, Madeleine Amorissani-Folquet, Sylvie N'Gbeche, Mariam Sylla, Elom Takassi, François Tanoh Eboua, Kouadio Kouakou, Lehila Bagnan Tossa, Caroline Yonaba, Valeriane Leroy","doi":"10.1136/bmjgh-2024-016512","DOIUrl":"10.1136/bmjgh-2024-016512","url":null,"abstract":"<p><strong>Introduction: </strong>We describe the 24-month incidence of Dolutegravir (DTG)-containing antiretroviral treatment (ART) initiation since its introduction in 2019 in West Africa.</p><p><strong>Methods: </strong>We included all patients aged 0-24 years on ART from nine clinics in Côte d'Ivoire (n=4), Ghana, Nigeria, Mali, Benin, and Burkina Faso. Baseline varied by clinic and was defined as date of first DTG prescription; patients were followed up until database closure/death/loss to follow-up (LTFU, no visit ≥7 months), whichever came first. We computed the cumulative incidence function for DTG initiation; associated factors were explored in a shared frailty model, accounting for clinic heterogeneity.</p><p><strong>Results: </strong>Since 2019, 3350 patients were included; 47.2% were female; 78.9% had been on ART ≥12 months. Median baseline age was 12.5 years (IQR 8.4-15.8). Median follow-up was 14 months (IQR 7-22). The overall cumulative incidence of DTG initiation reached 22.7% (95% CI 21.3 to 24.2) and 56.4% (95% CI 54.4 to 58.4) at 12 and 24 months, respectively. In univariate analyses, those aged <5 years and female were overall less likely to switch. Adjusted on ART line and available viral load (VL) at baseline, females aged >10 years were less likely to initiate DTG compared with males of the same age (adjusted HR among 10-14 years: 0.62, 95% CI 0.54 to 0.72; among ≥15 years: 0.43, 95% CI 0.36 to 0.50), as were those with detectable VL (>50 copies/mL) compared with those in viral suppression (aHR 0.86, 95% CI 0.77 to 0.97) and those on PIs compared with those on non-nucleoside reverse-transcriptase inhibitors (aHR after 12 months of roll-out: 0.75, 95% CI 0.65 to 0.86).</p><p><strong>Conclusion: </strong>Paediatric DTG uptake was incomplete and unequitable in west African settings: DTG use was least likely in children <5 years, females ≥10 years and those with detectable VL. Maintained monitoring and support of treatment practices is required to better ensure universal and equal uptake.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health and economic impact of oral PrEP provision across subgroups in western Kenya: a modelling analysis.","authors":"Rachel Wittenauer, Linxuan Wu, Sarah Cox, Brian Pfau, Monisha Sharma","doi":"10.1136/bmjgh-2024-015835","DOIUrl":"10.1136/bmjgh-2024-015835","url":null,"abstract":"<p><strong>Introduction: </strong>Oral pre-exposure prophylaxis (PrEP) is a priority intervention for scale-up in countries with high HIV prevalence. Policymakers must decide how to optimise PrEP allocation to maximise health benefits within limited budgets. We assessed the health and economic impact of PrEP scale-up among different subgroups and regions in western Kenya.</p><p><strong>Methods: </strong>We adapted an agent-based network model, EMOD-HIV, to simulate PrEP uptake in six counties of western Kenya across seven subgroups including serodiscordant couples (SDCs), adolescent girls and young women (AGYW), adolescent boys and young men, women with multiple partners and men with multiple partners. We modelled 5 years of PrEP provision assuming 90% PrEP uptake in the prioritised subgroups and evaluated outcomes over 20 years compared with a no PrEP scenario. All results are presented in 2021 USD$.</p><p><strong>Results: </strong>Population PrEP coverage was highest in the broad AGYW scenario (8.3%, ~2 fold higher than the next highest coverage scenario) and lowest in the SDC scenario (0.37%). Across scenarios, PrEP averted 4.5%-21.3% of infections over the 5-year implementation. PrEP provision to SDCs was associated with the lowest incremental cost-effectiveness ratio (ICER), $245 per disability-adjusted life year (DALY) averted (CI $179 to $435), followed by women and men with multiple partners ($1898 (CI $1002 to $6771) and $2351 (CI $1 831 to $3494) per DALY averted, respectively). Targeted strategies were more efficient than broad provision even in high HIV prevalence counties; PrEP scale-up for AGYW with multiple partners had an ICER per DALY averted of $4745 (CI $2059 to $22 515) compared with $12 351 for broad AGYW (CI $7 050 to $33,955). In general, ICERs were lower in counties with higher HIV prevalence.</p><p><strong>Conclusions: </strong>PrEP scale-up can avert substantial HIV infections and increasing PrEP demand for subgroups at higher risk can increase efficiency of PrEP programmes. Our results on health and cost impact of PrEP across geographic regions in western Kenya can be used for budgetary planning and priority setting.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 1","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749867/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}