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The evolving cost of HIV in South Africa: Changes in health care cost with duration on antiretroviral therapy for public sector patients.
Journal of Acquired Immune Deficiency Syndromes. 2007 Jul; 45(3):348-354.A retrospective costing study of 212 patients enrolled in a nongovernmental organization-supported public sector antiretroviral treatment (ART) program near Cape Town, South Africa was performed from a health care system perspective. t-Regression was used to analyze total costs in 3 periods: Pre-ART (median length = 30 days), first 48 weeks on ART (Year One), and 49 to 112 weeks on ART (Year Two). Average cost per patient Pre-ART was $404. Average cost per patient-year of observation was $2502 in Year One and $1372 in Year Two. The proportion of costs attributable to hospital care fell from 70% Pre-ART to 24% by Year Two; the proportion attributable to ART rose from 31% in Year One to 55% in Year Two. In multivariate analysis, Pre-ART and Year One costs were significantly lower for asymptomatic patients compared with those with AIDS. Costs were significantly higher for those who died Pre-ART or in Year One. In Year Two, only week 48 CD4 cell count and being male were significantly associated with lower costs. This analysis suggests that the total cost of treatment for patients on ART falls by almost half after 1 year, largely attributable to a reduction in hospital costs. (author's)
Connections. 2006 Jan;  p.In September 2005, the World Health Organization (WHO) awarded Ukraine a 2.5 million dollar grant to combat the country's growing tuberculosis epidemic, according to Mykola Polischuk, who was Minister of Health at the time the grant was awarded. This funding will provide for the purchase of high-quality medications and allow for the cost-effective treatment of 75,000 patients over three years beginning in January 2006. The new treatment program will employ the DOTS (Directly Observed Therapy-Short Course) strategy, which has been recognized as the world's best strategy for fighting TB largely due to its reliance on cheaper microbiological methods of diagnosis rather than X-rays. Patients are first identified using microscopy services then prescribed the correct dosage of anti-TB medicines for a period of six to eight months. If administered accurately, DOTS can successfully treat TB in 99 percent of cases. Ukrainian President Viktor Yushchenko echoed WHO's decision to increase TB funding in October when he pledged to increase health funding, restore the country's failing health system, and fight the spread of HIV and tuberculosis, according to the Associated Press. (excerpt)
Lancet Infectious Diseases. 2006 Jan; 6(1):14.Burma's Health Minister Kyaw Myint has sharply criticised a decision by the Global Fund To Fight AIDS, Tuberculosis, and Malaria to cancel grants worth US$98.4 million it approved in Nov 2004 and Jan 2005 to combat the three diseases in the country over the next 5 years. "Temporary restrictions on travel, that since have been relaxed, were not adequate reasons to cancel the grants", Myint said. He complained that the Global Fund did not warn his country of its intended action and warned that the termination would affect millions of people suffering from or at risk of HIV/AIDS, tuberculosis, and malaria in the country. Peter Newsum of CARE Myanmar believes the Fund's decision to cancel the grants will have a major impact on the work of organisations involved in combating the diseases in the country. (excerpt)
Role of WHO recruited consultants in successful implementation and expansion of the DOTS programme in India.
Journal of the Indian Medical Association. 2003 Mar; 101(3):182-185.For successful implementation of DOTS in India, many factors have played important part and one of which is the use of WHO- contracted local consultants. WHO had recruited consultants known as RNTCP Medical Consultants (RMCs) and assigned them to States and districts to provide technical assistance to the State and District TB Officers. In the districts the RMCs assist in preparation of action plans and interact with district and State authorities. The RMC network is funded by WHO and the Canadian International Development Agency. The assignment of RMCs has resulted in much more rapid implementation of the DOTS strategy with sustainable improvement in the quality of the programme in implementing districts. (excerpt)
Journal of the Indian Medical Association. 2003 Mar; 101(3):150-151.Tuberculosis (TB) remains a serious public health problem in spite of DOTS programme recommended by WHO. One person dies from TB in India every minute. Revised National TB Control Programme (RNTCP) is playing a major role in global DOTS expansion. DOTS coverage has expanded from 2% of the population in mid-1998 to 57% by the end of January, 2003. RNTCP has made a significant contribution to public health capacity. The programme has saved the people of India hundreds of millions of dollars. Monitoring the clinical course using smear microscopy and accurately reporting treatment outcomes is essential in well-functioning DOTS programme. RNTCP has invested heavily and made significant strides in maintaining and improving quality DOTS. State and district level programme reviews are a key component of the process. RNTCP has established guidelines for the involvement of the private sector and medical colleges. A member by ongoing technical activities will improve RNTCP’s surveillance and monitoring systems. However a challenge lies with the programme and a collective effort is welcome. (excerpt)
Bulletin of the World Health Organization. 2001; 79(1):69-70.This article reviews the 1991 paper by Arata Kochi on the strategy of WHO to control tuberculosis. It notes that Kochi's paper did not report a new scientific discovery, rather it depicted the devastating impact of tuberculosis around the world in a clear and forceful manner. Consequently, it changed the public health focus of WHO, national governments and leading voluntary organizations. Kochi's paper pinpointed three major programmatic deficiencies that had to be overcome: inadequate treatment services; high rates of failure to complete therapy; and the worldwide absence of adequate governmental surveillance and monitoring systems. Furthermore, the paper gave attention to the role of public health in addressing the tuberculosis issue. To address the problem, Kochi emphasized that it would take strong, directive leadership by national government to implement systems for an effective prevention and control program for tuberculosis.
AFRICA HEALTH. 1997 Nov; 20(1):19-20.About 80,000 cases of tuberculosis (TB) are reported annually in South Africa. However, control measures have failed to check the growing numbers of TB cases and the spread of HIV is bound to exacerbate the situation. The Western Cape has almost 3 times the national notification rate (663 vs. 225 per 100,000). With only 60-70% of patients in Western Cape found to adhere to treatment, the Community Health Association of South Africa (CHASA) recommended using the DOTS strategy to control TB. The DOTS method, however, burdens both health workers and those patients who have to travel long distances to reach a health center. Such inconvenience contributes to poor treatment compliance. Any strictly medical approach to TB eradication will fail. Medical interventions must instead be set within, and supported by, a strong social and political network. A change in attitude is needed in order to ensure the success of DOTS. The creation of the Western Cape TB Alliance (TBA), TB control-related research, DOTS implementation, and project objectives and achievements are described.