Benjamin Johns

The Expanding Epidemics of HIV Type 1 Among Men Who Have Sex With Men in Low- and Middle-Income Countries: Diversity and Consistency

Men who have sex with men (MSM) have borne a disproportionate burden of human immunodeficiency virus (HIV) infection and remain a markedly underresourced population globally. To better describe HIV epidemics among MSM in low- and middle-income countries, the authors conducted a systematic review of published and unpublished literature available after January 1, 2000 (2000-2009). A total of 133 HIV prevalence studies from 50 countries met the search criteria. Data were used to develop an algorithmic approach to categorize these epidemics. The authors found that the HIV epidemic in low- and middle-income countries may be described using the following 4 scenarios: 1) settings where MSM are the predominant contributor to HIV cases; 2) settings where HIV transmission among MSM occurs in the context of epidemics driven by injection drug users; 3) settings where HIV transmission among MSM occurs in the context of well-established HIV transmission among heterosexuals; and 4) settings where both sexual and parenteral modes contribute significantly to HIV transmission. The authors focused on Peru, Ukraine, Kenya, and Thailand to describe the diversity across and similarities between proposed epidemic scenarios. This scenario-based categorization of HIV epidemics among MSM may assist public health agencies and civil societies to develop and implement better-targeted HIV prevention programs and interventions.

Cost-effectiveness of new WHO recommendations for prevention of mother-to-child transmission of HIV in a resource-limited setting.

Objective:Nigeria has high rates of mother-to-child HIV transmission. We sought to determine whether new WHO recommendations for long-course antiretroviral therapy (ART) prophylaxis are cost-effective for prevention of mother-to-child transmission (PMTCT) of HIV compared to short-course strategies in Nigeria. Design:We conducted a cost-effectiveness analysis from a health-system perspective, with a target population consisting of HIV-infected pregnant women in Nigeria. Methods:A decision-analysis model compared two strategies for PMTCT: intervention – long-course maternal triple ART [zidovudine/lamivudine/efavirenz (ZDV/3TC/EFV)] beginning at 14 weeks gestation through the end of breastfeeding, with infant ART, per new WHO guidelines (option B); and minimal standard of care (MSOC) in Nigeria – short-course dual ART (ZDV/3TC) from 34 weeks gestation to 1 week postpartum, with single-dose nevirapine for infant and mother at labor/delivery. The primary outcomes were expected costs, pediatric HIV cases, and disability-adjusted life years (DALYs) accrued with each strategy; cost-effectiveness was represented using incremental cost-effectiveness ratios (ICERs). Results:If implemented at the level of antenatal coverage in Nigeria (58%), mother-to-child HIV transmission could be reduced to 16.1% with MSOC and 12.8% with the intervention. At current pregnancy rates, the intervention would prevent 7680 infant HIV cases and avert 230 400 DALYs annually, compared to MSOC. The average health-system cost of the intervention was US

The Cost-Effectiveness of Rotavirus Vaccination in Malawi

401 per pregnancy compared to

The Cost-Effectiveness of Supplementary Immunization Activities for Measles: A Stochastic Model for Uganda

293 per pregnancy with MSOC. The intervention was associated with an ICER of

Measles Eradication versus Measles Control: An Economic Analysis

113 per-DALY-averted compared to MSOC, and was highly cost-effective using a willingness-to-pay threshold of per-capita Nigerian GDP. Conclusion:Implementation of new WHO recommendations for extended maternal and infant prophylaxis is highly cost-effective compared to short-course regimens for PMTCT of HIV in Nigeria.

The highest attainable standard of evidence (HASTE) for HIV/AIDS interventions: toward a public health approach to defining evidence.

BACKGROUND Rotarix (GlaxoSmithKline), a newly licensed rotavirus vaccine requiring 2 doses, may have the potential to save hundreds of thousands of lives in Africa. Nations such as Malawi, where Rotarix is currently under phase III investigation, may nevertheless face difficult economic choices in considering vaccine adoption. METHODS The cost-effectiveness of implementing a Rotarix vaccine program in Malawi was estimated using published estimates of rotavirus burden, vaccine efficacy, and health care utilization and costs. RESULTS With 49.5% vaccine efficacy, a Rotarix program could avert 2582 deaths annually. With GAVI Alliance cofinancing, adoption of Rotarix would be associated with a cost of

Modelling the impact of HIV prevention and treatment for men who have sex with men on HIV epidemic trajectories in low- and middle-income countries.

5.07 per disability-adjusted life-year averted. With market pricing, Rotarix would be associated with a base case cost of

Capacity utilization and the cost of primary care visits: Implications for the costs of scaling up health interventions

74.73 per disability-adjusted life-year averted. Key variables influencing results were vaccine efficacy, under-2 rotavirus mortality, and program cost of administering each dose. CONCLUSIONS Adopting Rotarix would likely be highly cost-effective for Malawi, particularly with GAVI support. This finding holds true across uncertainty ranges for key variables, including efficacy, for which data are becoming available.

A cost function analysis of child health services in four districts in Malawi.

Supplemental Immunization Activities (SIAs) have become an important adjunct to measles control efforts in countries that endeavor to achieve higher levels of population immunity than can be achieved in a growing routine immunization system. Because SIAs are often supported with funds that have alternative uses, decision makers need to know how cost-effective they are compared with other options. This study integrated a dynamic stochastic model of measles transmission in Uganda (2010-2050) with a cost model to compare a strategy of maintaining Ugandas current (2008) levels of the first dose of routine measles-containing vaccine (MCV1) coverage at 68% with SIAs with a strategy using the same levels of MCV1 coverage without SIAs. The stochastic model was fitted with parameters drawn from district-level measles case reports from Uganda, and the cost model was fitted to administrative data from the Ugandan Expanded Program on Immunization and from the literature. A discount rate of 0.03, time horizon of 2010-2050, and a societal perspective on costs were assumed. Costs expressed in US dollars (2010) included vaccination costs, disease treatment costs including lost productivity of mothers, as well as costs of outbreaks and surveillance. The model estimated that adding on triennial SIAs that covered 95% of children aged 12-59 months to a system that achieved routine coverage rates of 68% would have an incremental cost-effectiveness ratio (ICER) of

The Global HIV epidemics among men who have sex with men

1.50 (