Charlotte Deogan

Resource Needs for Adolescent Friendly Health Services: Estimates for 74 Low- and Middle-Income Countries

Background In order to achieve Millennium Development Goals 4, 5 and 6, it is essential to address adolescents’ health. Objective To estimate the additional resources required to scale up adolescent friendly health service interventions with the objective to reduce mortality and morbidity among individuals aged 10 to 19 years in 74 low- and middle- income countries. Methods A costing model was developed to estimate the financial resources needed to scale-up delivery of a set of interventions including contraception, maternity care, management of sexually transmitted infections, HIV testing and counseling, safe abortion services, HIV harm reduction, HIV care and treatment and care of injuries due to intimate partner physical and sexual violence. Financial costs were estimated for each intervention, country and year using a bottom-up ingredients approach, defining costs at different levels of delivery (i.e., community, health centre, and hospital level). Programme activity costs to improve quality of care were also estimated, including activities undertaken at national-, district- and facility level in order to improve adolescents’ use of health services (i.e., to render health services adolescent friendly). Results Costs of achieving universal coverage are estimated at an additional US

A cost-effectiveness analysis of the Chlamydia Monday - A community-based intervention to decrease the prevalence of chlamydia in Sweden

15.41 billion for the period 2011–2015, increasing from US

Risk of self-reported Chlamydia trachomatis infection by social and lifestyle factors – A study based on survey data from young adults in Stockholm, Sweden

1.86 billion in 2011 to US

Sexual health among transgender people in Sweden

4,31 billion in 2015. This corresponds to approximately US

Further gender equality – is it good or bad for sexual health?

1.02 per adolescent in 2011, increasing to 4.70 in 2015. On average, for all 74 countries, an annual additional expenditure per capita ranging from of US

Erratum to: Health, disability and quality of life among trans people in Sweden–a web-based survey

0.38 in 2011 to US

Factors associated with condom use and HIV testing among young men who have sex with men: a cross-sectional survey in a random online sample in Sweden

0.82 in 2015, would be required to support the scale-up of key adolescent friendly health services. Conclusion The estimated costs show a substantial investment gap and are indicative of the additional investments required to scale up health service delivery to adolescents towards universal coverage by 2015.

Health, disability and quality of life among trans people in Sweden–a web-based survey

Aims: The study was undertaken to assess the cost-effectiveness of the Chlamydia Monday, 2007. This is a community-based intervention aimed at reducing the prevalence of chlamydia by information and increased availability of testing, treatment and contact tracing in Stockholm. The aim was to analyze the cost-effectiveness by estimating costs, savings and effects on health associated with the intervention, and to determine if cost-effectiveness varies between men and women. Methods: A societal perspective was adopted, meaning all significant costs and consequences were taken into consideration, regardless of who experienced them. A cost-effectiveness model was constructed including costs of the intervention, savings due to avoiding potential costs associated with medical sequels of chlamydia infection, and health gains measured as quality adjusted life years (QALY). Sensitivity analyses were done to explore model and result uncertainty. Results: Total costs were calculated to be 66,787.21; total savings to 30,370.14; and total health gains to 9.852324 QALYs (undiscounted figures). The discounted cost per QALY was 8,346.05 (10,810.77/QALY for women and 6,085.35/QALY for men). Sensitivity analyses included changes in effectiveness, variation of prevalence, reduced risk of sequel progression, inclusion of prevented future production loss and shortened duration for chronic conditions. The cost per QALY was consistently less than 50,000, which is often regarded as cost-effective in a Swedish context. Conclusions: The Chlamydia Monday has been demonstrated by this study to be a cost-effective intervention and should be considered a wise use of society’s resources.

Chlamydia prevention in Sweden—A case study of potential key factors in successful response

ABSTRACT Objective To analyse the associations between demographic, socio-economic and lifestyle factors, and the risk of self-reported chlamydial infection among young adults (20–29 years old) in Stockholm, Sweden. Methods This study was based on the Stockholm Public Health Survey of 2006 (N = 4278). Demographic factors (gender, age, and country of birth), socio-economic factors (individual and parental educational levels, individual income level, and employment status), and lifestyle factors (body mass index, mental health, alcohol consumption, and partnership status) were taken into account. Possible associations were analysed by logistic regression. Results The risk of self-reported chlamydial infection decreases with age, is higher among individuals both who personally, and whose parents, were educated to high school level compared to university level education, and is higher among those employed, unemployed or on sick-leave/pre-retired compared to students. The risk of chlamydial infection is also higher among subjects who report greater alcohol consumption, and those who live without a partner. After considering demographic, socio-economic and lifestyle factors, the associations with age, educational level, employment status and alcohol consumption are strong and statistically significant. Conclusion Indicators of risk-taking behaviours, especially in settings with generally little educational ambition or options, should be incorporated in the design of STI prevention strategies.

Cost-effectiveness of school-based prevention of cannabis use

ABSTRACT Introduction: Transgender people´s general health and sexual function has previously been studied. However, holistic sexual health—physical, emotional, and relational well-being in relation to sexuality—as both a determinant for and a part of general health is an understudied field in research concerning health among transgender people. There is no research addressing holistic sexual health and sexual health determinants combining quantitative and qualitative data. Aim: To explore and describe holistic sexual health and sexual health determinants among transgender people in Sweden. Methods: For the purpose of this paper, descriptive statistics from a previous web-based survey with 796 respondents and quotes from a previous qualitative interview study with 20 transgender people were combined. Results: Physical, emotional, and relational well-being are all vital aspects for experiencing holistic sexual health; that is, they are all important sexual health determinants, although of different importance to different individuals at different times. Satisfaction with sex life, having an ongoing sexual relationship and having been exposed to disrespectful or discriminatory care are examples of physical, emotional, and relational sexual health determinants that are connected to factors such as condom use, access to respectful STI/HIV-testing and having received reimbursement for sex. Experiences of disrespect and discrimination were reported in both the qualitative and the quantitative data, and in the qualitative data a wish for equity in access to sexual health care is evident. Conclusion: The results provide a broad and extensive insight into transgender people´s sexual health in Sweden. Furthermore it underlines that access to nondiscriminatory health care services is vital, including access to gender-confirming care and different sexual-health-promoting and preventive services such as testing facilities.