Abstract:
BACKGROUND:Avahan is a large-scale, HIV preventive intervention, targeting high-risk populations in south India. We assessed the cost-effectiveness of Avahan to inform global and national funding institutions who are considering investing in worldwide HIV prevention in concentrated epidemics. METHODS:We estimated cost effectiveness from a programme perspective in 22 districts in four high-prevalence states. We used the UNAIDS Costing Guidelines for HIV Prevention Strategies as the basis for our costing method, and calculated effect estimates using a dynamic transmission model of HIV and sexually transmitted disease transmission that was parameterised and fitted to locally observed behavioural and prevalence trends. We calculated incremental cost-effective ratios (ICERs), comparing the incremental cost of Avahan per disability-adjusted life-year (DALY) averted versus a no-Avahan counterfactual scenario. We also estimated incremental cost per HIV infection averted and incremental cost per person reached. FINDINGS:Avahan reached roughly 150 000 high-risk individuals between 2004 and 2008 in the 22 districts studied, at a mean cost per person reached of US$327 during the 4 years. This reach resulted in an estimated 61 000 HIV infections averted, with roughly 11 000 HIV infections averted in the general population, at a mean incremental cost per HIV infection averted of $785 (SD 166). We estimate that roughly 1 million DALYs were averted across the 22 districts, at a mean incremental cost per DALY averted of $46 (SD 10). Future antiretroviral treatment (ART) cost savings during the lifetime of the cohort exposed to HIV prevention were estimated to be more than $77 million (compared with the slightly more than $50 million spent on Avahan in the 22 districts during the 4 years of the study). INTERPRETATION:This study provides evidence that the investment in targeted HIV prevention programmes in south India has been cost effective, and is likely to be cost saving if a commitment is made to provide ART to all that can benefit from it. Policy makers should consider funding and sustaining large-scale targeted HIV prevention programmes in India and beyond. FUNDING:Bill & Melinda Gates Foundation.
journal_name
Lancet Glob Healthjournal_title
The Lancet. Global healthauthors
Vassall A,Pickles M,Chandrashekar S,Boily MC,Shetty G,Guinness L,Lowndes CM,Bradley J,Moses S,Alary M,Charme India Group.,Vickerman Pdoi
10.1016/S2214-109X(14)70277-3subject
Has Abstractpub_date
2014-09-01 00:00:00pages
e531-e540issue
9issn
2214-109Xpii
S2214-109X(14)70277-3journal_volume
2pub_type
杂志文章abstract:BACKGROUND:The average age at which people start smoking has been decreasing in many countries, but insufficient evidence exists on the adult hazards of having started smoking in childhood and, especially, in early childhood. We aimed to investigate the association between smoking habits (focusing on the age when smoke...
journal_title:The Lancet. Global health
pub_type: 杂志文章
doi:10.1016/S2214-109X(20)30221-7
更新日期:2020-06-01 00:00:00
abstract:BACKGROUND:As of 2018, the rubella vaccine had been incorporated into the national immunisation schedule of 168 countries, representing 87% of the world's population. Countries have used different strategies to reduce the burden of congenital rubella syndrome (CRS), such as vaccinating only females. Given the different...
journal_title:The Lancet. Global health
pub_type: 杂志文章
doi:10.1016/S2214-109X(20)30320-X
更新日期:2020-11-01 00:00:00
abstract:BACKGROUND:The age-specific association between blood pressure and vascular disease has been studied mostly in high-income countries, and before the widespread use of brain imaging for diagnosis of the main stroke types (ischaemic stroke and intracerebral haemorrhage). We aimed to investigate this relationship among ad...
journal_title:The Lancet. Global health
pub_type: 杂志文章
doi:10.1016/S2214-109X(18)30217-1
更新日期:2018-06-01 00:00:00
abstract:BACKGROUND:In malarious areas, pregnant women are more likely to have detectable malaria than are their non-pregnant peers, and the excess risk of infection varies with gravidity. Pregnant women attending antenatal clinic for their first visit are a potential pragmatic sentinel group to track the intensity of malaria t...
journal_title:The Lancet. Global health
pub_type: 杂志文章,meta分析,评审
doi:10.1016/S2214-109X(15)00049-2
更新日期:2015-10-01 00:00:00
abstract:BACKGROUND:In 2007, WHO launched a global initiative for the elimination of mother-to-child transmission of syphilis (congenital syphilis). An important aspect of the initiative is strengthening surveillance to monitor progress towards elimination. In 2008, using a health systems model with country data inputs, WHO est...
journal_title:The Lancet. Global health
pub_type: 杂志文章
doi:10.1016/S2214-109X(16)30135-8
更新日期:2016-08-01 00:00:00
abstract::Development assistance for health (DAH), the value of which peaked in 2013 and fell in 2015, is unlikely to rise substantially in the near future, increasing reliance on domestic and innovative financing sources to sustain health programmes in low-income and middle-income countries. We examined innovative financing in...
journal_title:The Lancet. Global health
pub_type: 杂志文章,评审
doi:10.1016/S2214-109X(17)30198-5
更新日期:2017-07-01 00:00:00
abstract:BACKGROUND:To contribute to the WHO initiative, VISION 2020: The Right to Sight, an assessment of global vision impairment in 2020 and temporal change is needed. We aimed to extensively update estimates of global vision loss burden, presenting estimates for 2020, temporal change over three decades between 1990-2020, an...
journal_title:The Lancet. Global health
pub_type: 杂志文章
doi:10.1016/S2214-109X(20)30425-3
更新日期:2021-02-01 00:00:00
abstract:BACKGROUND:Buruli ulcer can cause disfigurement and long-term loss of function. It is underdiagnosed and under-reported, and its current distribution is unclear. We aimed to synthesise and evaluate data on Buruli ulcer prevalence and distribution. METHODS:We did a systematic review of Buruli ulcer prevalence and used ...
journal_title:The Lancet. Global health
pub_type: 杂志文章
doi:10.1016/S2214-109X(19)30171-8
更新日期:2019-07-01 00:00:00
abstract:BACKGROUND:Understanding the effects of socioeconomic disparities in health outcomes is important to implement specific preventive actions. We assessed socioeconomic disparities in mortality indicators in a rural South African population over the period 2001-13. METHODS:We used data from 21 villages of the Agincourt H...
journal_title:The Lancet. Global health
pub_type: 杂志文章
doi:10.1016/S2214-109X(17)30297-8
更新日期:2017-09-01 00:00:00
abstract:BACKGROUND:In 2002-04, we did a randomised controlled trial in southern Nepal, and reported that children born to mothers taking multiple micronutrient supplements during pregnancy had a mean birthweight 77 g greater than children born to mothers taking iron and folic acid supplements. Children born to mothers in the s...
journal_title:The Lancet. Global health
pub_type: 杂志文章,随机对照试验
doi:10.1016/S2214-109X(14)70314-6
更新日期:2014-11-01 00:00:00
abstract:BACKGROUND:Social protection interventions might improve tuberculosis outcomes and could help to control the epidemic in Brazil. The aim of this study was to evaluate the independent effect of the Bolsa Familia Programme (BFP) on tuberculosis treatment outcomes in Brazil. METHODS:We prospectively recruited and followe...
journal_title:The Lancet. Global health
pub_type: 杂志文章,多中心研究
doi:10.1016/S2214-109X(18)30478-9
更新日期:2019-02-01 00:00:00
abstract:BACKGROUND:Low blood glucose concentrations are common in sick children who present to hospital in low-resource settings and are associated with increased mortality. The cutoff blood glucose concentration for the diagnosis and treatment of hypoglycaemia currently recommended by WHO (2·5 mmol/L) is not evidence-based. W...
journal_title:The Lancet. Global health
pub_type: 杂志文章,随机对照试验
doi:10.1016/S2214-109X(20)30388-0
更新日期:2020-12-01 00:00:00
abstract:BACKGROUND:Insufficient physical activity is a leading risk factor for non-communicable diseases, and has a negative effect on mental health and quality of life. We describe levels of insufficient physical activity across countries, and estimate global and regional trends. METHODS:We pooled data from population-based ...
journal_title:The Lancet. Global health
pub_type: 杂志文章
doi:10.1016/S2214-109X(18)30357-7
更新日期:2018-10-01 00:00:00
abstract:BACKGROUND:Improving access to reproductive health services and commodities is central to development. Efforts to assess progress on this front have been largely focused on national estimates, but such analyses can mask local disparities. We assessed progress in reproductive health services subnationally in India. MET...
journal_title:The Lancet. Global health
pub_type: 杂志文章
doi:10.1016/S2214-109X(17)30033-5
更新日期:2017-03-01 00:00:00
abstract:BACKGROUND:Progress in reproductive, maternal, newborn, and child health (RMNCH) in Kenya has been inconsistent over the past two decades, despite the global push to foster accountability, reduce child mortality, and improve maternal health in an equitable manner. Although several cross-sectional assessments have been ...
journal_title:The Lancet. Global health
pub_type: 杂志文章
doi:10.1016/S2214-109X(17)30246-2
更新日期:2017-08-01 00:00:00
abstract:BACKGROUND:Global efforts to increase births at health-care facilities might not reduce maternal or newborn mortality if quality of care is insufficient. However, little systematic evidence exists for the quality at health facilities caring for women and newborn babies in low-income countries. We analysed the quality o...
journal_title:The Lancet. Global health
pub_type: 杂志文章
doi:10.1016/S2214-109X(16)30180-2
更新日期:2016-11-01 00:00:00
abstract:BACKGROUND:Bereavement increases children's risk for psychological disorders, highlighting the need for effective interventions, especially in areas where orphanhood is common. We aimed to assess the effects of an eight-session support group intervention on the psychological health of bereaved female adolescents in Sou...
journal_title:The Lancet. Global health
pub_type: 杂志文章,随机对照试验
doi:10.1016/S2214-109X(17)30146-8
更新日期:2017-06-01 00:00:00
abstract:BACKGROUND:Faltering in linear growth and neurobehavioural development during early childhood are often assumed to have common causes because of their consistent association. This notion has contributed to a global focus on the promotion of nutrition during pregnancy and childhood to improve both conditions. Our aim wa...
journal_title:The Lancet. Global health
pub_type: 杂志文章
doi:10.1016/S2214-109X(19)30361-4
更新日期:2019-10-01 00:00:00
abstract:BACKGROUND:The reduction by a third of premature non-communicable disease (NCD) mortality by 2030 is the ambitious target of Sustainable Development Goal (SDG) 3.4. However, the indicator is narrowly defined, including only four major NCDs (cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases) an...
journal_title:The Lancet. Global health
pub_type: 杂志文章
doi:10.1016/S2214-109X(20)30035-8
更新日期:2020-04-01 00:00:00
abstract:BACKGROUND:The way in which a government chooses to finance a health intervention can affect the uptake of health interventions and consequently the extent of health gains. In addition to health gains, some policies such as public finance can insure against catastrophic health expenditures. We aimed to evaluate the hea...
journal_title:The Lancet. Global health
pub_type: 杂志文章
doi:10.1016/S2214-109X(14)70346-8
更新日期:2015-05-01 00:00:00
abstract::Child stunting is a global problem and is only modestly responsive to dietary interventions. Numerous observational studies have shown that water quality, sanitation, and handwashing (WASH) in a household are strongly associated with linear growth of children living in the same household. We have completed three rando...
journal_title:The Lancet. Global health
pub_type: 杂志文章
doi:10.1016/S2214-109X(19)30268-2
更新日期:2019-08-01 00:00:00
abstract:BACKGROUND:Many countries are implementing health system reforms to achieve universal health coverage (UHC) by 2030. To understand the progress towards UHC in Bangladesh, we estimated trends in indicators of the health service and of financial risk protection. We also estimated the probability of Bangladesh's achieving...
journal_title:The Lancet. Global health
pub_type: 杂志文章
doi:10.1016/S2214-109X(17)30413-8
更新日期:2018-01-01 00:00:00
abstract:BACKGROUND:Tuberculosis is recognised as a major cause of morbidity and mortality in children, with most cases in children going undiagnosed and resulting in poor outcomes. Household contact management, which aims to identify children with active tuberculosis and to provide preventive therapy for those with HIV or thos...
journal_title:The Lancet. Global health
pub_type: 杂志文章
doi:10.1016/S2214-109X(18)30401-7
更新日期:2018-12-01 00:00:00
abstract:BACKGROUND:The effects of political regimes on health are unclear because empirical evidence is neither strong nor robust. Traditional econometric tools do not allow the direction of causality to be established clearly. We used a new method to investigate whether political transition into democracy affected child morta...
journal_title:The Lancet. Global health
pub_type: 杂志文章
doi:10.1016/S2214-109X(16)30104-8
更新日期:2016-09-01 00:00:00
abstract:BACKGROUND:Chagas disease is currently prevalent in European countries hosting large communities from Latin America. Whether asymptomatic individuals at risk of Chagas disease living in Europe should be screened and treated accordingly is unclear. We performed an economic evaluation of systematic Chagas disease screeni...
journal_title:The Lancet. Global health
pub_type: 杂志文章
doi:10.1016/S2214-109X(17)30073-6
更新日期:2017-04-01 00:00:00
abstract:BACKGROUND:The population exposed to potentially hazardous substances through inappropriate and unsafe management practices related to disposal and recycling of end-of-life electrical and electronic equipment, collectively known as e-waste, is increasing. We aimed to summarise the evidence for the association between s...
journal_title:The Lancet. Global health
pub_type: 杂志文章,评审
doi:10.1016/S2214-109X(13)70101-3
更新日期:2013-12-01 00:00:00
abstract:BACKGROUND:Attainment of universal health coverage is a global health priority. The Myanmar Government has committed to attainment of universal health coverage by 2030, but progress so far has not been assessed. We aimed to estimate national and subnational health service coverage and financial risk protection. METHOD...
journal_title:The Lancet. Global health
pub_type: 评论,杂志文章
doi:10.1016/S2214-109X(18)30318-8
更新日期:2018-09-01 00:00:00
abstract:BACKGROUND:As the incomes of many AIDS-burdened countries grow and donors' budgets for helping to fight the disease tighten, national governments and external funding partners increasingly face the following question: what is the capacity of countries that are highly affected by AIDS to finance their responses from dom...
journal_title:The Lancet. Global health
pub_type: 杂志文章
doi:10.1016/S2214-109X(14)70342-0
更新日期:2015-01-01 00:00:00
abstract:BACKGROUND:Amid rapid urbanisation, the HIV epidemic, and increasing rates of non-communicable diseases, people in sub-Saharan Africa are especially vulnerable to kidney disease. Little is known about the epidemiology of chronic kidney disease (CKD) in sub-Saharan Africa, so we did a systematic review and meta-analysis...
journal_title:The Lancet. Global health
pub_type: 杂志文章,meta分析,评审
doi:10.1016/S2214-109X(14)70002-6
更新日期:2014-03-01 00:00:00
abstract:BACKGROUND:The intermittent administration of seasonal malaria chemoprevention (SMC) is recommended to prevent malaria among children aged 3-59 months in areas of the Sahel subregion in Africa. However, the cost-effectiveness and cost savings of SMC have not previously been evaluated in large-scale studies. METHODS:We...
journal_title:The Lancet. Global health
pub_type: 杂志文章
doi:10.1016/S2214-109X(20)30475-7
更新日期:2021-02-01 00:00:00