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2. Universal health coverage and intersectoral action for health: key messages from Disease Control Priorities, 3rd edition.

Author

Jamison, Dean T, Alwan, Ala, Mock, Charles N, Nugent, Rachel, Watkins, David, Adeyi, Olusoji, Anand, Shuchi, Atun, Rifat, Bertozzi, Stefano, Bhutta, Zulfiqar, Binagwaho, Agnes, Black, Robert, Blecher, Mark, Bloom, Barry R, Brouwer, Elizabeth, Bundy, Donald AP, Chisholm, Dan, Cieza, Alarcos, Cullen, Mark, Danforth, Kristen, de Silva, Nilanthi, Debas, Haile T, Donkor, Peter, Dua, Tarun, Fleming, Kenneth A, Gallivan, Mark, Garcia, Patricia J, Gawande, Atul, Gaziano, Thomas, Gelband, Hellen, Glass, Roger, Glassman, Amanda, Gray, Glenda, Habte, Demissie, Holmes, King K, Horton, Susan, Hutton, Guy, Jha, Prabhat, Knaul, Felicia M, Kobusingye, Olive, Krakauer, Eric L, Kruk, Margaret E, Lachmann, Peter, Laxminarayan, Ramanan, Levin, Carol, Looi, Lai Meng, Madhav, Nita, Mahmoud, Adel, Mbanya, Jean Claude, Measham, Anthony, Medina-Mora, María Elena, Medlin, Carol, Mills, Anne, Mills, Jody-Anne, Montoya, Jaime, Norheim, Ole, Olson, Zachary, Omokhodion, Folashade, Oppenheim, Ben, Ord, Toby, Patel, Vikram, Patton, George C, Peabody, John, Prabhakaran, Dorairaj, Qi, Jinyuan, Reynolds, Teri, Ruacan, Sevket, Sankaranarayanan, Rengaswamy, Sepúlveda, Jaime, Skolnik, Richard, Smith, Kirk R, Temmerman, Marleen, Tollman, Stephen, Verguet, Stéphane, Walker, Damian G, Walker, Neff, Wu, Yangfeng, and Zhao, Kun

Subjects
Humans, Health Priorities, Delivery of Health Care, Global Health, Universal Health Insurance, Behavioral and Social Science, Prevention, Generic health relevance, Good Health and Well Being, Medical and Health Sciences, General & Internal Medicine
Abstract

The World Bank is publishing nine volumes of Disease Control Priorities, 3rd edition (DCP3) between 2015 and 2018. Volume 9, Improving Health and Reducing Poverty, summarises the main messages from all the volumes and contains cross-cutting analyses. This Review draws on all nine volumes to convey conclusions. The analysis in DCP3 is built around 21 essential packages that were developed in the nine volumes. Each essential package addresses the concerns of a major professional community (eg, child health or surgery) and contains a mix of intersectoral policies and health-sector interventions. 71 intersectoral prevention policies were identified in total, 29 of which are priorities for early introduction. Interventions within the health sector were grouped onto five platforms (population based, community level, health centre, first-level hospital, and referral hospital). DCP3 defines a model concept of essential universal health coverage (EUHC) with 218 interventions that provides a starting point for country-specific analysis of priorities. Assuming steady-state implementation by 2030, EUHC in lower-middle-income countries would reduce premature deaths by an estimated 4·2 million per year. Estimated total costs prove substantial: about 9·1% of (current) gross national income (GNI) in low-income countries and 5·2% of GNI in lower-middle-income countries. Financing provision of continuing intervention against chronic conditions accounts for about half of estimated incremental costs. For lower-middle-income countries, the mortality reduction from implementing the EUHC can only reach about half the mortality reduction in non-communicable diseases called for by the Sustainable Development Goals. Full achievement will require increased investment or sustained intersectoral action, and actions by finance ministries to tax smoking and polluting emissions and to reduce or eliminate (often large) subsidies on fossil fuels appear of central importance. DCP3 is intended to be a model starting point for analyses at the country level, but country-specific cost structures, epidemiological needs, and national priorities will generally lead to definitions of EUHC that differ from country to country and from the model in this Review. DCP3 is particularly relevant as achievement of EUHC relies increasingly on greater domestic finance, with global developmental assistance in health focusing more on global public goods. In addition to assessing effects on mortality, DCP3 looked at outcomes of EUHC not encompassed by the disability-adjusted life-year metric and related cost-effectiveness analyses. The other objectives included financial protection (potentially better provided upstream by keeping people out of the hospital rather than downstream by paying their hospital bills for them), stillbirths averted, palliative care, contraception, and child physical and intellectual growth. The first 1000 days after conception are highly important for child development, but the next 7000 days are likewise important and often neglected.

Published
2018

21. Universal Health Coverage and Intersectoral Action for Health

Author

Jamison, Dean T., primary, Alwan, Ala, additional, Mock, Charles N., additional, Nugent, Rachel, additional, Watkins, David A., additional, Adeyi, Olusoji, additional, Anand, Shuchi, additional, Atun, Rifat, additional, Bertozzi, Stefano, additional, Bhutta, Zulfiqar, additional, Binagwaho, Agnes, additional, Black, Robert, additional, Blecher, Mark, additional, Bloom, Barry R., additional, Brouwer, Elizabeth, additional, Bundy, Donald A. P., additional, Chisholm, Dan, additional, Cieza, Alarcos, additional, Cullen, Mark, additional, Danforth, Kristen, additional, de Silva, Nilanthi, additional, Debas, Haile T., additional, Donkor, Peter, additional, Dua, Tarun, additional, Fleming, Kenneth A., additional, Gallivan, Mark, additional, Garcia, Patricia, additional, Gawande, Atul, additional, Gaziano, Thomas, additional, Gelband, Hellen, additional, Glass, Roger, additional, Glassman, Amanda, additional, Gray, Glenda, additional, Habte, Demissie, additional, Holmes, King K., additional, Horton, Susan, additional, Hutton, Guy, additional, Jha, Prabhat, additional, Knaul, Felicia, additional, Kobusingye, Olive, additional, Krakauer, Eric, additional, E. Kruk, Margaret, additional, Lachmann, Peter, additional, Laxminarayan, Ramanan, additional, Levin, Carol, additional, Looi, Lai Meng, additional, Madhav, Nita, additional, Mahmoud, Adel, additional, Mbanya, Jean-Claude, additional, Measham, Anthony R., additional, Medina-Mora, María Elena, additional, Medlin, Carol, additional, Mills, Anne, additional, Mills, Jody-Anne, additional, Montoya, Jaime, additional, Norheim, Ole, additional, Olson, Zachary, additional, Omokhodion, Folashade, additional, Oppenheim, Ben, additional, Ord, Toby, additional, Patel, Vikram, additional, Patton, George C., additional, Peabody, John, additional, Prabhakaran, Dorairaj, additional, Qi, Jinyuan, additional, Reynolds, Teri, additional, Ruacan, Sevket, additional, Sankaranarayanan, Rengaswamy, additional, Sepúlveda, Jaime, additional, Skolnik, Richard, additional, Smith, Kirk R., additional, Temmerman, Marleen, additional, Tollman, Stephen, additional, Verguet, Stéphane, additional, Walker, Damian, additional, Walker, Neff, additional, Wu, Yangfeng, additional, and Zhao, Kun, additional

Published
2017
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27. Text messaging for maternal and infant retention in prevention of mother-to-child HIV transmission services: A pragmatic stepped-wedge cluster-randomized trial in Kenya

Author

Odeny, Thomas A., Hughes, James P., Bukusi, Elizabeth A., Akama, Eliud, Geng, Elvin H., Holmes, King K., and McClelland, R. Scott

Subjects
EPUB (Standard), Clinical trials -- Analysis -- Health aspects, Text messaging -- Analysis -- Health aspects, Highly active antiretroviral therapy -- Analysis -- Health aspects, HIV infections -- Prevention -- Analysis -- Health aspects, HIV -- Prevention -- Analysis -- Health aspects, Infants, Infection, Text messaging, Biological sciences
Abstract

Background Timely diagnosis of infant HIV infection is essential for antiretroviral therapy (ART) initiation. In a randomized controlled trial, we found the Texting Improves Testing (TextIT) intervention (a theory-based text messaging system) to be efficacious for improving infant HIV testing rates and maternal retention in prevention of mother-to-child HIV transmission (PMTCT) programs. Using an implementation science approach, we aimed to evaluate real-world effectiveness of the intervention. Methods and findings In a pragmatic, cluster-randomized, stepped-wedge trial with 2 time periods of observation, we randomly allocated 10 clinics to begin implementing the intervention immediately and 10 clinics to begin implementing 6 months later. To approximate real-world conditions, inclusion criteria were broad. Women at clinics implementing the intervention received up to 14 text messages during pregnancy and after delivery and had the option to respond to text messages, call, or send inquiry text messages to a designated clinic phone. The primary outcomes were infant HIV testing and maternal retention in care during the first 8 weeks after delivery. We used modified Poisson regression with robust variance estimation to estimate the relative risk and 95% confidence intervals (CIs). Generalized estimating equations were applied on individual-level data to account for clustering by site. Between February 2015 and December 2016, 4,681 women were assessed for study participation, and 2,515 were included. Participant characteristics at enrollment did not differ by study arm. Overall median age was 27 years (interquartile range [IQR] 23-30), median gestational age was 30 weeks (IQR 28-34), 99% were receiving ART, and 87% who enrolled during intervention phases owned a phone. Of 2,326 infants analyzed, 1,466 of 1,613 (90.9%) in the intervention group and 609 of 713 (85.4%) in the control group met the primary outcome of HIV virologic testing performed before 8 weeks after birth (adjusted relative risk [aRR] 1.03; 95% CI 0.97-1.10; P = 0.3). Of 2,472 women analyzed, 1,548 of 1,725 (90%) in the intervention group and 571 of 747 (76%) in the control group met the primary outcome of retention in care during the first 8 weeks after delivery (aRR 1.12; 95% CI 0.97-1.30; P = 0.1). This study had two main limitations. Staff at all facilities were aware of ongoing observation, which may have contributed to increased rates of infant HIV testing and maternal retention in care at both intervention and control facilities, and programmatic initiatives to improve maternal and infant retention in care were ongoing at all facilities at the time of this study, which likely limited the ability to demonstrate effectiveness of the trial intervention. Conclusions In this study, a larger proportion of infants in the intervention group received HIV testing compared with the control group, but the difference was small and not statistically significant. There was also a nonsignificant increase in maternal postpartum retention in the intervention periods. Despite the lack of a significant effect of the intervention, key lessons emerged, both for strengthening PMTCT and for implementation research in general. Perhaps most important, improving the implementation of usual care may have been sufficient to substantially improve infant HIV testing rates. Trial registration ClinicalTrials.gov Trial Number NCT02350140., Author(s): Thomas A. Odeny 1,2,3,*, James P. Hughes 4, Elizabeth A. Bukusi 2,5,6, Eliud Akama 2,5, Elvin H. Geng 7, King K. Holmes 3,5,8,9,10, R. Scott McClelland 3,5,8,11 Introduction Timely [...]

Published
2019
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33. Expedited Partner Therapy: A Robust Intervention

Author

Shiely, Frances, Hayes, Kevin, Thomas, Katherine K., Kerani, Roxanne P., Hughes, James P., Whittington, William L. H., Holmes, King K., Handsfield, H. Hunter, Hogben, Matthew, and Golden, Matthew R.

Published
2010

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