Browsing by Author "Williams, Brian"
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- ItemAfrican voices and leadership is imperative for the global AIDS response(Pan African Medical Journal, 2019-02-22) Mbopi-Keou, Francois-Xavier; Williams, Brian; Belec, Laurent; Kalla, Ginette Claude Mireille; Ndoye, Ibra; Konate, Mamadou Henri; Mensah, Tina GiftyThis position paper is written in reference to the recent extensive media coverage of the report of the Independent Panel describing Harassment, Including Sexual Harassment, Bullying and Abuse of Power at UNAIDS Secretariat by several newspapers and authoritative journals such as Science and The Lancet. Unfortunately, none of these publications provide any clear evidence to support the accusations and merely repeat what are, in our view, unsubstantiated statements made in the report. Given the critical role that Africans have played in dealing with one of the most severe epidemics that the world has seen and the gravity of these charges, we believe it is essential to reaffirm that African voices and leadership is imperative for the global AIDS response.
- ItemCost-per-diagnosis as a metric for monitoring cost-effectiveness of HIV testing programmes in low-income settings in southern Africa : health economic and modelling analysis(International AIDS Society, 2019) Phillips, Andrew N.; Cambiano, Valentina; Nakagawa, Fumiyo; Bansi-Matharu, Loveleen; Wilson, David; Jani, Ilesh; Apollo, Tsitsi; Sculpher, Mark; Hallett, Timothy; Kerr, Cliff; Van Oosterhout, J.; Eaton, Jeffrey W.; Estill, Janne; Williams, Brian; Doi, Naoko; Cowan, Frances; Keiser, Olivia; Ford, Deborah; Hatzold, Karin; Barnabas, Ruanne; Ayles, Helen; Meyer-Rath, Gesine; Nelson, Lisa; Johnson, Cheryl; Baggaley, Rachel; Fakoya, Ade; Jahn, Andreas; Revill, PaulIntroduction: As prevalence of undiagnosed HIV declines, it is unclear whether testing programmes will be cost-effective. To guide their HIV testing programmes, countries require appropriate metrics that can be measured. The cost-per-diagnosis is potentially a useful metric. Methods: We simulated a series of setting-scenarios for adult HIV epidemics and ART programmes typical of settings in southern Africa using an individual-based model and projected forward from 2018 under two policies: (i) a minimum package of “core” testing (i.e. testing in pregnant women, for diagnosis of symptoms, in sex workers, and in men coming forward for circumcision) is conducted, and (ii) core-testing as above plus additional testing beyond this (“additionaltesting”), for which we specify different rates of testing and various degrees to which those with HIV are more likely to test than those without HIV. We also considered a plausible range of unit test costs. The aim was to assess the relationship between cost-per-diagnosis and the incremental cost-effectiveness ratio (ICER) of the additional-testing policy. The discount rate used in the base case was 3% per annum (costs in 2018 U.S. dollars). Results: There was a strong graded relationship between the cost-per-diagnosis and the ICER. Overall, the ICER was below $500 per-DALY-averted (the cost-effectiveness threshold used in primary analysis) so long as the cost-per-diagnosis was below $315. This threshold cost-per-diagnosis was similar according to epidemic and programmatic features including the prevalence of undiagnosed HIV, the HIV incidence and a measure of HIV programme quality (the proportion of HIV diagnosed people having a viral load <1000 copies/mL). However, restricting to women, additional-testing did not appear cost-effective even at a cost-per-diagnosis of below $50, while restricting to men additional-testing was cost-effective up to a cost-per-diagnosis of $585. The threshold cost per diagnosis for testing in men to be cost-effective fell to $256 when the cost-effectiveness threshold was $300 instead of $500, and to $81 when considering a discount rate of 10% per annum. Conclusions: For testing programmes in low-income settings in southern African there is an extremely strong relationship between the cost-per-diagnosis and the cost-per-DALY averted, indicating that the cost-per-diagnosis can be used to monitor the cost-effectiveness of testing programmes.
- ItemDeveloping and implementing national health identifiers in resource limited countries : why, what, who, when and how?(Taylor & Francis Open, 2018) Beck, Eduard J.; Shields, J. Mark; Tanna, Gaurang; Henning, Gerrit; De Vega, Ian; Andrews, Gail; Boucher, Philippe; Benting, Lionel; Garcia- Calleja, Jesus Maria; Cutler, John; Ewing, Whitney; Kijsanayotin, Boonchai; Kujinga, Tapiwanashe; Mahy, Mary; Makofane, Keletso; Marsh, Kim; Nacheeva, Chujit; Rangana, Noma; Vega, Mary Felissa Reyes; Sabin, Keith; Varetska, Olga; Wanyee, Steven Macharia; Watiti, Stephen; Williams, Brian; Zhao, Jinkou; Nunez, Cesar; Ghys, Peter; Low-Beer, DanielMany resource-limited countries are scaling up health services and health-information systems (HISs). The HIV Cascade framework aims to link treatment services and programs to improve outcomes and impact. It has been adapted to HIV prevention services, other infectious and non-communicable diseases, and programs for specific populations. Where successful, it links the use of health services by individuals across different disease categories, time and space. This allows for the development of longitudinal health records for individuals and de-identified individual level information is used to monitor and evaluate the use, cost, outcome and impact of health services. Contemporary digital technology enables countries to develop and implement integrated HIS to support person centred services, a major aim of the Sustainable Development Goals. The key to link the diverse sources of information together is a national health identifier (NHID). In a country with robust civil protections, this should be given at birth, be unique to the individual, linked to vital registration services and recorded every time that an individual uses health services anywhere in the country: it is more than just a number as it is part of a wider system. Many countries would benefit from practical guidance on developing and implementing NHIDs. Organizations such as ASTM and ISO, describe the technical requirements for the NHID system, but few countries have received little practical guidance. A WHO/UNAIDS stake-holders workshop was held in Geneva, Switzerland in July 2016, to provide a ‘road map’ for countries and included policy-makers, information and healthcare professionals, and members of civil society. As part of any NHID system, countries need to strengthen and secure the protection of personal health information. While often the technology is available, the solution is not just technical. It requires political will and collaboration among all stakeholders to be successful.
- ItemEstimating the resources needed and savings anticipated from roll-out of adult male circumcision in sub-Saharan Africa(Public Library of Science (PLOS), 2008-08) Auvert, Bertran; Marseille, Elliot; Korenromp, Eline L.; Lloyd-Smith, James; Sitta, Remi; Taljaard, Dirk; Pretorius, Carel; Williams, Brian; Kahn, James G.Background: Trials in Africa indicate that medical adult male circumcision (MAMC) reduces the risk of HIV by 60%. MAMC may avert 2 to 8 million HIV infections over 20 years in sub-Saharan Africa and cost less than treating those who would have been infected. This paper estimates the financial and human resources required to roll out MAMC and the net savings due to reduced infections. Methods: We developed a model which included costing, demography and HIV epidemiology. We used it to investigate 14 countries in sub-Saharan Africa where the prevalence of male circumcision was lower than 80% and HIV prevalence among adults was higher than 5%, in addition to Uganda and the Nyanza province in Kenya. We assumed that the roll-out would take 5 years and lead to an MC prevalence among adult males of 85%. We also assumed that surgery would be done as it was in the trials. We calculated public program cost, number of full-time circumcisers and net costs or savings when adjusting for averted HIV treatments. Costs were in USD, discounted to 2007. 95% percentile intervals (95% PI) were estimated by Monte Carlo simulations. Results: In the first 5 years the number of circumcisers needed was 2 282 (95% PI: 2 018 to 2 959), or 0.24 (95% PI: 0.21 to 0.31) per 10 000 adults. In years 6-10, the number of circumcisers needed fell to 513 (95% PI: 452 to 664). The estimated 5-year cost of rolling out MAMC in the public sector was $919 million (95% PI: 726 to 1 245).The cumulative net cost over the first 10 years was $672 million (95% PI: 437 to 1 021) and over 20 years there were net savings of $2.3 billion (95% PI: 1.4 to 3.4). Conclusion: A rapid roll-out of MAMC in sub-Saharan Africa requires substantial funding and a high number of circumcisers for the first five years. These investments are justified by MAMC's substantial health benefits and the savings accrued by averting future HIV infections. Lower ongoing costs and continued care savings suggest long-term sustainability. Copyright: © 2008 Auvert et al.
- ItemEvaluating the cost-effectiveness of pre-exposure prophylaxis (PrEP) and its impact on HIV-1 transmission in South Africa(Public Library of Science (PLOS), 2010-11) Pretorius, Carel; Stover, John; Bollinger, Lori; Bacaer, Nicolas; Williams, BrianBackground: Mathematical modelers have given little attention to the question of how pre-exposure prophylaxis (PrEP) may impact on a generalized national HIV epidemic and its cost-effectiveness, in the context of control strategies such as condom use promotion and expanding ART programs. Methodology/Principal Findings: We use an age- and gender-structured model of the generalized HIV epidemic in South Africa to investigate the potential impact of PrEP in averting new infections. The model utilizes age-structured mortality, fertility, partnership and condom use data to model the spread of HIV and the shift of peak prevalence to older age groups. The model shows that universal PrEP coverage would have to be impractically high to have a significant effect on incidence reduction while ART coverage expands. PrEP targeted to 15-35-year-old women would avert 10%-25% (resp. 13%-28%) of infections in this group and 5%-12% (resp. 7%-16%) of all infections in the period 2014-2025 if baseline incidence is 0.5% per year at 2025 (resp. 0.8% per year at 2025). The cost would be $12,500-$20,000 per infection averted, depending on the level of ART coverage and baseline incidence. An optimistic scenario of 30%-60% PrEP coverage, efficacy of at least 90%, no behavior change among PrEP users and ART coverage less than three times its 2010 levels is required to achieve this result. Targeting PrEP to 25-35-year-old women (at highest risk of infection) improves impact and cost-effectiveness marginally. Relatively low levels of condom substitution (e.g., 30%) do not nullify the efficacy of PrEP, but reduces cost-effectiveness by 35%-40%. Conclusions/Significance: PrEP can avert as many as 30% of new infections in targeted age groups of women at highest risk of infection. The cost-effectiveness of PrEP relative to ART decreases rapidly as ART coverage increases beyond three times its coverage in 2010, after which the ART program would provide coverage to more than 65% of HIV+ individuals. To have a high relative cost-effective impact on reducing infections in generalized epidemics, PrEP must utilize a window of opportunity until ART has been scaled up beyond this level. © 2010 Pretorius et al.
- ItemHIV-attributable causes of death in the medical ward at the Chris Hani Baragwanath Hospital, South Africa(Public Library of Science, 2019-05-06) Black, Andrew; Sitas, Freddy; Chibrawara, Trust; Gill, Zoe; Kubanje, Mmamapudi; Williams, BrianIntroduction: Data on the association between HIV infection and deaths from underlying medical conditions are needed to understand and assess the impact of HIV on mortality. We present data on mortality in the Chris Hani Baragwanath Hospital (CHBH) South Africa and analyse the relationship between each cause of death and HIV. Methods: From 2006 to 2009 data were collected on 15,725 deaths including age, sex, day of admittance and of death, HIV status, ART initiation and CD4+ cell counts. Causes of death associated with HIV were cases, causes of death not associated with HIV were controls. We calculate the odds-ratios (ORs) for being HIV-positive and for each AIDS related condition the disease-attributable fraction (DAF) and the population-attributable fraction (PAF) due to HIV for cases relative to controls. Results: Among those that died, the prevalence of HIV was 61% and of acquired immune deficiency syndrome (AIDS) related conditions was 69%. The HIV-attributable fraction was 36% in the whole sample and 60% in those that were HIV-positive. Cryptococcosis, Kaposi’s sarcoma and Pneumocystis jirovecii, TB, gastroenteritis and anaemia were highly predictive of HIV with odds ratios for being HIV-positive ranging from 8 to 124, while genito-urinary conditions, meningitis, other respiratory conditions and sepsis, lymphoma and conditions of skin and bone were significantly associated with HIV with odds ratios for being HIV-positive ranging from 3 to 8. Most of the deaths attributable to HIV were among those dying of TB or of other respiratory conditions. Conclusions: The high prevalence of HIV among those that died, peaking at 70% in those aged 30 years but still 7% in those aged 80 years, demonstrates the impact of the HIV epidemic on adult mortality and on hospital services and the extent to which early anti-retroviral treatment would have reduced the burden of both. These data make it possible to better assess mortality and morbidity due to HIV in this still high prevalence setting and, in particular, to identify those causes of death that are most strongly associated with HIV.
- ItemImplementing the Global Plan to Stop TB, 2011-2015 - optimizing allocations and the Global Fund's contributions : a scenario projections study(Public Library of Science, 2012-06-18) Korenromp, Eline L.; Glaziou, Philippe; Fitzpatrick, Christopher; Floyd, Katherine; Hosseini, Mehran; Raviglione, Mario; Atun, Rifat; Williams, BrianBackground: The Global Plan to Stop TB estimates funding required in low- and middle-income countries to achieve TB control targets set by the Stop TB Partnership within the context of the Millennium Development Goals. We estimate the contribution and impact of Global Fund investments under various scenarios of allocations across interventions and regions. Methodology/Principal Findings: Using Global Plan assumptions on expected cases and mortality, we estimate treatment costs and mortality impact for diagnosis and treatment for drug-sensitive and multidrug-resistant TB (MDR-TB), including antiretroviral treatment (ART) during DOTS for HIV-co-infected patients, for four country groups, overall and for the Global Fund investments. In 2015, China and India account for 24% of funding need, Eastern Europe and Central Asia (EECA) for 33%, sub-Saharan Africa (SSA) for 20%, and other low- and middle-income countries for 24%. Scale-up of MDR-TB treatment, especially in EECA, drives an increasing global TB funding need – an essential investment to contain the mortality burden associated with MDR-TB and future disease costs. Funding needs rise fastest in SSA, reflecting increasing coverage need of improved TB/HIV management, which saves most lives per dollar spent in the short term. The Global Fund is expected to finance 8–12% of Global Plan implementation costs annually. Lives saved through Global Fund TB support within the available funding envelope could increase 37% if allocations shifted from current regional demand patterns to a prioritized scale-up of improved TB/HIV treatment and secondly DOTS, both mainly in Africa − with EECA region, which has disproportionately high per-patient costs, funded from alternative resources. Conclusions/Significance: These findings, alongside country funding gaps, domestic funding and implementation capacity and equity considerations, should inform strategies and policies for international donors, national governments and disease control programs to implement a more optimal investment approach focusing on highest-impact populations and interventions.
- ItemProceedings of the 13th annual conference of INEBRIA(Biomed Central, 2016-09) Watson, Rod; Morris, James; Isitt, John; Barrio, Pablo; Ortega, Lluisa; Gual, Antoni; Conner, Kenneth; Stecker, Tracy; Maisto, Stephen; Paroz, Sophie; Graap, Caroline; Grazioli, Veronique S.; Daeppen, Jean-Bernard; Collins, Susan E.; Bertholet, Nicolas; McNeely, Jennifer; Kushnir, Vlad; Cunningham, John A.; Crombie, Iain K.; Cunningham, Kathryn B.; Irvine, Linda; Williams, Brian; Sniehotta, Falko F.; Norrie, John; Melson, Ambrose; Jones, Claire; Briggs, Andrew; Rice, Peter; Achison, Marcus; McKenzie, Andrew; Dimova, Elena; Slane, Peter W.; Grazioli, Véronique S.; Collins, Susan E.; Paroz, Sophie; Graap, Caroline; Daeppen, Jean-Bernard; Baggio, Stephanie; Dupuis, Marc; Studer, Joseph; Gmel, Gerhard; Magill, Molly; Grazioli, Veronique S.; Tait, Robert J.; Teoh, Lucinda; Kelty, Erin; Geelhoed, Elizabeth; Mountain, David; Hulse, Gary K.; Renko, Elina; Mitchell, Shannon G.; Lounsbury, David; Li, Zhi; Schwartz, Robert P.; Gryczynski, Jan; Kirk, Arethusa S.; Oros, Marla; Hosler, Colleen; Dusek, Kristi; Brown, Barry S.; Finnell, Deborah S.; Holloway, Aisha; Wu, Li-Tzy; Subramaniam, Geetha; Sharma, Gaurav; Wallhed Finn, Sara; Andreasson, Sven; Dvorak, Robert D.; Kramer, Matthew P.; Stevenson, Brittany L.; Sargent, Emily M.; Kilwein, Tess M.; Harris, Sion K.; Sherritt, Lon; Copelas, Sarah; Knight, John R.; Mdege, Noreen D.; McCambridge, Jim; Bischof, Gallus; Bischof, Anja; Freyer-Adam, Jennis; Rumpf, Hans-Juergen; Fitzgerald, Niamh; Scholin, Lisa; Toner, Paul; Böhnke, Jan R.; Veach, Laura J.; Currin, Olivia; Dongre, Leigh Z.; Miller, Preston R.; White, Elizabeth; Williams, Emily C.; Lapham, Gwen T.; Bobb, Jennifer J.; Rubinsky, Anna D.; Catz, Sheryl L.; Shortreed, Susan; Bensley, Kara M.; Bradley, Katharine A.; Milward, Joanna; Deluca, Paolo; Khadjesari, Zarnie; Watson, Rod; Fincham-Campbell, Stephanie; Drummond, Colin; Angus, Kathryn; Bauld, Linda; Baumann, Sophie; Haberecht, Katja; Schnuerer, Inga; Meyer, Christian; Rumpf, Hans-Jürgen; John, Ulrich; Gaertner, Beate; Barrault-Couchouron, Marion; Béracochea, Marion; Allafort, Vincent; Barthelemy, Valerie; Bonnefoi, Herve; Bussieres, Emmanuel; Garguil, Veronique; Auriacombe, Marc; Saint-Jacques, Marianne; Dorval, Michel; M’Bailara, Katia; Segura-Garcia, Lidia; Ibanez-Martinez, Nuria; Mendive-Arbeloa, Juan M.; Anoro-Perminger, Manel; Diaz-Gallego, Pako; Pinar-Mateos, M. Angeles; Colom-Farran, Joan; Deligianni, Marianthi; Yersin, Bertrand; Adam, Angeline; Weisner, Constance; Chi, Felicia; Lu, Wendy; Sterling, Stacy; Kraemer, Kevin L.; McGinnis, Kathleen A.; Fiellin, David A.; Skanderson, Melissa; Gordon, Adam J.; Robbins, Jonathan; Zickmund, Susan; Korthuis, P. T.; Edelman, E. J.; Hansen, Nathan B.; Cutter, Christopher J.; Dziura, James; Fiellin, Lynn E.; O’Connor, Patrick G.; Maisto, Stephen A.; Bedimo, Roger; Gilbert, Cynthia; Marconi, Vincent C.; Rimland, David; Rodriguez-Barradas, Maria; Simberkoff, Michael; Justice, Amy C.; Bryant, Kendall J.; Berman, Anne H.; Shorter, Gillian W.; Bray, Jeremy W.; Barbosa, Carolina; Johansson, Magnus; Hester, Reid; Campbell, William; Souza Formigoni, Maria L. O.; Andrade, Andre L. M.; Sartes, Laisa M. A.; Sundström, Christopher; Eék, Niels; Kraepelien, Martin; Kaldo, Viktor; Fahlke, Claudia; Hernandez, Lynn; Becker, Sara J.; Jones, Richard N.; Graves, Hannah R.; Spirito, Anthony; Diestelkamp, Silke; Wartberg, Lutz; Arnaud, Nicolas; Thomasius, Rainer; Gaume, Jacques; Grazioli, Veronique; Fortini, Cristiana; Malan, Zelra; Mash, Bob; Everett-Murphy, Katherine; Grazioli, Veronique S.; Studer, Joseph; Mohler-Kuo, M.; Bertholet, Nicolas; Gmel, Gerhard; Doi, Lawrence; Cheyne, Helen; Jepson, Ruth; Luna, Vanesa; Echeverria, Leticia; Morales, Silvia; Barroso, Teresa; Abreu, Angela; Aguiar, Cosma; Stewart, Duncan; Abreu, Angela; Brites, Riany M.; Jomar, Rafael; Marinho, Gerson; Parreira, Pedro; Seale, J. P.; Johnson, J. A.; Henry, Dena; Chalmers, Sharon; Payne, Freida; Tuck, Linda; Morris, Akula; Goncalves, Catia; Besser, Bettina; Casajuana, Cristina; Lopez-Pelayo, Hugo; Balcells, Maria M.; Teixido, Lidia; Miquel, Laia; Colom, Joan; Hepner, Kimberly A.; Hoggatt, Katherine. J.; Bogart, Andy; Paddock, Susan. M.; Hardoon, Sarah L.; Petersen, Irene; Hamilton, Fiona L.; Nazareth, Irwin; White, Ian R.; Marston, Louise; Wallace, Paul; Godfrey, Christine; Murray, Elizabeth; Sovinova, Hana; Csemy, LadislavENGLISH SUMMARY : Meeting abstracts.