Cost Of Kits Research Articles

Acceptability and use of HIV self-testing among young people in sub-Saharan Africa: a mixed methods systematic review

BackgroundYoung people (YP) are disproportionately affected by the HIV pandemic in sub-Saharan Africa (SSA), but testing rates remain low despite global targets of testing 95% of people with HIV infection by 2030. HIV self-testing (HIVST) has been recently introduced to reach high-risk population groups such as these. Thus, synthesis of emerging evidence on the acceptability and use of HIVST among YP in SSA is needed so that comprehensive information can be generated to inform policy and practice.MethodsWe employed a mixed methods systematic review of quantitative and qualitative literature reporting on HIVST among YP involving any design and published in English by 31st of October 2023. The review synthesized quantitative evidence on acceptability and use of HIVST, and qualitative evidence on perspectives of YP about HIVST. We searched databases of published articles (e.g. MEDLINE, CINAHL) and Gray literature sources (e.g. Google, Google Scholar). The concepts for the search included self-testing, HIV/AIDS, and countries in SSA. Two authors independently screened, retrieved full-text, and assessed quality of the studies.ResultsA total of 4150 studies were retrieved and 32 studies were finally included in the review. Acceptability of HIVST computed from a single item asking YP on their preference or willingness or demand for HIVST was moderate (34–67%) to high (≥ 67%) among YP in SSA. Nine of the fourteen studies that reported on acceptability found high acceptability of HIVST. Use of HIVST ranged from 0.8 to 100% while in most studies the use rate was below 50%. Key barriers to HIVST use were coping with a positive test in the absence of counselling and support, physical discomfort, and cost of kits. Perceived enablers included perceptions of HIVST as promoting personal empowerment and autonomy; privacy and confidentiality; and convenience in location, time, and skill.ConclusionsHIVST was highly accepted but not well utilized among YP in SSA. YP showed diversified needs with mixed preferences for location, and modalities of service provision. Overall, the review identified heterogeneous evidence in terms of methods, population, outcome measures, and results. The review was registered in the International Prospective Registry of Systematic Reviews (PROSPERO: ID = CRD42021278919).

B-330 Reducing Inappropriate Fecal Immunochemical Test

Abstract Background Colorectal cancer is the third most common cancer worldwide. The risk of colorectal cancer increases with age and predominantly affects individuals over the age of 50. Regular screening is crucial for early detection and prevention of colorectal cancer. Pre-cancerous polyps and colorectal cancers can bleed into the gastrointestinal tract. While the presence of blood in the stool cannot always be seen visually, it can be detected by the Fecal Immunochemical Test (FIT), currently the most sensitive method for directly measuring hemoglobin in this specimen type. In our province, FIT is recommended for testing average-risk asymptomatic patients aged 50 to 74 every 1-2 years. Patients aged 40 to 49 or 75 to 84 can be tested if they meet specific criteria. Like many other tests in the lab, FIT can be used inappropriately. The focus of this study was to examine the utilization of FIT in our institution. Methods Data were collected from our institution's laboratory information system for the FIT performed on-site from July to December 2023. Results We performed 91,545 FIT tests during the 6-month period with an overall positive rate of 6.8%. Of the total tests performed, 87.9% were for patients aged 50-74 years, 10.6% for patients aged 40-49 or 75-84 years, and 1.2% for patients outside the approved age range. Each year, we performed over 2,000 FIT tests for patients outside the accepted screening age, with an estimated cost of over 30,000 CAD. Conclusions Our results showed a significant number of FITs were ordered inappropriately by healthcare providers. Considering the relatively high cost of FIT kits, labor, reagents, etc., the overall cost per reportable is significant. Thus, we have started engaging healthcare providers involved in FIT testing to strategize approaches to improve utilization.

Optimizing Conditions of Polyethylene Glycol Precipitation for Exosomes Isolation From MSCs Culture Media for Regenerative Treatment.

Mesenchymal stem cell (MSC)-derived exosomes, as a cell-free alternative to MSCs, offer enhanced safety and significant potential in regenerative medicine. However, isolating these exosomes poses a challenge, complicating their broader application. Commonly used methods like ultracentrifugation (UC) and tangential flow filtration are often impractical due to the requirement for costly instruments and ultrafiltration membranes. Additionally, the high cost of commercial kits limits their use in processing large sample volumes. Polyethylene glycol (PEG) precipitation offers a more convenient and cost-effective alternative, but there is a critical need for optimized and standardized isolation protocols using PEG precipitation across different cell types and fluids to ensure consistent quality and yield. In this work, we optimized the PEG precipitation method for exosomes isolation and compared its effectiveness to two commonly used methods: UC and commercial exosome isolation kits (ExoQuick). The recovery rate of the optimized PEG method (about 61.74%) was comparable to that of the commercial ExoQuick kit (about 62.19%), which was significantly higher than UC (about 45.80%). Exosome cargo analysis validated no significant differences in miRNA and protein profiles associated with the proliferation and migration of exosomes isolated by UC and PEG precipitation, which was confirmed by gap closure and CCK8 assays. These findings suggest that PEG-based exosomes isolation could be a highly efficient and high-quality method and may facilitate the development of exosome-based therapies for regenerative medicine.

Rapid cost-effectiveness analysis: hemodialysis versus peritoneal dialysis for patients with acute kidney injury in Rwanda

BackgroundTo ensure the long-term sustainability of its Community-Based Health Insurance scheme, the Government of Rwanda is working on using Health Technology Assessment (HTA) to prioritize its resources for health. The objectives of the study were to rapidly assess (1) the cost-effectiveness and (2) the budget impact of providing PD versus HD for patients with acute kidney injury (AKI) in the tertiary care setting in Rwanda.MethodsA rapid cost-effectiveness analysis for patients with AKI was conducted to support prioritization. An ‘adaptive’ HTA approach was undertaken by adjusting the international Decision Support Initiative reference case for time and data constraints. Available local and international data were used to analyze the cost-effectiveness and budget impact of peritoneal dialysis (PD) compared with hemodialysis (HD) in the tertiary hospital setting.ResultsThe analysis found that HD was slightly more effective and slightly more expensive in the payer perspective for most patients with AKI (aged 15–49). HD appeared to be cost-effective when only comparing these two dialysis strategies with an incremental cost-effectiveness ratio of 378,174 Rwandan francs (RWF) or 367 United States dollars (US$), at a threshold of 0.5 × gross domestic product per capita (RWF 444,074 or US$431). Sensitivity analysis found that reducing the cost of HD kits would make HD even more cost-effective. Uncertainty regarding PD costs remains.Budget impact analysis demonstrated that reducing the cost of the biggest cost driver, HD kits, could produce significantly more savings in five years than switching to PD. Thus, price negotiations could significantly improve the efficiency of HD provision.ConclusionDialysis is costly and covered by insurance in many countries for the financial protection of patients. This analysis enabled policymakers to make evidence-based decisions to improve the efficiency of dialysis provision.

A novel framework based on deep learning for COVID-19 diagnosis from X-ray images.

The coronavirus infection has endangered human health because of the high speed of the outbreak. A rapid and accurate diagnosis of the infection is essential to avoid further spread. Due to the cost of diagnostic kits and the availability of radiology equipment in most parts of the world, the COVID-19 detection method using X-ray images is still used in underprivileged countries. However, they are challenging due to being prone to human error, time-consuming, and demanding. The success of deep learning (DL) in automatic COVID-19 diagnosis systems has necessitated a detection system using these techniques. The most critical challenge in using deep learning techniques in diagnosing COVID-19 is accuracy because it plays an essential role in controlling the spread of the disease. This article presents a new framework for detecting COVID-19 using X-ray images. The model uses a modified version of DenseNet-121 for the network layer, an image data loader to separate images in batches, a loss function to reduce the prediction error, and a weighted random sampler to balance the training phase. Finally, an optimizer changes the attributes of the neural networks. Extensive experiments using different types of pneumonia expresses satisfactory diagnosis performance with an accuracy of 99.81%. This work aims to design a new deep neural network for highly accurate online recognition of medical images. The evaluation results show that the proposed framework can be considered an auxiliary device to help radiologists accurately confirm initial screening.

A Trypan Blue-Based ELISA Practice Test to Evaluate Trainee Performance

Enzyme-linked immunosorbent assay (ELISA) is a valuable tool in various chemical and biological fields for investigating the presence and quantity of proteins of interest in given samples. The high importance of the assay makes it widely used in biological research and hence a crucial skill to master for up-and-coming scientists. A major impediment to teaching the skill to new students in research laboratories is the high cost of commercial ELISA kits. As a result of the cost of the kits, most investigators prefer that more experienced students or technicians carry out the assay to prevent errors, thus depriving less experienced students the chance to actively learn the process. Here, we present a practice ELISA test that can be done in any laboratory using different dilutions of trypan blue as the reagents and samples, thereby creating a product at one-hundredth the cost of the least expensive ELISA kits. Research has continuously shown that active learning tools such as this simulation enhance student engagement and self-efficacy. This practice test also generates a numerical score based on the students’ accuracy in pipetting and attention to detail, allowing students to identify sources of error. Therefore, the practice ELISA experiment acts as a medium to teach proper technique before performing a real ELISA, thus avoiding wasting expensive reagents and limited samples.

Evaluation of miniaturized Illumina DNA preparation protocols for SARS-CoV-2 whole genome sequencing.

The global pandemic caused by SARS-CoV-2 has increased the demand for scalable sequencing and diagnostic methods, especially for genomic surveillance. Although next-generation sequencing has enabled large-scale genomic surveillance, the ability to sequence SARS-CoV-2 in some settings has been limited by the cost of sequencing kits and the time-consuming preparations of sequencing libraries. We compared the sequencing outcomes, cost and turn-around times obtained using the standard Illumina DNA Prep kit protocol to three modified protocols with fewer clean-up steps and different reagent volumes (full volume, half volume, one-tenth volume). We processed a single run of 47 samples under each protocol and compared the yield and mean sequence coverage. The sequencing success rate and quality for the four different reactions were as follows: the full reaction was 98.2%, the one-tenth reaction was 98.0%, the full rapid reaction was 97.5% and the half-reaction, was 97.1%. As a result, uniformity of sequence quality indicated that libraries were not affected by the change in protocol. The cost of sequencing was reduced approximately seven-fold and the time taken to prepare the library was reduced from 6.5 hours to 3 hours. The sequencing results obtained using the miniaturised volumes showed comparability to the results obtained using full volumes as described by the manufacturer. The adaptation of the protocol represents a lower-cost, streamlined approach for SARS-CoV-2 sequencing, which can be used to produce genomic data quickly and more affordably, especially in resource-constrained settings.

Comparison of the sensitivity, specificity, correlation and inter-assay agreement of eight diagnostic in vitro assays for the detection of African swine fever virus.

With the recent spread of African swine fever (ASF) in Europe, Asia and the Caribbean region, after being endemic for decades in Africa, PCR-based commercial kits and various master mixes are increasingly being used in addition to the Office International des Epizooties-recommended protocol from King etal. (World Organization for Animal Health). Often, the availability and cost of commercial kits or master mixes can be a limiting factor for diagnostic laboratories, in addition to the requirements for transportation and storage of temperature-sensitive reagents in remote areas. In such cases, alternatives should be ready to maximize surveillance and mining of ASF. To evaluate alternatives, we tested five commercial quantitative real-time PCR (qPCR) master mixes from Applied Biosystems, Bio-Rad, Biotechrabbit, Promega and Qiagen using the same primers and probe mix derived from the King etal.'s protocol for the sensitivity, specificity, correlation and inter-assay agreement. We further included three ad hoc molecular diagnostic kits (VetMax™ African Swine Fever Virus Detection Kit [Applied Biosystems], ID Gene African Swine Fever Duplex [ID-Vet] and Virotype ASF PCR Kit [Qiagen/Indical]). The limit of detection (LOD) was assessed for each assay. The comparative study panel comprised 83 archived DNA samples from ASF virus (ASFV) clinical samples, belonging to five different genotypes from outbreaks in 16 countries in Asia and Africa. The analytical specificity was assessed against a panel of swine pathogens. The LOD ranged from 13 to 41 gene copies per reaction; VetMax ™ African Swine Fever Virus Detection Kit from Applied Biosystems exhibited the lowest detection limit (13 gene copies per reaction) and iQ Supermix from Bio-Rad the highest detection limit (41 gene copies per reaction). Cq values obtained from the lowest dilution, in which all replicates (n=25) could still be amplified (50 gene copies per reaction), were not significantly different between kits using Kruskal-Wallis test. Inter-assay agreement was assessed using statistical test Fleiss-Kappa and was shown to be excellent in all cases. Agreement using statistical test Bland-Altman was good for samples with Cq values<25 and moderate for Cq values>25. We conclude that all the assays evaluated in this study can be used for the routine detection of ASFV.

Deep Learning Approach for Analysis and Characterization of COVID-19

Early diagnosis of a pandemic disease like COVID-19 can help deal with a dire situation and help radiologists and other experts manage human resources more effectively. In a recent pandemic, laboratories perform diagnostics manually, which requires a lot of time and expertise of the laboratorial technicians to yield accurate results. Moreover, the cost of kits is high, and well-equipped labs are needed to perform this test. Therefore, other means of diagnosis is highly desirable. Radiography is one of the existing methods that finds its use in the diagnosis of COVID-19. The radiography observes change in Computed Tomography (CT) chest images of patients, developing a deep learning-based method to extract graphical features which are used for automated diagnosis of the disease ahead of laboratory-based testing. The proposed work suggests an Artificial Intelligence (AI) based technique for rapid diagnosis of COVID-19 from given volumetric chest CT images of patients by extracting its visual features and then using these features in the deep learning module. The proposed convolutional neural network aims to classify the infectious and non-infectious SARS-COV2 subjects. The proposed network utilizes 746 chests scanned CT images of 349 images belonging to COVID-19 positive cases, while 397 belong to negative cases of COVID-19. Our experiment resulted in an accuracy of 98.4%, sensitivity of 98.5%, specificity of 98.3%, precision of 97.1%, and F1-score of 97.8%. The additional parameters of classification error, mean absolute error (MAE), root-mean-square error (RMSE), and Matthew’s correlation coefficient (MCC) are used to evaluate our proposed work. The obtained result shows the outstanding performance for the classification of infectious and non-infectious for COVID-19 cases.

A fast and cheap in-house magnetic bead RNA extraction method for COVID-19 diagnosis

COVID-19 has posed a worldwide public health challenge affecting millions of people in different countries. Rapid and efficient detection of SARS-CoV-2 is essential for pandemic control. Reverse Transcription quantitative PCR (RT-qPCR) of nasopharyngeal swabs is the gold standard method for the virus detection, but the high demand for tests has substantially increased the costs and reduced the availability of reagents, including genetic material purification kits. Thus, the present study aimed to compare two bead-based RNA extraction methods (an in-house and a commercial kit) from nasopharyngeal swabs and RT-qPCR detection of SARS-CoV-2. Twenty-five positive and five negative nasopharyngeal swab samples were subjected to extraction of nucleic acids using both methods in an automated platform. Both protocols revealed a high correlation between Cycle Quantifications (Cqs) (r = 0.99, p < 0.0001). In addition, the in-house kit was 89.5 % cheaper when compared to the mean cost of commercial RNA extraction kits. The results show that the in-house protocol is an affordable and reliable option for RNA extraction for SARS-CoV-2 detection from nasopharyngeal swabs.

Stress and Financial Burden Faced by Dentists Amidst COVID 19 Pandemic

Introduction: The Covid-19 pandemic, initiated in Wuhan, China, had devastating effects on the dental industry world-wide. The mode of transmission of SARS Cov-2, causative agent of Covid-19, was through aerosol and saliva contamination putting dentists at high risk of contracting Covid-19. The measures taken to contain the spread of virus had financial repercussion on the dental industry. The survey was conducted to understand the mental health of dentists amidst Covid-19 pandemic.&#x0D; Aim: To analyse the concerns and anxiety faced by dental surgeons regarding vaccination and the psychological and socio-economic impact Covid-19 pandemic had on dental setups.&#x0D; Methods: A cross-sectional study was conducted for a period of 3 months. A sample size of 300 dentists belonging to age group of 25years to 45years was analysed. The dentists included in the sample practiced in Maharashtra, India. A questionnaire was formulated in Google forms and circulated through social media platform. The result was analysed and demonstrated in pie-charts.&#x0D; Results: The survey analysed that majority of dentists were apprehensive to carry out dental procedures. Along with the risk of contracting and being a source of transmission of Covid-19, dentists had huge financial burden of clinic rents, EMI loan pending bills, the cost of preventive kits and reduced patient flow.&#x0D; Conclusion: The survey was successful in analysing the monetary and safety concerns faced by dentists amidst Covid-19 pandemic. The survey also pointed out the mental stress dentists had to overcome to practice dental procedures.

Alternative RNA extraction-free techniques for the real-time RT-PCR detection of SARS-CoV-2 in nasopharyngeal swab and sputum samples

Standard diagnoses of SARS-CoV-2 infections are done by RNA extraction and real-time RT-PCR (rRT-PCR). However, the need for RNA extraction complicates testing due to increased processing time, high cost, and limited availability of commercial kits. Therefore, alternative methods for rRT-PCR detection of SARS-CoV-2 without RNA extraction were investigated. Nasopharyngeal and sputum samples were used to compare the sensitivity of three techniques: Trizol RNA extraction, thermal shock, and the direct use of samples with an RNase inhibitor. Direct, extraction-free use of primary samples plus the RNase inhibitor produced diagnostic values of 100 % sensitivity and specificity compared to standard protocols, and these findings were validated in a second, independent laboratory.

Perspectives of Policymakers on the Introduction and Scale-Up of HIV Self-Testing and Implication for National HIV Programming in Ghana.

Background: HIV self-testing (HIVST) has the potential to greatly increase HIV testing uptake, particularly among key populations (KPs) at higher risk for HIV. Studies have shown high acceptability and feasibility of HIVST among various target populations globally. However, less is known about the perspectives of policymakers, who are critical to the success of HIVST implementation. Their views on barriers to the introduction and scale-up of self-testing are critical to understand in order for HIVST to become part of the national HIV guidelines. We sought to understand policymakers' perspectives of challenges and facilitators to the introduction of HIVST at the client and structural levels.Method: Key informant interviews (KIIs) were conducted with national and regional level policymakers involved in the HIV response. Twenty policymakers were purposively selected from Greater Accra (capital) and Brong-Ahafo (outlying) regions. Qualitative content analysis was used to arrive at the results after the verbatim transcripts were coded.Results: Client-level challenges included lack of pre-test counseling, the need for confirmatory testing if reactive, potential for poor linkage to care and treatment, and client-level facilitator from policy makers' perspectives included increase testing modality that would increase testing uptake. Structural-level challenges mentioned by policymakers were lack of a national policy and implementation guidelines on HIVST, cost of HIVST kits, supply chain management of HIVST commodities, data monitoring and reporting of positive cases. The structural-level appeal of HIVST to policymakers were the reduced burden on health system and HIVST's contribution to achieving testing targets. Despite the challenges mentioned, policymakers unanimously favored and called for the introduction of HIVST in Ghana.Conclusions: Findings indicate that a non-conventional HIV testing strategy such as HIVST is highly acceptable to policymakers. However, successful introduction of HIVST hinges on having national guidelines in place and stakeholder consultations to address various individual and structural -level implementation issues.

The application of immuno-enzymal analysis as a method of early express diagnostics of rednoya in pond fish

Due to the lack of effective means of specific prevention of rubella in pond fish (CRF), it is obvious that early diagnosis is one of the most important and effective ways to combat this disease. This theoretical study is devoted to the development of an express method for the rapid detection of antibodies to rubella pathogens in pond fish (Aeromonas punctata, Pseudomonas, Rabdovirus cyprini). To date, the diagnosis of CRC (Rabdovirus cyprini) is determined by the results of the clinical picture, taking into account anatomical data, epizootological indicators and virological research results. The diagnosis of CRC (Aeromonas punctata, Pseudomonas) is determined by bacteriological results, taking into account epizootological indicators, clinical signs and pathological changes. The use of enzyme-linked immunosorbent assay (ELISA) for the determination of CRC antibodies is a comprehensive diagnostic kit that allows you to significantly reduce the time for examination (sample preparation, reaction, results recording), and also reduce the number of errors caused by the human factor. The ELISA reaction makes it possible to quickly and efficiently obtain research results. As a result of the study, indicators of the effectiveness of the application of this technique for the diagnosis of CRC were proposed. The advantage of ELISA in comparison with the bacteriological method lies in the simplicity of setting and the reduction in the time of analysis (within 1-2 hours). The proposed method for the determination of rubella in pond fish using enzyme-linked immunosorbent assay allows, within the framework of laboratory monitoring, to carry out an express diagnosis of the CRC disease. The possibility of early diagnosis of this disease, the low cost of diagnostic kits and the ability to automate most stages of the reaction, demonstrate the practical value of the presented method.

Rationale for the Choice of a Positioning System for Mobile Agricultural Robot Movement Controlling

A correctly selected positioning system for controlling the mobile robotic means movement ensures high positioning accuracy of the robotic platform in the garden, allows to automate precise operations in the garden and systematize route planning algorithms.(Research purpose) To substantiate the rational choice of a positioning system for controlling the mobile robotic device movement.(Materials and methods) The author formulated requirements for the positioning system to perform precise operations in the garden: mechanized collection of fruits and berries, diff erentiated application of fertilizers and chemical plant protection products. The main ones were: the positioning error was no more than 5 centimetres, the stability of information transfer to the server for building traffi c maps, the movement of a robotic device along a given trajectory, equipping beacons with a mobile power source with a capacity of at least 800 milliampere-hour, information exchange between the beacon and the built-in robotic means with a microprocessor controller according to the RS-485 standard, the signal coverage area was at least 100 square meter.(Results and discussion) The six most relevant positioning systems of the following manufacturers were described: RealTrac, Rusoft CKT, Neomatic, ISBC, Avtosensor, Marvelmind. The author compared their technical and operational parameters: operating frequencies, range, data transfer interface, location accuracy and cost of ready-made kits. He showed that Marvelmind provided uninterrupted operation at frequencies of 433 and 915 megahertz with a positioning error of no more than 2 centimetres. The tests were carried out on a small robotic vehicle with the following characteristics: maximum transport speed – 30 kilometre per hour, operating weight – 500 kilograms, length 2 metres, width – 1.2 metres, height – 1.6 metres.(Conclusions) The author substantiated the choice of the most suitable and aff ordable Marvelmind positioning system and experimentally confi rmed the positioning accuracy declared by the manufacturer. When driving in a loop-free and looped turn, the positioning accuracy did not exceed 1.5 centimetres, which met the agrotechnical requirements for mechanized collection of fruits and berries, for diff erentiated application of fertilizers and chemical plant protection products

A low-cost pipeline for soil microbiome profiling.

Common bottlenecks in environmental and crop microbiome studies are the consumable and personnel costs necessary for genomic DNA extraction and sequencing library construction. This is harder for challenging environmental samples such as soil, which is rich in Polymerase Chain Reaction (PCR) inhibitors. To address this, we have established a low‐cost genomic DNA extraction method for soil samples. We also present an Illumina‐compatible 16S and ITS rRNA gene amplicon library preparation workflow that uses common laboratory equipment. We evaluated the performance of our genomic DNA extraction method against two leading commercial soil genomic DNA kits (MoBio PowerSoil® and MP Biomedicals™ FastDNA™ SPIN) and a recently published non‐commercial extraction method by Zou et al. (PLoS Biology, 15, e2003916, 2017). Our benchmarking experiment used four different soil types (coniferous, broad‐leafed, and mixed forest plus a standardized cereal crop compost mix) assessing the quality and quantity of the extracted genomic DNA by analyzing sequence variants of 16S V4 and ITS rRNA amplicons. We found that our genomic DNA extraction method compares well to both commercially available genomic DNA extraction kits in DNA quality and quantity. The MoBio PowerSoil® kit, which relies on silica column‐based DNA extraction with extensive washing, delivered the cleanest genomic DNA, for example, best A260:A280 and A260:A230 absorbance ratios. The MP Biomedicals™ FastDNA™ SPIN kit, which uses a large amount of binding material, yielded the most genomic DNA. Our method fits between the two commercial kits, producing both good yields and clean genomic DNA with fragment sizes of approximately 10 kb. Comparative analysis of detected amplicon sequence variants shows that our method correlates well with the two commercial kits. Here, we present a low‐cost genomic DNA extraction method for soil samples that can be coupled to an Illumina‐compatible simple two‐step amplicon library construction workflow for 16S V4 and ITS marker genes. Our method delivers high‐quality genomic DNA at a fraction of the cost of commercial kits and enables cost‐effective, large‐scale amplicon sequencing projects. Notably, our extracted gDNA molecules are long enough to be suitable for downstream techniques such as full gene sequencing or even metagenomics shotgun approaches using long reads (PacBio or Nanopore), 10x Genomics linked reads, and Dovetail genomics.

Cost‐effectiveness of uterine tamponade devices for the treatment of postpartum hemorrhage: A systematic review

BackgroundUterine tamponade is widely promoted for treating refractory postpartum hemorrhage (PPH); however, its cost‐effectiveness may vary depending on unit costs and setting.ObjectiveTo review available data on cost‐effectiveness of uterine tamponade devices when used for PPH treatment.Search strategyPubMed and EMBASE were searched (1980 to January 2020), as well as the National Health Services Economic Evaluation database from inception (1995) to March 2015.Selection criteriaEligible studies were any type of economic evaluation, or effectiveness studies that provided cost or economic data.Data collection and analysisTwo reviewers independently screened studies, extracted data, and assessed quality.Main resultsEleven studies using a range of devices (condom catheter, uterine suction devices, Bakri, Inpress, Ellavi) were identified. Cost of condom catheter devices or kits ranged from US$0.64 to US$6, whereas purpose‐designed device costs were up to US$400. Two studies that took a health system perspective assessed the cost‐effectiveness of using uterine balloon tamponade and suggested that it was highly cost‐effective because of the low cost per disability‐adjusted life‐year averted, although both used effect estimates from case series.ConclusionsEvidence on the cost‐effectiveness of uterine tamponade devices was limited and not generalizable. Rigorous economic evaluations based on updated effect estimates are needed.

Economic evaluation of facility-based HIV self-testing among adult outpatients in Malawi.

IntroductionHIV self‐testing (HIVST) in outpatient departments (OPD) is a promising strategy for HIV testing in Malawi, given high OPD patient volumes and substantial wait times. To evaluate the relative cost and expected impact of facility‐based HIVST (FB‐HIVST) at OPDs in Malawi for increasing HIV status awareness, we conducted an economic evaluation of an HIVST cluster‐randomized controlled trial.MethodsA cluster‐randomized trial was conducted at 15 sites in Malawi from September 2017 to February 2018 with three arms: 1) Standard provider‐initiated‐testing‐and‐counselling (PITC); 2) Optimized PITC (additional provider training and job‐aids) and 3) FB‐HIVST (HIVST demonstration, distribution and kit use in OPD, private kit interpretation and optional HIV counselling). The total production cost per newly identified positive and per person newly initiated on ART were calculated by study arm. These were calculated as the total cost of testing everyone divided by the number of newly identified positives; and the total cost of testing everyone divided by the number of those initiated on ART. Cost‐outcomes were calculated under three cost scenarios: (1) full study costs, (2) routine implementation costs and (3) routine implementation + reduced cost for HIVST kits.ResultsThe average cost per person newly diagnosed in the full study cost scenario was $101, $156 and $189, and cost per person initiated on ART was $121, $156 and $279 for Standard PITC, Optimized PITC and FB‐HIVST respectively. In the routine implementation cost scenario, the average cost per person newly diagnosed was reduced to $83, and $93, and cost per person initiated on ART to $83, and $137 for Optimized PITC and FB‐HIVST respectively. In the negotiated HIVST cost scenario, the average cost per person newly diagnosed was reduced to $55 and cost per person newly initiated on ART reduced to $81 in the FB‐HIVST arm.ConclusionsWhile the cost per new ART initiation through FB‐HIVST was higher than Standard PITC, FB‐HIVST could become cost‐saving compared to PITC if the cost of kits is reduced or if treatment linkage rate were increased in the FB‐HIVST arm. For high volume OPDs, HIVST may increase facility capacity and increase the number of newly diagnosed positives.

O13 Acceptability and Affordability of a Meal Kit Intervention for Low-Income Families

Background Meal kit services are increasingly popular, yet target higher income consumers. Low-income families may benefit from this service because it reduces barriers to cooking healthy foods at home, but acceptability and affordability must be determined. Objective To determine the acceptability and affordability of a culturally acceptable, healthy meal kit service for low-income families. Study Design, Setting, Participants A 6-week pilot study was conducted with low-income, African American (n = 36) participants recruited from Gainesville, Florida. Participants were given weekly meal kits each containing 3 healthy recipes with ingredients to feed 4 people each, cooking tools, and nutrition handouts. Data collection occurred at baseline, weekly during the intervention, and post-intervention via face-to-face surveys. Measurable Outcome/Analysis Participant demographics were collected at baseline. Weekly process surveys were used to determine acceptability and willingness-to-pay (WTP) for each meal. Food shopping preferences, economic perspectives, and overall acceptability data were collected at baseline and post-intervention. Participant demographics and acceptability were analyzed using descriptive statistics. A cost analysis of the meal kits was completed and used to compare cost of meal kits versus participants’ WTP. Results Participants were 42.5 ± 13.8 years of age, primarily female (89%), had 2.3 ± 1.2 children in the household, and had a body mass index of 35.4 ± 9.2. Almost all (91%) of the meals were prepared, and 94% of participants were somewhat or very satisfied with the meal kits post-intervention. On average, the actual food cost of each weekly meal kit (containing 3 recipes) was $25.10, and individual recipes ranged in price from $3.65 to $14.96. Participants stated a WTP of $55.80 ± 42.13 per weekly meal kit. Of those who received SNAP benefits (n = 28), 100% would definitely or possibly use their benefits on meal kits. Conclusion Meal kits may be an acceptable and affordable resource for low-income families. Alternative production and delivery methods should be considered to keep meal kits affordable. Funding None.

"I couldn't buy the items so I didn't go to deliver at the health facility" Home delivery among rural women in northern Ghana: A mixed-method analysis.

BackgroundMaternal mortality remains a major challenge to health systems in low and middle-incoming countries. Some pregnant women develop potentially life-threatening complications during childbirth. Therefore, home delivery is a precursor for maternal mortality. In this study, we aimed at not only estimating the percentage of deliveries occurring at home and examining the factors associated with home delivery, but we also explored the reasons for home delivery among women in rural Ghana.MethodsThe study was conducted among mothers with delivery experience in selected communities in the Builsa South district located in the Upper East Region of Ghana. Both quantitative and qualitative data were collected using semi-structured questionnaires and Focus Group Discussion (FGD) guide respectively. A total of 456 mothers participated in this study. Regression models were used in the quantitative analysis whereas a thematic analysis approach was used to analyze the qualitative data.ResultsOf the 423 mothers in the quantitative research, 38.1% (95% CI: 33.5–42.8) delivered their index child at home. In adjusted analysis, women who were not exposed to information (AOR = 13.64, p<0.001) and women with 2 (AOR = 4.64, p = 0.014), 3 (AOR = 4.96, p = 0.025) or at least 4 living children (AOR = 9.59, p = 0.001) had higher odds of delivering at home. From the qualitative analysis, the poor attitude of nurses (midwives), lack of, and cost of transportation, cost of delivery kits, and traditional beliefs and practices were cited as reasons for home delivery.ConclusionDespite the government’s efforts to provide free maternal care services to women in Ghana, a significant proportion of rural women still deliver at home due to other ‘hidden costs’. Addressing poor staff attitude, transportation challenges, and negative traditional beliefs and practices through awareness creation may contribute to improving health facility delivery by rural pregnant women in Ghana.