Cost of TB services: approach and summary findings of a multi-country study (Value TB).

BACKGROUND: There are currently large gaps in unit cost data for TB, and substantial variation in the quality and methods of unit cost estimates. Uncertainties remain about sample size, range and comprehensiveness of cost data collection for different purposes. We present the methods and results of a project implemented in Kenya, Ethiopia, India, The Philippines and Georgia to estimate unit costs of TB services, focusing on findings most relevant to these remaining methodological challenges.METHODS: We estimated financial and economic unit costs, in close collaboration with national TB programmes. Gold standard methods included both top-down and bottom-up approaches to resource use measurement. Costs are presented in 2018 USD and local currency unit.RESULTS: Cost drivers of outputs varied by service and across countries, as did levels of capacity inefficiency. There was substantial variation in unit cost estimates for some interventions and high overhead costs were observed. Estimates were subject to sampling uncertainty, and some data gaps remain.CONCLUSION: This paper describes detailed methods for the largest TB costing effort to date, to inform prioritisation and planning for TB services. This study provides a strong baseline and some cost estimates may be extrapolated from this data; however, regular further studies of similar quality are needed to add estimates for remaining gaps, or to add new or changing services and interventions. Further research is needed on the best approach to extrapolation of cost data. Costing studies are best implemented as partnerships with policy makers to generate a community of mutual learning and capacity development.

Cost of TB services in the public and private sectors in Georgia (No 2).

BACKGROUND: Patient-centred care along with optimal financing of inpatient and outpatient services are the main priorities of the Georgia National TB Programme (NTP). This paper presents TB diagnostics and treatment unit cost, their comparison with NTP tariffs and how the study findings informed TB financing policy.METHODS: Top-down (TD) and bottom-up (BU) mean unit costs for TB interventions by episode of care were calculated. TD costs were compared with NTP tariffs, and variations in these and the unit costs cost composition between public and private facilities was assessed.RESULTS: Outpatient interventions costs exceeded NTP tariffs. Unit costs in private facilities were higher compared with public providers. There was very little difference between per-day costs for drug-susceptible treatment and NTP tariffs in case of inpatient services. Treatment day financing exceeded actual costs in the capital (public facility) for drug-resistant TB, and this was lower in the regions.CONCLUSION: Use of reliable unit costs for TB services at policy discussions led to a shift from per-day payment to a diagnosis-related group model in TB inpatient financing in 2020. A next step will be informing policy decisions on outpatient TB care financing to reduce the existing gap between funding and costs.

Hidden populations: discovering the differences between the known and the unknown drug using populations in the Republic of Georgia.

BACKGROUND: The HIV epidemic in Georgia is increasing. Data shows that compared to previous years, Georgia has increasingly more HIV-infected individuals than previous assessments. Select client groups remain hard to reach by harm reduction programs. The need for innovative strategies to involve these individuals is imperative. METHODS: The following study examines demographics and risk factors of participants, previously known and not known to harm reduction services, for HIV and other infectious disease in towns across Georgia in 2015 and compares risk among different groups, while also assessing the rationale for implementing Peer-Driven Interventions in Georgian Harm Reduction activities. Important differences in demographics and risk profile are thought to exist between those exposed, and those unexposed, to harm reduction activity. RESULTS: Important and striking differences between previously known and unknown participants, including demographic background and risk profile and behaviours exist in the drug using community. These differences can potentially explain some of the rise of HIV prevalence in Georgia. CONCLUSION: Significant differences exist between known and unknown drug users in Georgia, the differences between which are crucial for planning future and holistic harm reduction activities in Georgia, regionally and globally. The research advocates for smarter harm reduction activity, adds to the global evidence for the utility of Peer-Driven Intervention, and encourages sustained global effort for reduction of blood-borne disease burden globally.

HIV testing uptake among female sex workers and men who have sex with men in Tbilisi, Georgia.

OBJECTIVES: The aim of the study was to investigate HIV testing practice among female sex workers (FSWs) and men who have sex with men (MSM) in Tbilisi, Georgia and to identify determinants of never testing behaviour among MSM. METHODS: Data obtained in two rounds of bio-behavioural surveys among FSWs (2006 and 2009) and MSM (2007 and 2010) were analysed. Determinants of never testing behaviour among MSM were investigated among 278 respondents recruited in 2010 through respondent-driven sampling. RESULTS: Knowledge about the availability of HIV testing and never testing behaviour did not show changes among FSWs and MSM. Every third FSW and every second MSM had never been tested for HIV according to the latest surveys in 2010. In bivariate analysis among MSM, consistent condom use during anal intercourse with a male partner in the last year, awareness of HIV testing locations and preventive programme coverage were negatively associated with never testing behaviour, while those who considered themselves at no risk of HIV transmission were more likely to have never been tested. In multivariate analysis, lower odds of never testing for HIV remained for those who were aware of HIV testing locations [adjusted odds ratio (AOR) 0.12; 95% confidence interval (CI) 0.04-0.32] and who reported being covered by HIV prevention programmes (AOR 0.26; 95% CI 0.12-0.56). CONCLUSIONS: In view of the concentrated HIV epidemic among MSM in Georgia and the low rate of HIV testing uptake, interventions in this key population should take into consideration the factors associated with testing behaviour. The barriers to HIV testing and counselling uptake should be further investigated.

Examination of dental casts in newborns with bilateral complete cleft lip and palate.

This study reports measurements of dental casts in patients up to 6 months of age with bilateral complete cleft lip and palate (BCLP). 25 mouth casts of newborns with BCLP were selected from the hospital archive. They were measured independently by two examiners who assigned numbers to each measurement, referring to the expected reproducibility. The investigators also classified each dental cast according to an established score. The absolute values of all measured distances (P-P', L-C1-C2-T, L'-C1'-C2'-T', P-L, P'-L', L-L', C1-C1', C2-C2', Q1-Q1', Q2-Q2', T-T', I-Q1Q1', I-Q2Q2', I-TT') are reported. Inter-observer reproducibility was acceptable with total measurement errors ranging from 0.5 to 1.4mm. Most reliability scores, ranging from 1 (very high) to 5 (very low), showed a mean between 2 and 3 (min 2.17; max 3.16). The two examiners rated only one patient differently, according to the applied classification scheme. The absolute measurement values of the two classification systems accorded with the literature. This is the first study to measure the distances according to an established protocol in BCLP patients. The measurements between certain landmarks are more precise than others; it may be possible to use the more precise points for a longitudinal study from birth to 18 years.

[Rehabilitation of patients with newly generated malignant tumor of jaw-facial region with inner osseous implants].

Malignant tumors of the mouth cavity are characterized by aggressive progression as well as early metastasizing. As a rule, these patients need to undergo wide combined operations with resection of fragments of the jaw, causing some functional as well as psychosomatic disturbances. The purpose of the present investigation was the perfection of the methods for the rehabilitation of the given contingent of patients. The investigated patients (53 persons) underwent the treatment based on a single conception, i.e. on the 1st stage--chemical therapy, after elapsing of 4-6 weeks--radical surgical interference with a single moment plastic surgery, in the period of 6-8 months occurred total grafting of transplant tissue, giving an opportunity for implantation that was followed by prosthetic appliance. During the estimation of the results, various clinical and instrumental methods of investigation were taken into consideration. Summing up, we would like to note that application of inner bone implants with the subsequent prosthesis, seems to be an optimal method for maximal rehabilitation of patients with tumors of the jaw-facial region.

Radiation methods and means for testing radiodiagnostic equipment.

Discussed are the requirements for the methods and means of checking the electrical and radiation characteristics of radiodiagnostic equipment at three test levels, i.e. on release from the manufacturer, during the periodic test of the parameters and adjustment and repair in the clinic. Discussed are the description and construction of the simple and contact measuring devices for checking parameters at each level. The capabilities of the devices are compared to those of the series-produced analogs of various firms.