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1.
Health Res Policy Syst ; 18(1): 15, 2020 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-32039731

RESUMO

CONTEXT: Relationships between researchers and decision-makers have demonstrated positive potential to influence research, policy and practice. Over time, interest in better understanding the relationships between the two parties has grown as demonstrated by a plethora of studies globally. However, what remains elusive is the evolution of these vital relationships and what can be learned from them with respect to advancing evidence-informed decision-making. We therefore explored the nuances around the initiation, maintenance and dissolution of academic-government relationships. METHODS: We conducted in-depth interviews with 52 faculty at one school of public health and 24 government decision-makers at city, state, federal and global levels. Interviews were transcribed and coded deductively and inductively using Atlas.Ti. Responses across codes and respondents were extracted into an Excel matrix and compared in order to identify key themes. FINDINGS: Eight key drivers to engagement were identified, namely (1) decision-maker research needs, (2) learning, (3) access to resources, (4) student opportunities, (5) capacity strengthening, (6) strategic positioning, (7) institutional conditionalities, and (8) funder conditionalities. There were several elements that enabled initiation of relationships, including the role of faculty members in the decision-making process, individual attributes and reputation, institutional reputation, social capital, and the role of funders. Maintenance of partnerships was dependent on factors such as synergistic collaboration (i.e. both benefit), mutual trust, contractual issues and funding. Dissolution of relationships resulted from champions changing/leaving positions, engagement in transactional relationships, or limited mutual trust and respect. CONCLUSIONS: As universities and government agencies establish relationships and utilise opportunities to share ideas, envision change together, and leverage their collaborations to use evidence to inform decision-making, a new modus operandi becomes possible. Embracing the individual, institutional, networked and systems dynamics of relationships can lead to new practices, alternate approaches and transformative change. Government agencies, schools of public health and higher education institutions more broadly, should pay deliberate attention to identifying and managing the various drivers, enablers and disablers for relationship initiation and resilience in order to promote more evidence-informed decision-making.

2.
Artigo em Inglês | MEDLINE | ID: mdl-31698724

RESUMO

Mass media campaigns have been hailed as some of the most effective tobacco prevention interventions. This study examined the cost-effectiveness of the national tobacco prevention campaign, truth® FinishIt, to determine the cost per quality-adjusted life year (QALY) saved and the return on investment (ROI). The cost-utility analysis used four main parameters: program costs, number of smoking careers averted, treatment costs, and number of QALYs saved whenever a smoking career is averted. Parameters were varied to characterize cost-effectiveness under different assumptions (base case, conservative, optimistic, and most optimistic). The ROI estimate compared campaign expenditures to the cost saved due to the campaign implementation. Analyses were conducted in 2019. The base case analysis indicated the campaign results in a societal cost savings of $3.072 billion. Under the most conservative assumptions, estimates indicated the campaign was highly cost-effective at $1076 per QALY saved. The overall ROI estimate was $174 ($144 in costs to smokers, $24 in costs to the smoker's family, and $7 in costs to society) in cost savings for every $1 spent on the campaign. In all analyses, the FinishIt campaign was found to reach or exceed the threshold levels of cost savings or cost-effectiveness, with a positive ROI. These findings point to the value of this important investment in the health of the younger generation.

3.
J Acquir Immune Defic Syndr ; 82 Suppl 2: S148-S154, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31658203

RESUMO

BACKGROUND: Syringe exchange programs (SEP) reduce HIV incidence associated with injection drug use (IDU), but legislation often prohibits implementation. We examined the policy change impact allowing for SEP implementation on HIV diagnoses among people who inject drugs in 2 US cities. SETTING: Philadelphia, PA, and Baltimore, MD. METHODS: Using surveillance data from Philadelphia (1984-2015) and Baltimore (1985-2013) for IDU-associated HIV diagnoses, we used autoregressive integrated moving averages modeling to conduct 2 tests to measure policy change impact. We forecast the number of expected HIV diagnoses per city had policy not changed in the 10 years after implementation and compared it with the number of observed diagnoses postpolicy change, obtaining an estimate for averted HIV diagnoses. We then used interrupted time series analysis to assess the immediate step and trajectory impact of policy change implementation on IDU-attributable HIV diagnoses. RESULTS: The Philadelphia (1993-2002) model predicted 15,248 new IDU-associated HIV diagnoses versus 4656 observed diagnoses, yielding 10,592 averted HIV diagnoses over 10 years. The Baltimore model (1995-2004) predicted 7263 IDU-associated HIV diagnoses versus 5372 observed diagnoses, yielding 1891 averted HIV diagnoses over 10 years. Considering program expenses and conservative estimates of public sector savings, the 1-year return on investment in SEPs remains high: $243.4 M (Philadelphia) and $62.4 M (Baltimore). CONCLUSIONS: Policy change is an effective structural intervention with substantial public health and societal benefits, including reduced HIV diagnoses among people who inject drugs and significant cost savings to publicly funded HIV care.

4.
AIDS Behav ; 23(9): 2486-2489, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31254191

RESUMO

To address gaps in the cost literature by estimating the cost of delivering an evidence-based HIV risk reduction intervention for HIV-serodiscordant, heterosexual, African American couples (Eban II) and calculating the cost-effective thresholds at three participating sites. The cost, cost-saving, and cost-effectiveness thresholds for Eban II were calculated using standard methods. The analytic time period was from July 1 to September 31, 2014. Total costs for 3 months of program implementation were from $13,747 to $25,937, with societal costs ranging from $5632 to $17,008 and program costs ranging from $8115 to $14,122. The costs per participant were from $1621 to $2160; the cost per session (per participant) ranged from $147 to $196. Sites had achievable cost-saving thresholds, which were all less than one for the 3-month costing timeframe.


Assuntos
Afro-Americanos , Medicina Baseada em Evidências/economia , Infecções por HIV/prevenção & controle , Soronegatividade para HIV , Avaliação de Programas e Projetos de Saúde , Comportamento de Redução do Risco , Parceiros Sexuais , Adulto , Preservativos/estatística & dados numéricos , Análise Custo-Benefício , Custos e Análise de Custo , Feminino , Infecções por HIV/economia , Infecções por HIV/etnologia , Heterossexualidade , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde/economia , Sexo Seguro/etnologia , Sexo Seguro/estatística & dados numéricos
6.
AIDS Behav ; 23(11): 2899-2903, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30953303
7.
AIDS Behav ; 23(3): 557-563, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30796638

RESUMO

Progress in reducing HIV infections has been suboptimal despite availability of effective prevention and treatment interventions and national strategies to bring them to scale. As part of a community-driven process, we expanded previous epidemiologic models using updated surveillance data from the Centers for Disease Control and Prevention to estimate quantitative parameters for ambitious but attainable national HIV prevention goals. We estimated new HIV infections could be reduced by up to 67% and prevalence could begin to decline by 2030 if 95% targets for diagnosis, care retention, and viral suppression are met by 2025 and an additional 20% of transmissions are averted through targeted interventions such as pre-exposure prophylaxis. Notably, this would require the percentage of diagnosed persons retained in HIV care to increase by more than 35 percentage points, which would necessitate innovative models and a substantial expansion of supportive services. Although the HIV incidence reduction goal of 90% as unveiled in the 2019 State of the Union Address is likely unachievable with the current intervention toolkit, it is possible to begin to substantially reduce HIV prevalence in the next decade with sufficient investments and innovation.


Assuntos
Continuidade da Assistência ao Paciente , Epidemias , Infecções por HIV/epidemiologia , Profilaxia Pré-Exposição , Adulto , Metas , Humanos , Incidência , Prevalência , Estados Unidos/epidemiologia
9.
J Telemed Telecare ; 25(5): 301-309, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29448879

RESUMO

PURPOSE: Using a mixed-methods formative evaluation, the purpose of this study was to provide a broad overview of the Alabama eHealth programme set-up and initial patient outcomes. The Alabama eHealth programme uses telemedicine to provide medical care to people living with HIV in rural Alabama. It was led by a community-based organisation, Medical Advocacy and Outreach (MAO), and supported by AIDS United and the Corporation for National Community Service's Social Innovation Fund with matching support from non-federal donors. METHODS: We conducted and transcribed in-depth interviews with Alabama eHealth staff and then performed directed content analysis. We also tracked patients' ( n = 240) appointment attendance, CD4 counts, and viral loads. FINDINGS: Staff described the steps taken to establish the programme, associated challenges (e.g., costly, inadequate broadband in rural areas), and technology enabling this programme (electronic medical records, telemedicine equipment). Of all enrolled patients, 76% were retained in care, 88% had antiretroviral therapy and 75% had a suppressed viral load. Among patients without missing data, 96% were retained in care, 97% used antiretroviral therapy and 93% had suppressed viral loads. There were no statistically significant demographic differences between those with and without missing data. CONCLUSIONS: Patients enrolled in a telemedicine programme evaluation successfully moved through the HIV continuum of care.


Assuntos
Infecções por HIV/terapia , Acesso aos Serviços de Saúde/organização & administração , Serviços de Saúde Rural/organização & administração , Telemedicina/organização & administração , Adolescente , Adulto , Alabama , Antirretrovirais/uso terapêutico , Registros Eletrônicos de Saúde , Feminino , Infecções por HIV/tratamento farmacológico , Acesso aos Serviços de Saúde/economia , Humanos , Masculino , Pessoa de Meia-Idade , Serviços de Saúde Rural/economia , Fatores Socioeconômicos , Carga Viral , Adulto Jovem
10.
J Homosex ; 66(5): 571-589, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29297774

RESUMO

LGBT (lesbian, gay, bisexual, and transgender) populations experience disparities in health outcomes, both physical and mental, compared to their heterosexual and cisgender peers. This commentary confronts the view held by some researchers that the disparate rates of mental health problems reported among LGBT populations are the consequences of pursuing a particular life trajectory, rather than resulting from the corrosive and persistent impact of stigma. Suggesting that mental health disparities among LGBT populations arise internally, de novo, when individuals express non-heterosexual and non-conforming gender identities ignores the vast body of evidence documenting the destructive impact of socially mediated stigma and systemic discrimination on health outcomes for a number of minorities, including sexual and gender minorities. Furthermore, such thinking is antithetical to widely accepted standards of health and wellbeing because it implies that LGBT persons should adopt and live out identities that contradict or deny their innermost feelings of self.


Assuntos
Disparidades nos Níveis de Saúde , Minorias Sexuais e de Gênero/psicologia , Estigma Social , Feminino , Identidade de Gênero , Homossexualidade/psicologia , Humanos , Masculino , Saúde Mental , Distância Social
11.
Artigo em Inglês | MEDLINE | ID: mdl-30082612

RESUMO

In 2014, Truth Initiative launched the national FinishIt campaign to prevent smoking initiation among youth and young adults. The significant changes in the communications landscape requires further analysis to determine resource requirements for public education campaigns relative to their impact. This analysis estimates the cost of the FinishIt campaign based on data from expenditure records and uses published estimates of the lifetime treatment costs and quality-adjusted life years associated with smoking. The total cost of the FinishIt campaign for 2014⁻2016 was $162 million. Under assumptions associated with the pessimistic base-case (no medical care costs saved through prevention), 917 smoking careers would need to be averted for the campaign to be cost-effective. Assuming smoking leads to increased medical care costs, 7186 smoking careers would need to be averted for the campaign to be cost-saving. Given these thresholds (917 and 7186) and the estimate of the impact of the previous truth campaign, the investments in the Truth Initiative's FinishIt campaign are likely warranted for preventing smoking careers among youth and young adults.


Assuntos
Análise Custo-Benefício , Custos de Cuidados de Saúde/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Promoção da Saúde/economia , Anos de Vida Ajustados por Qualidade de Vida , Prevenção do Hábito de Fumar/economia , Adolescente , Humanos , Prevenção do Hábito de Fumar/métodos , Estados Unidos , Adulto Jovem
12.
AIDS Educ Prev ; 30(3): 199-207, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29969310

RESUMO

The fields of economic and policy analysis have long played a role in quantifying the burden of the HIV epidemic and informing how to best deploy interventions and policies aimed at maximizing HIV care and reducing transmission. Looking towards the ultimate goal of ending the AIDS epidemic, we describe five areas for further development and application towards HIV policies: (1) setting measurable objectives to create a vision and monitor progress, (2) taking a health and wellness approach to goal-setting, (3) using impact matrices to inform quantitative analysis to explicitly address health disparities, (4) conducting budget impact analyses to project annual program costs and benefits, and (5) advancing the public health systems and services research agenda.


Assuntos
Orçamentos , Epidemias/prevenção & controle , Infecções por HIV/economia , Infecções por HIV/prevenção & controle , Alocação de Recursos para a Atenção à Saúde , Política de Saúde , Formulação de Políticas , Análise Custo-Benefício , Disparidades nos Níveis de Saúde , Humanos , Modelos Teóricos , Pesquisa em Sistemas de Saúde Pública , Estados Unidos
13.
Health Res Policy Syst ; 16(1): 65, 2018 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-30045730

RESUMO

BACKGROUND: Schools of public health (SPHs) are increasingly being recognised as important contributors of human, social and intellectual capital relevant to health policy and decision-making. Few studies within the implementation science literature have systematically examined knowledge exchange experiences within this specific organisational context. The purpose of this study was therefore to elicit whether documented facilitators and barriers to engaging with government decision-makers resonates within an academic SPH context. We sought to understand the variations in such experiences at four different levels of government decision-making. Furthermore, we sought to elicit intervention priorities as identified by faculty. METHODS: Between May and December 2016, 211 (34%) of 627 eligible full-time faculty across one SPH in the United States of America participated in a survey on engagement with decision-makers at the city, state, federal and global government levels. Surveys were administered face-to-face or via Skype. Descriptive data as well as tests of association and logistic regression analyses were conducted using STATA. RESULTS: Over three-quarters of respondents identified colleagues with ties to decision-makers, institutional affiliation and conducting policy-relevant research as the highest facilitators. Several identified time constraints, academic incentives and financial support as important contributors to engagement. Faculty characteristics, such as research areas of expertise, career track and faculty rank, were found to be statistically significantly associated with facilitators. The top three intervention priorities that emerged were (1) creating incentives for engagement, (2) providing funding for engagement and (3) inculcating an institutional culture around engagement. CONCLUSIONS: The data suggest that five principal categories of factors - individual characteristics, institutional environment, relational dynamics, research focus and funder policies - affect the willingness and ability of academic faculty to engage with government decision-makers. This study suggests that SPHs could enhance the relevance of their role in health policy decision-making by (1) periodically measuring engagement with decision-makers; (2) enhancing individual capacity in knowledge translation and communication, taking faculty characteristics into account; (3) institutionalising a culture that supports policies and practices for engagement in decision-making processes; and (4) creating a strategy to expand and nurture trusted, relevant networks and relationships with decision-makers.


Assuntos
Pessoal Administrativo , Atitude , Docentes de Medicina , Política de Saúde , Pesquisa sobre Serviços de Saúde , Comunicação Interdisciplinar , Faculdades de Saúde Pública , Tomada de Decisões , Medicina Baseada em Evidências , Organização do Financiamento , Governo , Prioridades em Saúde , Humanos , Relações Interpessoais , Aprendizagem , Motivação , Cultura Organizacional , Formulação de Políticas , Saúde Pública , Inquéritos e Questionários , Pesquisa Médica Translacional , Estados Unidos
15.
AIDS Behav ; 22(7): 2322-2333, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29427233

RESUMO

The present study evaluated the potential use of Twitter data for providing risk indices of STIs. We developed online risk indices (ORIs) based on tweets to predict new HIV, gonorrhea, and chlamydia diagnoses, across U.S. counties and across 5 years. We analyzed over one hundred million tweets from 2009 to 2013 using open-vocabulary techniques and estimated the ORIs for a particular year by entering tweets from the same year into multiple semantic models (one for each year). The ORIs were moderately to strongly associated with the actual rates (.35 < rs < .68 for 93% of models), both nationwide and when applied to single states (California, Florida, and New York). Later models were slightly better than older ones at predicting gonorrhea and chlamydia, but not at predicting HIV. The proposed technique using free social media data provides signals of community health at a high temporal and spatial resolution.


Assuntos
Big Data , Infecções por Chlamydia/epidemiologia , Gonorreia/epidemiologia , Infecções por HIV/epidemiologia , Mídias Sociais , California/epidemiologia , Infecções por Chlamydia/diagnóstico , Estudos Transversais , Florida/epidemiologia , Gonorreia/diagnóstico , HIV , Infecções por HIV/diagnóstico , Humanos , New York/epidemiologia , Saúde Pública , Medição de Risco , Doenças Sexualmente Transmissíveis/epidemiologia , Estados Unidos/epidemiologia
16.
AIDS Behav ; 22(11): 3734-3741, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29302844

RESUMO

Linkage to HIV medical care and on-going engagement in HIV medical care are vital for ending the HIV epidemic. However, little is known about the cost-utility of HIV linkage, re-engagement and retention (LRC) in care programs. This paper presents the cost-utility analysis of Access to Care, a national HIV LRC program. Using standard methods from the US Panel on Cost-Effectiveness in Health and Medicine, we calculated the cost-utility ratio. Seven Access to Care programs were cost-effective and two were cost-saving. This study adds to a small but growing body of evidence to support the cost-effectiveness of LRC programs.


Assuntos
Fármacos Anti-HIV/economia , Serviços de Saúde Comunitária/economia , Continuidade da Assistência ao Paciente/economia , Análise Custo-Benefício/economia , Infecções por HIV/tratamento farmacológico , Custos de Cuidados de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/economia , Fármacos Anti-HIV/uso terapêutico , Análise Custo-Benefício/métodos , Epidemias , Infecções por HIV/economia , Infecções por HIV/epidemiologia , Humanos , Estados Unidos
17.
AIDS Educ Prev ; 29(5): 443-456, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29068718

RESUMO

The 2020 National HIV AIDS Strategy (NHAS) sets a target of 90% of diagnosed people living with HIV (PLWH) retained in HIV care. Access to Care (A2C) was a national HIV linkage, re-engagement, and retention in care program funded by AIDS United with support from the Corporation for National and Community Service that aimed to link and retain the most vulnerable PLWH into high-quality HIV care. This study explores the barriers and facilitators of implementing the A2C program from the perspective of program staff. Ninety-eight qualitative interviews were conducted with staff at implementing organizations over the 5 years of the project. Barriers included challenges with recruiting and retaining participants, staffing and administration, harmonizing partnerships, and addressing the basic and psychosocial needs of participants. Facilitators included strong relationships with partner organizations, flexible program models, and the passion and dedication of staff. Findings will inform the development of future programs and policy.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Continuidade da Assistência ao Paciente , Comportamento Cooperativo , Assistência à Saúde/organização & administração , Infecções por HIV/tratamento farmacológico , Acesso aos Serviços de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Adulto , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/psicologia , Humanos , Entrevistas como Assunto , Adesão à Medicação , Pesquisa Qualitativa , Estados Unidos
19.
Am J Prev Med ; 53(3): 275-281, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28522237

RESUMO

INTRODUCTION: The recently updated U.S. National HIV/AIDS Strategy sets key HIV prevention and care targets for 2020, but the trajectory of the epidemic remains unclear. Authors modeled HIV incidence, prevalence, and mortality for the U.S. over 10 years to determine whether an ambitious trajectory toward "ending AIDS" by 2025 would be achievable. METHODS: Authors utilized recently published 2010-2013 Centers for Disease Control and Prevention surveillance data to model HIV incidence, prevalence, and mortality. Authors applied a 90/90/90 framework (90% awareness of serostatus, 90% of diagnosed individuals in care, and 90% of individuals on antiretroviral therapy virally suppressed) by 2020 and 95/95/95 by 2025 to assess the feasibility of meeting epidemiologic targets. Analyses were conducted in 2016. RESULTS: With a goal of reducing infections to 21,000 new HIV infections in 2020, authors project a transmission rate of 1.74, 12,571 deaths, and a total of 1,205,515 people living with HIV. By 2025, with a target of 12,000 new HIV infections (a 69% decrease in HIV incidence), authors project a transmission rate of 0.98, 12,522 deaths, and a total of 1,220,615 people living with HIV. With a 90/90/90 framework by 2020 and a 95/95/95 framework by 2025, these epidemiologic targets would be feasible. CONCLUSIONS: Key programmatic milestones provide an ambitious, but important, pathway to reduce U.S. HIV incidence below 12,000 new infections by 2025. HIV incidence would decrease below mortality in 2025, marking a transition toward ending the HIV/AIDS epidemic. Such goals will require a sustained and intensified national commitment over the next decade.


Assuntos
Síndrome de Imunodeficiência Adquirida/epidemiologia , Síndrome de Imunodeficiência Adquirida/prevenção & controle , Transmissão de Doença Infecciosa/prevenção & controle , Soropositividade para HIV/epidemiologia , Sorodiagnóstico da AIDS , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Fármacos Anti-HIV/uso terapêutico , Transmissão de Doença Infecciosa/estatística & dados numéricos , Metas , Humanos , Incidência , Mortalidade/tendências , Prevalência , Estados Unidos/epidemiologia
20.
J Oncol Pract ; 13(5): e408-e420, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28418761

RESUMO

PURPOSE: Establish costs of an inpatient palliative care unit (PCU) and conduct a threshold analysis to estimate the maximum possible costs for the PCU to be considered cost effective. METHODS: We used a hospital perspective to determine costs on the basis of claims from administrative data from Johns Hopkins PCU between March 2013 and March 2014. Using existing literature, we estimated the number of quality-adjusted life years (QALYs) that the PCU could generate. We conducted a threshold analysis to assess the maximum costs for the PCU to be considered cost effective, incorporating willingness to pay ($180,000 per QALY). Three types of costs were considered, which included variable costs alone, contribution margin (ie, revenue minus variable costs), and PCU cost savings compared with usual care (from a separate publication). RESULTS: The data showed that there were 153 patient encounters (PEs), variable costs of $1,050,031 ($1,343 per PE per day), a contribution margin of $318,413 ($407 per PE per day), and savings compared with usual care of $353,645 ($452 savings per PE per day). On the basis of the literature, the program could generate 3.11 QALYs from PEs (0.05 QALY) and caregivers (3.06 QALYs). The threshold analysis determined that the maximum variable cost required to be cost effective was $559,800 (an additional $716 per PE per day could be spent). CONCLUSION: According to variable costs, the PCU was not cost effective; however, when considering savings of the PCU compared with usual care, the PCU was cost saving. The contribution margin showed that the PCU was cost saving. This study supports efforts to expand PCUs, which enhance care for patients and their caregivers and can generate hospital savings. Future research should prospectively explore the cost utility of PCUs.


Assuntos
Hospitalização/economia , Cuidados Paliativos/economia , Avaliação de Programas e Projetos de Saúde , Redução de Custos , Análise Custo-Benefício , Custos de Cuidados de Saúde , Humanos , Tempo de Internação , Avaliação de Programas e Projetos de Saúde/métodos , Avaliação de Programas e Projetos de Saúde/estatística & dados numéricos , Anos de Vida Ajustados por Qualidade de Vida
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