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Center For Disease Dynamics, Economics & Policy

Economic burden of Alzheimer’s; HIV treatment access

Women staring blankly at table with pill bottles in front of her while a man approaches her from behind.

The economic burden of Alzheimer’s disease and related dementias will grow inequitably.

One Health Trust researchers projected the global, regional, and national economic burden of Alzheimer’s disease and related dementias (ADRDs) from 2019 to 2050. In 2019, the global value of statistical life (VSL)-based economic burden of ADRDs was an estimated $2.8 trillion. Researchers projected that this economic burden would increase to $4.7 trillion in 2030 and up to $16.9 trillion in 2050. Low- and middle-income countries would account for 65% of the global VSL-based economic burden in 2050, as compared with only 18% in 2019. [eClinical Medicine]

Children with prior exposure to P. falciparum malaria respond differently to the infection than children without infection histories.

Researchers described the dynamics of immunoglobulin (Ig) responses to a panel of 32 P. falciparum antigens among pediatric patients followed for 42 days and classified individuals as showing characteristics of an apparent first P. falciparum infection (naïve) or a repeat exposure (non-naïve). Weeks after the infections resolved, there were stark differences in Ig levels and temporal trends between the two groups. For example, Naïve patients had significantly longer periods of time to reach peak Ig titer (from 4–7 days longer) and lower maximum Ig titers compared with non-naïve patients. [Frontiers in Medicine]

HIV care programs should target older adolescents with advanced diseases and strengthen primary public facilities to promote treatment adherence.

A retrospective cohort analysis of 25,484 adolescents living in Tanzania who received Antiretroviral Therapy (ART) from 2014 to 2016, revealed that 42% of adolescents were lost to follow-up (LTFU). Patients receiving care at health dispensaries or health centers, those aged 15–19 years, those who had an HIV/TB co-infection, were malnourished or had advanced HIV diseases were significantly more likely to be LTFU. [PLOS]

Pakistan facing COVID-19, typhoid, dengue, and measles simultaneously.

In Pakistan, the impact of COVID-19 on infectious disease mitigation and treatment could exceed the direct impact of the illness due to diversion of funding and an overburdened healthcare system. While it is the first country in the world to introduce the typhoid conjugate vaccine into its routine immunization schedule (2019), the available dengue vaccine is not yet included in the national vaccination program. Because of poor vector control measures dengue has recently become a leading cause of morbidity and mortality. Although the first and second doses of measles-containing vaccine were included in the immunization schedule, Pakistan is still far below the coverage of >95% required for herd immunity. Immunization programs in Pakistan face barriers to coverage, including poor investment in public health, vaccine hesitancy, poverty, high population density, misinformation, lack of access to health care services, and lack of education. [Journal of Global Health]

A framework is needed to evaluate computerized decision-support systems (CDSSs) for antimicrobial prescribing in diverse settings.

While some studies have shown that CDSSs can be used successfully to increase adherence to antimicrobial use guidelines in hospitals, a recent trial in Geneva, Switzerland found that in settings with extensive experience with electronic tools and a well-established antimicrobial stewardship program, the addition of a CDSS for antibiotic prescribing does not reduce overall antibiotic use. Frameworks for evaluating CDSS and antimicrobial stewardship programs are needed. CDSSs also need to be evaluated in settings outside of hospitals like pediatrics, primary care centers, and nursing homes. [The Lancet]

Education and awareness programs are needed on the effects of self-medication in Ghana.

Researchers conducted a critical synthesis of literature on the prevalence, patterns, and the determinants of self-medication among different segments of the Ghanaian population. Across 12 articles that met the study’s inclusion criteria, there was a high incidence of self-medication among diverse segments of the Ghanaian population (including pregnant women, persons diagnosed with HIV/AIDS, older people, and students). Factors that influenced self-medication included self-rated health, healthcare costs, and health system barriers. [Cogent Public Health]

HIV healthcare access diminished in Asian countries during the COVID-19 pandemic.

A descriptive, cross-sectional, online study that covered 10 Asian countries was conducted between October and November 2020 to analyze the impact of the COVID-19 pandemic on HIV healthcare access. Participants were categorized into people living with HIV (PLHIV, 702 participants), key populations (KPs, 551 participants), and healthcare providers (HCPs, 145 participants). PLHIVs and KPs had a decrease or no hospital/clinic visits: 35.9% and 57.5% respectively. Factors like travel restrictions, finances, and a lack of prescription refills limited antiretroviral therapy efforts. Telemedicine was practiced by 85.0% of HCPs, but about 60% of both the PLHIV and KP populations did not use them. [PLOS ONE]

A point-of-care strategy for cervical pre-cancer in low- and middle-income countries (LMICs) can be effective.

For cervical cancer screening, the World Health Organization (WHO) advises human papillomavirus (HPV) testing and same-day treatment in LMICs. Researchers conducted a single-arm HPV intervention trial organized at two clinical sites in Papua New Guinea. Of 4,285 participating women, 84.9% were HPV negative and 15.1% were positive. The adverse effects on women treated with same-day thermal ablation were brief and similar to previous research. The trial met the target coverage of 90% treatment completion in women with cervical pre-cancer and highlights the effectiveness of the strategy. [The Lancet Global Health]

Climate change and pollution disproportionately affects children’s health.

Children, including fetuses and infants — especially those of low socioeconomic status — are heavily susceptible to the effects of pollution, often caused by fossil fuel combustion, and climate change. Since children are constantly developing and growing, they are greatly impacted by toxicity and have not developed protection mechanisms. They breathe more air than adults, relative to body weight, which heightens air pollution exposure. Health professionals need to take action through identification of high-risk populations and awareness of the risks and potential mitigation strategies for pollution and climate change consequences on pediatric health. [The New England Journal of Medicine]