GLORIA

GEOMAR Library Ocean Research Information Access

X

Your email was sent successfully. Check your inbox.

An error occurred while sending the email. Please try again.

Proceed reservation?

Export
  • 1
    Online Resource
    Online Resource
    Cost‐effectiveness analysis of integrating screening and treatment of selected non‐communicable diseases into HIV/AIDS treatment in Uganda
    Wiley ; 2020
    In:  Journal of the International AIDS Society Vol. 23, No. S1 ( 2020-06)
    Details
    In: Journal of the International AIDS Society, Wiley, Vol. 23, No. S1 ( 2020-06)
    Abstract: Despite growing enthusiasm for integrating treatment of non‐communicable diseases (NCDs) into human immunodeficiency virus (HIV) care and treatment services in sub‐Saharan Africa, there is little evidence on the potential health and financial consequences of such integration. We aim to study the cost‐effectiveness of basic NCD‐HIV integration in a Ugandan setting. Methods We developed an epidemiologic‐cost model to analyze, from the provider perspective, the cost‐effectiveness of integrating hypertension, diabetes mellitus (DM) and high cholesterol screening and treatment for people living with HIV (PLWH) receiving antiretroviral therapy (ART) in Uganda. We utilized cardiovascular disease (CVD) risk estimations drawing from the previously established Globorisk model and systematic reviews; HIV and NCD risk factor prevalence from the World Health Organization’s STEPwise approach to Surveillance survey and global databases; and cost data from national drug price lists, expert consultation and the literature. Averted CVD cases and corresponding disability‐adjusted life years were estimated over 10 subsequent years along with incremental cost‐effectiveness of the integration. Results Integrating services for hypertension, DM, and high cholesterol among ART patients in Uganda was associated with a mean decrease of the 10‐year risk of a CVD event: from 8.2 to 6.6% in older PLWH women (absolute risk reduction of 1.6%), and from 10.7 to 9.5% in older PLWH men (absolute risk reduction of 1.2%), respectively. Integration would yield estimated net costs between $1,400 and $3,250 per disability‐adjusted life year averted among older ART patients. Conclusions Providing services for hypertension, DM and high cholesterol for Ugandan ART patients would reduce the overall CVD risk among these patients; it would amount to about 2.4% of national HIV/AIDS expenditure, and would present a cost‐effectiveness comparable to other standalone interventions to address NCDs in low‐ and middle‐income country settings.
    Type of Medium: Online Resource
    ISSN: 1758-2652 , 1758-2652
    URL: Issue
    URL: Article
    DOI: 10.1002/jia2.v23.s1
    DOI: 10.1002/jia2.25507
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2467110-1
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 2
    Online Resource
    Online Resource
    Evaluating different low‐density lipoprotein cholesterol thresholds to initiate statin for prevention of cardiovascular diseases in patients with type 2 diabetes mellitus: A target trial emulation study
    Wiley ; 2024
    In:  Diabetes, Obesity and Metabolism Vol. 26, No. 5 ( 2024-05), p. 1877-1887
    Details
    In: Diabetes, Obesity and Metabolism, Wiley, Vol. 26, No. 5 ( 2024-05), p. 1877-1887
    Abstract: The present study aimed to evaluate the effect of statin therapy for primary prevention of cardiovascular diseases (CVDs) when initiating therapy at different baseline low‐density lipoprotein cholesterol (LDL‐C) levels in patients with type 2 diabetes mellitus (T2DM). Materials and Methods Using territory‐wide public electronic medical records in Hong Kong, we emulated a sequence of trials on patients with T2DM with elevated LDL‐C levels in every calendar month from January 2008 to December 2014. Pooled logistic regression was applied to obtain the hazard ratios for the major CVDs (stroke, myocardial infarction, heart failure), all‐cause mortality and major adverse events (myopathies and liver dysfunction) of statin therapy. Results The estimated hazard ratios (95% confidence intervals) of CVD incidence for statin initiation were 0.78 (0.72, 0.84) in patients with baseline LDL‐C of 1.8‐2.5 mmol/L (i.e., 70‐99 mg/dL) and 0.90 (0.88, 0.92) in patients with baseline LDL‐C ≥2.6 mmol/L (i.e., ≥100 mg/dL) in intention‐to‐treat analysis, which was 0.59 (0.51, 0.68) and 0.77 (0.74, 0.81) in per‐protocol analysis, respectively. No significant increased risks were observed for the major adverse events. The absolute 10‐year risk difference of overall CVD in per‐protocol analysis was −7.1% (−10.7%, −3.6%) and −3.9% (−5.1%, −2.7%) in patients with baseline LDL‐C 1.8‐2.5 and ≥2.6 mmol/L, respectively. The effectiveness and safety were consistently observed in patients aged 〉 75 years initiating statin at both LDL‐C thresholds. Conclusions Compared with the threshold of 2.6 mmol/L, initiating statin in patients with a lower baseline LDL‐C level at 1.8‐2.5 mmol/L can further reduce the risks of CVD and all‐cause mortality without significantly increasing the risk of major adverse events in patients with T2DM, including patients aged 〉 75 years.
    Type of Medium: Online Resource
    ISSN: 1462-8902 , 1463-1326
    URL: Issue
    URL: Article
    DOI: 10.1111/dom.v26.5
    DOI: 10.1111/dom.15503
    Language: English
    Publisher: Wiley
    Publication Date: 2024
    detail.hit.zdb_id: 2004918-3
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 3
    Online Resource
    Online Resource
    Priority interventions to improve maternal and child diets in S ub‐ S aharan A frica and S outh A sia
    Wiley ; 2018
    In:  Maternal & Child Nutrition Vol. 14, No. 2 ( 2018-04)
    Details
    In: Maternal & Child Nutrition, Wiley, Vol. 14, No. 2 ( 2018-04)
    Abstract: Nutrition‐sensitive interventions to improve overall diet quality are increasingly needed to improve maternal and child health. This study demonstrates feasibility of a structured process to leverage local expertise in formulating programmes tailored for current circumstances in South Asia and Africa. We assembled 41 stakeholders in 2 regional workshops and followed a prespecified protocol to elicit programme designs listing the human and other resources required, the intervention's mechanism for impact on diets, target foods and nutrients, target populations, and contact information for partners needed to implement the desired programme. Via this protocol, participants described 48 distinct interventions, which we then compared against international recommendations and global goals. Local stakeholders' priorities focused on postharvest food systems to improve access to nutrient‐dense products (75% of the 48 programmes) and on production of animal sourced foods (58%), as well as education and social marketing (23%) and direct transfers to meet food needs (12.5%). Each programme included an average of 3.2 distinct elements aligned with those recommended by United Nations system agencies in the Framework for Action produced by the Second International Conference on Nutrition in 2014 and the Compendium of Actions for Nutrition developed for the Renewed Efforts Against Child Hunger initiative in 2016. Our results demonstrate that a participatory process can help local experts identify their own priorities for future investments, as a first step in a novel process of rigorous, transparent, and independent priority setting to improve diets among those at greatest risk of undernutrition.
    Type of Medium: Online Resource
    ISSN: 1740-8695 , 1740-8709
    URL: Issue
    URL: Article
    DOI: 10.1111/mcn.2018.14.issue-2
    DOI: 10.1111/mcn.12526
    Language: English
    Publisher: Wiley
    Publication Date: 2018
    detail.hit.zdb_id: 2140908-0
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 4
    Online Resource
    Online Resource
    Integrating care for non‐communicable diseases into routine HIV services: key considerations for policy design in sub‐Saharan Africa
    Wiley ; 2020
    In:  Journal of the International AIDS Society Vol. 23, No. S1 ( 2020-06)
    Details
    In: Journal of the International AIDS Society, Wiley, Vol. 23, No. S1 ( 2020-06)
    Abstract: There is great interest for integrating care for non‐communicable diseases (NCDs) into routine HIV services in sub‐Saharan Africa (SSA) due to the steady rise of the number of people who are ageing with HIV. Suggested health system approaches for intervening on these comorbidities have mostly been normative, with little actionable guidance on implementation, and on the practical, economic and ethical considerations of favouring people living with HIV (PLHIV) versus targeting the general population. We summarize opportunities and challenges related to leveraging HIV treatment platforms to address NCDs among PLHIV. We emphasize key considerations that can guide integrated care in SSA and point to possible interventions for implementation. Discussion Integrating care offers an opportunity for effective delivery of NCD services to PLHIV, but may be viewed to unfairly ignore the larger number of NCD cases in the general population. Integration can also help maintain the substantial health and economic benefits that have been achieved by the global HIV/AIDS response. Implementing interventions for integrated care will require assessing the prevalence of common NCDs among PLHIV, which can be achieved via increased screening during routine HIV care. Successful integration will also necessitate earmarking funds for NCD interventions in national budgets. Conclusions An expanded agenda for addressing HIV‐NCD comorbidities in SSA may require adding selected NCDs to conditions that are routinely monitored in PLHIV. Attention should be given to mitigating potential tradeoffs in the quality of HIV services that may result from the extra responsibilities borne by HIV health workers. Integrated care will more likely be effective in the context of concurrent health system reforms that address NCDs in the general population, and with synergies with other HIV investments that have been used to strengthen health systems.
    Type of Medium: Online Resource
    ISSN: 1758-2652 , 1758-2652
    URL: Issue
    URL: Article
    DOI: 10.1002/jia2.v23.s1
    DOI: 10.1002/jia2.25508
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2467110-1
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 5
    Online Resource
    Online Resource
    Association between HIV and blood pressure in adults and role of body weight as a mediator: Cross‐sectional study in Uganda
    Wiley ; 2017
    In:  The Journal of Clinical Hypertension Vol. 19, No. 11 ( 2017-11), p. 1181-1191
    Details
    In: The Journal of Clinical Hypertension, Wiley, Vol. 19, No. 11 ( 2017-11), p. 1181-1191
    Abstract: The authors sought to describe the association between human immunodeficiency virus (HIV) and blood pressure (BP) levels, and determined the extent to which this relationship is mediated by body weight in a cross‐sectional study of HIV ‐infected and HIV ‐uninfected controls matched by age, sex, and neighborhood. Mixed‐effects models were fit to determine the association between HIV and BP and amount of effect of HIV on BP mediated through body mass index . Data were analyzed from 577 HIV ‐infected and 538 matched HIV ‐uninfected participants. HIV infection was associated with 3.3 mm Hg lower systolic BP (1.2‐5.3 mm Hg), 1.5 mm Hg lower diastolic BP (0.2‐2.9 mm Hg), 0.3 m/s lower pulse wave velocity (0.1‐0.4 mm Hg), and 30% lower odds of hypertension (10%‐50%). Body mass index mediated 25% of the association between HIV and systolic BP . HIV infection was inversely associated with systolic BP , diastolic BP, and pulse wave velocity. Comprehensive community‐based programs to routinely screen for cardiovascular risk factors irrespective of HIV status should be operationalized in HIV ‐endemic countries.
    Type of Medium: Online Resource
    ISSN: 1524-6175 , 1751-7176
    URL: Issue
    URL: Article
    DOI: 10.1111/jch.2017.19.issue-11
    DOI: 10.1111/jch.13092
    Language: English
    Publisher: Wiley
    Publication Date: 2017
    detail.hit.zdb_id: 2058690-5
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
Close ⊗
This website uses cookies and the analysis tool Matomo. More information can be found here...