Browsing by Author "Hangoma P"

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    Costs and cost-effectiveness of a comprehensive tuberculosis case finding strategy in Zambia.
    (2021) Jo Y; Kagujje M; Johnson K; Dowdy D; Hangoma P; Chiliukutu L; Muyoyeta M; Sohn H; Centre For Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.; School of Public Health, University of Zambia, Lusaka, Zambia.; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.; University of North Carolina School of Global Public Health, Chapel Hill, North Carolina, United States of America.
    INTRODUCTION: Active-case finding (ACF) programs have an important role in addressing case detection gaps and halting tuberculosis (TB) transmission. Evidence is limited on the cost-effectiveness of ACF interventions, particularly on how their value is impacted by different operational, epidemiological and patient care-seeking patterns. METHODS: We evaluated the costs and cost-effectiveness of a combined facility and community-based ACF intervention in Zambia that utilized mobile chest X-ray with computer-aided reading/interpretation software and laboratory-based Xpert MTB/RIF testing. Programmatic costs (in 2018 US dollars) were assessed from the health system perspective using prospectively collected cost and operational data. Cost-effectiveness of the ACF intervention was assessed as the incremental cost per TB death averted over a five-year time horizon using a multi-stage Markov state-transition model reflecting patient symptom-associated care-seeking and TB care under ACF compared to passive care. RESULTS: Over 18 months of field operations, the ACF intervention costed $435 to diagnose and initiate treatment for one person with TB. After accounting for patient symptom-associated care-seeking patterns in Zambia, we estimate that this one-time ACF intervention would incrementally diagnose 407 (7,207 versus 6,800) TB patients and avert 502 (611 versus 1,113) TB-associated deaths compared to the status quo (passive case finding), at an incremental cost of $2,284 per death averted over the next five-year period. HIV/TB mortality rate, patient symptom-associated care-seeking probabilities in the absence of ACF, and the costs of ACF patient screening were key drivers of cost-effectiveness. CONCLUSIONS: A one-time comprehensive ACF intervention simultaneously operating in public health clinics and corresponding catchment communities can have important medium-term impact on case-finding and be cost-effective in Zambia. The value of such interventions increases if targeted to populations with high HIV/TB mortality, substantial barriers (both behavioral and physical) to care-seeking exist, and when ACF interventions can optimize screening by achieving operational efficiency.
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    The Costs and Cost-Effectiveness of a District-Strengthening Strategy to Mitigate the 3 Delays to Quality Maternal Health Care: Results From Uganda and Zambia.
    (2019-Mar-11) Johns B; Hangoma P; Atuyambe L; Faye S; Tumwine M; Zulu C; Levitt M; Tembo T; Healey J; Li R; Mugasha C; Serbanescu F; Conlon CM; U.S. Agency for International Development, Lusaka, Zambia.; Uganda Country Office, U.S. Centers for Disease Control and Prevention, Entebbe, Uganda.; International Development Division, Abt Associates Inc., Bethesda, MD, USA. ben_johns@abtassoc.com.; International Development Division, Abt Associates Inc., Bethesda, MD, USA.; Bureau for Global Health, U.S. Agency for International Development, Washington, DC, USA, and RTI, Washington, DC, USA. Now with Palladium, Abuja, Nigeria.; Bureau for Global Health, U.S. Agency for International Development, Washington, DC.; U.S. Agency for International Development, Lusaka, Zambia. Now based in Monrovia, Liberia.; Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.; U.S. Agency for International Development, Kampala, Uganda.; Department of Community Health and Behavioral Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    The primary objective of this study was to estimate the costs and the incremental cost-effectiveness of maternal and newborn care associated with the Saving Mothers, Giving Life (SMGL) initiative-a comprehensive district-strengthening approach addressing the 3 delays associated with maternal mortality-in Uganda and Zambia. To assess effectiveness, we used a before-after design comparing facility outcome data from 2012 (before) and 2016 (after). To estimate costs, we used unit costs collected from comparison districts in 2016 coupled with data on health services utilization from 2012 in SMGL-supported districts to estimate the costs before the start of SMGL. We collected data from health facilities, ministerial health offices, and implementing partners for the year 2016 in 2 SMGL-supported districts in each country and in 3 comparison non-SMGL districts (2 in Zambia, 1 in Uganda). Incremental costs for maternal and newborn health care per SMGL-supported district in 2016 was estimated to be US$845,000 in Uganda and $760,000 in Zambia. The incremental cost per delivery was estimated to be $38 in Uganda and $95 in Zambia. For the districts included in this study, SMGL maternal and newborn health activities were associated with approximately 164 deaths averted in Uganda and 121 deaths averted in Zambia in 2016 compared to 2012. In Uganda, the cost per death averted was $10,311, or $177 per life-year gained. In Zambia, the cost per death averted was $12,514, or $206 per life-year gained. The SMGL approach can be very cost-effective, with the cost per life-year gained as a percentage of the gross domestic product (GDP) being 25.6% and 16.4% in Uganda and Zambia, respectively. In terms of affordability, the SMGL approach could be paid for by increasing health spending from 7.3% to 7.5% of GDP in Uganda and from 5.4% to 5.8% in Zambia.