The Sentinel

Human Rights Action :: Humanitarian Response :: Health :: Education :: Heritage Stewardship ::
Sustainable Development
__________________________________________________
Week ending 24 September 2016

This weekly digest is intended to aggregate and distill key content from a broad spectrum of practice domains and organization types including key agencies/IGOs, NGOs, governments, academic and research institutions, consortia and collaborations, foundations, and commercial organizations. We also monitor a spectrum of peer-reviewed journals and general media channels. The Sentinel’s geographic scope is global/regional but selected country-level content is included. We recognize that this spectrum/scope yields an indicative and not an exhaustive product. Comments and suggestions should be directed to:

David R. Curry
Editor &
Founding Managing Director
GE2P2 Global Foundation – Center for Governance, Evidence, Ethics, Policy, Practice
david.r.curry@ge2p2center.net

pdf version: the-sentinel_-week-ending-24-september-2016

Contents
:: Week in Review
:: Key Agency/IGO/Governments Watch – Selected Updates from 30+ entities
:: INGO/Consortia/Joint Initiatives Watch – Media Releases, Major Initiatives, Research
:: Foundation/Major Donor Watch -Selected Updates
:: Journal Watch – Key articles and abstracts from 100+ peer-reviewed journals

The Sentinel

Human Rights Action :: Humanitarian Response :: Health :: Education :: Heritage Stewardship ::
Sustainable Development
__________________________________________________
Week ending 17 September 2016

This weekly digest is intended to aggregate and distill key content from a broad spectrum of practice domains and organization types including key agencies/IGOs, NGOs, governments, academic and research institutions, consortia and collaborations, foundations, and commercial organizations. We also monitor a spectrum of peer-reviewed journals and general media channels. The Sentinel’s geographic scope is global/regional but selected country-level content is included. We recognize that this spectrum/scope yields an indicative and not an exhaustive product. Comments and suggestions should be directed to:

David R. Curry
Editor &
Founding Managing Director
GE2P2 Global Foundation – Center for Governance, Evidence, Ethics, Policy, Practice
david.r.curry@ge2p2center.net

pdf version: the-sentinel_-week-ending-17-september-2016

Contents
:: Week in Review
:: Key Agency/IGO/Governments Watch – Selected Updates from 30+ entities
:: INGO/Consortia/Joint Initiatives Watch – Media Releases, Major Initiatives, Research
:: Foundation/Major Donor Watch -Selected Updates
:: Journal Watch – Key articles and abstracts from 100+ peer-reviewed journals

The Sentinel

Human Rights Action :: Humanitarian Response :: Health :: Education :: Heritage Stewardship ::
Sustainable Development
__________________________________________________
Week ending 10 September 2016

This weekly digest is intended to aggregate and distill key content from a broad spectrum of practice domains and organization types including key agencies/IGOs, NGOs, governments, academic and research institutions, consortia and collaborations, foundations, and commercial organizations. We also monitor a spectrum of peer-reviewed journals and general media channels. The Sentinel’s geographic scope is global/regional but selected country-level content is included. We recognize that this spectrum/scope yields an indicative and not an exhaustive product. Comments and suggestions should be directed to:

David R. Curry
Editor &
Founding Managing Director
GE2P2 Global Foundation – Center for Governance, Evidence, Ethics, Policy, Practice
david.r.curry@ge2p2center.net

pdf version: the-sentinel_-week-ending-10-september-2016

Contents
:: Week in Review
:: Key Agency/IGO/Governments Watch – Selected Updates from 30+ entities
:: INGO/Consortia/Joint Initiatives Watch – Media Releases, Major Initiatives, Research
:: Foundation/Major Donor Watch -Selected Updates
:: Journal Watch – Key articles and abstracts from 100+ peer-reviewed journals

:: Journal Watch

The Sentinel will track key peer-reviewed journals which address a broad range of interests in human rights, humanitarian response, health and development. It is not intended to be exhaustive. We will add to those monitored below as we encounter relevant content and upon recommendation from readers. We selectively provide full text of abstracts and other content but note that successful access to some of the articles and other content may require subscription or other access arrangement unique to the publisher. Please suggest additional journals you feel warrant coverage.

The Anticipated Clinical and Economic Effects of 90–90–90 in South Africa

Annals of Internal Medicine
6 September 2016, Vol. 165. No. 5
http://annals.org/issue.aspx

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Original Research
The Anticipated Clinical and Economic Effects of 90–90–90 in South Africa
Rochelle P. Walensky, MD, MPH; Ethan D. Borre, BA; Linda-Gail Bekker, MD, PhD; Stephen C. Resch, PhD; Emily P. Hyle, MD, SM; Robin Wood, MMed, DSc (Med); Milton C. Weinstein, PhD; Andrea L. Ciaranello, MD, MPH; Kenneth A. Freedberg, MD, MSc; and A. David Paltiel, MBA, PhD
Abstract
Background: The Joint United Nations Programme on HIV/AIDS (UNAIDS) 90–90–90 global treatment target aims to achieve 73% virologic suppression among HIV-infected persons worldwide by 2020.
Objective: To estimate the clinical and economic value of reaching this ambitious goal in South Africa, by using a microsimulation model of HIV detection, disease, and treatment.
Design: Modeling of the “current pace” strategy, which simulates existing scale-up efforts and gradual increases in overall virologic suppression from 24% to 36% in 5 years, and the UNAIDS target strategy, which simulates 73% virologic suppression in 5 years.
Data Sources: Published estimates and South African survey data on HIV transmission rates (0.16 to 9.03 per 100 person-years), HIV-specific age-stratified fertility rates (1.0 to 9.1 per 100 person-years), and costs of care ($11 to $31 per month for antiretroviral therapy and $20 to $157 per month for routine care).
Target Population: South African HIV-infected population, including incident infections over the next 10 years.
Perspective: Modified societal perspective, excluding time and productivity costs.
Time Horizon: 5 and 10 years.
Intervention: Aggressive HIV case detection, efficient linkage to care, rapid treatment scale-up, and adherence and retention interventions toward the UNAIDS target strategy.
Outcome Measures: HIV transmissions, deaths, years of life saved, maternal orphans, costs (2014 U.S. dollars), and cost-effectiveness.
Results of Base-Case Analysis: Compared with the current pace strategy, over 5 years the UNAIDS target strategy would avert 873 000 HIV transmissions, 1 174 000 deaths, and 726 000 maternal orphans while saving 3 002 000 life-years; over 10 years, it would avert 2 051 000 HIV transmissions, 2 478 000 deaths, and 1 689 000 maternal orphans while saving 13 340 000 life-years. The additional budget required for the UNAIDS target strategy would be $7.965 billion over 5 years and $15.979 billion over 10 years, yielding an incremental cost-effectiveness ratio of $2720 and $1260 per year of life saved, respectively.
Results of Sensitivity Analysis: Outcomes generally varied less than 20% from base-case outcomes when key input parameters were varied within plausible ranges.
Limitation: Several pathways may lead to 73% overall virologic suppression; these were examined in sensitivity analyses.
Conclusion: Reaching the 90–90–90 HIV suppression target would be costly but very effective and cost-effective in South Africa. Global health policymakers should mobilize the political and economic support to realize this target.
Primary Funding Source: National Institutes of Health and the Steve and Deborah Gorlin MGH Research Scholars Award.

BMC Health Services Research (Accessed 10 September 2016)

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 10 September 2016)

Research article
Charting health system reconstruction in post-war Liberia: a comparison of rural vs. remote healthcare utilization
Katherine Kentoffio, John D. Kraemer, Thomas Griffiths, Avi Kenny, Rajesh Panjabi, G. Andrew Sechler, Stephen Selinsky and Mark J. Siedner
BMC Health Services Research 2016 16:478
Published on: 7 September 2016
Abstract
Background
Despite a growing global emphasis on universal healthcare, access to basic primary care for remote populations in post-conflict countries remains a challenge. To better understand health sector recovery in post-conflict Liberia, this paper seeks to evaluate changes in utilization of health services among rural populations across a 5-year time span.
Methods
We assessed trends in healthcare utilization among the national rural population using the Liberian Demographic and Health Survey (DHS) from 2007 and 2013. We compared these results to results obtained from a two-staged cluster survey in 2012 in the district of Konobo, Liberia, to assess for differential health utilization in an isolated, remote region. Our primary outcomes of interest were maternal and child health service care seeking and utilization.
Results
Most child and maternal health indicators improved in the DHS rural sub-sample from 2007 to 2013. However, this progress was not reflected in the remote Konobo population. A lower proportion of women received 4+ antenatal care visits (AOR 0.28, P < 0.001) or any postnatal care (AOR 0.25, P <0.001) in Konobo as compared to the 2013 DHS. Similarly, a lower proportion of children received professional care for common childhood illnesses, including acute respiratory infection (9 % vs. 52 %, P < 0.001) or diarrhea (11 % vs. 46 %, P < 0.001).
Conclusions
Our data suggest that, despite the demonstrable success of post-war rehabilitation in rural regions, particularly remote populations in Liberia remain at disproportionate risk for limited access to basic health services. As a renewed effort is placed on health systems reconstruction in the wake of the Ebola-epidemic, a specific focus on solutions to reach isolated populations will be necessary in order to ensure extension of coverage to remote regions such as Konobo.

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Research article
Stigmatized by association: challenges for abortion service providers in Ghana
Unsafe abortion is an issue of public health concern and contributes significantly to maternal morbidity and mortality globally. Abortion evokes religious, moral, ethical, socio-cultural and medical concerns w…
Patience Aniteye, Beverley O’Brien and Susannah H. Mayhew
BMC Health Services Research 2016 16:486
Published on: 10 September 2016

Research article
Quality of care for remote orthopaedic consultations using telemedicine: a randomised controlled trial
Decentralised services using outreach clinics or modern technology are methods to reduce both patient transports and costs to the healthcare system. Telemedicine consultations via videoconference are one such …
Astrid Buvik, Einar Bugge, Gunnar Knutsen, Arvid Småbrekke and Tom Wilsgaard
BMC Health Services Research 2016 16:483
Published on: 8 September 2016

Research article
Developing, delivering and evaluating primary mental health care: the co-production of a new complex intervention
Health services face the challenges created by complex problems, and so need complex intervention solutions. However they also experience ongoing difficulties in translating findings from research in this area…
Joanne Reeve, Lucy Cooper, Sean Harrington, Peter Rosbottom and Jane Watkins
BMC Health Services Research 2016 16:470
Published on: 6 September 2016

Research
Workplace health promotion for older workers: a systematic literature review
Aging of the workforce is a growing problem. As workers age, their physical, physiological and psychosocial capabilities change. Keeping older workers healthy and productive is a key goal of European labor pol…
Andrea Poscia, Umberto Moscato, Daniele Ignazio La Milia, Sonja Milovanovic, Jovana Stojanovic, Alice Borghini, Agnese Collamati, Walter Ricciardi and Nicola Magnavita
BMC Health Services Research 2016 16(Suppl 5):329
Published on: 5 September 2016

Research
Predictors of healthy ageing: public health policy targets
The public health policy agenda oriented towards healthy ageing becomes the highest priority for the European countries. The article discusses the healthy ageing concept and its possible determinants with an a…
Agnieszka Sowa, Beata Tobiasz-Adamczyk, Roman Topór-Mądry, Andrea Poscia and Daniele Ignazio la Milia
BMC Health Services Research 2016 16(Suppl 5):289
Published on: 5 September 2016

Research involving adults lacking capacity to consent: the impact of research regulation on ‘evidence biased’ medicine

BMC Medical Ethics
http://www.biomedcentral.com/bmcmedethics/content
(Accessed 10 September 2016)

Debate
Research involving adults lacking capacity to consent: the impact of research regulation on ‘evidence biased’ medicine
Victoria Shepherd
Published on: 8 September 2016
Abstract
Background
Society is failing in its moral obligation to improve the standard of healthcare provided to vulnerable populations, such as people who lack decision making capacity, by a misguided paternalism that seeks to protect them by excluding them from medical research. Uncertainties surround the basis on which decisions about research participation is made under dual regulatory regimes, which adds further complexity. Vulnerable individuals’ exclusion from research as a result of such regulation risks condemning such populations to poor quality care as a result of ‘evidence biased’ medicine.
Main Text
This paper explores the research regulation provisions for proxy decision making for those unable to provide informed consent for themselves, and the subsequent legal and practical difficulties for decision-makers. There are two separate regulatory regimes governing research involving adults who lack capacity to consent in England and Wales. The Mental Capacity Act 2005 governs how incapacitated adults can be involved in research, however clinical trials of medicinal products are separately regulated by the Medicines for Human Use (Clinical Trials) Regulations 2004. There are significant differences under these dual regimes in the provisions for those lacking capacity to participate in medical research. The level of risk permitted differs, with a greater requirement for justification for participation in a clinical trial than other types of research. Who acts as proxy decision maker, how much information is provided to the person lacking capacity, and whether they retain the power of veto also significantly differs.
Conclusion
The development of two separate regulatory regimes has resulted in significant differences between the provisions for clinical trials and other forms of research, and from usual medical practice. The resulting uncertainty has reinforced the tendency of those approving and conducting research to exclude adults lacking capacity to avoid difficult decisions about seeking consent for their participation. Future developments, such as the incoming EU Regulations, may address some of these differences, however the justification and level of risk permitted requires review to ensure that requirements are appropriate and proportionate to the burdens and risks for the individual, and also to the benefits for the wider population represented.