Health
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Data project
Extrapulmonary Tuberculosis (EPTB) poses challenges from patient and health system perspectives. The cost-effectiveness analysis of the Xpert MTB/RIF (Xpert) test to diagnose pulmonary tuberculosis is documented. However, there are no economic evaluations for EPTB. Considering the reported better diagnostic sensitivity of the MPT64 test, this study explored its cost-effectiveness as an alternative diagnostic test. We conducted this economic evaluation to assess the cost-effectiveness of the MPT64 test compared to Xpert and ZN microscopy for EPTB adult patients. We utilised a Markov modelling approach to capture short- and long-term costs and benefits from a health system perspective. For the model inputs, we combined data from our cohort studies in Tanzania and peer-reviewed EPTB literature. We calculated the Incremental Cost Effectiveness Ratio (ICER) by comparing the cost (in USD) of each diagnostic test and Quality Adjusted Life Years (QALYs) as health gain. We found the MPT64 test cost-effective for EPTB diagnosis and absolutely dominated ZN microscopy and Xpert using the baseline model inputs. A scenario analysis showed that the Xpert test might be the most cost-effective at its higher test sensitivity, which corresponds to using it to diagnose lymph node aspirates. The prevalence of HIV among EPTB cases, their probability of treatment, costs of ART, and the probability of the MPT64 test in detecting EPTB patients were the main parameters associated with the highest impact on ICER in one-way deterministic analysis. The most cost-effective option for EPTB at the baseline parameters was the MPT64 diagnostic test. Including the MPT64 test in EPTB diagnostic pathways for previously untreated patients can lead to better resource use. The Xpert test was the most cost-effective diagnostic intervention at a higher diagnostic test sensitivity in scenario analyses based on different sites of infection, such as for the lymph node aspirates.
Geographies:United States of AmericaTechnology-mediated interventions to promote physical activity are growing in popularity and appear to be effective for supporting continued adherence for some people. Some of this efficacy may be related to the cultivation of motivation that is self-determined (i.e., autonomous), which is posited to arise from the satisfaction of three basic psychological needs: competence, relatedness, and autonomy. The Peloton Instructor Needs-Supportive Coaching (PINC) tool was used to code 80 Peloton cycling classes across 4 different class types (Beginner, Power Zone, Groove, and High-Intensity Interval Training) to quantify the frequency of needs-supportive and needs-indifferent coaching within a class. We also provide an example of a pilot study using the tool to test the association between needs-supportive coaching and intrinsic motivation. This dataset provides the valid survey data used in the pilot study analysis to test the association between needs-supportive coaching and intrinsic motivation.
Objectives This study evaluated the uptake of Western Australian (WA) pharmacist vaccination services, the profiles of consumers being vaccinated and the facilitators and challenges experienced by pharmacy staff in the preparation, implementation and delivery of services. Design Mixed-methods methodology with both quantitative and qualitative data through surveys, pharmacy computer records and immuniser pharmacist interviews. Setting Community pharmacies in WA that provided pharmacist vaccination services between March and October 2015. Participants Immuniser pharmacists from 86 pharmacies completed baseline surveys and 78 completed exit surveys; computer records from 57 pharmacies; 25 immuniser pharmacists were interviewed. Main outcome measures Pharmacy and immuniser pharmacist profiles; pharmacist vaccination services provided and consumer profiles who accessed services. Results 15 621 influenza vaccinations were administered by immuniser pharmacists at 76 WA community pharmacies between March and October 2015. There were no major adverse events, and <1% of consumers experienced minor events which were appropriately managed. Between 12% and 17% of consumers were eligible to receive free influenza vaccinations under the National Immunisation Program but chose to have it at a pharmacy. A high percentage of vaccinations was delivered in rural and regional areas indicating that provision of pharmacist vaccination services facilitated access for rural and remote consumers. Immuniser pharmacists reported feeling confident in providing vaccination services and were of the opinion that services should be expanded to other vaccinations. Pharmacists also reported significant professional satisfaction in providing the service. All participating pharmacies intended to continue providing influenza vaccinations in 2016. Conclusions This initial evaluation of WA pharmacist vaccination services showed that vaccine delivery was safe. Convenience and accessibility were important aspects in usage of services. There is scope to expand pharmacist vaccination services to other vaccines and younger children; however, government funding to pharmacists needs to be considered.
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Data project
Objectives: To estimate hepatitis B vaccination (HBVc) coverage, and knowledge and socio-demographic determinants of full-dose uptake in Federal Road Safety Corps (FRSC) members, Kaduna State, Nigeria in order to inform relevant targeted vaccination policies. Design: A cross-sectional survey of FRSC members, Kaduna Sector Command. Settings: Six randomly-selected Unit Commands under Kaduna Sector Command, Kaduna State, Nigeria. Participants: Pilot-tested structured self-administered questionnaire was administered to 341 participants aged 18 years and above with ≥6 months of service between 17th June and 22nd July, 2015. Excluded were FRSC members in Road Safety (RS) 1 Zonal Command headquarters as the Zonal Command includes other States beyond the study scope. Primary Outcome: HBVc status of participants categorized as ‘not vaccinated’ for uptake of <3 doses and ‘vaccinated’ for uptake of ≥3 doses. Analysis: Descriptive analysis estimated HBVc coverage while logistic regression ascertained associations. Results: Most participants were males, aged 30-39 years, with 3-10 years of service, and of Marshal cadre. HBVc coverage was 60.9% for ≥1 dose and 30.5% for ≥3 doses. Less than 47% of participants scored above the mean knowledge score for hepatitis B virus (HBV) and HBVc. Female sex (AOR 2.28, 95% CI 1.15-4.52, p<0.05), perceiving there to be an occupational risk of exposure to HBV (AOR 2.86, 95% CI 1.06-7.70, p<0.001), and increasing HBVc knowledge (AOR 2.68, 95% CI 1.83-3.92, p<0.001) were independent predictors of full-dose HBVc in FRSC members, Kaduna Sector Command. Conclusions: HBVc coverage and knowledge are poor among FRSC members, Kaduna Sector Command. Educational intervention, geared towards improving FRSC members’ knowledge of HBVc and perception of risk of occupational exposure to HBV, is recommended for these vulnerable public safety workers. Such enlightenment could be a cheap and easy way of improving HBVc coverage in the study population.