Maximizing womens' health benefits when resources are limited
Recent evidence suggests that women in developing countries would benefit from a once in-a-lifetime screen for cervical cancer, a leading cause of cancer death for this population. If a screening strategy for cervical cancer were introduced, it might provide a good opportunity to offer women other health checks, but it is unclear which interventions should be packaged together. Jane Kim and colleagues (Harvard University) have developed an analytic framework to identify an optimal package of health services to offer to women attending a clinic once for their lifetime cervical cancer screen.
Their model takes into account monetary limitations and possible shortages in trained personnel to do the health checks, and balances these constraints against the likely health benefits for the women. When they set a realistic budgetary constraint (based on the annual health budget of the poorest countries and a single health check per woman in the two decades following her reproductive years), the optimal health package included cervical cancer screening by testing for human papillomavirus (an accurate but complex test), treatment for depression, and screening or treatment for anemia. When a 50% shortage in general (for example, nurses) and specialized (for example, doctors) personnel time was also included, the health benefits of the package were maximized by using a simpler test for cervical cancer and by treating anemia but not depression; this freed up resources in some regions to screen for breast cancer or cardiovascular disease.
The results suggest that the packaging of multiple health services during a single visit has great potential to maximize health gains, provided the right interventions are chosen. The shortage of personnel, which has been ignored in previous analyses even though it is a major problem in many developing countries, affects which health conditions and specific interventions should be bundled together to provide the greatest impact on public health.
Citation: Kim JJ, Salomon JA, Weinstein MC, Goldie SJ (2006) Packaging health services when resources are limited: The example of a cervical cancer screening visit. PLoS Med 3(11): e434.
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HIV-1 Epidemic in Yunnan, China
Yunnan province, which borders Myanmar, Laos, and Vietnam and is a major entry point for illegal drugs, has the highest rate of HIV-infected individuals in China. It is also an important entry point of new HIV virus types into China, and some of the HIV types found in patients other parts of China seem to have come from Yunnan. A group of researchers from the US and China led by Zhiwei Chen (Rockefeller University) now report a thorough study of the molecular epidemiology of HIV-1 virus subtypes in Yunnan province. They found a dynamic and evolving pattern of HIV types segregating among different parts of the population. Sexual transmission seems to be on the rise, suggesting that the epidemic could rapidly spread from high-risk groups like drug users to the general population. HIV/AIDS education and prevention efforts in the general population are therefore urgently needed. It is likely that some of the developments of the HIV epidemic in Yunnan province will be similar in other parts of China as the various subtypes spread. The results of the study also have implications for future HIV vaccine development.
Citation: Zhang Y, Lu L, Ba L, Liu L, Yang L, et al. (2006) Dominance of HIV-1 subtype CRF01_AE in sexually acquired cases leads to a new epidemic in Yunnan province of China. PLoS Med 3(11): e443.
PLEASE ADD THE LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF YOUR REPORT: http://dx.doi.org/10.1371/journal.pmed.0030443
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