Archive for April, 2009

ART programme and task shifting

Wednesday, April 29th, 2009

The use of antiretroviral drugs, and HIV counselling and testing in Ethiopia has increased in Ethiopia. Dr Degu Dare, who was among the first to start ART at rural hospitals in Ethiopia, is the co-author of a recent paper in PLoS Medicine (1).

Has this expansion of ART affected the performance of other health programmes such as tuberculosis and maternal and child health services is the question they asked.

Very interestingly, the authors document task shifting to the health officers, nurses, and health extension workers, and that this might be responsible for the successes of the ART programme in Ethiopia. However, HIV prevention interventions and management of chronic care patients are lagging behind. This may be because doctors leave the public sector to work for NGOs.
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1. Assefa Y, Jerene D, Lulseged S, Ooms G, Van Damme W (2009) Rapid Scale-Up of Antiretroviral Treatment in Ethiopia: Successes and System-Wide Effects. PLoS Med 6(4): e1000056. doi:10.1371/ journal.pmed.1000056

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Cost of HIV treatment

Wednesday, April 22nd, 2009

As little is known about the costs of HIV treatment in Ethiopia, Asfaw Bikilla recently published a paper comparing the average cost of antiretroviral therapy in a typical district hospital in Ethiopia.

The paper provides much needed detailed cost estimates for ART provision in low resource African settings. There is a real lack of data in this area, and these data might be useful for other researchers and policy makers.

The average cost for each patient per year was US $ 235. An extra average cost of US $29 was estimated for admitted patients. The major cost driver under the ART scheme was the ART costs.

Article: Bikilla AD , Jerene D, Robberstad B and Lindtjorn B. Cost estimates of HIV care and treatment with and without anti-retroviral therapy at Arba Minch Hospital in southern Ethiopia. Cost Effectiveness and Resource Allocation 2009, 7:6doi:10.1186/1478-7547-7-6

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Malaria research in south Ethiopia

Thursday, April 16th, 2009

Malaria remains one of the leading causes of sickness and death in south Ethiopia. Recent information suggests that malaria now also occurs in the highlands. Demographic changes, poverty, climate instability and change, and drug and insecticide resistance have been the hindrances to the control malaria.

We study malaria transmission in Chano near Arba Minch, and our studies include research on disease occurrence (epidemiology) and description of the mosquitoes (entomology).

We aim to describe risk factors associated with malaria incidence, and to evaluate the clinical and parasitological response to Artemether - Lumefantrine drugs. Using data from the last 10 years, we shall do mathematical and statistical modelling to see how malaria is related to the climate. In the mosquito studies, we shall determine the abundance, species composition, biting rates and resting behaviour of mosquitoes.

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Thesis writing

Sunday, April 12th, 2009

Thesis.uib.no is a blog that aims to help PhD students in writing their PhD thesis.

The blog discusses important topics that PhD students need to know when working on their thesis.

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Intervention studies

Saturday, April 4th, 2009

During the past years there has been many papers on patient and treatment delay of tuberculosis. The reasons for delay seem to be with the patient: Delay is often associated with illiteracy, distance from the health institution, gender, poverty, and knowledge about tuberculosis.

Over the years, we have also published on this topic. However, I now doubt if we a need for any more cross-sectional studies. I often receive questions from editors to review such papers, and they do not contain anything new.

So, this raises the question on how many descriptive studies do we need before doing anything for the patients? Does a study showing any association between lack of knowledge on tuberculosis prove that educating the population would reduce delay? I doubt that we can make such a conclusion.

More emphasis should be on how to reduce delay. We need more intervention studies. And these intervention studies should focus on the providers’, and not on the patients’ side. One example of an intervention study is by Estifanos Birru. He showed that active case finding reduces patient delay.

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