Summary Objective To report on activities and lessons learned during the first 18 months of a rural programme of prevention of mother‐to‐child transmission of HIV (PMTCT) in Zimbabwe. Methods The PMTCT services were introduced in Murambinda Mission Hospital (120 beds), Buhera, in 2001. Programme strategies consisted in recruiting counselling staff, training health professionals, improving mother–child health (MCH) facilities and conducting information, education and communication activities within the community to address HIV/AIDS awareness and stigma. The following components were implemented within MCH services: voluntary counselling and testing of HIV using rapid testing, nevirapine short regimen proposed to all HIV‐infected mothers identified and their newborns, support to exclusive breastfeeding for 6‐ and 18‐month mother–child follow‐up. Routine monitoring data collected from August 2001 to February 2003 were used to estimate programme uptake. Results Of 2471 pregnant women using antenatal services, 2298 were pre‐test counselled, the acceptance of HIV testing reached 92.9%. Of the women who decided to take an HIV test, 1588 (74.3%) returned to collect their result. Overall HIV prevalence was 20.4% (n = 437); 326 of the HIV‐positive women were counselled and 104 (24%) received complete mother–child antiretroviral prophylaxis. Conclusions Acceptability of HIV testing after counselling has remained above 90% since the onset of the programme. Collection of test results and mother–child follow‐up are among the most challenging activities of the programme. A district approach and community participation are critical to develop PMTCT programmes in rural settings, even with reasonably good MCH services.
Background The treatment of childhood cancer often is assumed to be costly in African settings, thereby limiting advocacy and policy efforts. The authors determined the cost and cost‐effectiveness of maintaining childhood cancer centers across 4 hospitals throughout sub‐Saharan Africa. Methods Within hospitals representing 4 countries (Kenya, Nigeria, Tanzania, and Zimbabwe), cost was determined either retrospectively or prospectively for all inputs related to operating a pediatric cancer unit (eg, laboratory costs, medications, and salaries). Cost‐effectiveness was calculated based on the annual number of newly diagnosed patients, survival rates, and life expectancy. Results Cost per new diagnosis ranged from $2400 to $31,000, attributable to variances with regard to center size, case mix, drug prices, admission practices, and the treatment abandonment rate, which also affected survival. The most expensive cost input was found to be associated with medication in Kenya, and medical personnel in the other 3 centers. The cost per disability‐adjusted life‐year averted ranged from 0.3 to 3.6 times the per capita gross national income. Childhood cancer treatment therefore was considered to be very cost‐effective by World Health Organization standards in 2 countries and cost‐effective in 1 additional country. In all centers, abandonment of treatment was common; modeling exercises suggested that public funding of treatment, additional psychosocial personnel, and modifications of inpatient policies would increase survival rates while maintaining or even improving cost‐effectiveness. Conclusions Across various African countries, childhood cancer treatment units represent cost‐effective interventions. Cost‐effectiveness can be increased through the control of drug prices, appropriate policy environments, and decreasing the rate of treatment abandonment. These results will inform national childhood cancer strategies across Africa.
Introduction The Collaborative Wilms Tumour (WT) Africa Project implemented an adapted WT treatment guideline in six centres in sub‐Saharan Africa. The primary objectives were to describe abandonment of treatment, death during treatment, event‐free survival (EFS) and relapse following implementation. An exploratory objective was to compare outcomes with the baseline evaluation, a historical cohort preceding implementation. Methods The Collaborative WT Africa Project is a multi‐centre prospective clinical trial that began in 2014. Funding was distributed to all participating centres and used to cover treatment, travel and other associated costs for patients. Patient characteristics, tumour characteristics and events were described. Results In total, 201 WT patients were included. Two‐year EFS was 49.9 ± 3.8% when abandonment of treatment was considered an event. Relapse of disease occurred in 21% (42 of 201) of all included patients and in 26% (42 of 161) of those who had a nephrectomy. Programme implementation was associated with significantly higher survival without evidence of disease at the end of treatment (52% vs 68.5%, P = .002), significantly reduced abandonment of treatment (23% vs 12%, P = .009) and fewer deaths during treatment (21% vs 13%, P = .06). Conclusion This collaborative implementation of an adapted WT treatment guideline, using relatively simple and low‐cost interventions, was feasible. Two‐year EFS was almost 50%. In addition, a significant decrease in treatment abandonment and an increase in survival at the end of treatment were observed compared to a pre‐implementation cohort. Future work should focus on decreasing deaths during treatment and will include enhancing supportive care.
Background: 'Treatmentabandonment' is a common and preventable cause of childhood cancer treatment failure in low-and middle-income countries (LMIC). Risk factors and effective interventions in LMIC are reported. Poverty and costs of treatment are perceived as overriding causes in sub-Saharan Africa. The objective of this study was to study potential determinants of treatment abandonment, including aspects of treatment costs in sub-Saharan Africa, to be better informed for planned future interventions. Methods: A multicentre, prospective, observational, cohort study was conducted in five hospitals in sub-Saharan Africa. Children younger than 16 years with newly diagnosed cancer treated as inpatient with curative intent were included. The occurrence of treatment abandonment and potential determinants including aspects of treatment costs were documented during the first 3 months of treatment. Results:We included 252 patients (median age 6.0, range 0.2-15.0 years, 54% male). The most common cancer was Burkitt lymphoma (63/252, 25%). Seven percent of patients (18 of 252) abandoned treatment. Two thirds (65%, 163/252) of patients had to borrow money to reach the hospital for the diagnosis and start of treatment. Treatment abandonment occurred more frequently in families who had to borrow money (16/163, 10%) versus those who did not (2/89, 2%; p = .026). Conclusions: Limiting costs for families and improved counselling may reduce treatment abandonment. Development and implementation of interventions to reduce treatment abandonment are required in sub-Saharan Africa.
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