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Background. Cardiovascular disease (CVD) is a growing cause of mortality and morbidity in Tanzania, but contextualized evidence on cost-effective medical strategies to prevent it is scarce. We aim to perform a cost-effectiveness analysis of medical interventions for primary prevention of CVD using the World Health Organization's (WHO) absolute risk approach for four risk levels. Methods. The cost-effectiveness analysis was performed from a societal perspective using two Markov decision models: CVD risk without diabetes and CVD risk with diabetes. Primary provider and patient costs were estimated using the ingredients approach and step-down methodologies. Epidemiological data and efficacy inputs were derived from systematic reviews and meta-analyses. We used disability- adjusted life years (DALYs) averted as the outcome measure. Sensitivity analyses were conducted to evaluate the robustness of the model results. Results. For CVD low-risk patients without diabetes, medical management is not cost-effective unless willingness to pay (WTP) is higher than USD1327 per DALY averted. For moderate-risk patients, WTP must exceed USD164 per DALY before a combination of angiotensin converting enzyme inhibitor (ACEI) and diuretic (Diu) becomes cost-effective, while for high-risk and very high-risk patients the thresholds are USD349 (ACEI, calcium channel blocker (CCB) and Diu) and USD498 per DALY (ACEI, CCB, Diu and Aspirin (ASA)) respectively. For patients with CVD risk with diabetes, a combination of sulfonylureas (Sulf), ACEI and CCB for low and moderate risk (incremental cost-effectiveness ratio (ICER) USD608 and USD115 per DALY respectively), is the most cost-effective, while adding biguanide (Big) to this combination yielded the most favourable ICERs of USD309 and USD350 per DALY for high and very high risk respectively. For the latter, ASA is also part of the combination. Conclusions. Medical preventive cardiology is very cost-effective for all risk levels except low CVD risk. Budget impact analyses and distributional concerns should be considered further to assess governments' ability and to whom these benefits will accrue. ; publishedVersion

Understanding and solving transportation issues is a pressing need for governments in Latin America and the Caribbean region. An increasing number of private vehicles, chronically deficient public transport systems, and a lack of infrastructure that guarantees the safety of non-­motorized transport users characterize most of the major urban centers in this region, including Bogotá – capital of Colombia –, the city in which the present study is focused. As a result, there is the emergence of economic, social and environmental problems including congestion, loss of time, informality, inequality, growing greenhouse gas emissions and pollution, public health problems, etc. An approach that can greatly contribute to solving Bogotá's dire transport situation is the combination of bicycle and public transport use. This approach can have a substantial impact in people's mobility, motivate a shift in mindset that can potentially lead to a car-­free lifestyle, and improve the overall system's sustainability. These outcomes have been evidenced not only in developed cities like Munich but also in other cities within Colombia like Medellín. The overarching goal of the present study is to reveal the attitude of Bogotá residents towards cycle-­transit integration, gather insights from existing cycle-­transit users, and formulate strategies to address the system's structural deficiencies. The study includes an extensive review of existing literature on accessibility to public transport and the concept of cycle-­transit integration, commonly known as bike-­and-­ride, as well as a description of the current mobility situation in Bogotá. This is combined with face-­to-­face and online surveys to determine cycle-­transit users' demographic profile and trip characteristics, understand their perception of the current system's performance and issues, and identify how they prioritize measures aimed at improving the whole cycle-­transit integration. The combination of a deep-­dive in cycle-­transit integration theory and first-­hand verification and understanding of the reality faced by cycle-­transit users in Bogotá leads to the development of a set of specific recommendations organized in a three-­step course of action: i) incentives, ii) soft measures and iii) physical infrastructure enhancements. The study finalizes with an outline of the actions that should follow this thesis.

IntroductionThe success of prevention of mother‐to‐child transmission of HIV (PMTCT) is dependent upon high retention of mother‐infant pairs within these programmes. This is a systematic review to evaluate the effectiveness of interventions that aim to improve PMTCT service delivery and promote retention throughout the PMTCT steps.MethodsSelected databases were searched for studies published in English (up to September 2015). Outcomes of interest included antiretroviral (ARV) drugs or antiretroviral therapy (ART) initiation among HIV‐positive pregnant and/or breastfeeding women and their infants, retention into PMTCT programs, the uptake of early infant diagnosis (EID) of HIV and infant HIV status. Risk ratios and random‐effect meta‐analysis were used in the analysis.ResultsInterventions assessed in the 34 identified studies included male partner involvement in PMTCT, peer mentoring, the use of community health workers (CHWs), mobile phone‐based reminders, conditional cash transfer, training of midwives, integration of PMTCT services and enhanced referral. Five studies (two randomized) that evaluated mobile phone‐based interventions showed a statistically significant increase (pooled RR 1.18; 95% CI 1.05 to 1.32, I2=83%) in uptake of EID of HIV at around six weeks postpartum. Male partner involvement in PMTCT was associated with reductions in infant HIV transmission (pooled RR 0.61; 95% CI 0.39 to 0.94, I2=0%) in four studies (one randomized). Four studies (three randomized) that were grounded on psychological interventions reported non‐significant results (pooled RR 1.01; 95% CI 0.93 to 1.09, I2=69%) in increasing ARV/ART uptake among HIV‐positive pregnant and/or breastfeeding women and infant HIV testing (pooled RR 1.00; 95% CI 0.94 to 1.07, I2=45%). The effect of the other interventions on the effectiveness of improving PMTCT uptake was unclear. Heterogeneity of interventions limits these findings.ConclusionsOur findings indicate that mobile phone‐based reminders may increase the uptake of EID of HIV. Studies on male partner involvement in PMTCT reported reductions in infant HIV transmission. Stronger evidence is needed and future studies should determine the long‐term effects of these interventions in improving retention throughout the PMTCT steps.

Context Understanding population dynamics of invasive species is crucial for the development of management strategies. Feral horses (Equus caballus) are a growing problem in the Tuan–Toolara State Forest (TTSF), a coniferous plantation in south-eastern Queensland, Australia. Aim The population dynamics of the TTSF feral horses was not known. Therefore, the study was designed to characterise the major vital parameters of this population and, using these data, develop a long-term management plan. Methods The study was conducted over 3 years (2011–14) involving 522 individually identified horses. Foaling rates were used to calculate fecundity. Body fat distribution was estimated using body condition score (BCS), which reflects the nutritional, metabolic and general health of individual animals. Multi state mark–capture population models were used to estimate age-specific survival, and the Leslie age-structured projection matrix model was used to determine the annual rate at which the population increased. Key results The mean annual fecundity was low (0.23 ± 0.07 s.d.). The mean BCS of the population was mid-range (2.55 ± 0.51 s.d.) with adult females having lower scores than other age and gender groups. Survival estimates were consistently high (0.92–0.95) across all age groups. The average annual finite rate of population increase (λ) for the 3 years of the study was 1.09. Sensitivity analysis demonstrated that the population growth rate was almost seven times more sensitive to changes in adult survival compared with juvenile survival, and almost twice as sensitive to changes in fecundity. Key conclusions Population dynamics of the TTSF feral horses were comparable to other feral horse populations similarly challenged by environmental nutritional limitations. Implications Defining population dynamics of the TTSF feral horses permits the formulation of management goals that can be audited and adapted as required. The most effective strategy for controlling population growth in the TTSF would involve the continuing removal of substantial numbers of adult females or manipulation of survival and/or fecundity. As selective removal will likely alter the adult sex ratio and age structure of the population, ongoing assessment is necessary to minimise adverse welfare outcomes.

Despite the substantial burden of child undernutrition in South Asia, little is known on the relative importance and contribution of individual and micro/macro environments in shaping variation in child undernutrition. Using measures of anthropometry, we decompose the variation in child undernutrition in India to the levels of child, communities and states, quantifying the extent to which variation at each of these levels can be explained by known proximal and distal risk factors, measured at the individual (child/household) level. Data are from under-five singleton children participating in the 2005–2006 National Family Health Survey (NFHS-3). The outcome variables were: height-for-age z-score (HAZ), weight-for-age z-score (WAZ) and weight-for-height z-score (WHZ), as well as their associated measures of anthropometric failure: stunting, underweight and wasting, defined as more than two standard deviations below the median of the referred z-scores, respectively. We also considered the composite index of anthropometric failure (CIAF), defined by combinations of child anthropometric failure. After accounting for risk factors, of the total variation in HAZ, 93.2 per cent, 4.9 per cent and 1.9 per cent were attributable to the individual, community and state levels, respectively. The observed risk factors explained 6.3 per cent and 46.9 per cent of the variation at the individual and community level, respectively; however, between-state variation was not explained by these risk factors. Variability in other measures of anthropometry and anthropometric failure largely followed this pattern. Additionally, there were also considerable differences in the amount of variation at the individual and community levels among different states. Hence, there is a substantial variability at the community level compared to the state level, suggesting the presence of micro-geographies of undernutrition. Additionally, while a substantial majority of the variation in child undernutrition is at the individual level, our ability to explain variability in undernutrition at the individual-level risk factors is extremely limited. Further research is needed to explore community level or environmental factors affecting child undernutrition, generating evidence for policies to target these determinants.

OBJECTIVE To investigate the associations of exercise capacity and muscle strength in late adolescence with risk of vascular disease and arrhythmia. DESIGN Cohort study. SETTING General population in Sweden. PARTICIPANTS 1.1 million men who participated in mandatory military conscription between 1 August 1972 and 31 December 1995, at a median age of 18.2 years. Participants were followed until 31 December 2010. MAIN OUTCOMES Associations between exercise capacity and muscle strength with risk of vascular disease and subgroups (ischaemic heart disease, heart failure, stroke, and cardiovascular death) and risk of arrhythmia and subgroups (atrial fibrillation or flutter, bradyarrhythmia, supraventricular tachycardia, and ventricular arrhythmia or sudden cardiac death). Maximum exercise capacity was estimated by the ergometer bicycle test, and muscle strength was measured as handgrip strength by a hand dynamometer. High exercise capacity or muscle strength was deemed as above the median level. RESULTS During a median follow-up of 26.3 years, 26 088 vascular disease events and 17 312 arrhythmia events were recorded. Exercise capacity was inversely associated with risk of vascular disease and its subgroups. Muscle strength was also inversely associated with vascular disease risk, driven by associations of higher muscle strength with lower risk of heart failure and cardiovascular death. Exercise capacity had a U shaped association with risk of arrhythmia, driven by a direct association with risk of atrial fibrillation and a U shaped association with bradyarrhythmia. Higher muscle strength was associated with lower risk of arrhythmia (specifically, lower risk of bradyarrhythmia and ventricular arrhythmia). The combination of high exercise capacity and high muscle strength was associated with a hazard ratio of 0.67 (95% confidence interval 0.65 to 0.70) for vascular events and 0.92 (0.88 to 0.97) for arrhythmia compared with the combination of low exercise capacity and low muscle strength. CONCLUSIONS Exercise capacity and muscle strength in late adolescence are independently and jointly associated with long term risk of vascular disease and arrhythmia. The health benefit of lower risk of vascular events with higher exercise capacity was not outweighed by higher risk of arrhythmia.

Abstract Background There is considerable evidence that tobacco control mass media campaigns can change smoking behaviour. In the UK, campaigns over the last decade have contributed to declines in smoking prevalence and been associated with falls in cigarette consumption among continuing smokers. However, it is less evident whether such campaigns can also play a role in changing smokers' behaviour in relation to protecting others from the harmful effects of their smoking in the home. We investigated whether exposure to English televised tobacco control campaigns, and specifically campaigns targeting second hand smoking, is associated with smokers having a smoke-free home. Methods We used repeated cross-sectional national survey data on 9872 households which participated in the Health Survey for England between 2004 and 2010, with at least one adult current smoker living in the household. Exposure to all government-funded televised tobacco control campaigns, and to those specifically with a second hand smoking theme, was quantified in Gross Rating Points (GRPs), an average per capita measure of advert exposure where 100 GRPs indicates 100 % of adults exposed once or 50 % twice. Our outcome was self-reported presence of a smoke-free home (where no one smokes in the home on most days). Analysis used generalised additive models, controlling for individual factors and temporal trends. Results There was no association between monthly televised campaigns overall and the probability of having a smoke-free home. However, exposure to campaigns specifically targeting second hand smoke was associated with increased odds of a smoke-free home in the following month (odds ratio per additional 100 GRPs, 1.07, 95 % CI 1.01 to 1.13), though this association was not seen at other lags. These effects were not modified by socio-economic status or by presence of a child in the home. Conclusions Our findings provide tentative evidence that mass media campaigns specifically focussing on second hand smoke may be effective in reducing smoking in the home, and further evaluation of campaigns of this type is needed. General tobacco control campaigns in England, which largely focus on promoting smoking cessation, do not impact on smoke-free homes over and above their direct effect at reducing smoking.

In Nigeria, the teaching force is demoralized with little motivation. Teachers previously benefiting from considerable public respects and reasonable financial rewards, their status is today in exponential decay. The crises in the teaching profession are threatening the ability of Nigeria to reach internationally agreed targets to expand and improve education. To this regard, the study focuses on the situation of teachers in Nigeria today, the myriad problems they are facing and the detrimental effect these problems are having on children's ability to have quality education. The paper argues that the survival of Nigeria as a viable society will depend on the health of her educational institutions, more especially, on how well the teachers that are the backbone of quality education are treated. In an attempt to identify and find solution to the problems, the paper used participatory advocacy research methodology to explore teachers' views of their profession. What actually motivates teachers? What affects their morale? In addition, what will help them perform well? The problems and prospects gathered from the voices of teachers and educationists came out with holistic recommendations on how teachers' motivation and morale could be improved, in order to have a virile and quality education in Nigeria. It is expected that the outcomes of the study may benefit the overall population of Nigerians, with special reference to education policy formulators and implementers. It serves as a media through which teachers problems and voices will be spread and be heard. It is also hope that an efficient education policy that will address the myriad problems of teachers will have a positive impact on the overall development of socio-economic and political aspects of the entire country. Article DOI: https://dx.doi.org/10.20319/pijss.2015.s11.11941207 This work is licensed under the Creative Commons Attribution-Non-commercial 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc/4.0/ or send a letter to Creative Commons, PO Box 1866, Mountain View, CA 94042, USA.

IntroductionAdolescents are a unique and sometimes neglected group in the planning of healthcare services. This is the case in many parts of sub‐Saharan Africa, where more than eight out of ten of the world's HIV‐infected adolescents live. Although the last decade has seen a reduction in AIDS‐related mortality worldwide, largely due to improved access to effective antiretroviral therapy (ART), AIDS remains a significant contributor to adolescent mortality in sub‐Saharan Africa. Although inadequate access to ART in parts of the subcontinent may be implicated, research among youth with HIV elsewhere in the world suggests that suboptimal adherence to ART may play a significant role. In this article, we summarize the epidemiology of HIV among sub‐Saharan African adolescents and review their adherence to ART, emphasizing the unique challenges and factors associated with adherence behaviour.MethodsWe conducted a comprehensive search of online databases for articles, relevant abstracts, and conference reports from meetings held between 2010 and 2014. Our search terms included "adherence," "compliance," "antiretroviral use" and "antiretroviral adherence," in combination with "adolescents," "youth," "HIV," "Africa," "interventions" and the MeSH term "Africa South of the Sahara." Of 19,537 articles and abstracts identified, 215 met inclusion criteria, and 148 were reviewed.DiscussionAdolescents comprise a substantial portion of the population in many sub‐Saharan African countries. They are at particular risk of HIV and may experience worse outcomes. Although demonstrated to have unique challenges, there is a dearth of comprehensive health services for adolescents, especially for those with HIV in sub‐Saharan Africa. ART adherence is poorer among older adolescents than other age groups, and psychosocial, socio‐economic, individual, and treatment‐related factors influence adherence behaviour among adolescents in this region. With the exception of a few examples based on affective, cognitive, and behavioural strategies, most adherence interventions have been targeted at adults with HIV.ConclusionsAlthough higher levels of ART adherence have been reported in sub‐Saharan Africa than in other well‐resourced settings, adolescents in the region may have poorer adherence patterns. There is substantial need for interventions to improve adherence in this unique population.

IntroductionProtease inhibitors might be sufficient to maintain complete virological suppression when used as monotherapy for HIV‐1‐positive patients who have achieved sustained virological suppression on combination antiretroviral therapy (ART). The present study estimated the cost‐effectiveness of a strategy of switching the ART to protease inhibitor monotherapy (PIM) with prompt return to combination therapy in the event of viral load rebound compared to continuing the ongoing triple‐therapy (OTT) in the long‐term management of HIV‐1‐positive patients.Materials and MethodsA within‐trial cost‐effectiveness analysis and modelling of lifetime cost‐effectiveness was performed based on a randomized controlled trial of Protease Inhibitor monotherapy Versus Ongoing Triple‐therapy (PIVOT). The setting was HIV outpatient care in the UK National Health Service, and the trial involved 587 patients, aged 18 years or more, who achieved sustained virological suppression and have a CD4+ cell count >100 cells/mm3. Outcomes were NHS costs (2012 UK pounds sterling) and quality‐adjusted life‐years (QALY) with comparative results presented as incremental cost‐effectiveness ratios (ICERs).ResultsOverall, PIM was cost‐effective compared to OTT. PIM was cost‐saving due to large savings in the ART drug costs while being no less effective in terms of QALYs in the within‐trial analysis and only marginally less effective with modelling. In the base‐case within‐trial analysis, the incremental total cost per patient was −£6,424.11 (95% confidence interval:−£7,418.84 to −£5,429.38) and the incremental QALY was 0.0051 (95% confidence interval: −0.0479 to 0.0582) making PIM dominant compared to OTT. Multiple sensitivity analyses were conducted to assess the importance of assumptions surrounding drug costs, missing data, trial protocol driven costs and mortality. In all sensitivity analyses, PIM was cost‐saving and no marked difference in QALY was observed. Modelling of life time costs and QALYs showed significant cost‐savings and marginally less effectiveness such that switching to PIM appeared cost‐effective at accepted cost‐effectiveness thresholds.ConclusionsThe results suggest that PIM is a cost‐effective treatment strategy compared to OTT for HIV‐1‐positive patients who have achieved sustained virological suppression.

IntroductionClinical trials frequently show differences in viral load (VL) response between antiretroviral therapy (ART) regimes. Patterns of prescribing vary from country to country (Mocroft et al. Infection 2014 Jun 6 [epub ahead of print]), and are likely to vary between individual clinics. Scotland has a national database that records VL results and specific ART regimes for every patient under care, thus allowing different prescribing patterns between clinical centres to be monitored. Does this reveal any difference in achievement of undetectable VL?Materials and MethodsWe interrogated the database held by Health Protection Scotland (HPS) that contains a record of every VL result matched against prescribed ART. Results were censored at the end of December 2013 and are based on the latest attendance of patients who have been under monitoring for at least six months. For simplicity, we have broken the results into class of drug rather than individual drugs for example, nucleoside reverse transcriptase inhibitor (NRTI) rather than lamivudine, abacavir etc. The data were analyzed using univariate Poisson regression.ResultsThe anonymized records of 3302 individual patients who attended in 11 separate regions were scrutinized. Sixty‐eight different combinations of antiretroviral regimes were identified. The prescribing patterns for the five most frequently prescribed regimes in the four largest clinics are shown in Table 1, along with the overall percentage of patients with undetectable VL. A higher proportion of patients in Scotland who are prescribed regimes of NRTI×2 or NRTI/NtRTI plus PI have detectable VL but this is not statistically significant. Although the percentage of patients with VL<50 varies between regions 1 and 4 versus regions 2 and 3, this is also not statistically significant.ConclusionsOverall, a high proportion of Scottish patients on ART have undetectable VL. Patterns of ART prescribing in Scotland do vary by region but there are no significant differences in outcome with regard to undetectable VL. There is a non‐significant trend which may be accounted for by differing levels of PI prescribing.

Abstract Background Diabetes mellitus (DM) is a common serious health problem. Medication adherence is a key determinant of therapeutic success in patients with diabetes mellitus. The purpose of this study was to assess medication adherence and its potential association with beliefs and diabetes – related knowledge in patients with type II DM. Methods This study was carried out at Al-Makhfia governmental diabetes primary healthcare clinic in Nablus, Palestine. Main outcome of interest in the study was medication adherence. The Beliefs about Medicines Questionnaire (BMQ) was used to assess beliefs. Morisky Medication Adherence Scale (MMSA-8 © ) was used to assess medication adherence. The Michigan diabetes knowledge test (MDKT) was used to assess diabetes – related knowledge. Univariate and multivariate analysis were carried out using Statistical Package for Social Sciences (SPSS 20). Results Four hundred and five patients were interviewed. The mean ± SD age of the participants was 58.3 ± 10.4 (range = 28 – 90) years. More than half (53.3%) of the participants were females. Approximately 42.7% of the study sample were considered non-adherent (MMAS-8 © score of < 6). Multivariate analysis showed that the following variables were significantly associated with non-adherence: disease-related knowledge, beliefs about necessity of anti-diabetic medications, concerns about adverse consequences of anti-diabetic medications and beliefs that medicines in general are essentially harmful. Diabetic patients with high knowledge score and those with strong beliefs in the necessity of their anti-diabetic medications were less likely to be non-adherent ([O.R = 0.87, 95% CI of 0.78 – 0.97] and [O.R = 0.93, 95% of 0.88 – 0.99] respectively). However, diabetic patients with high concerns about adverse consequences of anti-diabetic medications and those with high belief that all medicines are harmful were more likely to be non-adherent ([O.R = 1.09; 95% C.I of 1.04 – 1.16] and [O.R = 1.09, 95% C.I of 1.02 – 1.16] respectively). Conclusions Beliefs and knowledge are important factors in understanding variations in medication adherence among diabetic patients. The BMQ can be used as a tool to identify people at higher risk of non-adherence. Improving knowledge of patients about their illness might positively influence their medication adherence.

Abstract Background The government has recognised the role of healthcare professionals in smoking cessation interventions with integrated care pathways for identification and referral of at-risk patients who smoke. Referral for suspected cancers has been suggested as a 'teachable moment', whereby individuals are motivated and more likely to adopt risk-reducing behaviours. A head and neck cancer referral clinic could therefore provide opportunities for smoking cessation intervention. This study aims to pilot a brief smoking cessation intervention during a consultation visit for patients referred with suspected head and neck cancer and evaluate its acceptability and impact. Methods A brief script for smoking cessation intervention which included a smoking cessation referral was designed to be delivered to patients attending a rapid access clinic. Patient outcome data was collected by the stop smoking team for patients who accepted the referral. A subset of these patients was also interviewed by telephone; these findings were combined with data provided by the stop smoking services to assess the acceptability and impact of pilot smoking cessation intervention on patients. Results In total, 473 new patients attended the clinic during the study period, of whom 102 (22%) were smokers. Of these, 80 (78%) accepted a referral to stop smoking services. A total of 75 (74%) patients were approached subsequently in a telephone survey. Of the 80 newly referred patients, 29 (36%) quit smoking at least temporarily. Another eight patients reduced their smoking or set a quit date (10%), so the experience of attending the clinic and the intervention impacted favourably on almost half of the patients (46%). The patient survey found the intervention to be acceptable for 94% (n = 50) of patients. Qualitative analysis of patient responses revealed five elements which support the acceptability of the intervention. Conclusions The findings of this pilot study suggest that discussion of smoking cessation with patients referred for suspected head and neck cancer may have an impact and facilitate the process towards quitting. A possible diagnosis of cancer appears to present a 'teachable moment' to encourage positive health behaviour change.

В 1925 г. на территории Калмыцкой автономной области под руководством П. Ю. Берлина работала научная экспедиция Наркомздрава. В течение нескольких месяцев ее участниками был собран значительный объем демографических, социальных, антропологических и других показателей, которые позволили установить причины сокращения численности калмыцкого народа. В статье, основанной на архивных материалах, значительная часть которых ранее не вводилась в научный оборот, рассмотрена деятельность экспедиции, выявлены основные проблемы в ее работе, определено значение в дальнейшем развитии региона. ; In 1925, the scientific expedition of the People's Commissariat for Healthcare under the guidance of P.Y.Berlin worked on the territory of the Kalmyk Autonomous Region. The warnings on the population reduction of the Kalmyks were periodically made by the officers and those enthusiastic doctors who worked selfl essly in the Kalmyk steppe, but the issue was seriously considered only after the Russian revolution when the Kalmyks got the right to solve their problems. The preliminary commission was sent to the Kalmyk region in order to evaluate the situation with the ethnic group. The conclusion was made that the Kalmyk population was in danger, and it was necessity to send another scientific expedition to explore the issue in details. Under the leadership of the Professor A.V. Molkov the Director of the State Institute for Social Hygiene the monitoring program, the plans and forms for investigating family and individual issues as well as housing conditions were worked out. During several months, the expedition members gathered considerable amount of demographical, social, anthropological and other data that helped to analyze the reasons for the Kalmyk population reduction. The researchers identified the underdeveloped economy as the main influence on the lack of the natural population increase. In 1928, the outcomes of the Scientific Expedition were published in the Digest «The Kalmyks. The Research on the Health Situation and Stamina». The article considers the archival material on P.Y.Berlin's expedition much of which has not been used in the scientific research yet. The basic problems concerned with the field study have been identified and considered. Special attention has been paid to the role of the expedition in attracting attention to some political issues in the USSR.

IntroductionAdherence to antiretroviral treatment (ART) is critical to maintaining health and good clinical outcomes in people living with HIV/AIDS. To address poor treatment adherence, low‐cost interventions using mobile communication technology are being studied. While there are some studies that show an effect of mobile phone reminders on adherence to ART, none has reported on the costs of such reminders for national AIDS programmes. This paper aims to study the costs of mobile phone reminder strategies (mHealth interventions) to support adherence in the context of India's National AIDS Control Program (NACP).MethodsThe study was undertaken at two tertiary level teaching hospitals that implement the NACP in Karnataka state, South India. Costs for a mobile phone reminder application to support adherence, implemented at these sites (i.e. weekly calls, messages or both) were studied. Costs were collected based on the concept of avoidable costs specific to the application. The costs that were assessed were one‐time costs and recurrent costs that included fixed and variable costs. A sequential procedure for costing was used. Costs were calculated at national‐programme level, individual ART‐centre level and individual patient level from the NACP's perspective. The assessed costs were pooled to obtain an annual cost per patient. The type of application, number of ART centres and number of patients on ART were varied in a sensitivity analysis of costs.ResultsThe Indian NACP would incur a cost of between 79 and 110 INR (USD 1.27–1.77) per patient per year, based on the type of reminder, the number of patients on ART and the number of functioning ART centres. The total programme costs for a scale‐up of the mHealth intervention to reach the one million patients expected to be on treatment by 2017 is estimated to be 0.36% of the total five‐year national‐programme budget.ConclusionsThe cost of the mHealth intervention for ART‐adherence support in the context of the Indian NACP is low and is facilitated by the low cost of mobile communication in the country. Extending the use of mobile communication applications beyond adherence support under the national programme could be done relatively inexpensively.