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BackgroundHIV viral load testing as a component of antiretroviral therapy monitoring is costly. Understanding the full costs and the major sources of inefficiency associated with viral load testing is critical for optimizing the systems and technologies that support the testing process. The objective of our study was to estimate the costs associated with viral load testing performed for antiretroviral therapy monitoring to both patients and the public healthcare system in a low‐HIV prevalence, low‐resource country.MethodsA detailed cost analysis was performed to understand the costs involved in each step of performing a viral load test in Nicaragua, from initial specimen collection to communication of the test results to each patient's healthcare provider. Data were compiled and cross referenced from multiple information sources: laboratory records, regional surveillance centre records, and scheduled interviews with the key healthcare providers responsible for HIV patient care in five regions of the country.ResultsThe total average cost of performing a viral load test in Nicaragua varied by region, ranging from US$99.01 to US$124.58, the majority of which was at the laboratory level: $88.73 to $97.15 per specimen, depending on batch size. The average cost to clinics at which specimens were collected ranged from $3.31 to $20.92, depending on the region. The average cost per patient for transportation, food, lodging and lost income ranged from $3.70 to $14.93.ConclusionsThe quantitative viral load test remains the single most expensive component of the process. For the patient, the distance of his or her residence from the specimen collection site is a large determinant of cost. Importantly, the efficiency of results reporting has a large impact on the cost per result delivered to the clinician and utility of the result for patient monitoring. Detailed cost analysis can identify opportunities for removing barriers to effective antiretroviral therapy monitoring programmes in limited‐resource countries with low HIV prevalence.

A high assurance architecture is described for the protection of distributed multilevel secure computing environments from malicious code and other attacks. Component security services and mechanisms extend and inter-operate with commodity PCs, commodity client software, applications, trusted components, and legacy single level networks, providing new capabilities for composing secure, distributed multilevel security. This architecture results from the realization that unless a secure system offers users comfortable and familiar interfaces for handling routine information, it will fail due to lack of user acceptability. Computer systems critical to business and government, the inadequacy of many security products combined with overmarketing and overstated claims leaves information managers with nowhere to turn. Cyber security education is needed to provide a population of individuals who can make sound choices for the operation and acquisition of information protection. A prerequisite is an adequate population of educators. We describe workshops intended to help educators new to the area of Information Assurance. The multiple objectives are: to identify key foundational topics to educators, to teach lessons learned regarding topics difficult to convey to students, and to create a sense of community among Information Assurance educators. ; Approved for public release; distribution is unlimited.

Background: The way in which a government chooses to finance a health intervention can affect the uptake of health interventions and consequently the extent of health gains. In addition to health gains, some policies such as public finance can insure against catastrophic health expenditures. We aimed to evaluate the health and financial risk protection benefits of selected interventions that could be publicly financed by the government of Ethiopia. Methods: We used extended cost-effectiveness analysis to assess the health gains (deaths averted) and financial risk protection afforded (cases of poverty averted) by a bundle of nine (among many other) interventions that the Government of Ethiopia aims to make universally available. These nine interventions were measles vaccination, rotavirus vaccination, pneumococcal conjugate vaccination, diarrhoea treatment, malaria treatment, pneumonia treatment, caesarean section surgery, hypertension treatment, and tuberculosis treatment. Findings: Our analysis shows that, per dollar spent by the Ethiopian Government, the interventions that avert the most deaths are measles vaccination (367 deaths averted per USD100 000 spent), pneumococcal conjugate vaccination (170 deaths averted per USD100 000 spent), and caesarean section surgery (141 deaths averted per USD100 000 spent). The interventions that avert the most cases of poverty are caesarean section surgery (98 cases averted per USD100 000 spent), tuberculosis treatment (96 cases averted per USD100 000 spent), and hypertension treatment (84 cases averted per USD100 000 spent). Interpretation: Our approach incorporates financial risk protection into the economic evaluation of health interventions and therefore provides information about the efficiency of attainment of both major objectives of a health system: improved health and financial risk protection. One intervention might rank higher on one or both metrics than another, which shows how intervention choice—the selection of a pathway to universal health coverage—might involve weighing up of sometimes competing objectives. This understanding can help policy makers to select interventions to target specific policy goals (ie, improved health or financial risk protection). It is especially relevant for the design and sequencing of universal health coverage to meet the needs of poor populations. ; publishedVersion