Suchergebnisse

BACKGROUND AND AIMS: To reduce hepatitis C virus (HCV) transmission among people who inject drugs (PWID), Scottish Government-funded national strategies, launched in 2008, promoted scaling-up opioid substitution therapy (OST) and needle and syringe provision (NSP), with some increases in HCV treatment. We test whether observed decreases in HCV incidence post-2008 can be attributed to this intervention scale-up. DESIGN: A dynamic HCV transmission model amongst PWID incorporating intervention scale-up and observed decreases in behavioural risk, calibrated to Scottish HCV prevalence and incidence data for 2008/09. SETTING: Scotland, UK PARTICIPANTS: PWID MEASUREMENTS: Model projections from 2008–2015 were compared with data to test whether they were consistent with observed decreases in HCV incidence amongst PWID while incorporating the observed intervention scale-up, and to determine the impact of scaling-up interventions on incidence. FINDINGS: Without fitting to epidemiological data post-2008/09, the model incorporating observed intervention scale-up agreed with observed decreases in HCV incidence amongst PWID between 2008–2015, suggesting HCV incidence decreased by 61.3% (95% credibility interval 45.1–75.3%) from 14.2/100pyrs (9.0–20.7) to 5.5/100pyrs (2.9–9.2). On average, each model fit lay within 84% (10.1/12) of the confidence bounds for the 12 incidence data points which the model was compared against. We estimate that scale-up of interventions (OST+NSP+HCV treatment) and decreases in high-risk behaviour from 2008–2015 resulted in a 33.9% (23.8–44.6%) decrease in incidence, with the remainder (27.4% (17.6–37.0%)) explained by historical changes in OST+NSP coverage and risk pre-2008. Projections suggest scaling-up of all interventions post-2008 averted 1,492 (657–2,646) infections over 7-years, with 1,016 (308–1,996), 404 (150–836) and 72 (27–137) due to scale-up of OST+NSP, decreases in high-risk behaviour, and HCV treatment, respectively. CONCLUSIONS: Most of the decline in hepatitis C virus (HCV) ...

Background The Kenyan government, working with international partners and local organizations, has developed an eHealth strategy, specified standards, and guidelines for electronic health record (EHR) adoption in public hospitals and implemented two major health information technology (IT) projects: District Health Information Software Version 2 (DHIS2), for collating national health care indicators and a rollout of the KenyaEMR and International Quality Care Health Management Information Systems, for managing 600 HIV clinics across the country. Following these projects, a modified version of the Open Medical Record System EHR was specified and developed to fulfill the clinical and administrative requirements of health care facilities operated by devolved counties in Kenya and to automate the process of collating health care indicators and entering them into the DHIS2 system. Objective We aimed to present a descriptive case study of the implementation of an open source EHR system in public health care facilities in Kenya. Methods We conducted a landscape review of existing literature concerning eHealth policies and EHR development in Kenya. Following initial discussions with the Ministry of Health, the World Health Organization, and implementing partners, we conducted a series of visits to implementing sites to conduct semistructured individual interviews and group discussions with stakeholders to produce a historical case study of the implementation. Results This case study describes how consultants based in Kenya, working with developers in India and project stakeholders, implemented the new system into several public hospitals in a county in rural Kenya. The implementation process included upgrading the hospital IT infrastructure, training users, and attempting to garner administrative and clinical buy-in for adoption of the system. The initial deployment was ultimately scaled back due to a complex mix of sociotechnical and administrative issues. Learning from these early challenges, the system is now being ...

Background and Aims: To reduce hepatitis C virus (HCV) transmission among people who inject drugs (PWID), Scottish Government-funded national strategies, launched in 2008, promoted scaling-up opioid substitution therapy (OST) and needle and syringe provision (NSP), with some increases in HCV treatment. We test whether observed decreases in HCV incidence post-2008 can be attributed to this intervention scale-up. Design: A dynamic HCV transmission model among PWID incorporating intervention scale-up and observed decreases in behavioural risk, calibrated to Scottish HCV prevalence and incidence data for 2008/09. Setting: Scotland, UK. Participants: PWID. Measurements: Model projections from 2008 to 2015 were compared with data to test whether they were consistent with observed decreases in HCV incidence among PWID while incorporating the observed intervention scale-up, and to determine the impact of scaling-up interventions on incidence. Findings: Without fitting to epidemiological data post-2008/09, the model incorporating observed intervention scale-up agreed with observed decreases in HCV incidence among PWID between 2008 and 2015, suggesting that HCV incidence decreased by 61.3% [95% credibility interval (CrI) = 45.1–75.3%] from 14.2/100 person-years (py) (9.0–20.7) to 5.5/100 py (2.9–9.2). On average, each model fit lay within 84% (10.1/12) of the confidence bounds for the 12 incidence data points against which the model was compared. We estimate that scale-up of interventions (OST + NSP + HCV treatment) and decreases in high-risk behaviour from 2008 to 2015 resulted in a 33.9% (23.8–44.6%) decrease in incidence, with the remainder [27.4% (17.6–37.0%)] explained by historical changes in OST + NSP coverage and risk pre-2008. Projections suggest that scaling-up of all interventions post-2008 averted 1492 (657–2646) infections over 7 years, with 1016 (308–1996), 404 (150–836) and 72 (27–137) due to scale-up of OST + NSP, decreases in high-risk behaviour and HCV treatment, respectively. Conclusions: Most of the decline in hepatitis C virus (HCV) incidence in Scotland between 2008 and 2015 appears to be attributable to intervention scale-up (opioid substitution therapy and needle and syringe provision) due to government strategies on HCV and drugs.