Suchergebnisse

Cover -- LITERARY CONJUGATIONS -- Title -- Copyright -- CONTENTS -- Introduction -- PART ONE: ECONOMICS AND INTELLECTUAL CULTURE -- Chapter 1 / Buying into Signs: Money and Semiosis in Eighteenth-Century German Language Theory -- Exchanging Words for Money and Money for Words -- Ambivalent Economics in Eighteenth-Century German Theories of Language -- Economics and the Paradigm Shift in Linguistic Theory -- Chapter 2 / Hypersign, Hypermoney, Hypermarket: Adam Müller's Theory of Money and Romantic Semiotics -- Thoroughly Contrary Müller -- Fiduciary Money and the Hypermarket of Incessant Circulation -- The Differential Nature of Monetary Signs and Economic Values -- Müller's Economic Theory and Romantic Semiotics -- Economics and the Poetic Imagination -- Chapter 3 / Economic Romanticism: Monetary Nationalism in Johann Gottlieb Fichte and Adam Müller -- German Economic Nationalism -- Monetary Nationhood in Fichte's Der geschlossene Handelsstaat -- Monetary Nationalism and German Transcendental Idealism -- Adam Müller, "Credit," and the Monetarized Nation -- Chapter 4 / Economics and the Imagination: Cultural Values and the Debate over Physiocracy in Germany, 1770-1789 -- The German Debate over Physiocracy -- The Theory and Practice of Physiocracy in German-Speaking Europe -- Productivity, Nature, Surplus Value -- The Dual Character of Value and the Commodity -- Johann Georg Schlosser: The Imaginary Value of Imaginary Things -- From Mimesis to Imagination -- Economics and Aesthetics of the Imagination -- PART TWO: LITERARY ECONOMIES -- Chapter 5 / Counting on God: Economic Providentialism in Johann Heinrich Jung-Stilling's Lebensgeschichte -- Social Climbing: The Metamorphoses of Johann Heinrich Jung-Stilling -- "Forgive Us Our Debts": Providentialism as Ideological Mask for Personal Ambition

AbstractIntroductionSimplified hepatitis C virus (HCV) diagnostic strategies have the potential to improve HCV diagnoses and treatment. We aimed to investigate the impact of simplified HCV diagnostic strategies on HCV incidence and its effect on HCV diagnosis and treatment among men who have sex with men (MSM) regardless of HIV status and use of HIV pre‐exposure prophylaxis (PrEP) in Taiwan.MethodsA compartmental deterministic model was developed to describe the natural history of HCV disease progression, the HCV care cascade and the HIV status and PrEP using among MSM. The model was calibrated to available data for HCV and HIV epidemiology and population demographics in Taiwan. We simulated the epidemic from 2004 and projected the impact of simplified testing strategies on the HCV epidemic among MSM over 2022–2030.ResultsUnder the current testing approach in Taiwan, total HCV incidence would increase to 12.6 per 1000 person‐years among MSM by 2030. Single‐visit point‐of‐care RNA testing had the largest impact on reducing the number of new HCV infections over 2022–2030, with a 31.1% reduction (interquartile range: 24.9%−32.8%). By 2030, single‐visit point‐of‐care HCV testing improved HCV diagnosis to 90.9%, HCV treatment to 87.7% and HCV cure to 81.5% among MSM living with HCV. Compared to status quo, prioritized simplified HCV testing for PrEP users and MSM living with diagnosed HIV had considerable impact on the broader HCV epidemic among MSM. A sensitivity analysis suggests that reinfection risk would have a large impact on the effectiveness of each point‐of‐care testing scenario.ConclusionsSimplified HCV diagnostic strategies could control the ongoing HCV epidemic and improve HCV testing and treatment among Taiwanese MSM. Single‐visit point‐of‐care RNA testing would result in large reductions in HCV incidence and prevalence among MSM. Efficient risk‐reduction strategies will need to be implemented alongside point‐of‐care testing to achieve HCV elimination among MSM in Taiwan.

IntroductionIt is increasingly important to prioritize the most cost‐effective HIV interventions. We sought to summarize the evidence on which types of interventions provide the best value for money in regions with concentrated HIV epidemics.MethodsWe conducted a systematic review of peer‐reviewed and grey literature reporting measurements of cost‐effectiveness or cost‐benefit for HIV/AIDS interventions in Asia and Eastern Europe. We also collated HIV/AIDS spending assessment data from case‐study countries in the region.ResultsWe identified 91 studies for inclusion, 47 of which were from peer‐reviewed journals. Generally, in concentrated settings, prevention of mother‐to‐child transmission programmes and prevention programmes targeting people who inject drugs and sex workers had lower incremental cost‐effectiveness ratios than programmes aimed at the general population. The few studies evaluating programmes targeting men who have sex with men indicate moderate cost‐effectiveness. Collation of prevention programme spending data from 12 countries in the region (none of which had generalized epidemics) indicated that resources for the general population/non‐targeted was greater than 30% for eight countries and greater than 50% for five countries.ConclusionsThere is a misalignment between national spending on HIV/AIDS responses and the most affected populations across the region. In concentrated epidemics, scarce funding should be directed more towards most‐at‐risk populations. Reaching consensus on general principles of cost‐effectiveness of programmes by epidemic settings is difficult due to inconsistent evaluation approaches. Adopting a standard costing, impact evaluation, benefits calculation, analysis and reporting framework would enable cross comparisons and improve HIV resource prioritization and allocation.

AbstractIntroductionAustralia has set the goal for the virtual elimination of HIV transmission by the end of 2022, yet accurate information is lacking on the level of HIV transmission occurring among residents. We developed a method for estimating the timing of HIV acquisition among migrants, relative to their arrival in Australia. We then applied this method to surveillance data from the Australian National HIV Registry with the aim of ascertaining the level of HIV transmission among migrants to Australia occurring before and after migration, and to inform appropriate local public health interventions.MethodsWe developed an algorithm incorporating CD4+ T‐cell decline back‐projection and enhanced variables (clinical presentation, past HIV testing history and clinician estimate of the place of HIV acquisition) and compared it to a standard algorithm which uses CD4+ T‐cell back‐projection only. We applied both algorithms to all new HIV diagnoses among migrants to estimate whether HIV infection occurred before or after arrival in Australia.ResultsBetween 1 January 2016 and 31 December 2020, 1909 migrants were newly diagnosed with HIV in Australia, 85% were men, and the median age was 33 years. Using the enhanced algorithm, 932 (49%) were estimated to have acquired HIV after arrival in Australia, 629 (33%) before arrival (from overseas), 250 (13%) close to arrival and 98 (5%) were unable to be classified. Using the standard algorithm, 622 (33%) were estimated to have acquired HIV in Australia, 472 (25%) before arrival, 321 (17%) close to arrival and 494 (26%) were unable to be classified.ConclusionsUsing our algorithm, close to half of migrants diagnosed with HIV were estimated to have acquired HIV after arrival in Australia, highlighting the need for tailored culturally appropriate testing and prevention programmes to limit HIV transmission and achieve elimination targets. Our method reduced the proportion of HIV cases unable to be classified and can be adopted in other countries with similar HIV surveillance protocols, to inform epidemiology and elimination efforts.

IntroductionInternational investment in the response to HIV and AIDS has plateaued and its future level is uncertain. With many countries committed to ending the epidemic, it is essential to allocate available resources efficiently over different response periods to maximize impact. The objective of this study is to propose a technique to determine the optimal allocation of funds over time across a set of HIV programmes to achieve desirable health outcomes.MethodsWe developed a technique to determine the optimal time‐varying allocation of funds (1) when the future annual HIV budget is pre‐defined and (2) when the total budget over a period is pre‐defined, but the year‐on‐year budget is to be optimally determined. We use this methodology with Optima, an HIV transmission model that uses non‐linear relationships between programme spending and associated programmatic outcomes to quantify the expected epidemiological impact of spending. We apply these methods to data collected from Zambia to determine the optimal distribution of resources to fund the right programmes, for the right people, at the right time.Results and discussionConsidering realistic implementation and ethical constraints, we estimate that the optimal time‐varying redistribution of the 2014 Zambian HIV budget between 2015 and 2025 will lead to a 7.6% (7.3% to 7.8%) decrease in cumulative new HIV infections compared with a baseline scenario where programme allocations remain at 2014 levels. This compares to a 5.1% (4.6% to 5.6%) reduction in new infections using an optimal allocation with constant programme spending that recommends unrealistic programmatic changes. Contrasting priorities for programme funding arise when assessing outcomes for a five‐year funding period over 5‐, 10‐ and 20‐year time horizons.ConclusionsCountries increasingly face the need to do more with the resources available. The methodology presented here can aid decision‐makers in planning as to when to expand or contract programmes and to which coverage levels to maximize impact.

AbstractIntroductionWe determined the contribution of undiagnosed HIV to new infections among gay and bisexual men (GBM) over a 12‐year period in Australia where there has been increasing focus on improving testing and HIV treatment coverage.MethodsWe generated annual estimates for each step of the HIV cascade and the number of new HIV infections for GBM in Australia over 2004 to 2015 using relevant national data. Using Bayesian melding we then fitted a quantitative model to the cascade and incidence estimates to infer relative transmission coefficients associated with being undiagnosed, diagnosed and not on ART, on ART with unsuppressed virus, or on ART with suppressed virus.ResultsBetween 2004 and 2015, we estimated the percentage of GBM with HIV in Australia who were unaware of their status to have decreased from 14.5% to 7.5%. During the same period, there was a substantial increase in the number and proportion of GBM living with HIV on treatment and with suppressed virus, with the number of virally suppressed GBM increasing from around 3900 (30.2% of all GBM living with HIV) in 2004 to around 14,000 (73.7% of all GBM living with HIV) in 2015. Despite the increase in viral suppression, the annual number of new infections rose from around 660 to around 760 over this period. Our results have a wide range due to the uncertainty in the cascade estimates and transmission coefficients. Nevertheless, undiagnosed GBM increasingly appear to contribute to new infections. The proportion of new infections attributable to undiagnosed GBM almost doubled from 33% in 2004 to 59% in 2015. Only a small proportion (<7%) originated from GBM with suppressed virus.DiscussionOur study suggests that an increase in HIV treatment coverage in Australia has reduced the overall risk of HIV transmission from people living with HIV. However, the proportion of infections and the rate of transmission from undiagnosed GBM has increased substantially. These findings highlight the importance of HIV testing and intensified prevention for Australian GBM at high risk of HIV.

AbstractIntroductionDue to a lack of robust population denominators, Australia is unable to accurately monitor changes in the HIV epidemic for some populations. The ratio of HIV transmission relative to the number of people with HIV (an incidence prevalence ratio, or IPR) can measure such changes. The IPR is measured against an IPR benchmark derived from post‐HIV acquisition life expectancy, to indicate whether an HIV epidemic is shrinking or growing. Using IPRs and Australia‐specific IPR benchmarks, this study aims to describe the Australian HIV epidemic among three groups: men with HIV attributed to male‐to‐male sex, women with HIV and people with HIV attributed to injection drug use.MethodsUsing mathematical modelling derived from HIV notifications, cohort and administrative data, IPRs were generated for each of the three groups. These IPRs were compared with IPR benchmarks derived from post‐HIV acquisition mortality estimates using abridged life tables for men, women and people who inject drugs. The IPR benchmark for men was applied to people with HIV attributed to male‐to‐male sex. Trends in the IPR over time were described for each reported population from 2015 to 2022.ResultsOverall, the IPR fell by 80%, from 0.040 (range: 0.034−0.045) in 2015 to 0.008 (range: 0.003−0.013) in 2022 and fell below the benchmark (0.022) in 2020. Among people with HIV attributed to male‐to‐male sex, the IPR fell by 85%, from 0.041 (range: 0.034−0.047) in 2015 to 0.006 (range: 0.003−0.024) in 2022 and fell below the benchmark (0.022) in 2020. Among women with HIV, the IPR fell by 56%, from 0.032 (range: 0.026−0.039) in 2015 to 0.014 (range: 0.003−0.029) in 2022 and fell below the benchmark (0.022) in 2019. Among people with HIV attributed to injection drug use, the IPR fell by 61%, from 0.036 (range: 0.022−0.047) in 2015 to 0.014 (range: 0.002−0.057) in 2022 and fell below the benchmark (0.028) in 2019.ConclusionsAustralian IPRs in all populations examined have dropped below the level required to sustain the HIV epidemic at current levels. By applying this method in other contexts, the changing scale of HIV epidemics may be better described for populations lacking robust population denominators.