19 results found
Thomas R, Friebel R, Barker K, et al., 2019, Work and home productivity of people living with HIV in Zambia and South Africa., AIDS, Vol: 33, Pages: 1063-1071
OBJECTIVE: To compare number of days lost to illness or accessing healthcare for HIV-positive and HIV-negative individuals working in the informal and formal sectors in South Africa and Zambia. DESIGN: As part of the HPTN 071 (PopART) study, data on adults aged 18-44 years were gathered from cross-sectional surveys of random general population samples in 21 communities in Zambia and South Africa. Data on the number of productive days lost in the last 3 months, laboratory-confirmed HIV status, labour force status, age, ethnicity, education, and recreational drug use was collected. METHODS: Differences in productive days lost between HIV-negative and HIV-positive individuals ('excess productive days lost') were estimated with negative binomial models, and results disaggregated for HIV-positive individuals after various durations on antiretroviral treatment (ART). RESULTS: From samples of 19 330 respondents in Zambia and 18 004 respondents in South Africa, HIV-positive individuals lost more productive days to illness than HIV-negative individuals in both countries. HIV-positive individuals in Zambia lost 0.74 excess productive days [95% confidence interval (CI) 0.48-1.01; P < 0.001] to illness over a 3-month period. HIV-positive in South Africa lost 0.13 excess days (95% CI 0.04-0.23; P = 0.007). In Zambia, those on ART for less than 1 year lost most days, and those not on ART lost fewest days. In South Africa, results disaggregated by treatment duration were not statistically significant. CONCLUSION: There is a loss of work and home productivity associated with HIV, but it is lower than existing estimates for HIV-positive formal sector workers. The findings support policy makers in building an accurate investment case for HIV interventions.
Li Donni P, Thomas R, Latent class models for multiple ordered categorical health data: Testing violation of the local independence assumption, Empirical Economics, ISSN: 0377-7332
Hauck K, Morton A, Chalkidou K, et al., 2019, How can we evaluate the cost-effectiveness of health system strengthening? A typology and illustrations, SOCIAL SCIENCE & MEDICINE, Vol: 220, Pages: 141-149, ISSN: 0277-9536
Schaefer R, Thomas R, Nyamukapa C, et al., 2018, Accuracy of HIV Risk Perception in East Zimbabwe 2003-2013., AIDS Behav
Risk perception for HIV infection is an important determinant for engaging in HIV prevention behaviour. We investigate the degree to which HIV risk perception is accurate, i.e. corresponds to actual HIV infection risks, in a general-population open-cohort study in Zimbabwe (2003-2013) including 7201 individuals over 31,326 person-years. Risk perception for future infection (no/yes) at the beginning of periods between two surveys was associated with increased risk of HIV infection (Cox regression hazard ratio = 1.38 [1.07-1.79], adjusting for socio-demographic characteristics, sexual behaviour, and partner behaviour). The association was stronger among older people (25+ years). This suggests that HIV risk perception can be accurate but the higher HIV incidence (1.27 per 100 person-years) illustrates that individuals may face barriers to HIV prevention behaviour even when they perceive their risks. Gaps in risk perception are underlined by the high incidence among those not perceiving a risk (0.96%), low risk perception even among those reporting potentially risky sexual behaviour, and, particularly, lack of accuracy of risk perception among young people. Innovative interventions are needed to improve accuracy of risk perception but barriers to HIV prevention behaviours need to be addressed too, which may relate to the partner, community, or structural factors.
Thomas R, Burger R, Hauck K, 2018, Richer, wiser and in better health? The socioeconomic gradient inhypertension prevalence, unawareness and control in South Africa, Social Science and Medicine, Vol: 217, Pages: 18-30, ISSN: 0277-9536
The socioeconomic gradient in chronic conditions is clear in the poorest and wealthiest of countries, but extant evidence on this relationship in low- and middle-income countries is inconclusive. We use data gathered between 2008-2012 from a nationally representative sample of over 10,000 South African adults, and objective health measures to analyse the differential effects of education, income and other factors on the prevalence of hypertension, individuals' awareness and control of hypertensive status. Prevalence of hypertension is high at 38% amongwomen and 34% among men. 59% of hypertensive individuals are unaware of their status. We and prevalence and unawareness of hypertension are a public health concern across all incomegroups in South Africa. Higher income is however associated with effective control amongst men. Completing secondary education is associated with 7 mmHg lower blood pressure only in a small sub-group of women but is associated with 22 percentage point higher likelihoodof effective hypertension control amongst women. We conclude that poorer and less educated individuals are particularly at high risk of cardiovascular disease in South Africa.
Morton A, Arulselvan A, Thomas R, 2018, Allocation rules for global donors, JOURNAL OF HEALTH ECONOMICS, Vol: 58, Pages: 67-75, ISSN: 0167-6296
Thomas R, Burger R, Harper A, et al., 2017, Differences in health-related quality of life between HIV-positive and HIV-negative people in Zambia and South Africa: a cross-sectional baseline survey of the HPTN 071 (PopART) trial, LANCET GLOBAL HEALTH, Vol: 5, Pages: E1133-E1141, ISSN: 2214-109X
Cundale K, Thomas R, Malaya JK, et al., 2017, A health intervention or a kitchen appliance? Household costs and benefits of a cleaner burning biomass-fuelled cookstove in Malawi, SOCIAL SCIENCE & MEDICINE, Vol: 183, Pages: 1-10, ISSN: 0277-9536
Hauck K, Thomas R, Smith PC, 2017, Beyond cost-effectiveness: Health systems constraints to delivery of a health benefits package, What's In, What's Out: Designing Benefits for Universal Health Coverage, Pages: 201-213, ISBN: 9781933286891
Thomas RA, Chalkidou K, 2016, Cost–effectiveness analysis, Health System Efficiency How to Make Measurement Matter for Policy and Management, Editors: Smith, Cylus, Papanicolas, Publisher: European Observatory on Health Systems and Policies, ISBN: 9789289050418
In this book the authors explore the state of the art on efficiency measurement in health systems and international experts offer insights into the pitfalls and potential associated with various measurement techniques.
Morton A, Thomas R, Smith PC, 2016, Decision rules for allocation of finances to health systems strengthening, JOURNAL OF HEALTH ECONOMICS, Vol: 49, Pages: 97-108, ISSN: 0167-6296
Heffernan A, Barber E, Thomas R, et al., 2016, Impact and Cost-Effectiveness of Point-Of-Care CD4 Testing on the HIV Epidemic in South Africa, PLOS ONE, Vol: 11, ISSN: 1932-6203
Fenton R, Nyamukapa C, Gregson S, et al., 2016, Wealth differentials in the impact of conditional and unconditional cash transfers on education: findings from a community-randomised controlled trial in Zimbabwe, PSYCHOLOGY HEALTH & MEDICINE, Vol: 21, Pages: 909-917, ISSN: 1354-8506
Hauck K, Thomas R, Smith PC, 2016, Departures from Cost-Effectiveness Recommendations: The Impact of Health System Constraints on Priority Setting, HEALTH SYSTEMS & REFORM, Vol: 2, Pages: 61-70, ISSN: 2328-8604
Thomas R, 2012, CONDITIONAL CASH TRANSFERS TO IMPROVE EDUCATION AND HEALTH: AN EX ANTE EVALUATION OF RED DE PROTECCION SOCIAL, NICARAGUA, Publisher: WILEY-BLACKWELL
Thomas R, 2012, CONDITIONAL CASH TRANSFERS TO IMPROVE EDUCATION AND HEALTH: AN EX ANTE EVALUATION OF RED DE PROTECCIÓN SOCIAL, NICARAGUA, Health Economics, Vol: 21, Pages: 1136-1154, ISSN: 1057-9230
Jones AM, Squire L, Thomas R, 2010, EVALUATING INNOVATIVE HEALTH PROGRAMS INTRODUCTION, HEALTH ECONOMICS, Vol: 19, Pages: 1-4, ISSN: 1057-9230
Thomas R, Jones A, Squire L, 2010, Methods for Evaluating Innovative Health Programs: a multi-country study, Journal of Development Effectiveness, Vol: 2, Pages: 504-520
Designed as a global research initiative, the Evaluating Innovative Health Programs project aims at adding to the evidence base of health interventions that have the potential to improve health outcomes in Africa and Asia. The project focuses on rigorous, quantitative evaluations of innovative local initiatives that address the Millennium Development Goals for health: reductions in child and maternal mortality and communicable diseases. This overview brings together the outcomes and lessons from the project for evaluation methods. It draws together the methodological implications of carrying out impact evaluations under very different settings and emphasises the need to build evaluations into project designs.
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