National tuberculosis spending efficiency and its associated factors in 121 low-income and middle-income countries, 2010–19: a data envelopment and stochastic frontier analysis

Jaoude, Gerard Joseph Abou; Baena, Ines Garcia; Nguhiu, Peter; Siroka, Andrew; Palmer, Tom; Goscé, Lara; Allel, Kasim; Sinanovic, Edina; Skordis‐Worrall, Jolene; Haghparast‐Bidgoli, Hassan

doi:10.1016/s2214-109x(22)00085-7

Cited by 19 publications

(17 citation statements)

References 29 publications

(45 reference statements)

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“…Also, high HIV-burden countries had the highest levels of inputs and output in our analyses which is driving the efficiency scores resulting in a better distribution of the resources (Fig F of Section B in S1 Text). Some of the least efficient countries identified here, such as Guinea-Bissau or the Central African Republic, were also found to be among the least efficient in recent DEA analyses of TB spending [38] and spending for UHC [37]-both of which use the Simar-Wilson approach. Similarly, some of the most efficient countries identified in this analysis, such as Rwanda or Zimbabwe, are also among the most efficient in the analyses of TB and UHC spending.…”

Section: Plos Global Public Healthmentioning

confidence: 61%

“…The two-stage double-bootstrap DEA approach, developed by Simar-Wilson [40,41], is used in this paper to explore how different country-level independent variables are associated with higher or lower efficiency scores. The Simar-Wilson double-bootstrap approach is increasingly being used to investigate technical efficiency in the health sector [19,28,37,38]. In the first stage, this linear programming approach adjusts initial efficiency scores by the potential biases caused by other independent variables.…”

Section: Discussionmentioning

confidence: 99%

“…This generated 581 observations in total. We used a different set of country-level characteristics as inputs, outputs, and independent variables for our main analysis following recent literature [19,22,[36][37][38] that we describe below. Finally, some auxiliary variables were only used for a posterior sensitivity analysis.…”

Section: Sample and Main Data Sourcesmentioning

confidence: 99%

“…To investigate the robustness of our main model technical inefficiency scores (reciprocal of efficiency), we carried out two sensitivity analyses. In the first analysis, we tested three different models by including auxiliary variables that have been relevant in the literature [22,36,38] but contained substantial missing data that had to be imputed. First, we added the number of…”

Section: Sensitivity Analysismentioning

confidence: 99%

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Technical efficiency of national HIV/AIDS spending in 78 countries between 2010 and 2018: A data envelopment analysis

Allel

Jaoude

Birungi

et al. 2022

PLOS Glob Public Health

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HIV/AIDS remains a leading global cause of disease burden, especially in low- and middle-income countries (LMICs). In 2020, more than 80% of all people living with HIV (PLHIV) lived in LMICs. While progress has been made in extending coverage of HIV/AIDS services, only 66% of all PLHIV were virally suppressed at the end of 2020. In addition to more resources, the efficiency of spending is key to accelerating progress towards global 2030 targets for HIV/AIDs, including viral load suppression. This study aims to estimate the efficiency of HIV/AIDS spending across 78 countries. We employed a data envelopment analysis (DEA) and a truncated regression to estimate the technical efficiency of 78 countries, mostly low- and middle-income, in delivering HIV/AIDS services from 2010 to 2018. Publicly available data informed the model. We considered national HIV/AIDS spending as the DEA input, and prevention of mother to child transmission (PMTCT) and antiretroviral treatment (ART) as outputs. The model was adjusted by independent variables to account for country characteristics and investigate associations with technical efficiency. On average, there has been substantial improvement in technical efficiency over time. Spending was converted into outputs almost twice as efficiently in 2018 (81.8%; 95% CI = 77.64, 85.99) compared with 2010 (47.5%; 95% CI = 43.4, 51.6). Average technical efficiency was 66.9% between 2010 and 2018, in other words 33.1% more outputs could have been produced relative to existing levels for the same amount of spending. There is also some variation between WHO/UNAIDS regions. European and Eastern and Southern Africa regions converted spending into outputs most efficiently between 2010 and 2018. Rule of Law, Gross National Income, Human Development Index, HIV prevalence and out-of-pocket expenditures were all significantly associated with efficiency scores. The technical efficiency of HIV investments has improved over time. However, there remains scope to substantially increase HIV/AIDS spending efficiency and improve progress towards 2030 global targets for HIV/AIDS. Given that many of the most efficient countries did not meet 2020 global HIV targets, our study supports the WHO call for additional investment in HIV/AIDS prevention and control to meet the 2030 HIV/AIDS and eradication of the AIDS epidemic.

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Section: Plos Global Public Healthmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Sample and Main Data Sourcesmentioning

confidence: 99%

Section: Sensitivity Analysismentioning

confidence: 99%

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Technical efficiency of national HIV/AIDS spending in 78 countries between 2010 and 2018: A data envelopment analysis

Allel

Jaoude

Birungi

et al. 2022

PLOS Glob Public Health

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“…The remaining studies were done in low- and lower-middle-income countries with high burden of disease. More than 90% of reported TB infections occur in low- and middle-income countries [ 102 ]. Low-income contexts tend to be more prone to racial issues inside and outside prisons.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of TB in prisoners: a metanalysis of the prevalence of active and latent TB

et al. 2023

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Background Tuberculosis (TB) in prisons usually occurs at higher rates than in the general population, especially in developing countries. TB has been reported as the most common cause of death among prisoners. Studies have shown limitations for early detection of TB in prisons that seem to result from mistaken concepts about TB, delayed diagnosis mainly due to the naturalization of lack of healthcare for this population Methods A scoping review was performed using the methodology of the Joanna Briggs Institute to assess “What are the scientific evidences on the epidemiology of TB in the prison system?”. Then, a meta-analysis was performed to assess the prevalence of TB (active and latent) TB in prisoners. The results are presented as prevalence, in percentage, through random effects models, with a confidence interval of 95%. Results Regarding active TB, the results of the metanalysis showed that countries with a high burden of TB had a prevalence of 3.54% [2.71; 4.63], countries not considered to be high burden TB countries had a prevalence of 1.43% [0.86; 2.37]. Latent TB had a prevalence of 51.61% [39.46; 63.58] in high TB burden countries and a prevalence of 40.24% [23.51; 59.61] in countries with low TB burden. In terms of development, in low- and lower-middle-income countries, the prevalence of active TB was 3.13% [1.84; 5.29] and in high- and upper-middle income countries the prevalence was 2.25% [1.70; 2.99]. The prevalence of latent TB in high- and middle-income countries was 43.77% [28.61; 60.18] and of 49.42% [45.91; 52.94] in low and lower middle-income countries. Conclusion Our analysis suggests that TB, and probably other infectious diseases, find fertile ground in prisons where previous acquire social disadvantages seem to thrive—therefore, TB in prisons is a global public health problem and effective strategies are needed to control the disease are needed targeting the prison environment, including rapid health assessments to understand each context and to implement tailored and precision interventions.

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Education, Research, and Outreach on SDG 3, SDG 6, and SDG 13 for Future Sustainability

Koh

Teh

2023

SDGs in the Asia and Pacific Region

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National tuberculosis spending efficiency and its associated factors in 121 low-income and middle-income countries, 2010–19: a data envelopment and stochastic frontier analysis

Cited by 19 publications

References 29 publications

Technical efficiency of national HIV/AIDS spending in 78 countries between 2010 and 2018: A data envelopment analysis

Technical efficiency of national HIV/AIDS spending in 78 countries between 2010 and 2018: A data envelopment analysis

Epidemiology of TB in prisoners: a metanalysis of the prevalence of active and latent TB

Education, Research, and Outreach on SDG 3, SDG 6, and SDG 13 for Future Sustainability

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