Browsing by Author "Reid, Andrew"

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    Cost Effectiveness Analysis of Clinically Driven versus Routine Laboratory Monitoring of Antiretroviral Therapy in Uganda and Zimbabwe
    (PloS one, 2012) Lara, Antonieta Medina; Kigozi, Jesse; Amurwon, Jovita; Muchabaiwa, Lazarus; Wakaholi, Barbara Nyanzi; Mota, Ruben E. Mujica; Walker, A. Sarah; Kasirye, Ronnie; Ssali, Francis; Reid, Andrew; Grosskurth, Heiner; Babiker, Abdel G.; Kityo, Cissy; Katabira, Elly; Munderi, Paula; Mugyenyi, Peter; Hakim, James; Darbyshire, Janet; Gibb, Diana M.; Gilks, Charles F.
    Despite funding constraints for treatment programmes in Africa, the costs and economic consequences of routine laboratory monitoring for efficacy and toxicity of antiretroviral therapy (ART) have rarely been evaluated.Cost-effectiveness analysis was conducted in the DART trial (ISRCTN13968779). Adults in Uganda/Zimbabwe starting ART were randomised to clinically-driven monitoring (CDM) or laboratory and clinical monitoring (LCM); individual patient data on healthcare resource utilisation and outcomes were valued with primary economic costs and utilities. Total costs of first/second-line ART, routine 12-weekly CD4 and biochemistry/haematology tests, additional diagnostic investigations, clinic visits, concomitant medications and hospitalisations were considered from the public healthcare sector perspective. A Markov model was used to extrapolate costs and benefits 20 years beyond the trial.3316 (1660LCM;1656CDM) symptomatic, immunosuppressed ART-naive adults (median (IQR) age 37 (32,42); CD4 86 (31,139) cells/mm3) were followed for median 4.9 years. LCM had a mean 0.112 year (41 days) survival benefit at an additional mean cost of $765 [95%CI:685,845], translating into an adjusted incremental cost of $7386 [3277,dominated] per life-year gained and $7793 [4442,39179] per quality-adjusted life year gained. Routine toxicity tests were prominent cost-drivers and had no benefit. With 12-weekly CD4 monitoring from year 2 on ART, low-cost second-line ART, but without toxicity monitoring, CD4 test costs need to fall below $3.78 to become cost-effective (<3xper-capita GDP, following WHO benchmarks). CD4 monitoring at current costs as undertaken in DART was not cost-effective in the long-term.There is no rationale for routine toxicity monitoring, which did not affect outcomes and was costly. Even though beneficial, there is little justification for routine 12-weekly CD4 monitoring of ART at current test costs in low-income African countries. CD4 monitoring, restricted to the second year on ART onwards, could be cost-effective with lower cost second-line therapy and development of a cheaper, ideally point-of-care, CD4 test.
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    Local communities, politics and the management of the Kasubi tombs, Uganda
    (World Archaeology, 2007) Kigongo, Remigius; Reid, Andrew
    The Kasubi tombs are the resting place of the previous four kings of Buganda. All four kings are buried within the Muzibu-Azaala-Mpanga, a unique structure which offers an unparalleled insight into the precolonial building traditions of Uganda. Being constructed almost entirely from various materials of botanical origin, there are considerable issues of preservation and conservation that have to be tackled at the site. Yet management of the site is by no means a straightforward process because of a number of issues. The original burial of Mutesa I in 1884 represented a shift in funerary practice related to the politics of the time and the interment of the subsequent three kings was a major change in practice, unseen in precolonial times. There is also currently significant factional fighting within Buganda over control of the tombs and the important rituals that continue to take place there. Meanwhile, national government wishes to use Kasubi as the showpiece of Uganda's heritage, as demonstrated by its recently acquired World Heritage status, but has no authority to oversee any form of management activity at the site. Kasubi is therefore not a mere symbol of precolonial achievement, but also of colonial transformation and ultimately of post-colonial accommodation.