La vie associative antillo-guyanaise oscille entre deux pôles : ressourcement identitaire plus ou moins élaboré d'une diaspora (soirée zouks, promotion de productions culturelles) et lutte contre des problèmes spécifiques à l'échelle locale (soutien scolaire, aide sociale). Fractionnées et souvent concurrentes, les activités proposées restent cependant largement impuissantes à structurer une «communauté» particulièrement éclatée.
Political economy report brings together results from tasks 1 and 2 of WP11 and further develops the economic, ethical and health policy analyses. The first part of this report offers a thorough micro-economic analysis of decrementally cost-effective interventions (d-CEIs) in order to identify their distinctive characteristics and their welfare properties. It focuses on one of the most central questions, namely the symmetry between willingness to accept and willingness to pay, and addresses the controversy on the slopes of the thresholds in the N-E and S-W quadrants. The second part consists of an inquiry into the ethics of d-CEIs. It questions the validity of the justification often used by policy-makers for not considering d-CEIs: their unethical nature. The third part analyses health policy in the making, by documenting HTA bodies' willingness to adopt d-CEIs whose cost-effectiveness has been scientifically established. The fourth part of this report presents the quantitative and qualitative results of the discrete choice experiment specifically designed for this research project.
AbstractIntroductionFrequent HIV testing of at‐risk individuals is crucial to detect and treat infections early and prevent transmissions. We assessed the effect of reminders on HIV retesting uptake.MethodsThe study was conducted within a programme involving four facilities providing free‐of‐charge HIV, syphilis and hepatitis B and C testing and counselling in northern Thailand. Individuals found HIV negative and identified at risk by counsellors were invited to participate in a three‐arm, open‐label, randomized, controlled trial comparing: (a) "No Appointment & No Reminder" (control arm); (b) "No Appointment but Reminder": short message service (SMS) sent 24 weeks after the enrolment visit to remind booking an appointment, and sent again one week later if no appointment was booked; and (c) "Appointment & Reminder": appointment scheduled during the enrolment visit and SMS sent one week before appointment to ask for confirmation; if no response: single call made within one business day. The primary endpoint was a HIV retest within seven months after the enrolment visit. The cost of each reminder strategy was calculated as the sum of the following costs in United States dollars (USD): time spent by participants, counsellors and hotline staff; phone calls made; and SMS sent. The target sample size was 217 participants per arm (651 overall).ResultsBetween April and November 2017, 651 participants were randomized. The proportion presenting for HIV retesting within seven months was 11.2% (24/215) in the control arm, versus 19.3% (42/218) in "No Appointment but Reminder" (p = 0.023) and 36.7% (80/218) in "Appointment & Reminder" (p < 0.001). Differences in proportions compared to the control arm were respectively +8.1% (95% CI: +1.4% to +14.8%) and +25.5% (+17.9% to +33.2%). The incremental cost‐effectiveness ratios of "No Appointment but Reminder" and "Appointment & Reminder" compared to the control arm were respectively USD 0.05 and USD 0.14 per participant for each 5% increase in HIV retesting uptake within seven months.ConclusionsScheduling an appointment and sending a reminder one week before was a simple, easy‐to‐implement and affordable intervention that significantly increased HIV retesting uptake in these at‐risk individuals. The personal phone call to clients probably contributed, and also improved service efficiency.
