Global Health Division, International Development Group, RTI International, Washington, District of Colombia, United States of America.
Global Health Division, International Development Group, RTI International, Atlanta, Georgia, United States of America.
PLoS Negl Trop Dis. 2019 Sep 5;13(9):e0007605. doi: 10.1371/journal.pntd.0007605. eCollection 2019 Sep.
Although trachoma causes more cases of preventable blindness than any other infectious disease, a combination of strategies is reducing its global prevalence. As a district moves toward eliminating trachoma as a public health problem, national programs conduct trachoma impact surveys (TIS) to assess whether to stop preventative interventions and trachoma surveillance surveys (TSS) to determine whether the prevalence of active trachoma has rebounded after interventions have halted. In some contexts, programs also conduct trachomatous trichiasis (TT)-only surveys. A few costing studies of trachoma prevalence surveys exist, but none examine TIS, TSS, or TT-only surveys.
METHODOLOGY/PRINCIPAL FINDINGS: We assessed the incremental financial cost to the national program of TIS, TSS, and TT-only surveys, which are standardized cluster-sampled prevalence surveys. We conducted a retrospective review of expenditures and grant disbursements for TIS and TSS in 322 evaluation units in 11 countries between 2011 and 2018. We also assessed the costs of three pilot and five standard TT-only surveys in four countries between 2017 and 2018. The median cost of TIS and TSS was $8,298 per evaluation unit [interquartile range (IQR): $6,532-$10,111, 2017 USD]. Based on a linear regression with bootstrapped confidence intervals, after controlling for country, costs per survey did not change significantly over time but did decline by $83 per survey implemented in a single round (95% CI: -$108 --$63). Of total costs, 80% went to survey fieldwork; of that, 58% went towards per diems and 38% towards travel. TT-only surveys cost a median of $9,707 (IQR: $8,537-$11,635); within a given country, they cost slightly more (106% [IQR: 94%-136%]) than TIS and TSS.
CONCLUSIONS/SIGNIFICANCE: The World Health Organization requires trachoma prevalence estimates for validating the elimination of trachoma as a public health problem. This study will help programs improve their planning as they assemble resources for that effort.
虽然沙眼导致的可预防盲病例数超过任何其他传染病，但多种策略的结合正在降低其全球患病率。随着一个地区向消除沙眼这一公共卫生问题迈进，国家项目会进行沙眼影响调查（TIS），以评估是否停止预防干预措施，以及沙眼监测调查（TSS），以确定干预措施停止后活动性沙眼的流行率是否反弹。在某些情况下，项目还会进行单纯性沙眼性倒睫（TT）调查。已有一些关于沙眼患病率调查的成本研究，但没有研究 TIS、TSS 或 TT 仅调查。
方法/主要发现：我们评估了 TIS、TSS 和 TT 仅调查（这三种都是标准化的聚类抽样患病率调查）给国家项目带来的额外财务成本。我们对 2011 年至 2018 年间 11 个国家的 322 个评估单位的 TIS 和 TSS 支出和赠款支付情况进行了回顾性审查。我们还评估了 2017 年至 2018 年间四个国家的三次试点和五次 TT 仅调查的成本。TIS 和 TSS 的中位成本为每个评估单位 8298 美元（四分位距[IQR]：6532-10111，2017 年美元）。基于 bootstrap 置信区间的线性回归，在控制国家因素后，调查成本并未随时间显著变化，但在一轮中实施的调查数量每增加一次，成本会下降 83 美元（95%CI：-108 美元至-63 美元）。总费用的 80%用于调查实地工作；其中，58%用于每日津贴，38%用于差旅。TT 仅调查的中位成本为 9707 美元（IQR：8537-11635）；在一个给定的国家内，其成本略高于 TIS 和 TSS（106%[IQR：94%-136%]）。
结论/意义：世界卫生组织要求提供沙眼患病率估计值，以验证消除沙眼这一公共卫生问题的成效。本研究将帮助项目在为这一工作筹集资源时，改善规划。
