The US President's Malaria Initiative, Plasmodium falciparum transmission and mortality: A modelling study.
The US President's Malaria Initiative, Plasmodium falciparum transmission and mortality: A modelling study.
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DOI：
10.1371/journal.pmed.1002448
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发表时间：
2017-11
期刊：
影响因子：
15.8
通讯作者：
Walker PGT
中科院分区：
文献类型：
--
作者：
Winskill P;Slater HC;Griffin JT;Ghani AC;Walker PGT
尽管近年来在减少全球疟疾传播方面取得了重大进展，但仍有大量人面临风险，因此取得的成果是脆弱的。供资远远落后于保护所有面临风险者所需的数额，而主要捐助者的持续捐助，如总统疟疾倡议，对于保持进展和进一步减轻负担至关重要。我们使用数学建模方法来估计PMI投资迄今在减少疟疾负担方面的影响，并探讨如果PMI资金减少44%，对疟疾负担的潜在负面影响。我们将建立的恶性疟原虫传播动力学数学模型与流行病学、干预和PMI融资数据相结合，以估计PMI通过资助长效驱虫蚊帐（LLINs）、室内滞留喷洒（IRS）和青蒿素联合疗法（ACT）对疟疾控制的贡献。我们估计，自2005年以来，PMI预防了1.85亿（95%CrI：1.38亿，2.3亿）疟疾病例，挽救了940，049（95%CrI：545，228，140万）人的生命。如果资金得以维持，PMI资助的干预措施估计将在2017年至2020年期间再避免1.62亿例（95% CrI：1.16亿，1.94亿）病例，再挽救692，589人（95% CrI：392，694，955，653人）的生命。据估计，每个残疾调整生命年（DALY）可避免94美元（95% CrI：51美元，166美元），PMI资助的干预措施具有很高的成本效益。我们还通过减少卫生系统的工作量证明了这种投资的进一步影响。如果PMI资金减少44%，我们预测这种直接援助的损失可能会导致2017年至2020年期间新增6700万（95% CrI：4900万，8200万）病例和290，649（95% CrI：167，208，395，263）例死亡。在本分析中，我们没有对PMI资金的间接影响（如加强卫生系统）进行建模。我们的模型估计，PMI自成立以来在减少疟疾病例和死亡方面发挥了重要作用。减少对疟疾倡议的供资可能导致疟疾病例和死亡人数大幅增加，损害控制和消除疟疾的全球目标。Peter Winskill及其同事估计了美国总统疟疾倡议资金在过去十年中对避免疟疾相关病例和死亡的影响，以及如果PMI资金减少的潜在影响。美国通过“总统疟疾倡议”以外援形式提供了全球防治疟疾预算的很大一部分。由于美国对外援助和PMI资金的拟议削减，展示PMI的影响和成本效益非常重要。我们使用一个已建立的疟疾传播模型来调查PMI资助对疟疾控制的影响。我们估计了PMI资金过去对疟疾相关病例和死亡的影响，以及如果PMI资金被削减，未来可能产生的影响。PMI的资金具有很高的成本效益，自2005年成立以来，估计避免了1.85亿起病例，挽救了940,049人的生命。资金减少44%将导致未来4年新增6700万例病例和290,649例死亡。疟疾防治倡议的持续支持对于维持疟疾控制方面的最新进展和实现消除疟疾目标的进展至关重要。PMI已被证明是一种具有高度成本效益的手段，美国可以通过这种手段将外援投资于减轻疟疾负担。
Although significant progress has been made in reducing malaria transmission globally in recent years, a large number of people remain at risk and hence the gains made are fragile. Funding lags well behind amounts needed to protect all those at risk and ongoing contributions from major donors, such as the President’s Malaria Initiative (PMI), are vital to maintain progress and pursue further reductions in burden. We use a mathematical modelling approach to estimate the impact of PMI investments to date in reducing malaria burden and to explore the potential negative impact on malaria burden should a proposed 44% reduction in PMI funding occur. We combined an established mathematical model of Plasmodium falciparum transmission dynamics with epidemiological, intervention, and PMI-financing data to estimate the contribution PMI has made to malaria control via funding for long-lasting insecticide treated nets (LLINs), indoor residual spraying (IRS), and artemisinin combination therapies (ACTs). We estimate that PMI has prevented 185 million (95% CrI: 138 million, 230 million) malaria cases and saved 940,049 (95% CrI: 545,228, 1.4 million) lives since 2005. If funding is maintained, PMI-funded interventions are estimated to avert a further 162 million (95% CrI: 116 million, 194 million) cases, saving a further 692,589 (95% CrI: 392,694, 955,653) lives between 2017 and 2020. With an estimate of US$94 (95% CrI: US$51, US$166) per Disability Adjusted Life Year (DALY) averted, PMI-funded interventions are highly cost-effective. We also demonstrate the further impact of this investment by reducing caseloads on health systems. If a 44% reduction in PMI funding were to occur, we predict that this loss of direct aid could result in an additional 67 million (95% CrI: 49 million, 82 million) cases and 290,649 (95% CrI: 167,208, 395,263) deaths between 2017 and 2020. We have not modelled indirect impacts of PMI funding (such as health systems strengthening) in this analysis. Our model estimates that PMI has played a significant role in reducing malaria cases and deaths since its inception. Reductions in funding to PMI could lead to large increases in the number of malaria cases and deaths, damaging global goals of malaria control and elimination. Peter Winskill and colleagues estimate the influence the US President's Malaria Initiative funding has had on averting malaria-related cases and deaths over the past decade and the potential impact if PMI funding is reduced going forward. The United States contributes a significant proportion of the global budget for malaria control in the form of foreign aid through the President’s Malaria Initiative (PMI). Due to proposed cuts to US foreign aid and PMI funding, it is important to demonstrate the impact and cost-effectiveness of PMI. We used an established malaria transmission model to investigate the impact of PMI funding for malaria control. We estimated the past impact of PMI funding on malaria-related cases and deaths and the potential future impact if PMI funding were to be cut. PMI funding is highly cost-effective, averting an estimated 185 million cases and saving 940,049 lives since it was set up in 2005. A reduction in funding of 44% would lead to an additional 67 million cases and 290,649 deaths over the next 4 years. Ongoing support from PMI is critical to maintain recent advances in malaria control and progress towards malaria elimination goals. PMI has proven to be a highly cost-effective means by which US foreign aid can be invested to reduce malaria burden.
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影响因子：
168.9
作者：
Lu, Chunling;Schneider, Matthew T.;Murray, Christopher J. L.
通讯作者：
Murray, Christopher J. L.
影响因子：
15.8
作者：
Snow, Robert W.;Guerra, Carlos A.;Hay, Simon I.
通讯作者：
Hay, Simon I.
影响因子：
15.8
作者：
Griffin, Jamie T.;Hollingsworth, T. Deirdre;Ghani, Azra C.
通讯作者：
Ghani, Azra C.
影响因子：
3
作者：
Gething PW;Patil AP;Smith DL;Guerra CA;Elyazar IR;Johnston GL;Tatem AJ;Hay SI
通讯作者：
Hay SI
影响因子：
11.1
作者：
Marseille E;Larson B;Kazi DS;Kahn JG;Rosen S
通讯作者：
Rosen S