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361: Awareness and perceptions among members of a Japanese cancer patient advocacy group concerning the financial relationships between the pharmaceutical industry and physicians: a mixed-methods analysis of survey data
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Posted 03 Jul 2021

Awareness and perceptions among members of a Japanese cancer patient advocacy group concerning the financial relationships between the pharmaceutical industry and physicians: a mixed-methods analysis of survey data
78 downloads medRxiv health policy

Anju Murayama, Yuki Senoo, Kayo Harada, Yasuhiro Kotera, Hiroaki Saito, Toyoaki Sawano, Yosuke Suzuki, Tetsuya Tanimoto, Akihiko Ozaki

Abstract Objectives Financial conflicts of interest (FCOI) between pharmaceutical companies (Pharma) and healthcare domains may unduly influence physician-led clinical practice and patient-centered care. However, the extent of awareness and perceptions of FCOI among Japanese cancer patients remains unclear. This study aimed to assess these factors and their impacts on physician trustworthiness among Japanese cancer patients. Methods A cross-sectional study using self-administered surveys was conducted on a Japanese cancer patient advocacy group with 800 registered members from January to February 2019. Main outcome measures included awareness and perceptions of physician-Pharma interactions, their impact on physician trustworthiness, and attitudes towards FCOI among professions. We also performed thematic analyses on additional comments responders provided in the surveys. Results Among the 524 invited members, 96 (18.3%) completed the questionnaire. Of these, 69 (77.5%) were cancer patients. The proportion of participants aware of such interactions ranged from 2.1% to 65.3%, depending on the interaction type. Participants were generally neutral on how the interactions would affect physician trustworthiness. A large proportion of participants agreed that these interactions were unethical, could influence physicians' prescribing behavior leading to unnecessary prescriptions, and negatively affect physician trustworthiness. Qualitative responses (n=56) indicated that patients expected physicians to use sound ethical judgment and avoid accepting incentives. Participants were also concerned about their treatment and the undue influence of FCOI on physicians. Conclusion Most participants were aware of at least one FCOI between Pharma and physicians and perceived them negatively. Further efforts to regulate FCOI appear necessary to protect patient-centered care.

362: Designing and implementing state-level fertility preservation health insurance benefit mandates
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Posted 16 Jun 2021

Designing and implementing state-level fertility preservation health insurance benefit mandates
76 downloads medRxiv health policy

Ricardo E Flores, Sara W Yoeun, Omar Mesian, Bonnie N Kaiser, Sara B McMenamin, H. Irene Su

Objective To describe the design and implementation of state-level fertility preservation (FP) health insurance benefit mandates and regulation and to provide stakeholders with guidance on best practices, gaps, and implementation needs. Design Legal mapping and implementation framework-guided analysis Setting U.S. states with state-level fertility preservation health insurance benefit mandates Patients Individuals at risk of iatrogenic infertility Intervention State laws mandating health insurance benefit coverage for fertility preservation services. Main Outcome Measures Design features of FP mandated benefit legislation; implementation process Results Between June, 2017 and March, 2021, 11 states passed FP benefit mandate laws. On average, states took 223 days to implement their mandates from the start of the law enactment dates to their corresponding effective dates, and a majority issued regulatory guidance after the law was in effect. Significant variation was observed in which FP services were specified for inclusion or exclusion in the laws and/or regulator guidance. Federal policies impacted state level implementation, with the ACA and HIPAA guiding design of fertility preservation benefits. In addition, a majority of states referenced medical society clinical practice guidelines in the design of FP mandated benefits. Conclusions Our policy scan documented significant variation in the design and implementation of health insurance benefit mandates for FP services. Future considerations for policy development include specificity and flexibility of benefit design, reference to external clinical practice guidelines to drive benefit coverage, inclusion of Medicaid populations in required coverage, and consideration of interaction with relevant state and federal policies. In addition, key considerations for implementation include the sufficient length of time for the implementation period, regulator guidance issued prior to the law going into effect, and explicit allocation of resources for the implementation process.

363: Data Driven Monitoring in Community Based Management of SAM children using Psychometric Techniques: An Operational Framework
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Posted 22 Jun 2021

Data Driven Monitoring in Community Based Management of SAM children using Psychometric Techniques: An Operational Framework
70 downloads medRxiv health policy

ANKUR JOSHI, Abhijit P Pakhare, Sivaja K Nair, G REVADI, MANOJ CHOUHAN, DEEPAK PANDEY, ARUN M KOKANE

Background- The success of the Community Based Management of Severe Malnutrition (CSAM)programme, largely depends on the knowledge and skills of Front-Line Workers (FLWs).A robust supportive supervision system in CSAM should be tailored to individualistic learning needs by distinguishing the FLWs as per their ability and simultaneously identifying the task domains to be emphasized more in supervisory visits.This paper details the ability assessment strategy developed and employed in the selected geographical locations in state of Madhya Pradesh (Central India) among the 197 Anganwadi workers (FLWs involved in CSAM implementation) Methodology-. A 25 items tool was developed based on an analytical construct for ability estimation through Rasch Analysis (RA). RA models the probability of right/wrong answer as a function of person(participants) and item (questions) parameters and calculates the item difficulty in relation with person ability on same unidimensional linear scale. The fitting of the data to Rasch model (Rasch diagnostic) was tested by both numeric (Anderson LR and Wald test) and graphical method. Suitable visualization like Item Characteristic Curve (ICC) and Person Item Map (PIM) were plotted in RA. Further a quadratic allocation of all AWWs into 4 quadrants were done as per the ability estimation (Rasch score) and adjusted numbers of SAM/MAM children in her center. Results-. . The item easiness parameter ({beta}) value related to Diarrhoeal assessment was lowest (-2.32, -2.91 to -1.73) and related to peer assessment consequential action (2.009, 1.669- 2.348)) was highest (most difficult). Anderson LR test (LR=31.32, df=24, p=0.079) showed the absence of global outliers. Quadrant analysis using the permutations of ability score and adjusted burden of malnutrition further mapped 41/197 (20.8%) FLWs to low ability -high burden quadrant and 44/197(25%) as low ability low burden quadrant. Conclusion- RASCH assessment may address the innate challenges to maintain homogeneity, discrimination capacity and linearity in a raw score-based measurement construct. The monitoring strategy developed on this thus may offer a judicious, pragmatic and thematic approach to supportive supervision in CSAM program. Keywords: Severe Acute Malnutrition, RASCH assessment, data driven monitoring

364: A reinforcement learning model to inform optimal decision paths for HIV elimination
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Posted 14 Jul 2021

A reinforcement learning model to inform optimal decision paths for HIV elimination
66 downloads medRxiv health policy

Seyedeh Nazanin khatami, Chaitra Gopalappa

The 'Ending the HIV Epidemic (EHE)' national plan aims to reduce annual HIV incidence in the United States from 38,000 in 2015 to 9,300 by 2025 and 3,300 by 2030. Diagnosis and treatment are two most effective interventions, and thus, identifying corresponding optimal combinations of testing and retention-in-care rates would help inform implementation of relevant programs. Considering the dynamic and stochastic complexity of the disease and the time dynamics of decision-making, solving for optimal combinations using commonly used methods of parametric optimization or exhaustive evaluation of pre-selected options are infeasible. Reinforcement learning (RL), an artificial intelligence method, is ideal; however, training RL algorithms and ensuring convergence to optimality are computationally challenging for large-scale stochastic problems. We evaluate its feasibility in the context of the EHE goal. We trained an RL algorithm to identify a 'sequence' of combinations of HIV-testing and retention-in-care rates at 5-year intervals over 2015-2070, which optimally leads towards HIV elimination. We defined optimality as a sequence that maximizes quality-adjusted-life-years lived and minimizes HIV-testing and care-and-treatment costs. We show that solving for testing and retention-in-care rates through appropriate reformulation using proxy decision-metrics overcomes the computational challenges of RL. We used a stochastic agent-based simulation to train the RL algorithm. As there is variability in support-programs needed to address barriers to care-access, we evaluated the sensitivity of optimal decisions to three cost-functions. The model suggests to scale-up retention-in-care programs to achieve and maintain high annual retention-rates while initiating with a high testing-frequency but relaxing it over a 10-year period as incidence decreases. Results were mainly robust to the uncertainty in costs. However, testing and retention-in-care alone did not achieve the 2030 EHE targets, suggesting the need for additional interventions. The results from the model demonstrated convergence. RL is suitable for evaluating phased public health decisions for infectious disease control.

365: Monday effect on confirmed cases of COVID-19 in Japan
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Posted 22 Jul 2021

Monday effect on confirmed cases of COVID-19 in Japan
61 downloads medRxiv health policy

Kuninori Nakagawa, Taro Kanatani

We examined the phenomenon of fewer new confirmed cases on Monday in Japan, which we refer to as the Monday effect. In Japan, prefectures aggregate and announce the number of daily confirmed cases. We analyzed the impact of this effect in each prefecture. The effect is mainly found in prefectures with populations of 2 million or more. This effect is also constantly observed in the three major metropolitan areas in Japan. However, the magnitude of the observed effect is uncorrelated with both the number of positives per 1,000 people and the population size. Our results suggest that the reporting delay occurs in prefectures above a specific size, but the magnitude of the delay differs among prefectures. We consider two possible explanations for this effect: 1) delays caused by the administrative system. 2) fewer tests are conducted on the previous day. Our results indicate that delays are caused by the administrative system in some prefectures and that some prefectures with larger populations are less likely to conduct screenings on holidays.

366: The impact of pausing the Oxford-AstraZeneca COVID-19 vaccine on uptake in Europe: a difference-in-differences analysis
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Posted 31 Aug 2021

The impact of pausing the Oxford-AstraZeneca COVID-19 vaccine on uptake in Europe: a difference-in-differences analysis
57 downloads medRxiv health policy

Vageesh Jain, Paula Lorgelly

Background Several countries paused their rollouts of the Oxford-AstraZeneca COVID-19 vaccine in mid-March 2021 due to concerns about vaccine-induced thrombosis and thrombocytopenia. Many warned that this risked damaging public confidence during a critical period of pandemic response. This study investigated whether the pause in the use of the Oxford-AstraZeneca vaccine had an impact on subsequent vaccine uptake in European countries. Methods We used a difference-in-differences approach capitalizing on the fact that some countries halted their rollouts whilst others did not. A longitudinal panel was constructed for European Economic Area countries spanning 15 weeks in early 2021. Media reports were used to identify countries that paused the Oxford-AstraZeneca vaccine and the timing of this. Data on vaccine uptake were available through the European Centre for Disease Control and Prevention COVID-19 Vaccine Tracker. Difference-in-differences linear regression models controlled for key confounders that could influence vaccine uptake, and country and week fixed effects. Further models and robustness checks were performed. Results The panel included 28 countries, with 19 in the intervention group and 9 in the control group. Pausing the Oxford-AstraZeneca vaccine was associated with a 0.52% decrease in uptake for the first dose of a COVID-19 vaccine and a 1.49% decrease in the uptake for both doses, comparing countries that paused to those that did not. These estimates are not statistically significant (p=0.86 and 0.39 respectively). For the Oxford-AstraZeneca vaccine only, the pause was associated with a 0.56% increase in uptake for the first dose and a 0.07% decrease in uptake for both doses. These estimates are also not statistically significant (p= 0.56 and 0.51 respectively). All our findings are robust to sensitivity analyses. Conclusion As new COVID-19 vaccines emerge, regulators should be cautious to deviate from usual protocols if further investigation on clinical or epidemiological grounds is warranted.

367: Analysis of alternative Covid-19 mitigation measures in school classrooms: an agent-based model of SARS-CoV-2 transmission
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Posted 30 Aug 2021

Analysis of alternative Covid-19 mitigation measures in school classrooms: an agent-based model of SARS-CoV-2 transmission
52 downloads medRxiv health policy

Mark J Woodhouse, Willy P Aspinall, Stephen RJ Sparks, CoMMinS prject "COVID-19 Mapping and Mitigation in Schools"

1.The SARS-CoV-2 epidemic has had major impacts on childrens education, with schools required to implement infection control measures that have led to long periods of absence and classroom closures. We develop an agent-based epidemiological model of SARS-CoV-2 transmission that is applied to model infection within school classrooms, with a contact model constructed using random networks informed by structured expert judgement. Mitigation strategies to control infection are modelled to allow analysis of their effectiveness in supressing infection outbreaks and in limiting pupil absence. The model is applied to re-examine Covid-19 in schools in the UK in autumn 2020, and to forecast infection levels in autumn 2021 when the more infectious Delta-variant is dominant and school transmission is likely to play a major role in a new wave of the epidemic. Our results indicate that testing-based surveillance of infections in the classroom population with isolation of positive cases is a more effective mitigation measure than bubble quarantine both for reducing transmission in schools and for avoiding pupil absence, even accounting for insensitivity of self-administered tests. Bubble quarantine results in large numbers of pupils absent from school, with only modest impact of classroom infection. However, maintaining a reduced contact rate within the classroom has a major beneficial impact for managing Covid-19 in school settings.

368: Can Vaccine Prioritization Reduce Disparities in Covid-19 Burden for Historically Marginalized Populations?
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Posted 30 Jul 2021

Can Vaccine Prioritization Reduce Disparities in Covid-19 Burden for Historically Marginalized Populations?
43 downloads medRxiv health policy

Erik Rosenstrom, Jessica A. Mele, Julie Ivy, Maria Mayorga, Mehul Patel, Kristen Hassmiller Lich, Karl D Johnson, Paul Delamater, Pinar Keskinocak, Ross Boyce, Raymond Smith, Julie L Swann

Importance: Nationally stated goals for distributing SARS-CoV-2 vaccines included to reduce COVID-19 mortality, morbidity, and inequity using prioritization groups. However, the impact of these prioritization strategies is not well understood, particularly their effect on health inequity in COVID-19 burden for historically marginalized racial and ethnic populations. Objective: To assess the impact of vaccination prioritization and operational strategies on disparities in COVID-19 burden among historically marginalized populations, and on mortality and morbidity by race and ethnicity. Design: We use an agent-based simulation model of North Carolina to project SARS-CoV-2 infections and COVID-19-associated deaths (mortality), hospitalizations (morbidity), and cases over 18 months (7/1/2020-12/31/2021) with vaccine distribution beginning 12/13/2020 to frontline medical and people 75+, assuming initial uptake similar to influenza vaccine. We study two-stage subsequent prioritization including essential workers (essential), adults 65+ (age), adults with high-risk health conditions, HMPs, or people in low income tracts, with eligibility for the general population in the third stage. For age-essential and essential-age strategies, we also simulated maximal uptake (100% for HMP or 100% for everyone), and we allowed for distribution to susceptible-only people. Results: Prioritizing Age then Essential had the largest impact on mortality (2.5% reduction from no prioritization); Essential then Age had the lowest morbidity and reduced infections (4.2% further than Age-Essential) without significantly impacting mortality. Under each prioritization scenario, the age-adjusted mortality burden for HMPs is higher (e.g., 33.3-34.1% higher for the Black population, 13.3%-17.0% for the Hispanic population) compared to the White population, and the gap grew under some prioritizations. In the Age-Essential strategy, the burden on HMPs decreases only when uptake is increased to 100% in HMPs. However, the Black population still had the highest mortality rate even with the Susceptible-Only distribution. Conclusions and Relevance: Simulation results show that prioritization strategies have differential impact on mortality, morbidity, and disparities overall and by race and ethnicity. If prioritization schemes were not paired with increased uptake in HMPs, disparities did not improve and could worsen. Although equity was one of the tenets of vaccine distribution, the vaccination strategies publicly outlined are insufficient to remove and may exacerbate disparities between racial and ethnic groups, thus targeted strategies are needed for the future.

369: Comparing organ donation decisions for next-of-kin versus the self: Results of a national survey
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Posted 14 Jul 2021

Comparing organ donation decisions for next-of-kin versus the self: Results of a national survey
42 downloads medRxiv health policy

Christopher WY Liu, Lynn N Chen, Amalina Anwar, Boyu Lu Zhao, Clin K. Y. Lai, Wei Heng Ng, Thangavelautham Suhitharan, Vui Kian Ho, Jean CJ Liu

Objectives: Intensive care audits point to family refusal as a major barrier to organ donation. In this study, we sought to understand refusal by accounting for the decision-maker's mindset. This focused on: (1) how decisions compare when made on behalf of a relative (versus the self); and (2) confidence in decisions made for family members. Design: Cross-sectional survey in Singapore. Setting: Participants were recruited from community settings via door-to-door sampling and community eateries. Participants: 973 adults who qualified as organ donors in Singapore. Results: Although 68.1% of participants were willing to donate their own organs, only 51.8% were willing to donate a relative's. Using machine learning, we found that consistency was predicted by: (i) religion, and (ii) fears about organ donation. Conversely, participants who were willing to donate their own organs but not their relative's were less driven by these factors, and may instead have resorted to heuristics in decision-making. Finally, we observed how individuals were overconfident in their decision-making abilities: although 78% had never discussed organ donation with their relatives, the large majority expressed high confidence that they would respect their relatives' wishes upon death. Conclusions: These findings underscore the distinct psychological processes involved when donation decisions are made for family members. Amidst a global shortage of organ donors, addressing the decision-maker's mindset (e.g., overconfidence, the use of heuristics) may be key to actualizing potential donors identified in intensive care units.

370: Beyond poverty as a proxy: reducing inequality in infant mortality by identifying and targeting higher risk births
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Posted 23 Jul 2021

Beyond poverty as a proxy: reducing inequality in infant mortality by identifying and targeting higher risk births
42 downloads medRxiv health policy

Antonio Ramos, Chad Hazlett, Stephen Smith

Infant mortality remains high and uneven in much of sub-Saharan Africa. Given finite resources, reducing premature mortality requires effective tools to identifying left- behind populations at greatest risk. While countries routinely use income- or poverty- based thresholds to target policies, we examine whether models that consider other factors can substantially improve our ability to target policies to higher-risk births. Using machine learning methods, and 25 commonly available variables that can be observed prior to birth, we construct child-level risk scores for births in 22 sub-Saharan African countries. We find that targeting based on poverty, proxied by income, is only slightly better than random targeting, with the poorest 10 percent of the population experiencing approximately 10 percent of total infant mortality burden. By contrast the 10 percent of the population at highest risk according to our model accounts for 15-30% of infants deaths, depending on country. A hypothetical intervention that can be administered to 10% of the population and prevents just 5% of the deaths that would otherwise occur, for example, would save roughly 841,000 lives if targeted to the poorest decile, but over 1.6 million if targeted using our approach.

371: Vaccine Approvals and the Role of the FDA Vaccine Advisory Committee, 2000-2019
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Posted 22 Jul 2021

Vaccine Approvals and the Role of the FDA Vaccine Advisory Committee, 2000-2019
41 downloads medRxiv health policy

Genevieve P Kanter, Neel Vallurupalli, Yao Xu, Ravi Gupta

Background: The US Food and Drug Administration (FDA) plays a critical role in bolstering public confidence in vaccines and the vaccine review process. An important tool for enhancing transparency and public trust is the FDA's Vaccine and Biological Related Products Advisory Committee (VRBPAC), a group of external experts that advises on scientific issues related to the licensure of vaccines. Objective: To analyze key features of VRBPAC meetings convened over 20 years; estimate the probability of advisory committee review of newly approved vaccines, focusing on vaccines targeting emerging diseases; and examine the speed of and variance in approval times as a function of VRBPAC review. Methods: Cross-sectional study of VRBPAC meetings convened and new vaccine licensure applications approved between January 1, 2000, and December 31, 2019. We analyzed the frequency of VRBPAC meetings and sessions; the percentage of newly licensed vaccines reviewed by VRBPAC; and the number of days between the submission of the licensure application and the date of FDA approval. Results: Between 2000 and 2019, VRBPAC convened for a mean of 4.1 sessions per year. One-quarter of sessions was devoted to the review of specific vaccine products. During the same period, 44 new vaccine licensures were approved, 20% of which were for vaccines targeting emerging diseases. Almost half (48%) of successful new vaccine applications were reviewed by VRBPAC (n=21), a rate lower than for therapeutic applications. Among new applications targeting emerging diseases, 29% of non-influenza vaccines were reviewed by VRBPAC. There was no difference in the median time to approval as a function of VRBPAC review (364 days with VRBAC review vs. 365 days with no review, p=0.870). Conclusion: The FDA has convened VRBPAC for reviews of about half of its vaccine products, less frequently for vaccines against non-influenza emerging diseases. There is considerable scope for the FDA to increase VRBPAC engagement in the vaccine review process.

372: Federal Vaccine Policy and Interstate Variation in COVID-19 Vaccine Coverage in India
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Posted 24 Aug 2021

Federal Vaccine Policy and Interstate Variation in COVID-19 Vaccine Coverage in India
24 downloads medRxiv health policy

Kanchan Mukherjee

Abstract Introduction: On August 13, 2021, India completed 30 weeks of vaccination against COVID-19 for its eligible citizens. While the vaccination has made progress, there has been no study analyzing the federal/union vaccine policy and its effect on vaccination coverage across Indian states. In this context, this study analyses the federal vaccination policy and its effect on interstate variation in vaccine coverage and the correlation of state economy with vaccination coverage. Methods: The study analyses vaccine policy documents, secondary data on vaccination coverage and state gross domestic product (GDP) available in public domain. ANOVA test has been used to assess the effect of vaccine policy on interstate vaccine coverage and correlation-regression analysis has been conducted to assess the type and strength of association between gross state domestic product and vaccination coverage. Results: Interstate variation in vaccination coverage in the first 15 weeks was the least (F=3.5), when vaccine procurement and supply was entirely provided by the union/federal government and vaccination was limited to priority groups. However, with the extension of vaccine policy to other groups and reduction in federal government involvement in vaccine procurement, the interstate variation in vaccination coverage increased significantly (F=10.74) by the end of 30 weeks. The highest interstate variation was observed in the period between 23-30 weeks (F=25.31). State GDP was positively and strongly correlated with state vaccination coverage with a high coefficient of correlation (R=0.94) and high coefficient of determination (Rsqaure= 0.88). Conclusions: The study finds that federal procurement and supply of vaccination among prioritized groups has been the best strategy till date to address the inequity in vaccination coverage across the states of India.

373: Use of health care services during the Covid-19 pandemic in Ethiopia: Evidence from a health facility survey
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Posted 10 Aug 2021

Use of health care services during the Covid-19 pandemic in Ethiopia: Evidence from a health facility survey
22 downloads medRxiv health policy

Zemzem Shigute Shuka, Anagaw Derseh Mebratie, Getnet Alemu, Matthias Rieger, Arjun Singh Bedi

Abstract Introduction: In recent years Ethiopia has made enormous strides in enhancing access to health care, especially, maternal and child health care (MCH). With the onset and spread of Covid-19, the attention of the health care system has pivoted to handling the disease, potentially at the cost of other health care needs. This paper explores whether this shift has come at the cost of non Covid related health care, especially the use of MCH services. Methods: Graphs, descriptive statistics and paired t-tests of significance are used to compare levels of inpatient and outpatient health care service utilization before and after the onset and spread of the virus. The analysis is based on a survey of 59 health centers and 29 public hospitals located in urban Ethiopia, the most acutely affected region of the country. Data on the use of health care services for a period of 24 months was gathered from the health management information systems (HMIS) of these facilities. Results: There is a sharp reduction in the use of both inpatient (20-27%) and outpatient (27-34%) care, particularly in Addis Ababa, which has been most acutely affected by the virus. However, the decline does not come at the cost of MCH services. The use of several MCH components (skilled birth attendant deliveries, immunization, post-natal care) remains unaffected throughout the period while others (family planning services, ante-natal care) experience a decline (8-17%) in the immediate aftermath but recover soon after. Conclusion: Concerns about the crowding out of MCH services due to the focus on Covid 19 are unfounded. Pro-active measures taken by the government and health care facilities to ring-fence the use of essential health care services have mitigated service disruptions. The results underline the resilience and agility displayed by one of the worlds most resource-constrained health care systems.

374: Impacts of Regional Lockdown Policies on COVID-19 Transmission in India in 2020
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Posted 10 Aug 2021

Impacts of Regional Lockdown Policies on COVID-19 Transmission in India in 2020
17 downloads medRxiv health policy

Aarushi Kalra, Paul Novosad

Objective: To assess the impact of non-pharmaceutical interventions (NPIs) on the first wave of COVID transmission and fatalities in India. Methods: We collected data on NPIs, using government notifications and news reports, in six major Indian states from March to August 2020, and we matched these with district-level data on COVID related deaths and Google Mobility reports. We used a district fixed effect regression approach to measure the extent to which district-level lockdowns and mobility restrictions helped reduce deaths in 2020. Results: In most states, COVID deaths grew most rapidly only after the initial lockdown was lifted. District-level NPIs were associated with a statistically significantly lower COVID death count in three out of five sample states (district analysis was not possible in Delhi) and in the aggregate. Interventions that were most associated with slowing fatalities were temple closures, retail closures, and curfews. Discussion: Outside of Maharashtra (the first state struck) the first fatality wave appears to have been delayed by the national lockdown. Indias NPIs, however incomplete, were successful in delaying or limiting COVID-19 deaths. Even with incomplete compliance, limiting mass gatherings in face of incipient viral waves may save lives.

375: Effects of Various Policy Options on COVID-19 Cases in Nova Scotia including Vaccination Rollout Schedule: A Modelling Study
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Posted 31 Jul 2021

Effects of Various Policy Options on COVID-19 Cases in Nova Scotia including Vaccination Rollout Schedule: A Modelling Study
17 downloads medRxiv health policy

Melissa Gillis, Ahmed Saif, Matthew Murphy, Noreen Kamal

Background: The COVID-19 pandemic presents a significant challenge to minimize mortality and hospitalizations due to this disease. Vaccinations have begun to roll-out; however, restriction policies required during and after the rollout remain uncertain. A susceptible-exposed-infected-recovered (SEIR) model was developed for Nova Scotia, and it accounted for the province's policy interventions, demographics, and vaccine rollout schedule. Methods: A modified SEIR model was developed to simulate the spread and outcomes from COVID-19 in Nova Scotia under different policy options. The model incorporated the age distribution and co-morbidity of the province. A system dynamics model was developed in Vensim. Several scenarios were run to determine the effects of various policy options and loosening of restrictions during and after the vaccine roll-out period. Results: When restrictions policy include moderate closure of businesses, restricting travel to Atlantic Canada, and the mandating of masks and physical distancing, the number of cumulative infections after 110 days was less than 120. However, if national travel was opened by July 5 2021 and there were no restrictions by September 2021, the number of active infections will peak at 6,114 by February 16 2022, and there will be a peak of 104 hospitalizations on February 16 2022. Immediate opening of travel and all restrictions on March 15, 2021 will result in 71,731 active infections by June 4 2021. Discussion: Moderate restrictions will be required even after the population is fully vaccinated in order to avoid a large number of infections and hospitalizations because herd immunity is not reached due to children under 12 not being vaccinated, the efficacy of the vaccine, and the portion of the population that will choose not to be vaccinated.

376: Perceptions of gender equity and markers of achievement in a National Institute for Health Research (NIHR) Biomedical Research Centre (BRC): A qualitative study.
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Posted 31 Jul 2021

Perceptions of gender equity and markers of achievement in a National Institute for Health Research (NIHR) Biomedical Research Centre (BRC): A qualitative study.
13 downloads medRxiv health policy

Lorna R Henderson, Rinita Dam, Syed Ghulam Sarwar Shah, Pavel V Ovseiko, Vasiliki Kiparoglou

ABSTRACT Background The need to improve gender equity (GE) in academic medicine is well documented. Biomedical Research Centres (BRCs), partnerships between leading National Health Service (NHS) organisations and universities in England, conduct world-class translational research funded by the National Institute for Health Research (NIHR). In 2011, eligibility for BRC funding was restricted to universities demonstrating sustained GE success recognised by the Athena SWAN Charter for Women in Science Silver awards. Despite this structural change, GE research in BRC settings is underdeveloped, yet critical to the acceleration of womens advancement and leadership. Objectives To explore both women's and men's perceptions of GE and current markers of achievement in a BRC setting. Methods Thematic analysis of data from two discrete research projects: 53 GE survey respondents free text comments (34 women, 16 men), and 16 semi structured interviews with women affiliated to the NIHR Oxford BRC. Results Four major themes emerged from the analysis: perceptions of the Athena Swan Charter for Women in Science (GE policy); views on monitoring GE in BRCs; views on current markers of achievement in academia and GE; and recommendations for actions to improve GE in BRC settings. Monitoring of GE in BRCs was deemed to be important, but complex. Participants felt current markers of achievement were not equitable to women as they did not take contextual factors into account such as maternity leave and caring responsibilities. BRC specific organisational policies and metrics are required to monitor and catalyse GE. Conclusions Markers of achievement for monitoring GE in BRCs should take into account contextual factors specific to BRCs and women's career progression and professional advancement. GE markers of achievement should be complimented with broader aspects of equality, diversity and inclusion.

377: Hepatitis B and D: a forecast on actions needed to reduce incidence and achieve elimination
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Posted 13 Aug 2021

Hepatitis B and D: a forecast on actions needed to reduce incidence and achieve elimination
8 downloads medRxiv health policy

Scott Greenhalgh, Andrew Klug

Background. Viral hepatitis negatively affects the health of millions, with the worst health outcomes associated with the hepatitis D virus (HDV). Fortunately, HDV is rare and requires prior infection with the hepatitis B virus (HBV) before it can establish infection and transmit. As such, public health officials have opted to indirectly control HDV by reducing HBV incidence, primarily through hepatitis B vaccination, which has dramatically reduced HBV incidence since its rollout in the 1980s. However, investigations into the consequences of hepatitis B vaccination on both the control and evolution of HDV remain limited. Methods. We developed a mathematical model of HBV and HDV transmission to investigate the effects of hepatitis B vaccination on both HBV and HDV. We calibrated our model to the HBV and HDV transmission scenarios occurring in Sub-Saharan Africa, and estimate HBV vaccination thresholds that cause HBV and HDV elimination, inhibit the spread of virulent HDV strains, and achieve the targets set by public health authorities for reducing all viral hepatitis incidence by 90%. Results. Our findings illustrate hepatitis B vaccination rates above 0.0096 year^(-1) and 0.018 year^(-1) will likely achieve HDV and HBV elimination, respectively. Furthermore, in the majority of transmission settings, scaling-up vaccination rates to at least 0.009 year^(-1) or 0.02136 year^(-1) will achieve the 90% reduction in hepatitis D and B, respectively, called for by health authorities. Conclusion. Our results suggest a scale-up of hepatitis B vaccination is required to achieve the targets set by public health officials for reducing all viral hepatitis by 90%. Furthermore, the scale-up required to achieve such targets would bring HBV and HDV to the brink of the vaccination threshold required for their elimination. Thus, with sufficient investments to scale up global hepatitis vaccination, prevention, testing, and treatment services, the eradication of both HBV and HDV are likely feasible endeavors, especially once the 90% reduction goal is reached.

378: Predictors of eviction and quality of tenant-landlord relationships during the 2020-2021 eviction moratorium in the U.S.
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Posted 29 Aug 2021

Predictors of eviction and quality of tenant-landlord relationships during the 2020-2021 eviction moratorium in the U.S.
6 downloads medRxiv health policy

Jack Tsai, Minda Huang, John Blosnich, Eric Elbogen

In 2020, the Centers for Disease Control and Prevention (CDC) issued several agency orders that put into effect a national moratorium on evictions for over one year to limit transmission of Coronavirus Disease 2019 (COVID-19). Little is known about landlord and tenant behaviors during the eviction moratorium. The current study used three waves of data from May 2020-April 2021 from a nationally representative sample of U.S. middle- and low-income tenants (n= 3,393 in Wave 1, n= 1,311 in Wave 2, and 814 in Wave 3) to examine tenants who were evicted during the eviction moratorium and the reported effects of the moratorium on tenant rental payments and tenant-landlord relationships. Across three Waves, 4.3% of tenants reported experiencing an eviction during the moratorium and 6-23% of tenants reported delaying paying rent because of the moratorium. Multivariable analyses found that tenants who delayed paying their rent, were female, or had a history of mental illness or substance use disorder were significantly more likely to report the eviction moratorium had a negative effect on the relationship with their landlord. Analyses also revealed that testing positive for COVID-19 was not a significant predictor of eviction but tenants with a history a homelessness were more than 9 times as likely to report an eviction than those without such a history. Together, these findings suggest the eviction moratorium has had some unintended consequences on rent payments and tenant-landlord relationships that need to be considered in the aftermath of the COVID-19 pandemic.

379: SARS-CoV-2 Suppression and Early Closure of Bars and Restaurants : A Longitudinal Natural Experiment
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Posted 08 Aug 2021

SARS-CoV-2 Suppression and Early Closure of Bars and Restaurants : A Longitudinal Natural Experiment
6 downloads medRxiv health policy

Reo Takaku, Izumi Yokoyama, Takahiro Tabuchi, Takeo Fujiwara

Despite severe economic damage, full-service restaurants and bars have been closed in hopes of suppressing the spread of SARS-CoV-2 worldwide. This study explores whether the early closure of restaurants and bars in February 2021 reduced symptoms of SARS-CoV-2 in Japan. Using a large-scale nationally representative longitudinal survey, we found that the early closure of restaurants and bars decreased the utilization rate among young persons (OR 0.688; CI95 0.515?0.918) and those who visited these places before the pandemic (OR 0.754; CI95 0.594?0.957). However, symptoms such of SARS-CoV-2 did not decrease in these active and high-risk subpopulations. Among the more inactive and low-risk subpopulations, such as elderly persons, no discernible impacts are observed in both the utilization of restaurants and bars and the symptoms of SARS-CoV-2. These results suggest that the early closure of restaurants and bars without any other concurrent measures does not contribute to the suppression of SARS-CoV-2.

380: Systematic review protocol exploring the impact of the COVID-19 pandemic on the wellbeing of general practitioners
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Posted 07 Aug 2021

Systematic review protocol exploring the impact of the COVID-19 pandemic on the wellbeing of general practitioners
3 downloads medRxiv health policy

Laura Jefferson, Su Golder, Veronica Dale, Holly Essex, Elizabeth McHugh, Karen Bloor

Background Over recent years chronic stress and burnout have been reported by doctors working in general practice in the UK NHS and internationally. The COVID-19 pandemic has changed general practitioners working lives; adding potential pressures from avoiding infection and addressing pent-up demand for care, but also changing processes such as rapidly taking up remote consultations. To date, there has been a focus on exploring the impact of the pandemic on the wellbeing of hospital clinicians. No registered systematic reviews currently focus on exploring the impact of the pandemic on the mental health and wellbeing of general practitioners. Aims and objectives To synthesise the current international evidence base exploring the impact of COVID-19 on the mental health and wellbeing of general practitioners, and which factors are associated with their reported mental health and wellbeing during the pandemic. Methods In this paper we report a systematic review protocol, following PRISMA guidance. In our search strategy we will identify primary research studies or systematic reviews exploring the mental health and wellbeing of general practitioners during the COVID-19 pandemic in four databases (MEDLINE, Embase, PsychInfo and Medrxiv) and Google Scholar. We will hand-search reference lists and grey literature. Two reviewers will undertake all stages including study selection, data extraction and quality assessment, with arbitration by a third reviewer where necessary. We will use standardised quality assessment tools to ensure transparency and reduce bias in quality assessment. Depending on the quality of included studies, we may undertake a sensitivity analysis by excluding studies from narrative synthesis that are rated as low quality using the checklists. We will describe the findings across studies using narrative thematic data synthesis, and if sufficiently homogenous data are identified, we will pool quantitative findings through meta-analysis.

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