Prioritisation processes for programme implementation and evaluation in public health: A scoping review.

Background: Programme evaluation is an essential and systematic activity for improving public health programmes through useful, feasible, ethical, and accurate methods. Finite budgets require prioritisation of which programmes can be funded, first, for implementation, and second, evaluation. While criteria for programme funding have been discussed in the literature, a similar discussion around criteria for which programmes are to be evaluated is limited. We reviewed the criteria and frameworks used for prioritisation in public health more broadly, and those used in the prioritisation of programmes for evaluation. We also report on stakeholder involvement in prioritisation processes, and evidence on the use and utility of the frameworks or sets of criteria identified. Our review aims to inform discussion around which criteria and domains are best suited for the prioritisation of public health programmes for evaluation. Methods: We reviewed the peer-reviewed literature through OVID MEDLINE (PubMed) on 11 March 2022. We also searched the grey literature through Google and across key websites including World Health Organization (WHO), US Centers for Disease Control and Prevention (CDC), European Centre for Disease Prevention and Control (ECDC), and the International Association of National Public Health Institutes (IANPHI) (14 March 2022). Articles were limited to those published between 2002 and March 2022, in English, French or German. Results: We extracted over 300 unique criteria from 40 studies included in the analysis. These criteria were categorised into 16 high-level conceptual domains to allow synthesis of the findings. The domains most frequently considered in the studies were "burden of disease" (33 studies), "social considerations" (30 studies) and "health impacts of the intervention" (28 studies). We only identified one paper which proposed criteria for use in the prioritisation of public health programmes for evaluation. Few prioritisation frameworks had evidence of use outside of the setting in which they were developed, and there was limited assessment of their utility. The existing evidence suggested that prioritisation frameworks can be used successfully in budget allocation, and have been reported to make prioritisation more robust, systematic, transparent, and collaborative. Conclusion: Our findings reflect the complexity of prioritisation in public health. Development of a framework for the prioritisation of programmes to be evaluated would fill an evidence gap, as would formal assessment of its utility. The process itself should be formal and transparent, with the aim of engaging a diverse group of stakeholders including patient/public representatives.

Costs and impact on HIV transmission of a switch from a criminalisation to a public health approach to injecting drug use in eastern Europe and central Asia: a modelling analysis.

BACKGROUND: HIV incidence is increasing in eastern Europe and central Asia, primarily driven by injecting drug use. Coverage of antiretroviral therapy (ART) and opioid agonist therapy are suboptimal, with many people who inject drugs (PWID) being incarcerated. We aimed to assess whether use of monies saved as a result of decriminalisation of drug use or possession to scale up ART and opioid agonist therapy could control HIV transmission among PWID in eastern Europe and central Asia. METHODS: A dynamic HIV transmission model among PWID incorporating incarceration, ART, and opioid agonist therapy was calibrated to Belarus, Kazakhstan, Kyrgyzstan, and St Petersburg (Russia). Country-specific costs for opioid agonist therapy, ART, and incarceration were collated or estimated. Compared with baseline, the model prospectively projected the life-years gained, incremental costs (2018 euros), and infections prevented over 2020-40 for three scenarios. The decriminalisation scenario removed incarceration resulting from drug use or possession for personal use, reducing incarceration among PWID by 24·8% in Belarus, Kazakhstan, and Kyrgyzstan and 46·4% in St Petersburg; the public health approach scenario used savings from decriminalisation to scale up ART and opioid agonist therapy; and the full scale-up scenario included the decriminalisation scenario plus investment of additional resources to scale up ART to the UNAIDS 90-90-90 target of 81% coverage and opioid agonist therapy to the WHO target of 40% coverage. The incremental cost-effectiveness ratios per life-year gained for each scenario were calculated and compared with country-specific gross domestic product per-capita willingness-to-pay thresholds. Costs and life-years gained were discounted 3% annually. FINDINGS: Current levels of incarceration, opioid agonist therapy, and ART were estimated to cost from €198 million (95% credibility interval 173-224) in Kyrgyzstan to €4129 million (3897-4358) in Kazakhstan over 2020-40; 74·8-95·8% of these total costs were incarceration costs. Decriminalisation resulted in cost savings (€38-773 million due to reduced prison costs; 16·9-26·1% reduction in overall costs) but modest life-years gained (745-1694). The public health approach was cost saving, allowing each setting to reach 81% ART coverage and 29·7-41·8% coverage of opioid agonist therapy, resulting in 17 768-148 464 life-years gained and 58·9-83·7% of infections prevented. Results were similar for the full scale-up scenario. INTERPRETATION: Cost savings from decriminalisation of drug use could greatly reduce HIV transmission through increased coverage of opioid agonist therapy and ART among PWID in eastern Europe and central Asia. FUNDING: Alliance for Public Health, US National Institute of Allergy and Infectious Diseases and National Institute for Drug Abuse, and Economist Intelligence Unit.

Stroke prevention in Europe: how are 11 European countries progressing toward the European Society of Cardiology (ESC) recommendations?

PURPOSE: Stroke is a leading cause of death and disability, although studies show that 90% of strokes can be prevented. The evidence base for stroke prevention is well established, and this study aimed to investigate how well European countries are adopting the European Society of Cardiology (ESC) guidelines, particularly toward implementation of the recommended best practice in stroke prevention. MATERIALS AND METHODS: We developed a stroke prevention scorecard - populated with World Health Organization (WHO) data, secondary research, time-series data, and a survey of 550 physicians - to benchmark 11 European countries in the context of the ESC guidelines. RESULTS: All countries were found to have policies in place to manage general behavioral risk factors of noncommunicable disease (NCD), but we found that more needs to be done to address cardiovascular disease - specifically, stroke risk factors. Although ten of the countries in this study endorse the ESC cardiovascular clinical guidelines, implementation is lacking. Eight out of the 11 countries received the lowest score in regard to raising awareness around stroke, and 7 countries were found not to have a stroke registry. Among physicians surveyed in primary care it was reported that less than 30% of patients over 40 years old were screened for blood pressure, whereas even fewer were screened for atrial fibrillation; in 10 out of the 11 countries, less than 20% of patients over 65 years old were screened for atrial fibrillation. CONCLUSION: Although progress is being made in managing the burden of NCDs, our findings reveal opportunities for improvement in the primary prevention of stroke. Further developments in strategic planning, raising awareness, and monitoring disease are required, as is research on barriers to the implementation of best practice screening of blood pressure and atrial fibrillation in primary care.

Complementary medicine and safety: a systematic investigation of design and reporting of systematic reviews.

OBJECTIVES: The objective of this study was to examine the methods used in systematic reviews of safety across a range of complementary therapies to assess the variation in approach and the potential for developing guidance on conduct and reporting. DESIGN: Systematic reviews focusing on safety were retrieved from NHS Evidence and searches of major databases. A pre-prepared template was used for data extraction. Information extracted included details of search strategies, sources, participants, interventions, reported adverse event/effect(s) and causality assessment. Data extraction was carried out by one researcher and a check for accuracy by a second researcher. Methods were assessed against criteria based on guidance provided by the Cochrane Adverse Effects Methods Group. RESULTS: A total of 2563 citations were screened and 88 systematic reviews were selected for inclusion. The majority focused on the safety of herbs and nutritional supplements. Approximately half the reviews covered all aspects of safety; other reviews addressed specific adverse effects or interactions. Types of data included in the reviews did not always reflect the focus of the review. Search strategies, sources used, quality assessment and assessment of causality also varied. CONCLUSIONS: Detailed examination and comparison of the methods has highlighted several areas in which there is potential for development of guidelines and consensus on standards. These include search strategies, sources of information, data extraction and assessment of causality. The value of systematic reviews in relation to large outcome studies requires further consideration.

St John's wort for depression: time for a different perspective?

OBJECTIVES: To review the development of the evidence on the herbal remedy, St John's wort (SJW) (Hypericum perforatum), in the treatment of depression. METHODS: Searches of major biomedical and specialist databases including EMBASE, MEDLINE, PsycINFO, AMED and HerbMed were conducted. Searches aimed to identify quantitative research (systematic reviews and meta-analyses) and relevant qualitative studies. Data were extracted systematically. RESULTS: Systematic reviews have been published regularly over the past 10 years. Methodology has varied resulting in differing estimates of effectiveness but overall findings have been positive when compared with placebo for mild to moderate depression. Recent reviews have focused on adverse effects and interactions. One qualitative study focusing on SJW in depression was retrieved. CONCLUSIONS: SJW has received intensive and continued attention since initial indications of its potential effectiveness for depression. The focus appears to be moving from effectiveness to safety but the patient's perspective has received less attention and may prove a valuable avenue for future studies.

"No language restrictions" in database searches: what does this really mean?

The aim of this study was to investigate the coverage of non-English journals by MEDLINE((R)) and EMBASE, the two major biomedical databases used for identifying studies for possible inclusion in systematic reviews and meta-analyses. A series of searches were conducted to compare the coverage of journals in languages other than English. The results were compared against listings in Ulrich's Periodicals Directory, an authoritative source of information on periodicals published in more than 200 countries. This study has highlighted the existence of a database coverage bias, in terms of the systematic exclusion of journals from certain countries and/or in certain languages. Searching that relies only on English language databases may result in failure to find many relevant studies published in languages other than English, irrespective of the research question and the avoidance of any language restrictions.