Each year there are over 300 natural disasters globally with millions of victims that cost economic losses near USD$100 billion. In the context of climate change, an emerging literature linking extreme weather events to HIV infections suggests that efforts to control the HIV epidemic could be under threat. We used Demographic and Health Survey (DHS) data collected during the 2015–2016 harsh drought that affected several areas of Malawi to provide new evidence on the effect of an unanticipated economic shock on sexual behaviours of young women and men. We find that amongst women employed in agriculture, a six-months drought doubles their likelihood of engaging in transactional sex compared to women who were not affected by the drought and increases their likelihood of having a sexually transmitted infections (STI) by 48% in the past twelve months. Amongst men employed outside of agriculture, drought increases by 50% the likelihood of having a relationship with a woman engaged in transactional sex. These results suggest that women in agriculture experiencing economic shocks as a result of drought use transactional sex with unaffected men, i.e. men employed outside agriculture, as a coping mechanism, exposing themselves to the risk of contracting HIV. The effect was especially observed among non-educated women. A single drought in the last five years increases HIV prevalence in Malawi by around 15% amongst men and women. Overall, the results confirm that weather shocks are important drivers of risky sexual behaviours of young women relying on agriculture in Africa. Further research is needed to investigate the most adequate formal shock-coping strategies to be implemented in order to limit the negative consequences of natural disasters on HIV acquisition and transmission.

Background: Sleepio is an automated digital program that delivers digital cognitive behavioural therapy for insomnia (dCBT-I). Sleepio has been proven effective in improving sleep difficulties; however, evidence for the possible impact of Sleepio use on healthcare costs in the UK has not, to the authors’ knowledge, previously been developed.Aim: To identify the effect of a population-wide rollout of Sleepio in terms of primary care costs in the NHS in England.Design & setting: The study was conducted in the Thames Valley region of England, where access to Sleepio was made freely available to all residents between October 2018 and January 2020. The study relies on a quasi-experimental design, using an interrupted time series (ITS) to compare the trend in primary care costs before and after the rollout of Sleepio.Method: Primary care data for people with relevant characteristics from nine general practices in Buckinghamshire was used. Primary care costs include general practice contacts and prescriptions. Segmented regression analysis was used to estimate primary and secondary outcomes.Results: For the 10 705 patients included in the sample, the total saving over the 65-week follow-up period was £71 027. This corresponds to £6.64 per person in the sample or around £70.44 per Sleepio user. Secondary analyses suggest that savings may be driven primarily by reductions in prescribing.Conclusion: Sleepio rollout reduced primary care costs. National adoption of Sleepio may reduce primary care costs by £20 million in the first year. The expected impact on primary care costs in any particular setting will depend on the uptake of Sleepio.

The objectives of this research were to produce a macro-level overview of the global COVID-19 burden and estimate the value of access to COVID-19 vaccines. A targeted literature review collated evidence of the burden. Linear modelling and data analysis estimated the health and economic effects of COVID-19 vaccines delivered in 2021, and whether additional value could have been achieved with broader and more equitable access. By 1 December 2020, there had been an estimated 17 million excess deaths due to COVID-19. Low-income countries allocated more than 30% of their healthcare budgets to COVID-19, compared to 8% in high-income countries. All country income groups experienced gross domestic product (GDP) growth lower than predicted in 2020. If all 92 countries eligible for COVAX Advance Market Committee (AMC), access had reached 40% vaccination coverage in 2021, 120% more excess deaths would have been averted, equivalent to USD 5 billion (10⁹) in savings to healthcare systems. Every USD spent by advanced economies on vaccinations for less advanced economies averted USD 28 of economic losses in advanced economies and USD 29 in less advanced economies. The cost to high-income countries when not all countries are vaccinated far outweighs the cost of manufacturing and distributing vaccines globally.

Objectives: Health technology assessment (HTA) is a critical part of healthcare decision making in many countries. Changes in Methods and Processes (M&P) of HTA agencies can affect the time and degree of patient access to treatments. Published literature focuses on the different M&P adopted by HTA agencies, rather than on how these have come about over time. Our study investigates key HTA reforms and explores their drivers and interdependencies in a set of HTA agencies in Europe, Asia-Pacific, and North America. Methods: We conducted a targeted literature review on M&P guidelines and subsequent changes to those, for 14 HTA agencies. We supplemented and validated initial findings with 29 semi-structured interviews with country-specific experts. We used analytical tools to create process maps, proactivity and influence networks, and clusters of HTA agencies. Results: We found that processes leading to M&P reforms follow similar steps across HTA agencies. The three most important drivers to reforms were HTA practice and guidelines in other countries; the healthcare policy, legal, and political context within the agency’s country; and experience of challenges in the assessment by the HTA body itself. International collaborations have the potential to accelerate the evolution of HTA systems and the implementation of reforms. Conclusion: We identified PBAC (Australia), CDA-AMC (Canada), NICE (England), IQWiG (Germany), and ZIN (the Netherlands) as HTA agencies that are catalysts of HTA reforms as well as internationally influential. International collaborations may represent a useful route to accelerate changes as long as they ensure wide stakeholder engagement at an early stage.

Following the fall in new HIV diagnoses in gay, bisexual and other men who have sex with men (GBMSM) since 2015, the English government published an HIV Action Plan committing to end HIV transmission by 2030. Underlying HIV transmission, migration and access to testing, influence diagnosis trends and may not reflect incidence as people could be living with undiagnosed HIV for many years. We derived HIV incidence by clinical risk markers and PrEP use. Using GUMCAD STI surveillance data between 2014/15 and 2022/23, we calculated yearly HIV incidence among HIV-negative GBMSM attending sexual health services (SHS) in England with at least 2 HIV tests within 365 days (‘repeat testers’). Annual incidence was stratified by clinical risk markers: bacterial STI history and recent HIV test (from the previous year). Incidence was further stratified by PrEP use in 2022/23. The number of HIV-negative GBMSM attending SHS in England increased by 34% from 111,977 in 2014/15 to 149,904 in 2022/23, of whom repeat testers were 34% (37,576) in 2014/15 and 38% (56,896) in 2022/23. HIV incidence reduced by 93% overall (1.77/100py [95 CI 1.61-1.94] in 2014/15 to 0.12/100py [0.09-0.16] in 2022/23). Incidence reduced by at least 89% in all groups irrespective of clinical risk markers: with bacterial STI history (3.68/100py [3.17-4.27] to 0.26 [0.18-0.38]); the subset with a rectal bacterial infection (5.18/100py [4.13-6.49] to 0.58 [0.36-0.93]), and with a recent HIV test (1.93/100py [1.66-2.24] to 0.08 [0.05-0.13]). In 2022/23, using PrEP reduced HIV incidence by 86% (using PrEP: 0.05/100py [0.03-0.08]) vs not using PrEP: 0.36/100py [0.26-0.50]). There was a sustained and large decline in HIV incidence among GBMSM, while incidence remains highest among those with a recent bacterial STI history. This analysis further highlights the real-world impact of PrEP and highlights the importance of equitable provision of HIV combination prevention interventions.

Background Students in higher education exhibit higher rates of mental health problems than the general population and often lack access to effective treatments and services. The COVID-19 pandemic has exacerbated already high levels of need. Policymakers must have the relevant evidence to inform resource allocation and investment decisions about student mental health services. Aim We aim to identify and summarise economic analyses of interventions to prevent and treat mental health problems in university students in terms of the studies’ findings and the methods used. Method We will review all published economic analyses relating to interventions designed to prevent or treat student mental health problems. We will search the following databases: PubMed, MEDLINE, Embase, Web of Science, EconLit, PsycINFO and the National Health Service Economic Evaluation Databases (NHS EED). The review will be conducted following PRISMA guidelines. Key data items relating to the methods and results of the included studies will be extracted, and the resulting database will be made publicly available. Registration This review is registered on PROSPERO (ID CRD42021250228) Funding This research is funded by UK Research and Innovation (grant number ES/S00324X/1).