Journal of School of Public Health and

Background and Aim: Amblyopia is an important cause of weak vision and blindness. A preliminary study on validity of the current screening program in Shahrood City's kindergartens showed that this method may not be efficient enough, especially because of low sensitivity and referral problems. We tried to compare efficiencies and costs of screening by trained staff and optometrists in detecting patients.

Materials and Methods: We conducted a cost-effectiveness analysis using the decision-tree method. We replaced nurses with optometrists to compare costs per detected case by the two screening methods. The number of detected cases and costs per each detected case are compared. Also, the cost-effectiveness of four criteria screening examinations (with different validities) used by optometrists was estimated.

Results: Costs per case detected by optometrists and by current screening methods were 270000 and 556000 Rails (Rs), respectively (with baseline examination criteria and 6.4% prevalence). With a lower prevalence of amblyopic patients, CER (cost-effectiveness ratio) will increase in both methods, but the increase in the current screening method is less than the optometric method. In the optometrist method, avoidable costs and savings per detected case vary from 250000 Rs at a prevalence of 7.4% to 1185000 Rs at a prevalence of 1.4%. Sensitivity analysis showed that costs of "monitoring of screening" in the optometrists method and costs of "follow up in the current screening method" have strong effects on CER CER will decrease by 9.6% and 15%, respectively, if this costs decrease to 25%.

Conclusion: The cost, per detected case, of screening amblyopia by optometrists in kindergartens is half that by the current method. In areas with a low prevalence, the efficiency of screening by using optometrists increases remarkably.

Background and Aim: The aim of this study was to assess the adherence to anti-retroviral prophylaxis after occupational and non-occupational exposure to human immunodeficiency virus (HIV) in patients consulting the Voluntary Counseling and Testing Center (VCT) of Imam Khomeini Hospital, Tehran during the period 2008 to 2009.

Materials and Methods: In this prospective study, patients were selected, the required information about them was recorded, and adherence to anti-retroviral drugs (including Ziduvudin, Lamivudin and Efavirens) was determined based on self-report by the patients. Eighty-nine exposed patients were followed monthly for 4 months, and in the case of low-adherence (less than 95%) they were asked for the reason(s) for noncompliance.

Results: Of the 89 patients, 55 were men (61.8%) and 34 (38/2%) were women with a mean age of 30.16± 8.39 years 47 participants (52.8%) were single and 42 (47.1%) married 27 subjects (30.3%) were physicians, 35 (39.3%) nurses and 27 (30.3%) had occupations outside the healthcare system. From among the 36 subjects (40.5%) who stopped the treatment, 24 (27.0%) stopped it correctly (that is, when the serological test proved to be negative), while 12 (13.4%) did not stop it on a sound basis. Fifty-three subjects (59.6%) completed the prophylaxis. Adherence was found to be significantly associated with age and marital status (p<0.05).

Conclusion: The main reason for stopping the prophylaxis (a negative serological test result of the resource patient) was more pronounced than previous studies, which indicates the higher availability of the resource patient.