There are also two internal territories: Northern Territory , established as a self-governing territory in , and the Australian Capital Territory including the city of Canberra , which attained self-governing status in Papua New Guinea, formerly an Australian external territory, gained its independence in Historically part of the British Empire and now a member of the Commonwealth , Australia is a relatively prosperous independent country.
Australians are in many respects fortunate in that they do not share their continent—which is only a little smaller than the United States —with any other country.
Introduction to Australia’s National Security Challenges and Policy Making
Extremely remote from their traditional allies and trading partners—it is some 12, miles 19, km from Australia to Great Britain via the Indian Ocean and the Suez Canal and about 7, miles 11, km across the Pacific Ocean to the west coast of the United States—Australians have become more interested in the proximity of huge potential markets in Asia and in the highly competitive industrialized economies of China , Japan , South Korea , and Taiwan. Article Media. Info Print Print. Table Of Contents. Submit Feedback.
Thank you for your feedback. Written By: John J. A mathematical model of HIV transmission was employed to link programmatic coverage levels with estimates of numbers of HIV infections averted. One third of this cost would have been paid for as out-of-pocket expenditures by IDUs purchasing syringes in pharmacies. The intervention had been implemented in at 28 sites across the USA; he examined eight of the sites.
The authors concluded that short-term incidence analysis substantially overstated syringe exchange program effectiveness and cost-effectiveness in preventing HCV. But the analysis indicated that there had been significant financial savings accruing to government from the expenditure on NSPs and that these savings were expected to continue.
An Introduction to the Country and Continent of Australia
The study demonstrated that NSPs have also yielded a significant public health benefit in terms of avoidance of deaths and gains in the duration of life and improvements in the quality of life of IDUs. Each year at least 30 to 40 new HIV infections and 8, to 10, HCV infections occur through the sharing of syringes. In this context, it is important to re-assess the impact of NSPs and estimate the cost-effectiveness of current programs, as well as the cost-effectiveness of increasing or decreasing the allocation of resources to NSPs and the programs that they deliver.
A detailed description of the model is provided in Appendix A and a complete listing of the parameters and assumptions of the model and explanation of values used in the analysis are provided in Appendix B. Briefly, the model considered heterogeneity in injecting behaviour, including frequency of injecting and sharing of injecting equipment as well as rates of cleaning equipment. Mathematical associations were derived to describe the coverage of injecting equipment among IDUs for different levels of NSP distribution of sterile injecting equipment.
The model tracked the changing number of IDUs in the population, including the entry of new injectors and the rate of ceasing injecting behaviour.
1 • INTRODUCTION
The structure of the analysis was a compartmental model based on a large system of ordinary differential equations see Appendix A. The model was used to estimate the number of people in each HIV and HCV health state, including important clinical endpoints as well as drug-related, disease-related, and background death rates , for various NSP-delivery and behavioural scenarios see Appendix A.
All available Australian behavioural and epidemiological data and international disease-related data were used as inputs to calibrate the model to the relevant Australian population see Appendix B. The model also accounted for the total number of needles and syringes distributed to IDUs in each population, as informed by each State and Territory health department. Uncertainty and sensitivity analyses were carried out by varying all input parameters over plausible ranges, using Latin Hypercube Sampling implemented in the SaSAT software package 40 , and running the mathematical model 10, times.
Separate analyses were carried out for Australian IDUs at a national level and by each Australian state and territory, as well as for Aboriginal and Torres Strait Islander populations. Population-specific behavioural and epidemiological data were used to inform the inputs for the model simulations see Appendix A. The model's epidemiological outputs were aligned with available national surveillance data and NSP survey data with estimations from the HCV Projections Working Group study The numbers of people in each health state over time were used to inform the economic analyses of NSPs.
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The decade from was investigated to determine the effectiveness, and cost-effectiveness, of NSPs in the past. Analyses were also conducted to simulate what is likely to have occurred over the last decade, had NSPs not been in place or if the coverage of syringes among IDUs had been different. The model was then used to forecast epidemic trajectories over the next 70 years under assumptions that behaviour of IDUs or funding and services of NSPs remain unchanged or according to changes in conditions.
Epidemic projections are shown over the period Economic analysis methods The economic analysis was designed to calculate the net present value and future values and cost-effectiveness of NSPs with respect to their benefits in averting HIV and HCV infections from a health sector government as third party payer perspective. Therefore, the analysis is the most conservative and rigorous estimate of the true return on investment as the many other benefits of NSPs were not factored into the analysis support, referral, education etc.
The analysis used budget data provided by State and Territory health departments to derive the cost of NSPs and their associated interventions.
Healthcare costs saved for HIV and HCV prevented by the intervention were derived from models of service delivery, calibrated with data from local and international research on utilisation and valued using appropriate government cost sources. Outcomes of interest included the life years gained, disability adjusted, of the current expenditure on NSPs, compared to a range of alternatives, including an absence of program or 'partial null'.
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The time horizon of the economic model was varied to reflect different decision contexts: the period to reflect past investment in NSPs, to and to reflect the impact of choices made in in relation to the next years, and and to consider whole of lifetime impacts. Top of page Comparators The current provision of NSPs was compared to a scenario where publically funded NSPs did not exist the no program or partial null scenario.
This was based on the estimates of private needle purchase provided by the States and Territories. It is important to note that community pharmacies are a critical component of needle and syringe programs.
If publicly funded access to sterile injection equipment had not been put in place, but simply the enabling legislation enacted, or was at some stage removed. Earth Sciences and Geography. Engineering and Technology.
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Human Geography. Research and Information. Social Work. Warfare and Defence. Read More. Front Matter List of illustrations List of Maps 1. The making of Australia 2. Shaping the continent 3. Governing Australia 4. Australia and the world 5. All rights reserved.