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Optimizing Vaccine Clinic Operations in Low and Middle Income Countries

Hasanzadeh Mofrad, Maryam (2016) Optimizing Vaccine Clinic Operations in Low and Middle Income Countries. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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This dissertation focuses on two open questions in operating vaccination clinics in low and middle income countries. First, as a result of limited ``open vial life," clinicians face difficult tradeoffs between opening a multi-dose vial to satisfy a potentially small immediate demand versus retaining the vial to satisfy a potentially large future demand. Second, in low and middle income countries, governmental health organizations face tradeoffs between locating (additional) clinics or conducting outreach trips to vaccinate patients in remote locations.

To answer the first question, we formulate Markov decision process models that determine when to conserve vials as a function of the time of day, the current vial inventory, and the remaining clinic-days until the next replenishment. The objective is to minimize ``open-vial waste" while administering as many vaccinations as possible. For the base model, we analytically establish that the optimal policy is of a threshold type; conduct extensive sensitivity analysis on model parameters; develop a practical heuristic policy; suggest operational approaches that do not overly inconvenience patients; define metrics for determining appropriate operating hours and sessions per inventory replenishment cycle; and study the impact of random vial yield. We then generalize the base model by considering a positive probability of return for patients who are not vaccinated on their first visit and incorporating non-stationary arrival rates. To study these enhancements, we perform extensive numerical experiments at the clinic level for a single replenishment cycle and then extrapolate to multiple clinics and the entire world on an annual basis. The results indicate potential savings on the order of millions of doses per year.

To answer the second question, given a network of population centers we develop a mixed integer linear programming model that determines clinic locations and outreach activities. The model minimizes cost over a specified period of time subject to constraints on coverage, trip distance, trip size, trip frequency and patient travel. We address demand uncertainty; perform sensitivity analysis on key model parameters; compare the performance of the optimal solution to heuristic policies; and conclude that while counterintuitive it is often suboptimal to locate clinics in the largest population centers.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Hasanzadeh Mofrad, MaryamHasanzadeh.mofrad@gmail.comMAH249
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairMaillart, Lisa A.maillart@pitt.eduMAILLART
Committee MemberNorman, Bryan A.banorman@engr.pitt.eduBANORMAN
Committee MemberRajgopal, Jayantrajgopal@pitt.eduRAJGOPAL
Committee MemberProaño, Rubén
Date: 15 June 2016
Date Type: Publication
Defense Date: 25 March 2016
Approval Date: 15 June 2016
Submission Date: 20 March 2016
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 125
Institution: University of Pittsburgh
Schools and Programs: Swanson School of Engineering > Industrial Engineering
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: Markov decision process, perishable inventory model, multi-dose vial, vaccine wastage, capacitated facility location, outreach trip
Date Deposited: 15 Jun 2016 18:50
Last Modified: 15 Jun 2018 05:15


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