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HIV interventions and performance management: what can we learn from the data?
Stefano M Bertozzi
Point of Care Diagnostics Seminar
Saint Patrick’s Day, 2015
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Evaluación de la eficiencia técnica de los programas
de prevención y tratamiento de VIH
Sergio Bautista, Director, Economía de la Salud
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Número de sitios que componen la muestra analítica, por tipo de unidad y país
Hospital de referencia
Hospital general
Centro de salud
Otras unidades primarias
Total
HTC
Kenya 2 20 15 11 48
Rwanda - 1 51 - 52
South Africa 2 22 11 20 55
Zambia - 14 42 5 61
PMTCT
Kenya 2 17 14 6 39
Rwanda - 1 51 - 52
South Africa 1 10 12 20 43
Zambia - 13 35 1 49
VMMC
Kenya 1 12 14 10 37
Rwanda - 7 20 - 27
South Africa 1 17 4 5 27
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Costo por cliente de HTC, PMTCT y cascada de atención
HTC PMTCT
17 453 5 1,367 27 154 21 142 61 1,207 2,441 16 3,641 3,923 114 574 1,978 70 767 3,887
$10
$100
$1,000
Kenya Rwanda South Africa Zambia Kenya Rwanda South Africa Zambia
Ave
rag
e c
ost
pe
r clie
nt
(US
D)
Type of client Tested Tested + positive Positive + on ART
Kenya Rwanda South Africa Zambia
6.2
15
8.6
2.91.4 .7
1921
24
13
19
12
0
5
10
15
20
25
NationalHIV prevalence
HTC positivityrate
PMTCT positivityrate
NationalHIV prevalence
HTC positivityrate
PMTCT positivityrate
NationalHIV prevalence
HTC positivityrate
PMTCT positivityrate
NationalHIV prevalence
HTC positivityrate
PMTCT positivityrate
HIV
pre
vale
nce
(%
)
Note: Labels inside the bars indicate precise dollar figures
Note: Positivity rate was calculated as the percentage of (HTC , PMTCT) clients tested and HIV+ / (HTC , PMTCT) clients tested
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Categorías de costos y distribución del personal
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Tanzania: Number of People Living with HIV, 2014
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0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1
10
42
07
31
04
13
51
66
19
72
28
25
92
81
03
11
13
4
12
37
13
40
14
43
15
46
16
49
17
52
18
55
19
58
20
61
21
64
22
67
23
70
24
73
25
76
26
79
27
82
28
85
29
88
30
91
31
94
32
97
34
00
35
03
36
06
37
09
38
12
39
15
40
18
41
21
42
24
43
27
44
30
45
33
46
36
47
39
% H
IV p
osi
tive
wo
me
n id
en
tifi
ed
in 6
mo
nth
s
# sites
Kenya PMTCT Site Yield Distribution (SAPR14)
90% of patients are in 28% of the sites
Geographic Refocusing in Kenya% HIV Positive Women Identified in PMTCT Sites
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Costos promedio y escala
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Excess costs: viral supp. & immun. recovery vs treatment costs
Baseline CD4>200 cel/mm3 VL<50 copies/mm3 (6−18 m)VL<50 copies/mm3 (6−18 m)
and CD4 recovery (>400cel/mm3)
$10,000
$20,000
$30,000
$40,000
$50,000
25 50 75 25 50 75 25 50 75Percentage of clients, by clinical characteristic
Ave
rag
e a
nnual co
st p
er
clie
nt
with
VL<
50
and
CD
4>
400
(U
SD
)
New clients2012
200
400
600
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Percentage of patients who initiatedART with CD4>200 cel/ml
0% 25% 50% 75% 100%Percentage of patients withCV<50 copies/ml (6−18 m)
0% 25% 50% 75% 100%Percentage of patients with CV<50 copies/ml
and CD4 recovery
0% 25% 50% 75% 100%
Notes: Bar widths are propor tional to patient volume
Programa de atención en México: desempeño clínico a nivel de la unidad
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IN THE LAST YEAR
To improve management, need to monitor
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Reaching 100% ART coverage for TB/HIV patients must be a priority
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%A
ngo
la
Bo
tsw
a…
Cam
ero
…
Co
te…
DR
…
Eth
iop
ia
Gh
ana
Hai
ti
Ken
ya
Leso
tho
Mal
awi
Mo
zam
…
Nam
ibia
Nig
eria
Rw
and
a
Sou
th…
Swaz
ila…
Tan
zan
ia
Uga
nd
a
Zam
bia
Zim
bab
…
* ART eligibility at <350 CD4
World Health Organization, Global TB report 2013
Goal: 100% Coverage
Current ART coverage among eligible* TB PLHIV
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Agradecimientos
- El proyecto ORPHEA es financiado por la Fundación Bill & Melinda Gates.
- Agradecemos la colaboración de nuestros socios académicos en Kenya, Rwanda, Sudáfrica, Zambia y los Estados Unidos.
- Estamos agradecidos con nuestros colegas del Programa Global de VIH/SIDA del Banco Mundial, el CGD y ONUSIDA por su apoyo y colaboración.
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……………………………………………………………………………
PEPFAR
Ambassador Deborah L. Birx, M.D.U.S. Global AIDS Coordinator
U.S. Department of State
UCSF
October, 2014
Changing the Course of the HIV/AIDS EpidemicUsing Data, Modeling, Economic Analyses and Innovation
to Improve Program Impact