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Strictly Confidential © 2014Strictly Confidential © 2014
WHY HIGH-QUALITY POPULATION SIZEESTIMATES OF KEY POPULATIONS AREIMPORTANT
David WilsonHNP - GP World Bank
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Strictly Confidential © 2014
‘We Have Run Out Of Money; Now We Have to Think’
W.S. Churchill
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Joint Program Competencies as Pillars of Strategic Planning
• Multisectoral approach
• NSP3G guidance• Allocative efficiency
studies
• Service delivery solutions
• Program efficiency • Impact evaluation
• Multisectoral approach
• Evidence for strategic planning
• Epidemic appraisal
• Fiscal space analysis• Sustainable financing
research• Investment cases
Sustain Understand
DesignDeliver
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What Does Success Look Like?India Joint Program Example
Understandthe epidemic
Design:Implementation
efficiency Deliver:Effectiveness
Sustain:Sustainability
Understand:Allocative Efficiency
70% of transmission sex work in 4 states
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UNDERSTAND
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Strictly Confidential © 2014
Prevalence of Injecting Drug Use
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Strictly Confidential © 2014
Prevalence of HIV among PWID
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What we knowInaction is costly, and not the equivalent of nothing happening; It is hard to reverse epidemic once established
Whereas harm reduction is - Effective - in terms of HIV cases averted - Cost-effective - in terms of healthy years
gained and costs - Social benefits exceed treatment costs- And benefits the whole population
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What is the global coverage of harm reduction services?
Source: Authors’ literature review and estimates, using Mathers et al. 2010
Few PWID access all three priority interventions
Female PWID far lower access than males
An estimated 10% access NSP
About 14% of HIV+ PWID
access ART
An estimated 8% access OST
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How much is spent on harm reduction?
Sources: Stimson et al 2010 (three cents report), UNAIDS 2009; UNAIDS Progress report 2012; Global State of Harm Reduction, 2012; Bridge et al 2012
Estimated $160 million in LMIC in 2007 (3 cents per PWID per day): 90% from international donors
Global Fund largest HR funder (estimated $430 million 2002-2009) > 50% to Eastern Europe and Central Asia
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How much is needed to scale up priority harm reduction interventions?
NSP coverage
(%)
Needles / PWID /year
OST uptake
(%)
ART uptake of HIV+ PWID
(%)Current estimated level 10 22 8 14Scenarios: Mid target 20 100 20 25 High target 60 200 40 75
Very preliminary resource estimates based on regional estimates of current NSP /OST /ART coverage, population sizes and unit costs
Mid and high target scenarios costed
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Summary: Estimated annual cost of scale-up of NSP, OST and ART for PWIDs
Mid target20% NSP coverage20% OST coverage25% ART coverage
High target60% NSP coverage40% OST coverage75% ART coverage
South, East & South East Asia 527M 1,49B
Latin America & Caribbean 625M 1,47B
Middle East & North Africa 26M 55M
W- Europe, N- America & Australasia 17M 1,19B
Eastern Europe & Central Asia 1.04B 2,51B
Sub-Saharan Africa 414M 901M
Total per year 2,65B 7,62B
1: Mathers et al, Lancet (2010) 2: Scale-up calculations by UNSW
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Annual scale-up costs by region and intervention
Costs dominated by Eastern Europe and Central Asia
E-Europe & C-Asia 38%
SSA16% S, E & SE
Asia20%
LA & Caribbean
24%
W-Europe, N-America & Australasia
1%M-East & N-
Africa1%
1: Mathers et al, Lancet (2010) 2: Scale-up calculations by UNSW
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Cost-effectiveness and relative return on investment ranges by region
() number of studies in literature
Western Europe, North America & Australasia
CE1:ROI2:
$402-$34,278 (9)$1.1-$5.5 (3)
Sub-Saharan Africa
Eastern Europe & Central Asia
The Middle East & North Africa South, East & South East Asia
Latin America & The Caribbean
CE1:ROI2:
$97-$564 (3)$1.4 (1)
CE1: $1,456-$2,952 (1) CE1:ROI2:
$71-$2,800 (7)$1.2-$8.0 (4)
1: Cost per HIV infection averted 2: Total future return per $1 invested (3% discount rate)
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Harm Reduction Data Challenges
• Limited population size estimates• Inconsistent service quality data• Surveys miss hidden populations• ATS increasingly used and injected but
missed in surveys• Significant but undocumented scale-down of
services
Sources: UNGASS country progress reports 2012; Mathers et al., 2010; Global State of Harm Reduction, 2012
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Why we need reliable estimates of the size of populations at high risk
Policy- Advocacy- Response planning and resource allocation- Estimates number of infected with HIV and
projections of the burden diseaseProgramming- Intervention planning- Measurement of coverage- M & E interventions
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Adjust for SW mobility with mathematical model to reduce double-counting of SW frequenting multiple spots
Regression modelling to generate province-wide SW population size estimates from the towns mapped, with lower and upper bounds and
Define Population Size and Program TargetsPopulation Size Estimation with Modeling to Improve Estimates
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Know Your Epidemic: Epidemic, Response and Policy Syntheses