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Global Health Intervention Review: Making Global Health Data Accessible to Policy Makers
Global Health Intervention Review: Making Global Health Data Accessible to Policy Makers
Global Health Intervention Review: Making Global Health Data Accessible to Policy Makers
Global Health Intervention Review: Making Global Health Data Accessible to Policy Makers
Global Health Intervention Review: Making Global Health Data Accessible to Policy Makers
Global Health Intervention Review: Making Global Health Data Accessible to Policy Makers
Global Health Intervention Review: Making Global Health Data Accessible to Policy Makers
Global Health Intervention Review: Making Global Health Data Accessible to Policy Makers
Global Health Intervention Review: Making Global Health Data Accessible to Policy Makers
Global Health Intervention Review: Making Global Health Data Accessible to Policy Makers
Global Health Intervention Review: Making Global Health Data Accessible to Policy Makers
Global Health Intervention Review: Making Global Health Data Accessible to Policy Makers
Global Health Intervention Review: Making Global Health Data Accessible to Policy Makers
Global Health Intervention Review: Making Global Health Data Accessible to Policy Makers
Global Health Intervention Review: Making Global Health Data Accessible to Policy Makers
Global Health Intervention Review: Making Global Health Data Accessible to Policy Makers
Global Health Intervention Review: Making Global Health Data Accessible to Policy Makers
Global Health Intervention Review: Making Global Health Data Accessible to Policy Makers
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Global Health Intervention Review: Making Global Health Data Accessible to Policy Makers

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  • Waterborne and HIV in bold because most advanced on web and will present today.
  • Transcript

    • 1. Global Health Intervention ReviewGlobal Health Intervention Review (GHIR):(GHIR): Making Global Health DataMaking Global Health Data Accessible to Policy MakersAccessible to Policy Makers Mohsen Malekinejad MD, Dr.PHMohsen Malekinejad MD, Dr.PH Institute for Health Policy StudiesInstitute for Health Policy Studies University of California, San FranciscoUniversity of California, San Francisco CUGH, September 21, 2010CUGH, September 21, 2010 University of WashingtonUniversity of Washington
    • 2. BackgroundBackground  Growing evidence baseGrowing evidence base in global health, muchin global health, much needed butneeded but dauntingdaunting inin quantity and technicalquantity and technical complexitycomplexity  Kaiser Family Foundation project toKaiser Family Foundation project to make keymake key global health information accessibleglobal health information accessible to policyto policy makers and health mediamakers and health media  UCSF asked toUCSF asked to distill existing evidence ondistill existing evidence on intervention effectsintervention effects for broad set of healthfor broad set of health conditions and interventionsconditions and interventions
    • 3. Goals – 1Goals – 1  Translate evidence baseTranslate evidence base for intervention effectsfor intervention effects into technically sound, concise, accessibleinto technically sound, concise, accessible quantitative synthesisquantitative synthesis  Prevention and treatmentPrevention and treatment  Focus onFocus on data of most potential relevancedata of most potential relevance forfor policy and funding decisionspolicy and funding decisions  Complement other summaries with aComplement other summaries with a focus onfocus on systematic, health-condition level, maximalsystematic, health-condition level, maximal synthesis of “what works?”synthesis of “what works?”
    • 4. Goals – 2Goals – 2  Phase 1: summarizing evidence of efficacy for 10Phase 1: summarizing evidence of efficacy for 10 conditionsconditions:: Waterborne diarrheaWaterborne diarrhea HIVHIV malariamalaria TBTB dengue feverdengue fever soil-transmitted helminthssoil-transmitted helminths unintended pregnancyunintended pregnancy maternal post partum hemorrhagematernal post partum hemorrhage maternal sepsismaternal sepsis hypertension (pending)hypertension (pending)
    • 5. MethodsMethods  Stepwise, transparent progressionStepwise, transparent progression fromfrom evidence base (mainly systematic reviews)evidence base (mainly systematic reviews) to key findingsto key findings  Standardized outcome metricStandardized outcome metric “relative risk“relative risk reduction” (RRR) =reduction” (RRR) = By what % does the interventionBy what % does the intervention reduce negative health outcomes?reduce negative health outcomes?  Strength of evidenceStrength of evidence – 0 to 6 scale, like– 0 to 6 scale, like cell phone reception, based on extent andcell phone reception, based on extent and type of studies, review quality, precision.type of studies, review quality, precision.
    • 6. Search for systematic reviews & pivotal new studies for prevention & treatment for a health condition. Select potentially policy-relevant reviews and comparisons Extract context, method, and findings for quantitative efficacy Rate strength of evidence (quantity & type of studies, precision) Present key findings Combine evidence by intervention type GHIR data distillation process Massive, Diverse, Technical Concise, Consistent, AccessibleConsult with experts
    • 7. Data DistillationData Distillation Health Condition Review Studies Intervention- outcome Comparisons Key Findings Dengue fever 7 79 6 HIV 36 579 39 malaria 17 337 12 soil-transmitted helminths 5 in progress in progress TB 18 250 34 waterborne diarrhea 24 373 11 maternal sepsis 20 150 10 maternal PPH* 15 163 11 unintended pregnancy 15 327 15 Nine conditions (total) 157 2321 138 * PPH: post partum hemorrhage
    • 8. Web site: Key FindingsWeb site: Key Findings Diarrhea – PreventionDiarrhea – Prevention
    • 9. Web site: Key FindingsWeb site: Key Findings Diarrhea – TreatmentDiarrhea – Treatment
    • 10. DISEASE ACQUISITION DISEASE PROGRESSION Disease process: Fluid loss Dehydration Intestinal wall infection / bleeding Water source (risk of microbial contamination) Water & food handling in household (risk of microbial contamination) DiarrheaDiarrhea DEATH • Protection of source (eg bore holes) Waterborne diarrhea Consumption of contaminated water or food • Oral rehydration • Micronutrients • Antimicrobrial for certain pathogens • Intravenous rehydration • Decontamination at point of use (eg filters, safe vessels) • Latrines and sewers Light blue boxes indicate mechanisms of disease acquisition and progression. Orange boxes indicate interventions Contamination of hands •Behavioral (eg hand washing) Hand-mouth contact
    • 11. Web site: OverviewWeb site: Overview Diarrhea –1Diarrhea –1
    • 12. Web site: OverviewWeb site: Overview Diarrhea – 2Diarrhea – 2
    • 13. Interventions forInterventions for diarrheadiarrhea withwith RRR>20% and SoE+++RRR>20% and SoE+++  PreventionPrevention • typhoid vaccine 49%-72%typhoid vaccine 49%-72% • rotavirus vaccine 63%-85%rotavirus vaccine 63%-85% • decontamination of water at point of usedecontamination of water at point of use 24%-37%24%-37% • behavioral intervention 23%-41%behavioral intervention 23%-41% • multifaceted intervention 26%-57%multifaceted intervention 26%-57%  TreatmentTreatment • advance oral rehydration 30%-41%advance oral rehydration 30%-41% • oral zinc 29%-45%oral zinc 29%-45% • anti-protozoan 61%-87%anti-protozoan 61%-87%
    • 14. Interventions forInterventions for malariamalaria withwith RRR>20% and SoE+++RRR>20% and SoE+++  PreventionPrevention • bed nets 17%-23%*bed nets 17%-23%* • chemoprophylaxis (IPT) for childrenchemoprophylaxis (IPT) for children 24%-57%24%-57%  TreatmentTreatment • Artemisinin-based combination regimenArtemisinin-based combination regimen 38%-88%, and 25%-49%*38%-88%, and 25%-49%*
    • 15. Interventions forInterventions for HIVHIV withwith RRR>20% and SoE +++RRR>20% and SoE +++  PreventionPrevention • adult male circumcision 50%-54%adult male circumcision 50%-54% • Zidovudine for infected mothers to baby 54%-Zidovudine for infected mothers to baby 54%- 69%*69%*  TreatmentTreatment • ART + CD4 count + clinical monitoring 26%*ART + CD4 count + clinical monitoring 26%* • Early initiation of ART 74%*Early initiation of ART 74%* • Cotrimoxazole 23%-37%*Cotrimoxazole 23%-37%* • Fluconazole for oropharyngeal candidiasis 39%-Fluconazole for oropharyngeal candidiasis 39%- 84%84%
    • 16. Phase 1 limitationsPhase 1 limitations  EfficacyEfficacy (risk reduction in ideal setting)(risk reduction in ideal setting) essential but insufficient … need real worldessential but insufficient … need real world effects, impact, and resource allocation.effects, impact, and resource allocation.  Orientation aroundOrientation around intervention-outcomeintervention-outcome pairs within health conditionspairs within health conditions usual &usual & hence necessary, but poorly matched tohence necessary, but poorly matched to some policy issues (e.g., MDGs) andsome policy issues (e.g., MDGs) and opportunities (e.g., system building).opportunities (e.g., system building).
    • 17. Next Step:Phase 2 – Objectives:Next Step:Phase 2 – Objectives:  Effectiveness:Effectiveness: How well does theHow well does the intervention evidence base reflect real-intervention evidence base reflect real- world, large scale implementation?world, large scale implementation?  Burden reduction:Burden reduction: How much wouldHow much would intervention scale-up reduce burden ofintervention scale-up reduce burden of disease? Measured in DALYsdisease? Measured in DALYs  Cost-effectiveness:Cost-effectiveness: How does a set ofHow does a set of interventions translate to cost per DALYinterventions translate to cost per DALY averted?averted?
    • 18. Investigators (phase1): Jim G Kahn MD, MPH (PI) Mohsen Malekinejad MD, DrPH Brian Harris M.A. Institute for Health policy Studies, University of California, San Francisco Elliot Marseille DrPH, MPP Health International Strategies Jeniffer Kates MPH Kaiser Family Foundation

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