Your SlideShare is downloading. ×
  • Like
Using modelling to inform our diagnostics strategy
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×

Now you can save presentations on your phone or tablet

Available for both IPhone and Android

Text the download link to your phone

Standard text messaging rates apply

Using modelling to inform our diagnostics strategy

  • 325 views
Published

Presentation by

Presentation by

Published in Health & Medicine
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
    Be the first to like this
No Downloads

Views

Total Views
325
On SlideShare
0
From Embeds
0
Number of Embeds
0

Actions

Shares
Downloads
7
Comments
0
Likes
0

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide
  • Following that approach, we arrived at three major areas of focus. Ultimately, we allocate about half of our resources to our work in global health, a quarter to our work in the United States, and another quarter to our work in global development.
  • Our grantmaking involves four key steps: developing strategy, making grants, measuring progress, and adjusting strategy.(CLICK)  Develop Strategy: Before making a grant, we try to figure out which problems in our three program areas cause the most harm and receive the least attention. Program areas consider the costs, risks, long-term viability, and possible impacts of each potential solution. For each opportunity, we work with external experts to develop a strategy and budget, identify desired outcomes, and create a plan to measure short- and long-term results. Co-chairs Bill and Melinda Gates and CEO Jeff Raikes then review and approve the strategy.(CLICK)  Make Grants: After receiving approval, we look for the partners and grantees best qualified to implement the strategy. In most cases, we make grants and establish formal agreements that specify target outcomes. Most grants go to large intermediary partners, organizations that fund and support those working in the field. These intermediaries have years of experience and help make sure our investments have the intended impact. (CLICK)  Measure Progress: After making a grant, we require grantees to measure and report on their work at least once a year. We also assess progress toward our own goals each year. Every one to two years, we take stock of our overall strategy and the extent to which we have accomplished our key goals.Third-party evaluations provide in-depth findings on the effectiveness of our work. In some cases, we evaluate specific grants. In others, we review entire programs.Outside advisors and experts help us examine our efforts and provide honest counsel.By talking with those we intend to help—our ultimate beneficiaries—we can assess whether we are meeting their needs.(CLICK) Adjust Strategy: After we gather feedback, our program presidents and CEO decide whether to continue on the same course or adjust strategy. Bill and Melinda review and approve all major strategic changes.
  • NOTE TO PRESENTERS: This animation is only meant to illustrate a concept and is not an exact to scale diagram of the relationship.  Making grants is the bulk of what we do, but money alone can’t fix these problems. In 2008, Congress passed a bill to increase the President’s Emergency Plan for AIDS Relief (PEPFAR) to $50 billion, including $6 billion this year. (CLICK) In 2008, we made grants totaling $343 million for work on HIV/AIDS, less than 6 percent of what PEPFAR spent, and PEPFAR’s was just a tiny portion of all U.S. AIDS relief program funding. This doesn’t even account for all of the other donor countries and their investments for AIDS. Ultimately, the money we put into fighting HIV/AIDS isn’t nearly as significant as our ability to get everyone on board.
  • Bill and Melinda Gates started the foundation because they believe every person should have the chance to live a healthy and productive life.

Transcript

  • 1. Using modeling to inform our diagnostics strategy
    Christine Rousseau, Ph. D.
    July 18, 2011
  • 2. Our Areas of Focus
    2
    25%
    Global Development Program
    25%
    United States Program
    50%
    Global Health Program
    August 15, 2011
  • 3. 3
    4
    AdjustStrategy
    Our Approach to Giving
    2
    1
    3
    MeasureProgress
    DevelopStrategy
    STEP ONE: Develop Strategy
    STEP TWO: Make Grants
    STEP THREE: Measure Progress
    STEP FOUR: Adjust Strategy
    MakeGrants
    August 15, 2011
  • 4. The Importance of Advocacy
    4
    Our money alone can’t fix these problems. Consider:
    President’s Emergency Plan for AIDS Relief Commitment in 2008: $6 billion
    Foundation HIV/AIDS grant total in 2008:$343 million
    <6%
    $6B
    of President’s Emergency Plan for AIDS Relief commitment
    August 15, 2011
  • 5. HIV Theory of Change
    Goal
    Outcome
    Activities
    Impact
    Enabling Environment
    Generate tools & knowledge
    Plan
    Execute
    R&D and health infrastructure
    Discover, develop, refine tools
    Reduced exposure
    Political will
    Changed behavior
    Optimize resource allocation among interventions
    Generatedemand
    Reduced transmission (given exposure)
    Synthesize knowledge
    • population
    • 6. providers
    Social & structural conditions
    Progressively and sustainably reduce the incidence of HIV and increase life expectancy for those living with HIV
    Improved coverage
    Optimize targeting
    Deliver services
    Funding and financing mechanisms
    Reduced disease burden (given infection)
    Research delivery (efficiency & effectiveness)
    Input costs
    5
  • 7. Where the foundation can act
    What happens as a result of our (collective) action
    Where most national & international actors focus
    Exogenous?
    Goal
    Outcome
    Activities
    Impact
    Enabling Environment
    Generate tools & knowledge
    Plan
    Execute
    R&D and health infrastructure
    Discover, develop, refine tools
    Reduced exposure
    Political will
    Changed behavior
    Optimize resource allocation among interventions
    Generatedemand
    Reduced transmission (given exposure)
    Synthesize knowledge
    • population
    • 8. providers
    Social & structural conditions
    Progressively and sustainably reduce the incidence of HIV and increase life expectancy for those living with HIV
    Improved coverage
    Optimize targeting
    Deliver services
    Funding and financing mechanisms
    Reduced disease burden (given infection)
    Research delivery (efficiency & effectiveness)
    Input costs
    6
  • 9. Investment Principles
    Take risks and fill gaps where others won’t play
    Maximize leverage
    Maximize flexibility
    Exploit comparative advantage
    7
  • 10. Goal
    Outcome
    Activities
    Impact
    Enabling Environment
    Generate tools & knowledge
    Plan
    Execute
    R&D and health infrastructure
    Discover, develop, refine tools
    Reduced exposure
    Political will
    Changed behavior
    Optimize resource allocation among interventions
    Generatedemand
    Reduced transmission (given exposure)
    Synthesize knowledge
    Social & structural conditions
    Progressively and sustainably reduce the incidence of HIV and increase life expectancy for those living with HIV
    $$$$$$$$$$
    Improved coverage
    Optimize targeting
    Deliver services
    Funding and financing mechanisms
    Reduced disease burden (given infection)
    Research delivery (efficiency & effectiveness)
    Input costs
    8
  • 12. 9
    5
    2
    6
    3
    7
    4
    Our Theory of Action identified 7 strategic initiatives
    Vaccines
    ARV-based Prevention
    Efficiency & Effectiveness (E2)
    Diagnostics
    1
    Male Circumcision
    TB/HIV
    Prevention implementation
  • 13. Number of people (all age groups) receiving and needing antiretroviral therapy, and percentage coverage in low- and middle-income countries by region, 2008 to 2009
    Source: Towards universal access; Progress report 2010; UNAIDS, WHO
  • 14. 11
    The cost of providing HIV treatment in PEPFAR-supported programs
    August 15, 2011
    Menzies et al AIDS 2011
  • 15. 12
    August 15, 2011
    Diagnostics for HIV
    Detection of infection
    2nd line
    Treatment
    Which tests?
    When to use?
    Impact on individual?
    Impact on epidemic?
  • 25. HIV Synthesis transmission model
    Andrew Phillips1, Valentina Cambiano1, Alec Miners2, Diane Bennett1, Deenan Pillay1, Geoff Garnett3, Marco Vitoria1, Tim Hallett3, and Jens Lundgren41UCL, London, UK, 2LSHTM, London, UK, 3Imperial College, London, UK and 4Universitty of Copenhagen, Denmark
  • 26. HIV transmission synthesis model:
    Heterosexual epidemic in southern Africa
    Creates a ‘dataset’ of the lifetime experiences of ~50,000 people in a
    population, aged over 15.
    Years from 1985
    1985 1985.25 1985.5 1985.75 1986.00 1986.25
    Additional variables updated over time
    e.g.
    Calendar date
    Infection with HIV
    Sexual risk behaviour:
    • Long term partnership status
    • 27. Number of new partners
  • Risk of HIV infection in uninfected subject
    Number of new
    partnerships formed
    by HIV+ people
    Subject
    Concurrent
    HIV+
    population
    Current viral
    load of infected
    partner
    Number of
    new partners
    Number of new
    partners who are
    HIV+
    Probability of
    HIV infection
    Gender
    Age
    Long term
    partner HIV+
    Long
    term partnership
    status
    Incidence and prevalence
    of HIV in people with
    long term partnerships
    Risk of infection
    also depends on current STI
  • 28. +65% per life-year cf no CD4
    +11% per life-year cf central CD4
    -$25 per life-year
    Hallett et al (personal comm.)
  • 29. 17
    August 15, 2011
    Prediction of the Impact of Potentially Newly Available Diagnostic and Monitoring Tools
     
  • 30. Assumption of % of people with CD4 count access
    central lab device- device-free
    dependent
    No change 40% 0% 0%
    Device-dependent only 40% 30% 0%
    scenario
    With device-free 40% 30% 20%
    scenario*
    * Thus, we assume availability of a device-free test would result in 20% more people having CD4 available by 2018, because it can be used in more remote areas. - All measures assumed to be equally accurate
  • 31. Incremental cost effectiveness ratio (ICER)
    (quality adjusted and with discounting)
    of device-free test introduction, according to share of CD4 counts done by a device-free test by 2018
    20% (as in main results shown) $ 551
    66% $ 301
    If device-free coverage expands beyond 20% and takes some of
    Centralized lab or device-based test share of then introduction becomes more cost-effective since it has a lower unit cost.
    If we assume that the CD4 count at initiation of ART remains at 200
    throughout (rather than increasing to 350): cost per qaly = $338
  • 32. HIV Modelling Consortium
    AIM: To significantly improve scientific support for decision making by co-coordinating a wide range of research activities in mathematical modelling the HIV epidemic.
    20
    >> Identify questions that demand mathematical modelling input and identify new modeling results that may require further validation;
    >> Facilitate sharing of information, modelling techniques, data and expertise between research groups.
    >> Provide a forum for rigorous review of new mathematical modelling research.
    >> Provide funding through sub-contracts to commission research to address those needs;
  • 33. 21
    Main Themes
  • 34. 22
    Questions to address
    Which model to select?
    Impact on total cost of treatment weighed against impact on the epidemic
    How to define scenario?
    How to define costs? Take into account implementation costs, volume discounts, transportation costs, etc.
    Combination of tests based on decision points
    Platform technologies that can apply to multiple tests
    August 15, 2011
  • 35. Every Person Deserves the Chance to Live a Healthy, Productive Life.
    23
    August 15, 2011