March 17 2015 PoCDx Seminar - Stefano Bertozzi - HIV Prevention Interventions & Performance Management: What Can We Learn From the Data
March 17 2015 PoCDx Seminar - Stefano Bertozzi - HIV Prevention Interventions & Performance Management: What Can We Learn From the Data
Stefano Bertozzi, MD PhD Dean, School of Public Health Professor, Health Policy and Management UC Berkeley March 17, 2015 UC Berkeley, Blum Hall B100 ------------------------------------------------------------------------------------------------ HIV Prevention Interventions & Performance Management: What Can We Learn From the Data The access to large datasets containing management information of health facilities represents an opportunity to analyze and improve the performance and efficiency of such facilities. The heterogeneity observed across facilities is related not only to the diseases that they treat but also to their management decisions. This seminar presents (with concrete examples of HIV interventions in Africa and Mexico) what decision makers could learn from the data to improve the performance of the facilities. ------------------------------------------------------------------------------------------------ Dr. Bertozzi began his service as dean and professor of health policy and management at the University of California, Berkeley School of Public Health in September 2013. Previously he was a senior fellow at the Bill & Melinda Gates Foundation, where he has directed the HIV and tuberculosis programs and led a team that manages the foundation’s portfolio of grants in HIV vaccine development, biomedical prevention research, diagnostics, and strategies for introduction and scaling-up of interventions. He oversaw the development of a new initiative in efficiency and effectiveness, and represented the private foundation’s constituency on the board of the Global Fund to Fight AIDS, Tuberculosis and Malaria. He also serves on the scientific advisory boards for the President’s Emergency Plan for AIDS Relief, the National Institute of Health’s Office of AIDS Research and the World Health Organization. Prior to joining the Gates Foundation, Dr. Bertozzi worked at the Mexican National Institute of Public Health as director of its Center for Evaluation Research and Surveys. He led economics and statistics teams that conducted impact evaluations of large health and social programs in Mexico, as well as in Africa, Asia and Latin America. He also led the institute’s AIDS/Sexually Transmitted Infections research group. Before moving to Mexico he was part of UNAIDS' founding management team after being the last person to lead WHO's Global Programme on AIDS. He is a physician and a health economist and received his training at MIT, UCSD and UCSF. The GBD Compare website mentioned in the talk can be found at: http://http://vizhub.healthdata.org/gbd-compare/ Video of the talk can be found on our YouTube page at:
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March 17 2015 PoCDx Seminar - Stefano Bertozzi - HIV Prevention Interventions & Performance Management: What Can We Learn From the Data
- 1. 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
- 2. Evaluación de la eficiencia técnica de los programas de prevención y tratamiento de VIH Sergio Bautista, Director, Economía de la Salud
- 3. 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
- 4. 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 Averagecostperclient(USD) Type of client Tested Tested + positive Positive + on ART Kenya Rwanda South Africa Zambia 6.2 15 8.6 2.9 1.4 .7 19 21 24 13 19 12 0 5 10 15 20 25 National HIV prevalence HTC positivity rate PMTCT positivity rate National HIV prevalence HTC positivity rate PMTCT positivity rate National HIV prevalence HTC positivity rate PMTCT positivity rate National HIV prevalence HTC positivity rate PMTCT positivity rate HIV prevalence(%) 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
- 5. Categorías de costos y distribución del personal
- 6. Tanzania: Number of People Living with HIV, 2014
- 7. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 1 104 207 310 413 516 619 722 825 928 1031 1134 1237 1340 1443 1546 1649 1752 1855 1958 2061 2164 2267 2370 2473 2576 2679 2782 2885 2988 3091 3194 3297 3400 3503 3606 3709 3812 3915 4018 4121 4224 4327 4430 4533 4636 4739 %HIVpositivewomenidentifiedin6months # 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
- 8. Costos promedio y escala
- 9. 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 (>400 cel/mm3) $10,000 $20,000 $30,000 $40,000 $50,000 25 50 75 25 50 75 25 50 75 Percentage of clients, by clinical characteristic AverageannualcostperclientwithVL<50andCD4>400(USD) New clients 2012 200 400 600
- 10. Percentage of patients who initiated ART with CD4>200 cel/ml 0% 25% 50% 75% 100% Percentage of patients with CV<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 proportional to patient volume Programa de atención en México: desempeño clínico a nivel de la unidad
- 12. IN THE LAST YEAR To improve management, need to monitor
- 16. Reaching 100% ART coverage for TB/HIV patients must be a priority 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Angola Botswa… Camero… Cote… DR… Ethiopia Ghana Haiti Kenya Lesotho Malawi Mozam… Namibia Nigeria Rwanda South… Swazila… Tanzania Uganda Zambia Zimbab… * ART eligibility at <350 CD4 World Health Organization, Global TB report 2013 Goal: 100% Coverage Current ART coverage among eligible* TB PLHIV
- 17. 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.
- 18. …………………………………………………………………………… 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 Epidemic Using Data, Modeling, Economic Analyses and Innovation to Improve Program Impact