Tools for Resource Allocation amongEnhanced Comprehensive HIV Prevention      Plans (ECHPP) Interventions         Feng Lin...
Outline□ Background□ Objective□ Resource allocation tools with illustrative examples    Tool A: Priority setting tool   ...
Background□ ECHPP funded jurisdictions differ in their    Technical capacity for mathematical modeling and     economic e...
Objective□ To develop tools for local health departments to  help with efficient resource allocation for HIV  prevention
Resource Allocation Tools□ Tool A: Priority setting tool      Step 1: Set priority level for each intervention based     ...
A: PRIORITY SETTING TOOL
Snapshot: Priority Setting Tool
Illustrative Example:       Step 1: Priority setting for testing in clinical settings                        Consideration...
Illustrative Example: Step 2: Establish funding requirement for testing in clinical setting       Measure                 ...
B: RESOURCE ALLOCATION MODEL
Methods□ To develop a mathematical model to identify the optimal  combination of interventions that prevent the most new  ...
Target Population of Interventions                 PLWHA                     At-risk population          Behavioral       ...
Illustrative Example:       Sample of inputs to resource allocation modelIntervention              Annual cost per        ...
Illustrative Example:                      Result: budget allocation             Intervention              Budget         ...
Illustrative Example:                          Result: budget allocation           Intervention             Optimal alloca...
Discussion: Priority Setting Tool□ Provides a framework to facilitate decision making□ Requires moderate amount of data□ C...
Discussion: Resource Allocation Model□ Allocation decisions are driven by cost and effectiveness    Synthesizes data from...
Acknowledgements□ ECHPP team; Division of HIV/AIDS Prevention, Centers  for Disease Control and Prevention□ AIDS Activitie...
Thank youFor more information please contact: Feng Lin (Flin@cdc.gov)Centers for Disease Control and Prevention1600 Clifto...
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Tools for Resource Allocation among Enhanced Comprehensive HIV Prevention Plans (ECHPP) Interventions

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Tools for Resource Allocation among Enhanced Comprehensive HIV Prevention Plans (ECHPP) Interventions

  1. 1. Tools for Resource Allocation amongEnhanced Comprehensive HIV Prevention Plans (ECHPP) Interventions Feng Lin, PhD; Arielle Lasry, PhD; Stephanie Sansom, PhD Prevention Modeling and Economics Team National HIV Prevention Conference August 14-17, 2011 National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of HIV/AIDS Prevention
  2. 2. Outline□ Background□ Objective□ Resource allocation tools with illustrative examples  Tool A: Priority setting tool  Tool B: Resource allocation model□ Discussion
  3. 3. Background□ ECHPP funded jurisdictions differ in their  Technical capacity for mathematical modeling and economic evaluation of HIV interventions  Access to data on resource utilization, cost and efficacy of interventions, risk populations, transmission dynamics and other data required by economic-based allocation tools
  4. 4. Objective□ To develop tools for local health departments to help with efficient resource allocation for HIV prevention
  5. 5. Resource Allocation Tools□ Tool A: Priority setting tool  Step 1: Set priority level for each intervention based on strength of evidence on efficacy, cost- effectiveness and other considerations  Step 2: Determine budget requirement for each intervention based on funding gap to reach desired penetration rate□ Tool B: Resource allocation model:  To identify the optimal combination of interventions that prevents the most new HIV infections over one- year planning horizon, based on jurisdiction’s HIV epidemic
  6. 6. A: PRIORITY SETTING TOOL
  7. 7. Snapshot: Priority Setting Tool
  8. 8. Illustrative Example: Step 1: Priority setting for testing in clinical settings Considerations Yes NoDoes strong scientific evidence exist that this intervention iseffective towards meeting NHAS targets?  Does this intervention have the potential to identify the desirednumber of unaware PLWHA compared with alternative strategies?  Is it feasible to expand this intervention?  Can you expand the intervention to the desired penetration rate?  Is there evidence supporting the cost-effectiveness of thisintervention?  Priority level:  High  Medium  Low  None: Maintain or reduce the investment in this intervention
  9. 9. Illustrative Example: Step 2: Establish funding requirement for testing in clinical setting Measure Estimation/Calculation Example[a] Current budget Current annual budget 750,000[b] Number of persons served Program data 10,000[c] Budget per person [c]=[a]/[b] 75[d] Maximum capacity Estimated maximum number of 100,000 people that can be served, assuming no resource constraints[e] Penetration rate [d]=[b]/[d] 10%[f ] Desired penetration rate Consensus among key 15% stakeholders[g] Gap in penetration rate [g]=[f ]-[e] 5%[h] Other funding identified Additional funds beyond [a] 125,000[i] Additional funding [i]=[c]*[d]*[g]-[h] 250,000 required =75*(15%-10%) * 100,000 - 125,000
  10. 10. B: RESOURCE ALLOCATION MODEL
  11. 11. Methods□ To develop a mathematical model to identify the optimal combination of interventions that prevent the most new infections based on jurisdiction’s HIV epidemic□ Annual HIV prevention budget allocation model:  One-period epidemic model with optimization component  Selected interventions: • Testing • Behavioral interventions for • Partner services positives • Linkage to care • Behavioral intervention for • Retention in care negatives • Adherence to HAART  Inputs: cost, target population, efficacy, maximum % of target population reachable, total budget
  12. 12. Target Population of Interventions PLWHA At-risk population Behavioral All infected All at risk intervention for negativesUndiagnosed Diagnosed 21% 79% Behavioral intervention forTesting Not linked to care Linked to care positives 31% 69% Linkage to care Not retain in care Retain in care 15% 85% Retention in care Viral load not Viral load suppressed suppressed Adherence to ART 20% 80%
  13. 13. Illustrative Example: Sample of inputs to resource allocation modelIntervention Annual cost per Efficacy: Duration Max % of effective outcome: Reduction in of effect target 2009$ transmission population reachableTesting in clinical 5,000 0.0903 Assume 10% Cost per new diagnosis 5-yearsTesting in non-clinical 11,073 0.0903 10% Cost per new diagnosisPartner services 15,768 0.0903 5% Cost per new diagnosisLinkage to care 4,377 0.0572 Assume 20% Cost per additional person linked 1- yearRetention in care 4,377 0.0673 20% Cost per additional person retainedAdherence to HAART 3,650 0.0841 20% Cost per additional person adhereBehavioral intervention 514 0.0141 20%for HIV+ Cost per client servedBehavioral intervention 322 0.0006 10%for HIV- Cost per client served
  14. 14. Illustrative Example: Result: budget allocation Intervention Budget Nb. of infections ($ in million) avertedTesting in clinical 2.7 52Testing in non-clinical 5.9 52Partner services 4.2 26Linkage to care 2.5 32Retention in care 1.8 28Adherence to HAART 1.7 40Behavioral intervention for HIV+ 1.1 30Behavioral intervention for HIV- - 0Total 20 260
  15. 15. Illustrative Example: Result: budget allocation Intervention Optimal allocation Equal allocation Budget Nb. of Budget Nb. of ($ in million) infections ($ in infections averted million) avertedTesting in clinical 2.7 52 2.5 48Testing in non-clinical 5.9 52 2.5 22Partner services 4.2 26 2.5 15Linkage to care 2.5 32 2.5 33Retention in care 1.8 28 2.5 28Adherence to HAART 1.7 40 2.5 40Behavioral intervention for HIV+ 1.1 30 2.5 30Behavioral intervention for HIV- - 0 2.5 5Total 20 260 20 221
  16. 16. Discussion: Priority Setting Tool□ Provides a framework to facilitate decision making□ Requires moderate amount of data□ Considers qualitative factors that decision makers face□ Allocation decisions are based on priority level□ Does not provide estimates of the number of infections averted□ Results are somewhat subjective
  17. 17. Discussion: Resource Allocation Model□ Allocation decisions are driven by cost and effectiveness  Synthesizes data from many different sources  Predicts the impact of an intervention on HIV infections  Indicates the optimal allocations of prevention funds among several interventions and populations□ Model should inform conversations between researchers and policy makers  Models are based on sometimes uncertain input data, as well as assumptions and expert opinion  Consequently, numerical results may not be precise.  Rather results suggest where more resources may lead to a larger effect
  18. 18. Acknowledgements□ ECHPP team; Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention□ AIDS Activities Coordinating Office, Philadelphia Department of Public Health□ Prevention Modeling and Economics Team, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention
  19. 19. Thank youFor more information please contact: Feng Lin (Flin@cdc.gov)Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov Web: http://www.cdc.govThe findings and conclusions in this report are those of the authors and do not necessarily represent the official position ofthe Centers for Disease Control and Prevention. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of HIV/AIDS Prevention

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