Using modelling to inform our diagnostics strategy

568 views

Published on

Presentation by

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
568
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
9
Comments
0
Likes
0
Embeds 0
No embeds

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.
  • Using modelling to inform our diagnostics strategy

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

    ×