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

Evaluación de la eficiencia técnica de los programas

de prevención y tratamiento de VIH

Sergio Bautista, Director, Economía de la Salud

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

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

Ave

rag

e c

ost

pe

r clie

nt

(US

D)

Type of client Tested Tested + positive Positive + on ART

Kenya Rwanda South Africa Zambia

6.2

15

8.6

2.91.4 .7

1921

24

13

19

12

0

5

10

15

20

25

NationalHIV prevalence

HTC positivityrate

PMTCT positivityrate

NationalHIV prevalence

HTC positivityrate

PMTCT positivityrate

NationalHIV prevalence

HTC positivityrate

PMTCT positivityrate

NationalHIV prevalence

HTC positivityrate

PMTCT positivityrate

HIV

pre

vale

nce

(%

)

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

Categorías de costos y distribución del personal

Tanzania: Number of People Living with HIV, 2014

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1

10

42

07

31

04

13

51

66

19

72

28

25

92

81

03

11

13

4

12

37

13

40

14

43

15

46

16

49

17

52

18

55

19

58

20

61

21

64

22

67

23

70

24

73

25

76

26

79

27

82

28

85

29

88

30

91

31

94

32

97

34

00

35

03

36

06

37

09

38

12

39

15

40

18

41

21

42

24

43

27

44

30

45

33

46

36

47

39

% H

IV p

osi

tive

wo

me

n id

en

tifi

ed

in 6

mo

nth

s

# 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

Costos promedio y escala

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 (>400cel/mm3)

$10,000

$20,000

$30,000

$40,000

$50,000

25 50 75 25 50 75 25 50 75Percentage of clients, by clinical characteristic

Ave

rag

e a

nnual co

st p

er

clie

nt

with

VL<

50

and

CD

4>

400

(U

SD

)

New clients2012

200

400

600

Percentage of patients who initiatedART with CD4>200 cel/ml

0% 25% 50% 75% 100%Percentage of patients withCV<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 propor tional to patient volume

Programa de atención en México: desempeño clínico a nivel de la unidad

IN THE LAST YEAR

To improve management, need to monitor

Reaching 100% ART coverage for TB/HIV patients must be a priority

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%A

ngo

la

Bo

tsw

a…

Cam

ero

…

Co

te…

DR

…

Eth

iop

ia

Gh

ana

Hai

ti

Ken

ya

Leso

tho

Mal

awi

Mo

zam

…

Nam

ibia

Nig

eria

Rw

and

a

Sou

th…

Swaz

ila…

Tan

zan

ia

Uga

nd

a

Zam

bia

Zim

bab

…

* ART eligibility at <350 CD4

World Health Organization, Global TB report 2013

Goal: 100% Coverage

Current ART coverage among eligible* TB PLHIV

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.

……………………………………………………………………………

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 EpidemicUsing Data, Modeling, Economic Analyses and Innovation

to Improve Program Impact