Transcript ppt
Using Burden of Disease to Improve Implementers’ Decision Making and Program Relevance Kim Longfield Lek Ngamkitpaiboon Amy Ratcliffe GHME Conference Seattle, WA June 18, 2013 Background 66 developing countries More than 60 products and services PSI Strategic Plan 2012 - 2016 :: RELEVANCE :: SCALE :: VALUE Global Burden of Disease Category Intervention(s) Tuberculosis TB DOTS Methods HIV/AIDS Condoms, MC, HTC, Needle & Syringe, ART, PMTCT Diarrhea ORS, Zinc, Water Treatment Lower Respiratory Infections Tanzania Pneumonia PPT Malaria LLINs, ACTs, RDTs Maternal Disorders17% 4% :: Maternal Hemorrhage :: Maternal Sepsis 12% 60% :: Abortion Cambodia 2% 3% HIV AIDS All FP products and services Diarrheal diseases 7% 2% Malaria 1% Misoprostol for PPH Maternal Disorders 4% 0% Preterm birth complications Clean Delivery Kits STD excluding HIV Abortion81% services, Post-Abortion Care Remaning burden HIV AIDS Diarrheal diseases Lower Respiratory Infections Malaria Maternal Disorders Preterm birth complications STD excluding HIV Remaning burden 2% 3% :: Preterm Birth Complications 2% All FP products and services :: Sepsis and Other Infectious Disorders of the Newborn Baby Clean Delivery Kits Nutritional Deficiencies HIV basic care package (male & female) :: VitaminCondoms A Deficiency Emergency contraception :: Iron-Deficiency Anemia Contraceptive implants Injectable contraceptives Sexually Transmitted Diseases Excluding HIV/AIDS IUDs Acute Hepatitis B & Cfor post abortion care Misoprostol Oral Secondary contraceptives Liver Cancer to Hepatitis B & C LLINs Cervical Cancer Water treatment tablets Safe water solution Opioid Use Disorders Condoms Contraceptive implants Injectable contraceptives IUDs STI Kits, Condoms Medication Abortion MVA Needles & Syringes ACTs Needles & Syringes Malaria net retreatment Diarrhea treatment kits (ORS, zinc) Visual Inspection andWater Cryotherapy treatment tablets Pneumonia treatment (antibiotics) Naloxone Tobacco Smoking (risk factor) Smoking cessation program Neonatal Disorders Tanzania Interventions: Cambodia Interventions: 40% relevance in Sprinkles TanzaniaSprinkles 19% relevance in Cambodia General Findings 335,515,910 DALYs = 20.5% 1,638,175,656 DALYs PSI targets 20.5% HIV/AIDS STD excluding HIV of DALY burden in countries 335m DALYs 20.5% Hepatitis B & C where it works. Opioid use disorder Tuberculosis Programs in Africa are most relevant (18-50%) with a Maternal disorders Newborn sepsis heavy focus on HIV and malaria. Preterm birth complications Malaria Programs in Asia and Latin America are less relevant Diarrheal diseases Iron deficiency anemia (1-31%) because of higher shares of non1.33b 79.5%DALYs Vitamin A deficiency communicable diseases and injuries, which PSI has Respiratory infections Cervical cancer not traditionally targeted. Tobacco smoking Remaining burden Case Study: PSI’s Response to HIV/AIDS in Southern Africa HIV/AIDS, 2010 Percent of total DALYs 29.8% of the world’s HIV burden comes from just 9 countries in HIVSouthern Burden –Africa There are 81.5 million HIV/AIDS DALYs globally In these countries, HIV represents 18-40% PSI delivers HIV/AIDS-related interventions or services in countries of the national disease that represent 89% of all DALYsburden due to HIV/AIDS 48% of PSI’s HIV-related Source: GBD 2010 Image from: GBD Compare, © University of Washington impact is generated in these countries Case Study: Respiratory Infections Lower respiratory infections, 2010 Percent of total DALYs PSI currently has pneumonia interventions in 7 countries: Cambodia, DRC, Madagascar, Malawi, Myanmar, South Sudan, and Uganda Image from: GBD Compare, © University of Washington How can relevance inform decision-making? In countries where PSI works Top 15 in % burden: PNG, Tajikistan, Guinea, Guatemala, Ethiopia, Zimbabwe, Liberia, Benin, Laos, Kenya, Kyrgyzstan, Cote d’Ivoire, Malawi, Togo, Pakistan Relevance and potential health impact inform where we could expand our programs LRI represents a high % of national burden and a large number of DALYs in Ethiopia, Kenya, Cote d’Ivoire, and Pakistan Image from: GBD Compare, © University of Washington 8.2-12.7% of national disease burden Top 15 in absolute burden: India, Nigeria, Pakistan, China, Ethiopia, DRC, Tanzania, Kenya, South Sudan, Cote d’Ivoire, Myanmar, Mozambique, Russia, Malawi 58% of global DALYs from LRI Source: GBD 2010 Next Steps: Increasing our relevance with NCDs Burden of Disease2010 in PSI Cervical Cancer, Countries Percent1.64b of total DALYs DALYs 12% Communicable, maternal, neonatal & nutritional 41% Non-communicable diseases Injuries 47% NCDs account for 47% of the burden of disease in countries where PSI works Image from: GBD Compare, © University of Washington Source: GBD 2010 Limitations :: At PSI, relevance includes scoping and pilots to reward innovation :: Relevance does not account for scale :: Relevance can only be as specific as available GBD data Interpretation :: Adoption of a relevance goal has encouraged spread of existing PSI interventions and innovative work in new health areas :: PSI can increase relevance by: :: Expanding successful programs to new countries: For example, pneumonia treatment, nutrition, TB diagnosis and treatment :: Learning from pilots to target new health areas: For example, cervical cancer, smoking-related burden, injury prevention, other NCDs Relevance is just one of several factors for decision making Burden Policy environment Strategic advantage Funding Logistical feasibility Potential health impact Thank You Kim Longfield Director, Research & Metrics Amy Ratcliffe Sr. Technical Advisor, Metrics [email protected] Graham Smith Associate Researcher Lek Ngamkitpaiboon Data Analyst Meghan Reidy Consultant Hongmei Yang Researcher