This policy brief summarizes the findings of an allocative efficiency study of Romania’s Tuberculosis (TB) response, which was conducted using the Optima-TB model.
... Exibir mais + The analysis was conducted to support Romania in its decision-making on strategic TB investments during the current National Strategic Plan for the Control of Tuberculosis in Romania (NSP, 2015‒20) and up to 2030. The analysis highlights the potential for Romania to maximize its impact on the TB response by reallocating spending on unnecessary hospitalization to increase the coverage of ambulatory care, treatment of drug-resistant TB and enhanced and active case finding in congregate community settings and high-risk areas.
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The report summarizes the findings of an allocative and implementation efficiency analysis of Zimbabwe's HIV response across the care cascade, which was conducted using the Optima-HIV model.
... Exibir mais + The analysis was conducted to support Zimbabwe in its decision-making on strategic HIV investments, highlighting opportunities to maximise the impact of HIV financial resources in Zimbabwe through allocative and implementation efficiency gains.
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Hypertension is one of the leading causes of preventable mortality in Ukraine. It is estimated that high systolic blood pressure was responsible for 42 percent of total deaths in 2016, which is among the highest rates in the world.
... Exibir mais + This report presents key findings from an analysis of the continuum of hypertension care in Ukraine, where the World Bank implements a technical assistance program to support reforms and governance in the health sector. The analysis found significant gaps in detection, treatment monitoring and treatment adherence in hypertension care. The largest breakpoints were blood pressure monitoring at the frequency recommended by the protocol (67 and 71 percent gap in compliance in Lviv and Poltava regions) and achieving normal blood pressure while on treatment (76 and 65 percent gap among patients with monitoring data in Lviv and Poltava regions). The analysis provided lessons with policy implications, including more systematic screening to detect hypertension early and link cases to effective treatment, and a monitoring focus on patients with stage 2 and 3 hypertension and those with co-morbidities like diabetes to prevent poor outcomes. Treatment for blood pressure control is cost-effective in all regions of the world, and in Ukraine improved hypertension care would save lives, reduce disability and save resources in health care.
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Hypertension is one of the leading causes of preventable mortality in Ukraine. It is estimated that high systolic blood pressure was responsible for 42 percent of total deaths in 2016, which is among the highest rates in the world.
... Exibir mais + This report presents key findings from an analysis of the continuum of hypertension care in Ukraine, where the World Bank implements a technical assistance program to support reforms and governance in the health sector. The analysis found significant gaps in detection, treatment monitoring and treatment adherence in hypertension care. The largest breakpoints were blood pressure monitoring at the frequency recommended by the protocol (67 and 71 percent gap in compliance in Lviv and Poltava regions) and achieving normal blood pressure while on treatment (76 and 65 percent gap among patients with monitoring data in Lviv and Poltava regions). The analysis provided lessons with policy implications, including more systematic screening to detect hypertension early and link cases to effective treatment, and a monitoring focus on patients with stage 2 and 3 hypertension and those with co-morbidities like diabetes to prevent poor outcomes. Treatment for blood pressure control is cost-effective in all regions of the world, and in Ukraine improved hypertension care would save lives, reduce disability and save resources in health care.
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Cervical cancer is an important disease in Ukraine: Among all cancers in females, it ranks 5th for incidence and 6th for mortality. While first year mortality shows some decline, progress in earlier detection has been very modest.
... Exibir mais + This report presents key findings from an analysis of the continuum of cervical cancer care in Ukraine, where the World Bank implements a technical assistance program to support reforms and governance in the health sector. The analysis determined the breakpoints in the care cascade from screening to long-term monitoring of cases, and identified opportunities for action. The screening gaps were 47 percent (Lviv Region) and 38 percent (Poltava Region). Due to Ukraine's cervical cancer screening eligibility from 18 years of age, screening has a low yield, and this is further reduced by the short screening intervals with almost half of the women screening at least once every year, leading to efficiency concerns. Among the diagnosed cervical cancer cases, treatment completion and negative outcomes were not sufficiently documented. Understanding of diagnosis and treatment gaps helps pinpoint solutions ranging from simplified decision-making for cancer treatment, to improved pharmaceutical supplies and access to diagnostic equipment. The analysis highlights the need for age- and risk-appropriate screening invitations and recall systems to increase the efficiency and effectiveness of the cervical cancer program in Ukraine.
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Diabetes is the 7th most important cause of years lived with disability in Ukraine. Prevalence is estimated at 8.4 percent and there are over 1 million undiagnosed cases.
... Exibir mais + Expenditure for diabetes treatment is growing, in 2016, annual expenditure for diabetes was about 460 million US dollars. This report presents key findings from an analysis of the continuum of type-2 diabetes care in Ukraine, where the World Bank implements a technical assistance program to support reforms and governance in the health sector. The analysis determined the breakpoints in the care cascade from screening to sustained glucose control of diagnosed cases. Attainment of sustained glucose control was the largest breakpoint in the cascade in the two regions studied with 80 percent (Lviv Region) and 73 percent (Poltava Region) of HbA1C monitored cases not meeting the target. At the same time, there are high rates of hospital admissions in Ukraine due to diabetes. The analysis presents important lessons and policy implications for diabetes care. Diabetes screening needs to be strengthened and the PHC level needs to have the confidence, capacity and resources to manage diabetes patients as tasks are shifted from specialists to family doctors. The cascade framework offers an analysis approach to track change in the continuum of diabetes care as the PHC reform takes effect.
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Diabetes is the 7th most important cause of years lived with disability in Ukraine. Prevalence is estimated at 8.4 percent and there are over 1 million undiagnosed cases.
... Exibir mais + Expenditure for diabetes treatment is growing, in 2016, annual expenditure for diabetes was about 460 million US dollars. This report presents key findings from an analysis of the continuum of type-2 diabetes care in Ukraine, where the World Bank implements a technical assistance program to support reforms and governance in the health sector. The analysis determined the breakpoints in the care cascade from screening to sustained glucose control of diagnosed cases. Attainment of sustained glucose control was the largest breakpoint in the cascade in the two regions studied with 80 percent (Lviv Region) and 73 percent (Poltava Region) of HbA1C monitored cases not meeting the target. At the same time, there are high rates of hospital admissions in Ukraine due to diabetes. The analysis presents important lessons and policy implications for diabetes care. Diabetes screening needs to be strengthened and the PHC level needs to have the confidence, capacity and resources to manage diabetes patients as tasks are shifted from specialists to family doctors. The cascade framework offers an analysis approach to track change in the continuum of diabetes care as the PHC reform takes effect.
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Hypertension is a major driver of pre-mature death and disability in Tajikistan, a low-income country in Central Asia. The high burden of disease also results in significant health care expenditure and lost labour productivity.
... Exibir mais + Therefore, there is an urgent need to strengthen service delivery systems through early detection of high blood pressure, prompt diagnosis, sustained treatment maintenance, and the attainment of blood pressure control. The Ministry of Health and Social Protection and the World Bank undertook implementation research to identify effective and context-appropriate solutions for improving hypertension services. The assessment used the cascade framework to describe drop-offs along the continuum of care, collected patient and health care provider perspectives on the causes of discontinuities, used routine data from participating facilities in a Bank-supported operation, and drew on the international literature on chronic care interventions. The report presents feasible and cost-effective recommendations that, if adopted, can strengthen current programs and policies to address the growing burden of hypertension in Tajikistan.
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Hypertension is a major driver of pre-mature death and disability in Tajikistan, a low-income country in Central Asia. The high burden of disease also results in significant health care expenditure and lost labour productivity.
... Exibir mais + Therefore, there is an urgent need to strengthen service delivery systems through early detection of high blood pressure, prompt diagnosis, sustained treatment maintenance, and the attainment of blood pressure control. The Ministry of Health and Social Protection and the World Bank undertook implementation research to identify effective and context-appropriate solutions for improving hypertension services. The assessment used the cascade framework to describe drop-offs along the continuum of care, collected patient and health care provider perspectives on the causes of discontinuities, used routine data from participating facilities in a Bank-supported operation, and drew on the international literature on chronic care interventions. The report presents feasible and cost-effective recommendations that, if adopted, can strengthen current programs and policies to address the growing burden of hypertension in Tajikistan.
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In 2014, city leaders from around the world endorsed the Paris Declaration on fast-track cities, pledging to achieve the 2020 and 2030 human immunodeficiency virus (HIV) targets championed by Joint United Nations Program on HIV and acquired immunodeficiency syndrome (AIDS) (UNAIDS).
... Exibir mais + The City of Johannesburg - one of South Africa’s metropolitan municipalities and also a health district - has over 600,000 people living with HIV (PLHIV), more than any other city worldwide. The authors estimate what it will take in terms of programmatic targets and costs for the City of Johannesburg to meet the fast-track targets and demonstrate the impact that this will have. The authors applied the optima HIV epidemic and resource allocation model to demographic, epidemiological, and behavioral data on 26 sub-populations in Johannesburg. Plausible scale-ups of other proven interventions ((voluntary medical male circumcision (VMMC), condom distribution, and female sex workers (FSW) strategies) can yield additional reductions in new infections (between 4 and 15 percent), and in overall treatment investment needs. Scaling up VMMC in line with national targets is found to be cost-effective in the medium term. The scale-up in testing and treatment programs over this decade has been rapid, but these efforts must be doubled to reach 2020 targets. Strategic investments in proven interventions will help Johannesburg achieve the treatment targets and be on track to end AIDS by 2030.
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Many new HIV cases are lost to follow-up before they can be enrolled in care and treatment programs. This report summarises a proof-of-concept evaluation of a mHealth intervention which aims to improve linkage of newly diagnosed HIV cases to care.
... Exibir mais + The design was a randomised controlled multi-center trial enrolling consenting patients in clinics in Inner-city Johannesburg. The trial developed and tested the “SmartLink” app which is designed to make laboratory data directly available to patients via a secure account and send them appointment reminder and notifications on their smartphone. The primary endpoint was linkage to care in the first 8 months after diagnosis, as evidenced by a HIV-related laboratory test. The report provides the key findings on phone ownership of the target group, and which demographics can best be reached via apps and data-based communication (which is cheaper and offers more scope than text messaging). The app worked best in younger HIV patients under 30 years of age, who had their linkage to HIV care improved by 20 percent through the app. This younger age group is difficult to reach with traditional interventions, and reacted positively to a technology solution. The unique feature of this custom-made app (sending real-time CD4/VL test data from the laboratory database to HIV clients) is highly scalable among smartphone owners.
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Breast cancer is the leading cancer in Ukrainian females, however, there is evidence of progress with earlier detection and decreased first year mortality after diagnosis from 14.5 percent in 2000 to 9.7 percent in 2015.
... Exibir mais + This report presents key findings from an analysis of the continuum of breast cancer care in Ukraine, where the World Bank implements a technical assistance program to support reforms and governance in the health sector. The analysis determined the breakpoints in the breast cancer care cascade from screening to long-term monitoring of cancer cases, and identified opportunities for action. It was found that the breast cancer screening gaps were 64 perent (Lviv Region) and 39 percent (Poltava Region). At least 3 of 10 positive screens were followed up with diagnostic tests. Among the diagnosed cases, negative outcomes (death, loss to care, treatment refusal, and withdrawal from treatment) were poorly documented, as was treatment completion. Understanding of diagnosis and treatment gaps and delays from cascade analysis helps identify solutions ranging from simplified decision-making for cancer treatment, to improved pharmaceutical supplies and access to diagnostic equipment. The analysis highlighted the need for age- and risk-appropriate screening invitations and recall systems for an improved and more efficient breast cancer program in Ukraine.
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With limited funds available, meeting global health targets requires countries to both mobilize and prioritize their health spending. Within this context, countries have recognized the importance of allocating funds for HIV as efficiently as possible to maximize impact.
... Exibir mais + Over the past six years, the governments of twenty-three countries in Africa, Asia, Eastern Europe and Latin America have used the Optima HIV tool to estimate the optimal allocation of HIV resources. Each study commenced with a request by the national government for technical assistance in conducting an HIV allocative efficiency study using Optima HIV. Each study team validated the required data, calibrated the Optima HIV epidemic model to produce HIV epidemic projections, agreed on cost functions for interventions, and used the model to calculate the optimal allocation of available funds to best address national strategic plan targets. From a review and analysis of these twenty-three country studies, we extract common themes around the optimal allocation of HIV funding in different epidemiological contexts. The optimal distribution of HIV resources depends on the amount of funding available and the characteristics of each country’s epidemic, response and targets. Universally, the modelling results indicated that scaling up treatment coverage is an efficient use of resources. There is scope for efficiency gains by targeting the HIV response towards the populations and geographical regions where HIV incidence is highest. Across a range of countries, the model results indicate that a more efficient allocation of HIV resources could reduce cumulative new HIV infections by an average of eighteen percent over the years to 2020 and twenty-five percent over the years to 2030, along with an approximately twenty-five percent reduction in deaths for both timelines. However, in most countries this would still not be sufficient to meet the targets of the national strategic plan, with modelling results indicating that budget increases of up to one hundred and eighty-five percent would be required. Greater epidemiological impact would be possible through better targeting of existing resources, but additional resources would still be required to meet targets. Allocative efficiency models have proven valuable in improving the HIV planning and budgeting process.
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This report describes the short-term outcomes of an evaluation study for five different HIV cohorts using routinely collected data. The evaluation study is a collaboration between the National Department of Health of South Africa, the National Health Laboratory Service (NHLS) and the World Bank.
... Exibir mais + Boston University/Health Economics and Epidemiology Research Office (HE2RO) is the academic partner in the evaluation. The overall aims of the evaluation are to assess the impact of South Africa`s Adherence Guideline interventions on HIV patients’ treatment outcomes; estimate the costs of the interventions; and describe the cascade of care for TB, hypertension, and diabetes at the same clinics. The short-term endpoints reported on herein concern ART initiation among FTIC eligible patients, ARV medication pick-up among AC and DMD eligible patients, retention in care among TRIC eligible patients, and viral load suppression among EAC eligible patients. The final outcomes of this evaluation will be reported on separately, once patients have been follow-up for one year and routine data on viral load suppression and retention in care become available
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This report describes enrollment into the cohorts for protocol 1 for the Evaluation of the National Adherence Guidelines for Chronic Diseases in South Africa Using Routinely Collected Data.
... Exibir mais + The study is evaluating short-term and long-term effects of five interventions being implemented by the National Department of Health (NDoH) in South Africa to improve adherence to HIV care and chronic disease care in general: Fast track initiation counselling, decentralized medicine delivery, adherence clubs, early patient tracing and enhanced adherence counselling. The study uses a randomized evaluation design to compare sites where the intervention was rolled out with control sites providing standard of care. Enrollment began in June 2016 and was uneven in time and by province, as expected in a process using routine data and relying on programmatic implementation. Enrollment of HIV clients into cohorts will enable the NDoH to understand the short-term and long-term impacts of interventions to improve HIV treatment initiation, adherence and retention in care.
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This multi-country study focuses on evaluating whether ART scale-up and changes in sexual risk behavior have contributed to the declining trends of HIV incidence and prevalence.
... Exibir mais + The World Bank, UNAIDS, UNFPA, WHO, the Global Fund, and Imperial College London agreed upon specific criteria used to identify Botswana, Dominican Republic, Kenya, Malawi and Zambia as the five countries engaged in this study. Within Botswana, there was strong evidence that showed that ART and changes in sexual risk behavior had an impact of averting 210,000 infections in urban areas as 120,000 infections in rural areas (1975-2012). This discrepancy between urban and rural area results was thought to be due to geographical heterogeneity in HIV epidemiology or lack of power in available data. The changes in sexual risk behavior had a comparatively larger impact on the epidemic than ART, averting approximately 460,000 cumulative infections between 1982 and 2015. ART alone was found to be insufficient to explain the observed trend (approx. 44,000 FSW infections averted, 33,000 Bataeyes, and 28,000 amongst MSM). Results from Kenya showed that again that changes in sexual risk behavior, and to a much lesser extent ART, had averted approximately 4,107,000 infections between 1980-2015. An important takeaway from these results was that ART had marginal impact on prevalence trends but that it has yet to be fully optimized.
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This report presents the findings of a large national analysis of determinants of CD4 immune recovery among individuals on antiretroviral therapy in South Africa.
... Exibir mais + It is part of the second phase of a series of analytical and evaluation studies contributing to the design of an impact and process evaluation of South Africa’s National Adherence Guidelines for Chronic Diseases. The analysis was conducted by the National Institute for Communicable Diseases (NICD) in collaboration with the National Health Laboratory Service (NHLS), Boston University/Health Economics and Epidemiology Research Office (HE2RO), the National Department of Health of South Africa, and the World Bank. The analysis used a novel database created through probabilistic matching of routine CD4 count and viral load data to unique individuals. The report describes the proportions of individuals 15 years or older who initiated antiretroviral therapy between 2010 and 2014 and achieved CD4 count recovery to 200, 350 and 500 cells/μl, their time to CD4 count recovery, and extent of recovery in the first 12 months of follow up. The cohort included 1,070,900 individuals (4.37 million CD4 tests). Findings suggest that among South African HIV patients under treatment, CD4 immune recovery is associated with age, sex, baseline CD4 count and viral suppression. Demographic CD4 recovery patterns can inform CD4 monitoring policies in resource-constrained settings.
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This report presents the findings of a large spatial analysis of almost 3 million viral load tests from over 2 million HIV patients on antiretroviral therapy in South Africa.
... Exibir mais + It is part of the second phase of a series of analytical and evaluation studies contributing to the design of an impact and process evaluation of South Africa’s National Adherence Guidelines for Chronic Diseases. The analysis was conducted by the National Health Laboratory Service (NHLS) and Boston University/Health Economics and Epidemiology Research Office (HE2RO), in collaboration with the National Institute for Communicable Diseases (NICD), the National Department of Health of South Africa, and the World Bank. A number of other institutions contributed in the multi-step process of creating a patient-linked cohort through a novel record linkage algorithm and a masterlist of public sector health facilities, which are both underpinning this analysis and described in the report. The analysis demonstrates the diversity in the proportion of HIV patients getting a viral load test annually and patients virally suppressed. The variation shows by geographic location and facility, as well as by age, gender and demography. It sheds light on high viral load levels in young HIV patients on treatment. Also, one in six male and one in nine female ART patients were identified as having a high risk of HIV transmission due to viral load levels above 10,000 copies/mL
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An accurate measurement of HIV incidence is a key for policy makers and HIV program managers directing national HIV response. However, there is no perfect method to measure or estimate the rate at which new HIV infections occur in a population.
... Exibir mais + This review compiles and triangulates longitudinal HIV incidence and prevalence data from published studies and trials, national reports and surveys, and the Joint United Nations Programme on HIV/AIDS estimates from the Spectrum model, focusing on 20 countries in Sub-Saharan Africa with generalized HIV epidemics. Three main points can be taken from this analysis of HIV incidence trends. First, modeled HIV incidence and nationally reported HIV prevalence levels in young females suggest that national HIV incidence has declined since 2000 in all except three countries analyzed (stable estimated HIV trends in Burkina Faso, Burundi, and Uganda), but trial and survey data suggest that in some demographics, HIV incidence remains critically high. Second, all modeled national HIV incidence curves and most empirically observed trends commenced a downward trajectory prior to the introduction of anti-retroviral therapy programs around 2004, suggesting the contribution of other factors, such as HIV prevention programs and natural epidemic dynamics, to this decline. Third, modeled HIV incidence estimates, including the incidence peaks in the past, exhibit much variation between Spectrum model versions and when new data are added, emphasizing the uncertainty of model outputs and the need to use incidence estimates with caution.
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Documento de trabalho sobre pesquisa de políticas WPS7042 SEP 01, 2014
