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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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 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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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
This report summarizes the findings of an allocative efficiency analysis on Sudans national HIV epidemic and response conducted in 2014. HIV allocative efficiency studies are generally trying to answer the question How can HIV funding be optimally allocated to the combination of HIV response interventions that will yield the highest impact.
... Exibir mais + In the first half of 2014, the Sudan National AIDS Programme has reviewed its national strategic plan (NSP) on HIV and AIDS, while at the same time preparing a concept note for submission to the Global Fund for AIDS, Tuberculosis and Malaria, the single largest funding partner of the national HIV response. In this context the government of Sudan approached the World Bank with a request to conduct an allocative efficiency analysis to inform both the prioritization of the national HIV response and the concept note development.
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Niger's morbidity and mortality statistics are dominated by communicable diseases while there is until now a relatively low burden of disease attributable to non-communicable diseases.
... Exibir mais + Despite Niger being a low human immunodeficiency virus (HIV) prevalence and comparatively low HIV and acquired immunodeficiency syndrome (AIDS) burden country, HIV and AIDS is an emerging and significant cause of disability adjusted life year (DALYs) since recent years. Better implementing, integrating, and allocating resources has the potential of saving time and money, and freeing up resources to address other key development challenges in Niger. The overarching objective is to provide the Government of Niger with a comprehensive investment case analysis on HIV financing needs and investment opportunities in the context of burden of disease priorities, health financing, and health system strengthening, in order to inform a HIV response which is efficient, impactful, cost-effective, and financially sustainable. Such an analysis supports decision-making on HIV policy options, investment scenarios, and programmatic targeting and prioritization. It also helps Niger make the case for investment for HIV and health impact, and provides estimates of health care savings. A financial commitment framework was used to estimate longer-term costs and savings of the HIV program and the fiscal dimension of HIV in Niger. In this context, this report is organized as follows: section one gives introduction. Section two gives development context, health priorities, and health system challenges in Niger. Section three presents the state of the HIV epidemic. Section four presents HIV financing, services and programs, and their efficiency. Section five focuses on impacts from past HIV expenditures and best resource allocations in the current strategic plan period. Section six deals with financing needs and fiscal space implications of HIV investments.
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The main objective of the study is to provide a comprehensive analysis of HIV and health financing needs, investment opportunities, and health system development in the context of the Government of Niger's HIV National Strategic Plan (NSP) 2013-17.
... Exibir mais + The analysis provides support for HIV policy decision-making, investment scenarios and programmatic targeting and prioritization. In addition, the analysis helps Niger build the case for HIV and health impact investment including delivering estimates of health care savings as a result of these investments. The analysis was implemented by the World Bank in collaboration with UNAIDS from a request for analytical support from the Government of Niger. The study involved a desk review of HIV- and health-related evidence, epidemic trends and financial modeling. The Optima model (formerly Prevtool) was used to estimate optimal resource allocation during the NSP, and the impact and cost-effectiveness of past HIV investments. A financial commitment framework was used to estimate longer-term costs and savings of the HIV program and the fiscal dimension of HIV in Niger.
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Niger's morbidity and mortality statistics are dominated by communicable diseases while there is until now a relatively low burden of disease attributable to non-communicable diseases.
... Exibir mais + Despite Niger being a low human immunodeficiency virus (HIV) prevalence and comparatively low HIV and acquired immunodeficiency syndrome (AIDS) burden country, HIV and AIDS is an emerging and significant cause of disability adjusted life year (DALYs) since recent years. Better implementing, integrating, and allocating resources has the potential of saving time and money, and freeing up resources to address other key development challenges in Niger. The overarching objective is to provide the Government of Niger with a comprehensive investment case analysis on HIV financing needs and investment opportunities in the context of burden of disease priorities, health financing, and health system strengthening, in order to inform a HIV response which is efficient, impactful, cost-effective, and financially sustainable. Such an analysis supports decision-making on HIV policy options, investment scenarios, and programmatic targeting and prioritization. It also helps Niger make the case for investment for HIV and health impact, and provides estimates of health care savings. A financial commitment framework was used to estimate longer-term costs and savings of the HIV program and the fiscal dimension of HIV in Niger. In this context, this report is organized as follows: section one gives introduction. Section two gives development context, health priorities, and health system challenges in Niger. Section three presents the state of the HIV epidemic. Section four presents HIV financing, services and programs, and their efficiency. Section five focuses on impacts from past HIV expenditures and best resource allocations in the current strategic plan period. Section six deals with financing needs and fiscal space implications of HIV investments.
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The main objective of the study is to provide a comprehensive analysis of HIV and health financing needs, investment opportunities, and health system development in the context of the Government of Niger's HIV National Strategic Plan (NSP) 2013-17.
... Exibir mais + The analysis provides support for HIV policy decision-making, investment scenarios and programmatic targeting and prioritization. In addition, the analysis helps Niger build the case for HIV and health impact investment including delivering estimates of health care savings as a result of these investments. The analysis was implemented by the World Bank in collaboration with UNAIDS from a request for analytical support from the Government of Niger. The study involved a desk review of HIV- and health-related evidence, epidemic trends and financial modeling. The Optima model (formerly Prevtool) was used to estimate optimal resource allocation during the NSP, and the impact and cost-effectiveness of past HIV investments. A financial commitment framework was used to estimate longer-term costs and savings of the HIV program and the fiscal dimension of HIV in Niger.
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This study used an innovative methodology of qualitative data collection - hearsay ethnography. The methodology gives insights into sexual and societal norms and cultural scripts held by community members.
... Exibir mais + Trained ethnographers listened to public conversations about HIV-related topics which occurred in public and could be noted down in journals. The research was carried out in several places in Swaziland in order to capture some of the diversity in the country: Ludzeludze, Bhuleni, Siphofaneni and Mathandele. The research found that there is a great deal of talk about all types of sexual partnerships, from marriage to multiple sexual partners to commercial sex work.
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In recent years, with the HIV epidemic in East and Southern Africa stabilising and treatment programs in place, questions have arisen as to whether those sub-populations who have traditionally been seen as at risk of HIV transmission are still the main sources of new infections.
... Exibir mais + The importance of 'knowing your epidemic' (KYE) and 'knowing your response' (KYR) has become evident to target and improve HIV responses. The World Bank, UNAIDS and other agencies have initiated a series of HIV epidemiological, policy and response syntheses in Africa, Asia and Latin America. This report is a summary of an epidemiological analysis conducted in Burundi in early 2010.
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In recent years, with the HIV epidemic in East and Southern Africa stabilising and treatment programs in place, questions have arisen as to whether those sub-populations who have traditionally been seen as at risk of HIV transmission are still the main sources of new infections.
... Exibir mais + The importance of 'knowing your epidemic' (KYE) and 'knowing your response' (KYR) has become evident to target and improve HIV responses. The World Bank, UNAIDS and other agencies have initiated a series of HIV epidemiological, policy and response syntheses in Africa, Asia and Latin America. This report is a summary of an epidemiological analysis conducted in Burundi in early 2010.
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Structures of the synthesis report are as follows: chapter one provides the background and context for the synthesis. It describes the purpose, objectives and key questions of the synthesis, the synthesis concept and use of the findings.
... Exibir mais + Chapter 2 describes how the study was carried out, the methodology followed. The methods for each of the components and for the synthesis of all the data are introduced, and the study's limitations noted. Chapter three provides the Know Your Epidemic (KYE) synthesis results. These include the epidemic state and trends in HIV prevalence and incidence, transmission pathways, sources of new HIV infections, data on sexual behaviors and male circumcision. It also provides data on the socio-cultural and economic context of the epidemic in Zambia. Chapter four presents the Know Your Response (KYR) results, which include policy level issues relevant to prevention, strategic information aspects of prevention, and a description of preventive interventions currently provided by implementers in the different sectors. Chapter five links the epidemic situation to the response, i.e. it provides an overall synthesis of the KYE and KYR data presented in chapters three and four. The chapter tries to answer the three key questions posed in this synthesis process. Chapter six lists the recommendations emanating from this analysis. It contains policy level recommendations and programmatic recommendations and presents specific recommendations for capacity building and research and monitoring and evaluation.
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