1. 1 Facilitating global health delivery through operations research Center for Strategic HIV Operations Research (CSHOR) Deborah Cotton MD, MPH Chief Medical Officer Clinton Foundation HIV/AIDS Initiative (CHAI) Mexico City August 4, 2008

2. 2 Clinton Foundation HIV/AIDS Initiative Work with governments and partners to increase availability of high-quality care and treatment for people in need Negotiate lower costs for tests and treatment Establish major initiatives to enable widespread access to HIV-related care Provide strategic and targeted technical assistance where it is most needed

3. 3 Clinton Foundation HIV/AIDS Initiative 22 national governments have CHAI partnership 69 countries access CHAI prices (>90% of people on treatment)

4. 4 Center for Strategic HIV Operations Research (CSHOR) Better informed resource allocation decisions Complex health systems, with financial and capacity constraints Mathematical models and statistics Research team within CHAI, launched in response to direct appeals for assistance with resource planning and allocation

5. 5 Center for Strategic HIV Operations Research (CSHOR) Better informed resource allocation decisions Complex health systems, with financial and capacity constraints Mathematical models and statistics Simulate the effects of proposed interventions Calculate the most efficient ways to distribute or utilize available resources Research team within CHAI, launched in response to direct appeals for assistance with resource planning and allocation

6. 6 CSHOR previews: AIDS 2008 - Mexico City Forecast ARV product demand using simulation modeling, in coordination with WHO and global suppliers Session: ARV Policy and Delivery, Thursday 13:00-14:00 (Meg O’Brien)

7. 7 CSHOR previews: AIDS 2008 - Mexico City Forecast ARV product demand using simulation modeling, in coordination with WHO and global suppliers Session: ARV Policy and Delivery, Thursday 13:00-14:00 (Meg O’Brien) Model financial impact of ART protocol revisions, with support from Government of Botswana Session: Economics of HIV Prevention and Treatment: Value for Money?, Tuesday 13:00-14:00 (Jennifer Campbell)

8. 8 CSHOR previews: AIDS 2008 - Mexico City Forecast ARV product demand using simulation modeling, in coordination with WHO and global suppliers Session: ARV Policy and Delivery, Thursday 13:00-14:00 (Meg O’Brien) Model financial impact of ART protocol revisions, with support from Government of Botswana Session: Economics of HIV Prevention and Treatment: Value for Money?, Tuesday 13:00-14:00 (Jennifer Campbell) Assess human resource needs for male circumcision via time study, in collaboration with partners in Kenya and Zambia Poster group: Male Circumcision, Monday 12:30-14:30 (Jessica Fast)

9. 9 CSHOR previews: AIDS 2008 - Mexico City Forecast ARV product demand using simulation modeling, in coordination with WHO and global suppliers Session: ARV Policy and Delivery, Thursday 13:00-14:00 (Meg O’Brien) Model financial impact of ART protocol revisions, with support from Government of Botswana Session: Economics of HIV Prevention and Treatment: Value for Money?, Tuesday 13:00-14:00 (Jennifer Campbell) Assess human resource needs for male circumcision via time study, in collaboration with partners in Kenya and Zambia Poster group: Male Circumcision, Monday 12:30-14:30 (Jessica Fast) Quantify physician-time saved in task-shifting pilot through simulation modeling, in partnership with Government of Rwanda and FHI Session: Task Shifting and Decentralising Care, Wednesday 14:30-16:00 (Joyce Chung)

10. 10 CSHOR previews: AIDS 2008 - Mexico City Forecast ARV product demand using simulation modeling, in coordination with WHO and global suppliers Session: ARV Policy and Delivery, Thursday 13:00-14:00 (Meg O’Brien) Model financial impact of ART protocol revisions, with support from Government of Botswana Session: Economics of HIV Prevention and Treatment: Value for Money?, Tuesday 13:00-14:00 (Jennifer Campbell) Assess human resource needs for male circumcision via time study, in collaboration with partners in Kenya and Zambia Poster group: Male Circumcision, Monday 12:30-14:30 (Jessica Fast) Quantify physician-time saved in task-shifting pilot through simulation modeling, in partnership with Government of Rwanda and FHI Session: Task Shifting and Decentralising Care, Wednesday 14:30-16:00 (Joyce Chung)

11. 11 Results from Rwanda task-shifting analysis 77 150 17 59,000 on treatment by end of 2008 ~9,300 hrs of physician consultations/month (51%) (11%)

12. 12 Results from Rwanda task-shifting analysis 77 150 17 59,000 on treatment by end of 2008 ~9,300 hrs of physician consultations/month 78% ↓ in physician demand for HIV services 183% ↑ in physician capacity for non-HIV services

13. 13 Challenges for operations research Lack of comprehensive and reliable data management systems continues to inhibit OR analyses Increasing integration of HIV care and treatment into other health programs adds complexity to mathematical modeling Potential for OR-based approaches to facilitate global health delivery is not well understood, which limits its use

14. 14 Thank you Bill & Melinda Gates Foundation Renee Ridzon Kim Shaffer Modeling team Meg O’Brien Justin Cohen Kendra Ludwig Michelle Nowakowski Jennifer Usas Country Operation team Sandra Cress Jennifer Campbell Joyce Chung Zelalem Gizachew Gaurav Kapoor Mooketsi Motsumi Maaya Sundaram Adam Was Brian Wayda Policy team Elizabeth McCarthy Jessica Fast Aaron Tjoa CSHOR Deborah Cotton