by Stephane Verguet Department of Global Health University of Washington Presented at 2012 AIDS Satellite Meeting

1. Integrated Prevention Campaigns (IPCs):
opportunities & challenges of a health delivery
platform for HIV, malaria & diarrhea
Stéphane Verguet
verguet@uw.edu
Department of Global Health, University of Washington
XIXth International AIDS Conference, Washington, DC, July 25, 2012

2. Overview
Synergies & efficiency gains of IPCs ?
Equity gains of IPCs ?
Opportunity costs of IPCs ?
Broader health system integration of IPCs ?
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3. Health system delivery platforms
Policy Instruments
(e.g. universal public finance; taxation; conditional cash transfers)
Platform 1 Platform 2
Platform 2 Platform 1
e.g. HIV-dedicated e.g. routine vaccine e.g.
e.g. IPC Child Health Days
clinic services (EPI)
immunization campaigns
Water
ART ART DTP BCG Vitamin A Deworming
filters
VCT ITNs
Measles
Adult health Child health
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4. Synergies & efficiency gains of IPCs ?
VCT
Referral to ART
IPC platform
ITNs
Water filters
….
May raise impact at low marginal cost with few add-ons
Impact of add-ons due to:
- biological synergies (e.g. competing risks, potentiation and antagonism)
- operational synergies (e.g. logistical integration)
- epidemiology and coverage of pre-existing interventions
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5. Equity gains of IPCs ?
 Potential benefit of IPCs = enhanced outreach to underserved
(e.g. reach out to remote areas)
 Effects of alternative IPC strategies on health disparities among
sub-groups (wealth status, urban vs. rural):
Are IPCs targeting the poorest ?
???
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6. Opportunity costs of IPCs ?
 Implementation of IPCs requires large health workforce
- diversion from accomplishing routine duties
 What can be negative impacts on routine health services?
- interruption of some services during IPC campaigns ?
 How to limit opportunity costs?
- use non-technical workers e.g. community health workers (CHWs)
- prioritize simple IPC interventions requiring unskilled workers
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7. Example: “Child Health Days” in sub-Saharan Africa
 Mass immunization campaigns
- delivery of multiple child health interventions
polio, measles vaccines
ITNs
vitamin A
deworming
 Case of South Africa’s Child Health Days (Verguet et al., 2012)
- vitamin A inclusion much more cost-effective than stand-alone measles
vaccine
- use of routine health services decreases during platform implementation
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8. Broader health system connections of IPCs?
 IPC mostly targets adults
- opportunity for including other adult health interventions (e.g. TB)
- opportunity for leveraging infrastructure for non-communicable diseases
(e.g. hypertension, diabetes screening)
 IPC as a lever to strengthen health services?
- integrate vertical disease programs and intersectoral policies
- link communities to basic health services
(e.g. child health example = México’s National Health Weeks
(Sepúlveda et al., 2006))
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9. Acknowledgments
• Aliya Jiwani • James G. Kahn
• Elliot Marseille • Alastair Matheson
• Stephane Verguet • Judd Walson
Opportunity Index – Lisa Manhart, Gillian Levine, Patricia
Pavlinac, Adam Akullian, Arianna Rubin
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