Transcript Document

Overview of activities targeting the
objectives of the
Presentation – Global Campaign for
Microbicides
Dr Ian Sanne,
19 June 2008
About Right to Care (RTC)
Overview of Right to Care
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RTC is a non-profit, Section 21 company specialising in HIV disease management,
(company registered 23 January 2003; PBO registration 2004)
Funded by the US Presidents Emergency Programme For Aids Relief through
USAID
Clinicians of RTC have a long track record of ARV and TB research with NIH funding
ACTG, CIPRA, R01’s, and are members of the WHO and South African guideline
committees for adult and paediatric treatment.
Diversified management structure compliant with empowerment criteria
Corporate governance – much attention has been paid to Corporate Governance
Vision:
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All HIV positive patients receive high quality treatment, care and support improving
their quality of life, productivity and survival
Mission:
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To facilitate access and build capacity to deliver innovative HIV treatment, care and
support services
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To develop HIV treatment capacity both in the public and private sectors
Funding level employed:
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Total of $35 Million PEPFAR funding spent to date
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Current funding levels $27 Million for BY 08 ending Sept 08; $35 Million budget 09.
Structure for treatment provision
Funding arrangement
- actuarial calc.
- Cell captive, Foundation
Medical Scheme
Administration
Treatment implementation
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HPTN Foundation
NIH Foundation
K401 Trust/Foundation
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Administration and billing
Service provider networks
Claims processing and payment
Financial and outcome reporting
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Accredited provider network
Prevention trial accredited
Management, Lab., Pharmacy
etc.
Practical Implementation of our Clinical
Services
• Case manager proactively
support patient treatment
• Specialist physicians review
GP medical report and lab
results; and confirm script
for processing
• Patient visits doctor of choice
• Doctor sends medical report to
RTC
• Doctor can prescribe treatment
• RTC processes script and offers
education
Patient
GP
• Patient can
decide where
drugs must be
delivered for
confidential
collection
Collection
RTC Data
Entry
• Clinical case
managers enter
data onto IT
Platform
• System
programmed to
alert potential
problems
RTC
Medical
Experts
Distribution
• RTC sends script
to courier
pharmacy for
distribution to
patient
Lab
• Doctor can send
blood sample to any
certified lab
• Lab sends result to
Doctor and RTC
Advice
& Counseling
• Medical and
psychological support
available via 24 hour
call centre
Implementation of Clinical Services
TherapyEdge-HIV developments at RTC 2007-08
VCT Module
Laboratory Integration
Lancet, Toga, NHLS
Implemented
Beta Testing
Request
Result
Development
Data outputs
TherapyEdge-HIV
Data transfer
for patient Mx
PEPFAR and DORA
Rapid data capture
Down referral
Export to SAS™
Reports
Referral
Implementation
as “Live” system
Paediatric Module
TB Management
Module
Cervical dysplasia
HPV
Pharmacy supply
chain management
Private sector
network
Link Genotype to Therapy
TherapyEdge
HIV clinical
information
Clinicians
Data capturers
Core DB
Linking genetic information with clinical outcome
To measure impact of therapeutics and
patients disease management
ViroScore Suite
HIV virological
information
Virologists
HIV
Epidemiological
information
M+E
Epidemiologists
Statisticians
PEPFAR indicators
DORA
Paediatric data capture
Resistance testing
Red bar indicates drugs with known resistance, green bar indicates no
resistance. Note decrease in viral load after resistance is detected and
correct treatment implemented
HIV ViroScore – TherapyEdge™
Used to develop six treatment models
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Support for the Department of Health CCMT sites – responsible for 38
government sites in five provinces
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Direct access to specialist care – drug resistance and complex opportunistic
infections seen at Helen Joseph Hospital Site. Access to new and unregistered
antiretroviral drugs for salvage therapy on section 21 approval.
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Foundation funded community programs – funded by Oprah Winfrey
Foundation and Housing for HIV
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Community Clinics model – support six clinics with over 6000 patients on
treatment,
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SMME treatment model – area based clinic to provide the employer funded model
to SMME’s
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Private practitioners treating indigent patients – capitation fee model for the VCT
and ARV treatment
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Workplace model – Direct AIDS Intervention (DAI in partnership with Alexander
Forbes Health Management Solutions)
Q1 Monitoring Evaluation -Treatment target
ARV
TREATMENT
109
119
109%
# patients on ART since start of funding
(cumulative)
60,000
48,353
81%
66,458
111%
# patients on ART at year end (current)
44,350
38,413
87%
52,503
118%
subset: # newly initiated patients during
year
23,600
6,079
26%
24,105
102%
subset: # paeds on ART at year end
(current)
1,610
2,165
134%
500
117
23%
# ARV treatment outlets during year
# people trained in ART during year
% patient attrition
% of attrition due to default/LTF
% of new cumulative patients retained as
current
21%
49%
78%
Government treatment sites
• RTC sites are responsible for over 10% of all ART patients in SA
• Themba Lethu Clinic at Helen Joseph Hospital
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Largest and most efficient in South Africa
Over 11,000 patients initiated on ART since April 2004
A further 5000 pre-ART patients
Development site for TherapyEdge, TB Focal Point, Down Referral,
Laboratory Integration
– CHRU research site
• Public Private Interaction MOU’s – Gauteng, Mphumalanga,
Northern Cape, Free State, Western Cape
• 38 government sites
RTC supports government through…
• Needs assessments at the sites included in the MOU
• Recruitment and seconding personnel – currently over 700
employee seconded to DoH
• Training of personnel – in-house HIV training program
responsible for over 3500 health care workers trained in 2007
• On-site expertise – preceptors trained by RTC brought to site to
increase confidence and capacity of on-site personnel
• Provision of the TherapyEdge data system to DoH sites
throughout the country
• Infrastructure assessment and capacity building – over R35M
spent in 2007 on department of health sites
• Access to specialized laboratory testing not accessible to DoH
e.g. Resistance testing
Partnerships with Community Organisations (1)
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CHRU
– Strategic founding partner of Right to Care
– 12 Year track record of phase 2 and 3a and 3b clinical trials (ART, TB,
MDR TB and opportunistic infections). Currently there over 500 patients
participating in 35 clinical trials
– Strong Epidemiology and Public Health Evaluation Agenda using the large
database of Therapy Edge
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ACTS
– Based in the Masoyi Tribal Area near White River
– 95% adherence rate
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Rea’phela
– An initiative of Right to Care, situated in Wynberg
– Fastest growing clinic with a focus on ARV’s
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Witkoppen Health and Welfare Centre
– Services Diepsloot, Zevenfontein, Lion Park & Kya Sands
– Over 250 patients on ART with 90% adherence rate
Partnerships with Community Organisations (2)
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Ndlovu Medical Trust
– Situated in Elandshoorn, Mpumalanga, servicing
30,000 – 40,000 people.
– Initiate a number of community upliftment programmes
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Babesi Medical Trust
– Situated close to the Kruger National Park
– Servicing a population of 100,000 people
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Refilwe Community Project
– Initially a palliative care centre
– Focus on OVC
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Care Organisations:
– Community AIDS Response (CARE)
– Friends for Life
– Vuselela Ulwazi Lwakho (Vuselela)
Public-Private Partnerships
• Direct AIDS Intervention (DAI)
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Partnership with Alexander Forbes Health Management Services
Reaches over 32 corporate organisations in South Africa
Over 78,000 employees covered
(see program slides below)
• Thusong Community Treatment Programme
– Provides ART services via independent GP’s and GP networks
– Active in 5 provinces, 14 participating GP’s
Partnerships with Foundations
• Oprah Winfrey Foundation – Provision of home based testing
and treatment to community members
• Housing for HIV – provision of home-based HIV testing,
treatment and management of treatment to low-income home
owners. This program is linked to the Home Loan Guarantee
Company to underwrite lender risk in low income populations
RTC Measured Performance
• In-house monitoring evaluation team focused on site performance
• Strong Public Health Evaluation and Epidemiology Research
Group developing research agenda
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Treatment outcomes
Interactions between HIV and TB
Social science agenda including loss to initiation, loss to follow-up
Economics research agenda – health cost economics and macroeconomic impact of HIV on society
Q1 Monitoring Evaluation Results Period Dec 07
Program
VCT
HIV CARE &
SUPPORT
Indicator
Target
Actual
104
101
97%
# people tested and given test results during
year
110,00
0
23,194
21%
# TB patients tested and given results during
year
10,000
0
0%
# people trained in VCT during year
200
44
22%
# HIV Care outlets during year
114
130
114%
96,000
55,082
57%
# people receiving PEP
100
67
67%
# people trained in HIV Care during year
600
241
40%
# TB outlets during year
16
13
81%
5,350
1,926
36%
200
85
43%
# VCT outlets during year
# patients given HIV Care during quarter
(current)
TB/HIV
# HIV/TB patients given TB Tx during year
# people trained in TB/HIV during year
% Target
Anualize
d
%
Annual
92,272
84%
67,996
71%
Q1 Monitoring Evaluation -Treatment target
ARV
TREATMENT
109
119
109%
# patients on ART since start of funding
(cumulative)
60,000
48,353
81%
66,458
111%
# patients on ART at year end (current)
44,350
38,413
87%
52,503
118%
subset: # newly initiated patients during
year
23,600
6,079
26%
24,105
102%
subset: # paeds on ART at year end
(current)
1,610
2,165
134%
500
117
23%
# ARV treatment outlets during year
# people trained in ART during year
% patient attrition
% of attrition due to default/LTF
% of new cumulative patients retained as
current
21%
49%
78%
Direct AIDS Intervention: A partnership with Alexander
Forbes – Employer Funded Treatment Programs
It can be economically viable to treat a single
HIV+ employee…
Do-nothing costs
yr 1
yr 5
yr 9
HIV contracted
Sick leave
Productivity
Death benefit
Recruit & train
Op drugs
HAART
yr 3
yr 7
Treated costs
Patient not identified
Disease
progression
monitoring
HIV related disease
AIDS sick
Delaying an
employee’s termination
by 7 years, and
avoiding absenteeism
costs saves
R171k
NPV for a R10’600/m
employee
yr 11
yr 13
55 days
additional
sick leave
over 2 yrs
yr 15
yr 17
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25%
productivity
drop for 2 yrs
yr 19
R200k
7 year productive life
extension due to
HAART drugs
3 months
salary cost to
recruit & train
R400k
Cycle of demise excludes
absenteeism costs
R100k
R200k
Direct AIDS Intervention (DAI)
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Workplace programme in
partnership with AFHMS
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300 Doctors supported by ETP
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Programme covers over 130,000
employees of 38 companies
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Many employers are moving to
funding family members
RTC role in DAI program
• Initial program design and negotiation with service delivery
partners – Dr Ian Sanne, Chris Barker
• Modeling of HIV risk and funding by company profile – Dr Ian
Sanne and Chris Barker
• Public and Boardroom presentations of the program – Dr Ian
Sanne, presented to over 300 companies
• Development of all clinical protocols and VCT protocols
• On-site VCT for companies
• Development of TherapyEdge-HIV™
• Development of case management division in RTC
• Reporting of clinical outcomes
• Rightmed Provision of ART in selected populations and
programs
• Since Dr Strydom left less interaction with Alexander Forbes
Pricing scenarios – uptake 20%
Scenario:
Quote/employee/year
Administration (HMS)
24hr call centre (Access Health)
Clinical counselling (ICAS)
Data hosting (R2C)
Actuarial & auditing (AF)
Payroll synch (First connect)
Cell Captive fee (excl education)
Education
Estimated costs/empl/yr
VCT
Pre-test counselling
Pathology VCT
Post-test counseling
Treatment
Doctor
Drug
STI treatment
Micronutrients for HIV+
Vaccines for HIV+ (new HIV+ only)
Lab (treated bloods)
Lab (HIV+ monitoring)
Drug delivery
Scripting expertise
Total req (est/empl/yr)
20.0%
25.0%
30.0%
35.0%
40.0%
(341.7)
(130.7)
(48.0)
(31.2)
(6.0)
(3.0)
(3.0)
(19.8)
(100.0)
(343.6)
(130.7)
(48.0)
(31.2)
(6.0)
(3.0)
(3.0)
(21.7)
(100.0)
(345.5)
(130.7)
(48.0)
(31.2)
(6.0)
(3.0)
(3.0)
(23.7)
(100.0)
(347.4)
(130.7)
(48.0)
(31.2)
(6.0)
(3.0)
(3.0)
(25.6)
(100.0)
(349.3)
(130.7)
(48.0)
(31.2)
(6.0)
(3.0)
(3.0)
(27.5)
(100.0)
(273.7)
(52.0)
(8.0)
(20.0)
(24.0)
(221.7)
(11.6)
(90.4)
(30.0)
(13.3)
(14.7)
(23.2)
(7.1)
(11.6)
(19.9)
(321.6)
(52.0)
(8.0)
(20.0)
(24.0)
(269.6)
(14.5)
(113.0)
(30.0)
(16.7)
(18.3)
(29.0)
(8.9)
(14.5)
(24.8)
(369.4)
(52.0)
(8.0)
(20.0)
(24.0)
(317.4)
(17.4)
(135.6)
(30.0)
(20.0)
(22.0)
(34.8)
(10.6)
(17.4)
(29.8)
(417.3)
(52.0)
(8.0)
(20.0)
(24.0)
(365.3)
(20.3)
(158.2)
(30.0)
(23.3)
(25.6)
(40.6)
(12.4)
(20.3)
(34.7)
(465.2)
(52.0)
(8.0)
(20.0)
(24.0)
(413.2)
(23.2)
(180.7)
(30.0)
(26.6)
(29.3)
(46.3)
(14.2)
(23.2)
(39.7)
(615.3)
(665.1)
(715.0)
(764.8)
(814.6)
Negotiable
Essential
Optional
Essential
Optional
N/A
Essential
Negotiable
Optional
Optional
Optional
Optional
Essential
Pricing scenarios – uptake 50%
Scenario:
Quote/employee/year
Administration (HMS)
24hr call centre (Access Health)
Clinical counselling (ICAS)
Data hosting (R2C)
Actuarial & auditing (AF)
Payroll synch (First connect)
Cell Captive fee (excl education)
Education
Estimated costs/empl/yr
VCT
Pre-test counselling
Pathology VCT
Post-test counseling
Treatment
Doctor
Drug
STI treatment
Micronutrients for HIV+
Vaccines for HIV+ (new HIV+ only)
Lab (treated bloods)
Lab (HIV+ monitoring)
Drug delivery
Scripting expertise
Total req (est/empl/yr)
20.0%
25.0%
30.0%
35.0%
40.0%
(356.3)
(130.7)
(48.0)
(31.2)
(6.0)
(3.0)
(3.0)
(34.4)
(100.0)
(361.1)
(130.7)
(48.0)
(31.2)
(6.0)
(3.0)
(3.0)
(39.2)
(100.0)
(365.9)
(130.7)
(48.0)
(31.2)
(6.0)
(3.0)
(3.0)
(44.0)
(100.0)
(370.7)
(130.7)
(48.0)
(31.2)
(6.0)
(3.0)
(3.0)
(48.8)
(100.0)
(375.5)
(130.7)
(48.0)
(31.2)
(6.0)
(3.0)
(3.0)
(53.6)
(100.0)
(639.1)
(130.0)
(20.0)
(50.0)
(60.0)
(509.1)
(29.0)
(226.0)
(30.0)
(33.3)
(36.6)
(57.9)
(17.7)
(29.0)
(49.6)
(758.9)
(130.0)
(20.0)
(50.0)
(60.0)
(628.9)
(36.2)
(282.4)
(30.0)
(41.6)
(45.8)
(72.4)
(22.1)
(36.2)
(62.0)
(878.6)
(130.0)
(20.0)
(50.0)
(60.0)
(748.6)
(43.4)
(338.9)
(30.0)
(50.0)
(55.0)
(86.9)
(26.6)
(43.4)
(74.4)
(998.4)
(130.0)
(20.0)
(50.0)
(60.0)
(868.4)
(50.7)
(395.4)
(30.0)
(58.3)
(64.1)
(101.4)
(31.0)
(50.7)
(86.8)
(1'118.1)
(130.0)
(20.0)
(50.0)
(60.0)
(988.1)
(57.9)
(451.9)
(30.0)
(66.6)
(73.3)
(115.9)
(35.4)
(57.9)
(99.2)
(995.4)
(1'120.0)
(1'244.5)
(1'369.0)
(1'493.6)
Negotiable
Essential
Optional
Essential
Optional
N/A
Essential
Negotiable
Optional
Optional
Optional
Optional
Essential