Week 7 Flashcards
US grants
-we give more in terms of $
-but as a percent it’s less than 0.4% of GNP (UN target is 0.7%)
-sweden gives most as %
USAID cuts
-most staff laid off
-essentially ending foreign assistance programs
-9k jobs lost
Trends in life expectancy for patients with HIV
-world life expectancy increasing
-dec in African countries 1980-2002
2004 HIV epidemic
-antiretroviral meds too expensive for majority of patients in sub-saharan africa
-by the time many felt signs to get tested, it’s too late to do anything, so a lot went untested
-90% on prevention, 10% on treatment
-mother to child had highest rate of transmission (20% and 3/10 women had HIV)
-heterosexual transmission accounted for absolute highest amount of transmission tho
-1/5 mortality?
Start with One (AmpathKenya)
-1984: Iu working in kenya to develop school of medicine
-hospital shifted to be 60-80% HIV that came to die
-med student infected and near death
-IU forced to fully engage against HIV/AIDs
-gave meds and saved student’s life
Ampath + PEPFAR
PEPFAR (US preseident’s emergency plan for AIDS relief)
-800 care sites across kenya
-serving cathment population of 24 mil
-127,00 people with HIV actively in care
Who had most benefit from treatment
-pregnant mothers
-prevent spread to child
-inc in life expectancy bc children weren’t dying
Trends in life expectancy for patients with HIV through PEPFAR
-25 mill lives saved
-5.5 mil babies born HIV free
-65 mil HIV tested
-3 mil adolescent/young girls reached w prevention
-7 mil orphans
-20 mil on antiretroviral tx
-30 mil circumcisions
-1.5 mil clients on PrEP to prevent HIV
-340k new health workers
Projected consequences if PEPFAR is stopped
-additional 6.3 million deaths (opposed to 700k)
-3.4 million orphans
-350k new HIV infections among children
-8.7 million new adult infections by 2029
-current trajectory of ending AIDS as a public threat by 2030 is lost
Consequences to AMPATH
-127k without access to HIV care
-109k children lacking services
-700+ employees unexpectedly losing employments
-25 years of progress halted
Layers of protection from health disease
-10% physical environment
-20% clinical care
-30% health behaviors
-40% social and economic factors
-high income more protection
Ampath expansion
-mexico
-Guyana
-Ghana
-Nepal
-India
-Kenya
Going beyond health care approach (Tumaini model)
- Rehab, counseling, health
- basic literacy/numeracy
- Innovative educational center
- Potential sources of income
-build dorms, fam structure, economic support
-building new school with USAID
-tourisms, finance, info technology, trades, science, daycare
The old model
-get everyone home and back to school
-but abusive homes, low value education, stigma
=80% of children returning to street
USAID work stop order
-legally told to leave everything
-big hole jeopardizing other buildings around bc they can’t touch it
-getting sued by donors for not continuing work
Life expectancy in Indy counties
-
US has highest rates of avoidable deaths
-only high-income country that does not guarantee health coverage
-deaths from assaults are highest
-infant and maternal deaths are increasing
What does the government invest in? (richest 20%, middle 20%, poorest 20%)
-lifetime contribution to Medicare and Medicaid, per person: $248k, $82k, $33k
-value of healthcare received aged 65+: $401k, $337k, $229k
-funding gap per person: $153k, $255k, $196k
Inverse Incentives
-where should we be concentrating our efforts towards population health?
-we have the privilege choosing who we will treat
-do these priorities and resource allocation differ based on the type of health system you’re in
Interventions for diabetes
-medically tailored food (ready to eat meals 2 weeks, groceries 12 weeks)
-support: weekly RD consults
-Tools: nutrition education resources
-some pt had an 8 point drop in A1c yay
Self-employed women’s association (SEWA)
-2mil informal workers
-operate children care for working women
-nutrition, education, exercise
Current model of care
-awareness
-screening
-diagnosis
-treatment
-retention
-adherence
