1. Selection of Priority Geographic Areas Integrated Prevention Campaigns: Evidence for Impact and Efficiency, Global Potential, and Sustainability 07/25/2012 PANEL 2: Judd L Walson, MD, MPH University of Washington Depts of Global Health, Internal Medicine (Infectious Disease), Pediatrics and Epidemiology

2. OBJECTIVE Assess country opportunity and feasibility for implementation of an HIV, malaria and diarrhea IPC

3. Opportunity Index (OI) Designed to:  Summarize large amount of data from disparate sources  Summarize burden of diseases that may be impacted by the IPC  Reflect existing relevant interventions that may affect diarrhea, malaria, or HIV burden  Facilitate identification of countries where opportunity for IPC implementation is greatest 3

4. OI: At a Glance DiarrheaMalariaHIV Country Total DALY burden DALYs per capita Population Under-5 mortality rate Overall mortality rate Life expectancy Diarrhea burden Annual deaths DALYs Improved drinking water coverage Malaria burden (WHO) Childhood malaria burden (IHME) Annual deaths DALYs Total PAR (WHO) ITN coverageHIV burden Annual deaths DALYs Pregnant women tested, coverage ART coverage (CD4<350) Botswana146,8890.07322,006,94546.413.1537.01013,086960.412.515458652124.85,800143,346>9583 Malaysia144,5980.005128,401,0174.7 741.0351,0691000.10.06183Unknown650.55,800143,3467723 Peru144,1950.005029,076,51224.35.4744.565820,102850.0 175194700.45,000123,5747837 Iran, Islamic Rep.136,8950.001973,973,63024.25.4739.84,480136,86496Unknown0.0131Unknown10.2Unknown 4 Algeria133,2410.003835,468,20819.24.97312.83,876118,41283Unknown 000100*0.160014,829Unknown25 Mauritania124,2290.03593,459,77378.29.75815.71,93659,145506.1144.31,64550,25590640.760014,829325 Morocco118,7720.003731,951,41233.15.87212.42,91789,115830.0Unknown000 0.11,20029,658<127 Eritrea109,7450.02095,253,67670.47.76121.42,18866,844Unknown0.5169.329886100170.81,70042,0152737 Brazil109,4000.0006194,946,47020.96.4735.33,543108,239980.00.1381,1612600.45Unknown 7960 Gabon91,9430.06111,505,46367.08.9625.91805,4998712.0146.388827,12810005.22,40059,3155547 Papua New Guinea85,4700.01256,858,26665.77.6625.272822,240409.024.01,01831,100100260.91,30032,1292452 Uzbekistan85,2870.003028,562,40041.04.76812.02,54977,872870.0 00Unknown100*0.13007,41488Unknown Bolivia80,8480.00819,929,84954.17.36615.22,15865,927Unknown 0.5392Unknown 0.260014,829Unknown19 Honduras80,3310.01067,600,52421.84.9739.860518,483870.0 2614200.82,50061,7876233 Tajikistan77,8020.01136,878,63743.76.26719.22,30470,387640.00.300Unknown50.23007,4146211 Dominican Republic77,6490.00789,927,32027.65.9739.267720,682860.10.041228000.92,30056,8444147 Argentina74,5450.001840,412,37614.27.7760.9942,872Unknown0.0 009100*0.52,90071,673>9570 Korea, Dem. Rep.67,2710.002824,346,22923.09.96912.12,20267,271Unknown 0.000Unknown1 0 Ecuador66,2260.004614,464,73919.45.0755.538811,853940.00.1005250.42,20054,3729230 Mexico61,1610.0005113,423,04718.14.7775.52,00261,161960.0 005100*0.3Unknown 3454

5. OI: Top 10 DALY Burden Countries DiarrheaMalariaHIV Country Total DALY burden DALYs per capita Diarrhea burden Annual deaths DALYs Improved drinking water coverage Malaria burden (WHO) Annual deaths DALYsITN coverageHIV burden Annual deaths DALYs Pregnant women tested, coverage Nigeria 18,229,3340.115118.7201,3686,151,810582.7217,3576,640,275493.6220,0005,437,25014 India 11,648,8280.009513.0237,4827,255,095920.16,292192,22110.3170,0004,201,51123 South Africa 7,855,3890.15718.76,293192,252910.2511,558100*17.8310,0007,661,579>95 DRC 6,014,5480.091218.5102,6793,136,8524535.594,1962,877,69669Unknown 11 Uganda 3,810,0690.114016.030,391928,4487225.142,5491,299,876576.564,0001,581,74563 Kenya 3,793,9340.093620.538,8021,185,4045964.020,666631,348376.380,0001,977,18283 Tanzania 3,621,0800.080811.620,211617,4485335.328,745878,162100*5.686,0002,125,47086 Ethiopia 2,906,1380.035022.873,3412,240,574441.921,786665,56462Unknown 26 Afghanistan 2,742,0230.079728.989,7092,740,618500.1461,40513Unknown Mozambique 2,650,5070.113311.913,105400,3594714.313,789421,2553811.574,0001,828,89387 5 *PEPFAR countries Top 10 countries based on total DALY burden (diarrhea, malaria, HIV):

6. OI – A Closer Look DiarrheaMalariaHIV Country Total DALY burden DALYs per capita Population Under-5 mortality rate Overall mortality rate Life expectancy Diarrhea burden Annual deaths DALYs Improved drinking water coverage Malaria burden (WHO) Childhood malaria burden (IHME) Annual deaths DALYs Total PAR (WHO) ITN coverage HIV burden Annual deaths DALYs Pregnant women tested, coverage ART coverage (CD4<350) 6 Diarrhea Country Total DALY burden DALYs per capita Population Under-5 mortality rate Overall mortality rate Life expectancy Diarrhea burden Annual deaths DALYs Improved drinking water coverage MalariaHIV Malaria burden (WHO) Childhood malaria burden (IHME) Annual deaths DALYs Total PAR (WHO) ITN coverage HIV burden Annual deaths DALYs Pregnant women tested, coverage ART coverage (CD4<350)

7. OI: Identifying the Opportunity Diarrhea Country Total DALY burden DALYs per capita Diarrhea burden Annual deaths DALYs Improved drinking water coverage MalariaHIV Malaria burden (WHO) Annual deaths DALYs ITN coverage HIV burden Annual deaths DALYs Pregnant women tested, coverage Diarrhea Country Total DALY burden DALYs per capita Diarrhea burden Annual deaths DALYs Improved drinking water coverage Nigeria 18,229,3340.115118.7201,3686,151,81058 India 11,648,8280.009513.0237,4827,255,09592 South Africa 7,855,3890.15718.76,293192,25291 DRC 6,014,5480.091218.5102,6793,136,85245 Uganda 3,810,0690.114016.030,391928,44872 Kenya 3,793,9340.093620.538,8021,185,40459 Tanzania 3,621,0800.080811.620,211617,44853 Ethiopia 2,906,1380.035022.873,3412,240,57444 Afghanistan 2,742,0230.079728.989,7092,740,61850 Mozambique 2,650,5070.113311.913,105400,35947 MalariaHIV Malaria burden (WHO) Annual deaths DALYs ITN coverage HIV burden Annual deaths DALYs Pregnant women tested, coverage 2.7217,3576,640,275493.6220,0005,437,25014 0.16,292192,22110.3170,0004,201,51123 0.2511,558100*17.8310,0007,661,579>95 35.594,1962,877,69669Unknown 11 25.142,5491,299,876576.564,0001,581,74563 64.020,666631,348376.380,0001,977,18283 35.328,745878,162100*5.686,0002,125,47086 1.921,786665,56462Unknown 26 0.1461,40513Unknown 14.313,789421,2553811.574,0001,828,89387

8. DALYs per Capita

9. Opportunity Exists

10. Grouped into high, medium and low feasibility Feasibility Index Identify key characteristics of successful programs 10 Feasibility Indicator Source Economic Risk RatingEuler Hermes Economic Country Risk Rating Violent conflictState Department country profile pages CorruptionTransparency International Govt. investment in healthGovernment health expenditure as % of total government expenditure (WHO data)

11. Feasibility Index 11 Country Economic Stability Violent conflictCorruption Health Expenditure NigeriaD YES: Ongoing civil/rebel conflict in Niger River Delta 2.46.4 IndiaB YES: Minor regional ongoing civil/rebel conflict in northeast India and on western border 3.14.1 South AfricaBBYES:4.19.3 DRCDYES: Ongoing civil/rebel conflict2.01.7 UgandaC YES: Minor ongoing rebel conflict in the north 2.411.6 KenyaDYES:2.25.4 TanzaniaCNO3.018.1 EthiopiaD YES: Minor conflict on border with Somalia 2.711.4 AfghanistanDYES: Ongoing civil/rebel conflict1.53.7 MozambiqueCNO2.714.2

12. Country Profile  Expands on and provides context for information in the Opportunity and Feasibility Indices  Provides subnational information where possible  Provides detailed information for planning and implementation of campaigns, including country specific cost data 12