1) The document assesses country opportunity and feasibility for implementing an integrated prevention campaign (IPC) targeting HIV, malaria, and diarrhea. 2) An "Opportunity Index" (OI) was developed to summarize disease burden data from different sources and identify countries where IPC implementation potential is highest. 3) The OI considers factors like total disease burden, mortality rates, intervention coverage levels, and identifies the top 10 countries by total DALY burden as those with the greatest opportunity for impact through an IPC.

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

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
Diarrhea Malaria HIV
Childhood Pregnant
Overall Improved Malaria
Total DALY DALYs per Under-5 Life Diarrhea Annual malaria Annual Total PAR Annual women ART coverage
Country Population mortality DALYs drinking water burden DALYs ITN coverage HIV burden DALYs
burden capita mortality rate expectancy burden deaths burden deaths (WHO) deaths tested, (CD4<350)
rate coverage (WHO)
(IHME) coverage
Botswana 146,889 0.0732 2,006,945 46.4 13.1 53 7.0 101 3,086 96 0.4 12.5 15 458 65 21 24.8 5,800 143,346 >95 83
Malaysia 144,598 0.0051 28,401,017 4.7 4.7 74 1.0 35 1,069 100 0.1 0.0 6 183 Unknown 65 0.5 5,800 143,346 77 23
Peru 144,195 0.0050 29,076,512 24.3 5.4 74 4.5 658 20,102 85 0.0 0.0 17 519 47 0 0.4 5,000 123,574 78 37
Iran, Islamic Rep. 136,895 0.0019 73,973,630 24.2 5.4 73 9.8 4,480 136,864 96 Unknown 0.0 1 31 Unknown 1 0.2 Unknown Unknown Unknown 4
Algeria 133,241 0.0038 35,468,208 19.2 4.9 73 12.8 3,876 118,412 83 Unknown Unknown 0 0 0 100* 0.1 600 14,829 Unknown 25
Mauritania 124,229 0.0359 3,459,773 78.2 9.7 58 15.7 1,936 59,145 50 6.1 144.3 1,645 50,255 90 64 0.7 600 14,829 3 25
Morocco 118,772 0.0037 31,951,412 33.1 5.8 72 12.4 2,917 89,115 83 0.0 Unknown 0 0 0 Unknown 0.1 1,200 29,658 <1 27
Eritrea 109,745 0.0209 5,253,676 70.4 7.7 61 21.4 2,188 66,844 Unknown 0.5 169.3 29 886 100 17 0.8 1,700 42,015 27 37
Brazil 109,400 0.0006 194,946,470 20.9 6.4 73 5.3 3,543 108,239 98 0.0 0.1 38 1,161 26 0 0.45 Unknown Unknown 79 60
Gabon 91,943 0.0611 1,505,463 67.0 8.9 62 5.9 180 5,499 87 12.0 146.3 888 27,128 100 0 5.2 2,400 59,315 55 47
Papua New Guinea 85,470 0.0125 6,858,266 65.7 7.6 62 5.2 728 22,240 40 9.0 24.0 1,018 31,100 100 26 0.9 1,300 32,129 24 52
Uzbekistan 85,287 0.0030 28,562,400 41.0 4.7 68 12.0 2,549 77,872 87 0.0 0.0 0 0 Unknown 100* 0.1 300 7,414 88 Unknown
Bolivia 80,848 0.0081 9,929,849 54.1 7.3 66 15.2 2,158 65,927 Unknown Unknown 0.5 3 92 Unknown Unknown 0.2 600 14,829 Unknown 19
Honduras 80,331 0.0106 7,600,524 21.8 4.9 73 9.8 605 18,483 87 0.0 0.0 2 61 42 0 0.8 2,500 61,787 62 33
Tajikistan 77,802 0.0113 6,878,637 43.7 6.2 67 19.2 2,304 70,387 64 0.0 0.3 0 0 Unknown 5 0.2 300 7,414 62 11
Dominican Republic 77,649 0.0078 9,927,320 27.6 5.9 73 9.2 677 20,682 86 0.1 0.0 4 122 80 0 0.9 2,300 56,844 41 47
Argentina 74,545 0.0018 40,412,376 14.2 7.7 76 0.9 94 2,872 Unknown 0.0 0.0 0 0 9 100* 0.5 2,900 71,673 >95 70
Korea, Dem. Rep. 67,271 0.0028 24,346,229 23.0 9.9 69 12.1 2,202 67,271 Unknown Unknown 0.0 0 0 Unknown 1 Unknown Unknown Unknown Unknown 0
Ecuador 66,226 0.0046 14,464,739 19.4 5.0 75 5.5 388 11,853 94 0.0 0.1 0 0 52 5 0.4 2,200 54,372 92 30
Mexico 61,161 0.0005 113,423,047 18.1 4.7 77 5.5 2,002 61,161 96 0.0 0.0 0 0 5 100* 0.3 Unknown Unknown 34 54

5. OI: Top 10 DALY Burden
Countries
Top 10 countries based on total DALY burden
(diarrhea, malaria, HIV):
Diarrhea Malaria HIV
Improved Pregnant
Total DALY DALYs per Diarrhea Annual Malaria burden Annual Annual
Country DALYs drinking water DALYs ITN coverage HIV burden DALYs women tested,
burden capita burden deaths (WHO) deaths deaths
coverage coverage
Nigeria 18,229,334 0.1151 18.7 201,368 6,151,810 58 2.7 217,357 6,640,275 49 3.6 220,000 5,437,250 14
India 11,648,828 0.0095 13.0 237,482 7,255,095 92 0.1 6,292 192,221 1 0.3 170,000 4,201,511 23
South Africa 7,855,389 0.1571 8.7 6,293 192,252 91 0.2 51 1,558 100* 17.8 310,000 7,661,579 >95
DRC 6,014,548 0.0912 18.5 102,679 3,136,852 45 35.5 94,196 2,877,696 69 Unknown Unknown Unknown 11
Uganda 3,810,069 0.1140 16.0 30,391 928,448 72 25.1 42,549 1,299,876 57 6.5 64,000 1,581,745 63
Kenya 3,793,934 0.0936 20.5 38,802 1,185,404 59 64.0 20,666 631,348 37 6.3 80,000 1,977,182 83
Tanzania 3,621,080 0.0808 11.6 20,211 617,448 53 35.3 28,745 878,162 100* 5.6 86,000 2,125,470 86
Ethiopia 2,906,138 0.0350 22.8 73,341 2,240,574 44 1.9 21,786 665,564 62 Unknown Unknown Unknown 26
Afghanistan 2,742,023 0.0797 28.9 89,709 2,740,618 50 0.1 46 1,405 13 Unknown Unknown Unknown Unknown
Mozambique 2,650,507 0.1133 11.9 13,105 400,359 47 14.3 13,789 421,255 38 11.5 74,000 1,828,893 87
*PEPFAR countries
5

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

7. OI: Identifying the Opportunity
Diarrhea
Total DALY DALYs per Diarrhea Annual Improved drinking
Country DALYs
burden capita burden deaths water coverage
Nigeria 18,229,334 0.1151 18.7 201,368 6,151,810 58
India 11,648,828 0.0095 13.0 237,482 7,255,095 92
South Africa 7,855,389 0.1571 8.7 6,293 192,252 91
DRC 6,014,548 0.0912 18.5 102,679 3,136,852 45
Uganda 3,810,069 0.1140 16.0 30,391 928,448 72
Kenya 3,793,934 0.0936 20.5 38,802 1,185,404 59
Tanzania 3,621,080 0.0808 11.6 20,211 617,448 53
Ethiopia 2,906,138 0.0350 22.8 73,341 2,240,574 44
Afghanistan 2,742,023 0.0797 28.9 89,709 2,740,618 50
Mozambique 2,650,507 0.1133 11.9 13,105 400,359 47
Malaria HIV
Pregnant
Malaria burden Annual ITN HIV Annual
DALYs DALYs women tested,
(WHO) deaths coverage burden deaths
coverage
2.7 217,357 6,640,275 49 3.6 220,000 5,437,250 14
0.1 6,292 192,221 1 0.3 170,000 4,201,511 23
0.2 51 1,558 100* 17.8 310,000 7,661,579 >95
35.5 94,196 2,877,696 69 Unknown Unknown Unknown 11
25.1 42,549 1,299,876 57 6.5 64,000 1,581,745 63
64.0 20,666 631,348 37 6.3 80,000 1,977,182 83
35.3 28,745 878,162 100* 5.6 86,000 2,125,470 86
1.9 21,786 665,564 62 Unknown Unknown Unknown 26
0.1 46 1,405 13 Unknown Unknown Unknown Unknown
14.3 13,789 421,255 38 11.5 74,000 1,828,893 87

8. DALYs per Capita

9. Opportunity Exists

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

11. Feasibility Index
Economic Health
Country Violent conflict Corruption
Stability Expenditure
YES: Ongoing civil/rebel conflict in
Nigeria D 2.4 6.4
Niger River Delta
YES: Minor regional ongoing
India B civil/rebel conflict in northeast India 3.1 4.1
and on western border
South Africa BB YES: 4.1 9.3
DRC D YES: Ongoing civil/rebel conflict 2.0 1.7
YES: Minor ongoing rebel conflict in
Uganda C 2.4 11.6
the north
Kenya D YES: 2.2 5.4
Tanzania C NO 3.0 18.1
YES: Minor conflict on border with
Ethiopia D 2.7 11.4
Somalia
Afghanistan D YES: Ongoing civil/rebel conflict 1.5 3.7
Mozambique C NO 2.7 14.2
11

12. Country Profile
12
 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

13. Acknowledgments
• Aliya Jiwani • James G. Kahn
• Elliot Marseille • Alastair Matheson
• Stephane Verguet
Opportunity Index – Lisa Manhart, Gillian
Levine, Patricia Pavlinac, Adam
Akullian, Arianna Rubin