Operational Research for HIV Treatment and Prevention:

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• Operational Research for HIV Treatment and
  Prevention
• Framework, Approaches, and Tools

November 18, 2005
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Overall operational research strategy for HIV
treatment and prevention

• Reaching consensus on operational researcha
  difficult undertaking
• Linking research to policyno single answer to
  this longstanding challenge
• Sense of urgency in contributing to learning by
  doing approach
• Get started, in countries, review how
  this is working, revise as needed
• The strategy we have adopted What we have
  done

• Seek expert advice on a general framework
• Encourage country ownership of the process, and
  facilitate priority setting
• Foster the preparation of proposals
• Facilitate implementation of OR on key topics

? July 04 consultation scope for OR,
multi-disciplinary approaches, country ownership
? Dec 04 Kampala workshop ?Technical support
to country teams and submission of proposals for
review ? Plan meeting to develop generic tools
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Key operational research questions

• Cross-cutting questions
• Improving treatment and access
• Providing medicines to those who need them
• Dispensing ARVs and supporting adherence
• Optimizing consequences of treatment for
  individuals and communities
• Strengthening health systems
• Across disciplinary fields
• Costs, sustainability, incentives? Economics
• Avoiding vertical programs, improving quality and
  integration ? Health systems
• Drug regimens to be applied to multiple
  populations ? Clinical
• Behaviors, individuals, communities ?
  Sociobehavioral

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The Generic Tools project

• Tools
• Periodic reviews of records and statistics
• Key informant interviews
• Observations _at_ clinics
• Surveys patients, other users, providers
• Qualitative methods as appropriate

• Topics
• Adherence
• Access/ stigma
• Economic dimension health facilities
• Economics households
• Treatment-prevention links

Generic tools to be tested and adapted Optimal
combination of methods Appropriate populations
and samples Mechanisms to test and
revise Analyses and results comparative
analyses Facilitate integration into programs
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How are we doing? Successes and challenges

• 5 countries are about to go into implementation
  the feedback from the field has been very
  positive, teams have been put together , NGOs
  have been involved, MOH are more interested in
  research, priorities have been debated.
• Time reflects the capacity building that is
  necessary in most settings
• Support secured for the 5 countries. How do we
  sustain the momentum, and expand to other
  countries? Identifying key partners to support
  the work
• Essential questions in countries and across
  settings How best to ensure that we continue to
  reflect priorities?
• Technical support is labor-intensive, yet our
  capacity at HQ is limited
• can we standardize, use regional office?
• can we use the 5 countries to scale-up to
  others?
• Incentives to ensure rapid implementation and
  quality results?