Operations Research in HIV IAS Professional Development Program IAS 2009 Debrework Zewdie Director Global AIDS Program The World Bank Cape Town, South Africa July 17, 2009
Overview • Sydney to Cape Town • The Sydney Declaration • Progress on 3 Sydney Recommendations • Priority research needs • Where are we now? • Changing Landscape • Where do we go from here?
The Sydney Declaration “Ten per cent of all resources dedicated to HIV programming should be used for research towards optimizing interventions utilized and health outcomes achieved”
Progress since Sydney 1) Sydney Declaration + Financial Crisis = ?? TOTAL annual resources available for AIDS 1996 - 2008 ?? Global financial crisis Notes:  1986-2000 figures are for international funds only  Domestic funds are included after 2001 [i] 1996-2006 data: Extracted from 2008 Report on the Global AIDS Epidemic (UNAIDS, 2008)
Progress since Sydney 2) Effective Partnerships North-South and South-South • Two major international meetings of significance took place: • WHO Consultation Meeting, 2008 • Vancouver Summit, 2009 • Examples of Partnerships • INTEREST Workshop support to Network of HIV/AIDS researchers from resource poor settings. • International Center for AIDS Care and Treatment Programs (ICAP) at Columbia University and South Africa’s Stellenbosch University • Gilead Clinical Development Partnerships
Progress since Sydney 3) A shared agenda between research and programs AIDS Vaccine Efforts and Contributions to Health Systems ----- IAVI
Optimizing Treatment approach and effectiveness Integration of services Greater understanding of social, political and cultural barriers Integration of new therapies, technologies and guidelines Sustainability and cost effectiveness Priority Research Needs in 2007 Where are we now?
Priority Research Needs in 2007 Where are we now? - Optimizing treatment • When to start treatment? How?
Priority Research Needs in 2007 Where are we now? - Cost Effectiveness Programspoorlymanaged: Enormousvariation in unitcosts $1000 Mexico Uganda Russia India South Africa $100 Cost per VCT Completed (unit cost) $10 $1 0 10 100 1000 10,000 Annual Clients Completing VCT (scale)
The Changing Research Landscape • Economic Crisis • Inadequate focus on prevention • More people on treatment • Changing treatment guidelines
Priority Research Needs: 2009 • Research to accelerate expansion of prevention services building on epidemic and programmatic evidence • 2. Evidence to inform new treatment guidelines • Improving pharmacovigilence and monitoring of adverse events and toxicities in resource poor settings • Strengthening linkages of HIV and TB services within the context of primary health care and chronic disease management
Where do we go from here? • Provide robust, transparent, and consist research support for countries to develop, finance, and implement research agendas Address significant HR constraints Strengthen coordination amongst donors and development partners in the spirit of the ‘Three Ones’ and the Accra declaration ENSURE RESEARCH IS AN INTEGRAL PART OF THE FIGHT AGAINST AIDS, TB, MALARIA
WWW.WORLDBANK.ORG/AIDS Plan for relevant RESEARCH AT THE BEGINNING OF EVERY PROGRAM Not as an afterthought!