Debrework ZewdieDirectorGlobal AIDS ProgramThe World Bank
Cape Town, South AfricaJuly 17, 2009
Operations Research in HIVIAS Professional Development Program
IAS 2009
1. Sydney to Cape Town
– The Sydney Declaration
– Progress on 3 Sydney
Recommendations
2. Priority research needs
– Where are we now?
3. Changing Landscape
4. Where do we go from here?
Overview
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”
TOTAL annual resources available for AIDS 1996 - 2008
Notes: [1] 1986-2000 figures are for international funds only [2] Domestic funds are included after 2001
[i] 1996-2006 data: Extracted from 2008 Report on the Global AIDS Epidemic (UNAIDS, 2008)
Global financial crisis
??
Progress since Sydney1) Sydney Declaration + Financial Crisis = ??
• Two major international meetings of significance took place: 1. WHO Consultation Meeting, 20082. 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 Sydney2) Effective Partnerships North-South and
South-South
Progress since Sydney3) 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 2007Where are we now?
• When to start treatment? How?
Priority Research Needs in 2007Where are we now? - Optimizing
treatment
Programs poorly managed: Enormous variation in unit costs
$1
$10
$100
$1000
0 10 100 1000 10,000
Annual Clients Completing VCT (scale)
Cos
t per
VC
T C
ompl
eted
(uni
t cos
t)
MexicoUgandaRussiaIndiaSouth Africa
Priority Research Needs in 2007Where are we now? - Cost
Effectiveness
The Changing Research LandscapeEconomic Crisis
Inadequate focus on prevention
More people on treatment
Changing treatment guidelines
Priority Research Needs: 20091. Research to accelerate expansion of prevention services
building on epidemic and programmatic evidence
2. Evidence to inform new treatment guidelines
3. Improving pharmacovigilence and monitoring of adverse events and toxicities in resource poor settings
4. Strengthening linkages of HIV and TB services within the context of primary health care and chronic disease management
Where do we go from here?1. Provide robust,
transparent, and consist research support for countries to develop, finance, and implement research agendas
2. Address significant HR constraints
3. 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
Plan for relevant Plan for relevant RESEARCH AT THE RESEARCH AT THE
BEGINNING OF EVERY BEGINNING OF EVERY PROGRAMPROGRAM
Not as an afterthought! Not as an afterthought!
WWW.WORLDBANK.ORG/AIDS