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