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Slides used for the Mapping Pathways Knowledge Exchange Workshop held in Washington, DC on October 8, 9 2013. Visit us at www.mappingpathways.org
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Knowledge exchange workshopRAND, Washington, DC8 – 9, October 2013
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Our agenda in brief• Welcome – Bill McColl/AIDS United
• Introductions
• Overview of the Mapping Pathways project
• Scenarios
– What do we need to consider for ARV-based strategies to be effective for prevention?
– PEST framework exercise
• Political/Regulatory, Economic, Social, Technological
• Using PEST factors, develop scenarios
• Tools for planning
• Next steps
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We are a community-led research initiative
Unrestricted educational grants Merck & Co. NIH Be The Generation Bridge The Gilead Foundation
www.mappingpathways.org
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We are a community-led research initiative
Video
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Snapshot of interventions
PrEP
PEP
Treatment – TLC+ (TasP, T4P, TnT)
Microbicides
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WHAT DID WE LEARN?
What did we do?
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Yes, we have compelling results from clinical trials, and make no mistake, we will have more. But the opinions, perspectives and lived wisdom of communities, from the grassroots to the grasstops, matter just as much as the peer-reviewed scientific data that are coming at us fast and furiously. How communities absorb, understand and prioritise the science matters.
- Archbishop Desmond Tutu
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Literature review
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Literature review conducted 2011, 2012
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119 relevant articles fully read and synthesised
Summary of empirical papers included in the full text review, by strategy
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Literature snapshot
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The grassroots – online survey
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Grassroots: TLC+ very important
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Grassroots: Yes to PrEP, but…
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Grassroots: Microbicides important
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Grassroots: PEP views variable
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Need to take a cost-effectiveness point of view…Targeting
strategies is essential.
- US
How could we devise advocacy
and communications
campaigns to raise awareness of these
approaches?- India
Grassroots: In their own words
A tricky subject (PrEP) in a
community that is illiterate, poor, unemployed…
- SA
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Grassroots snapshot
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The grasstops – one-on-one interviews
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Things are moving fast, may find
ourselves chasing events…
- US
Behavioural change and education is
key, not treatment as prevention.
- India
I am concerned that we are not including other
sub-Saharan African countries in this
analysis.- SA
Grasstops – Views on Mapping Pathways
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This is the biggest mistake we can
make! Prevention is cheaper.
- US
In India, people don’t come in for
diagnosis early, so the question is if
you want to use it as a prevention strategy, how do you get them in
earlier?- India
Grasstops – Views on TLC+
We need to save lives and treat who needs treatment as
a first priority.- SA
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We need to reach the people who are so
vulnerable they can’t negotiate condom usage
regularly.- US
It will be hard for an individual to accept they are ‘high risk’ and
should take this treatment.
- IndiaI think we can look at targeted PrEP use in high-risk groups, but that won’t be easy.
- SA
Grasstops – Views on PrEP
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Discounted costs (making HIV rare relative to $
saved due to Tx and lost economic output)
- US
• Identification of main barriers
• Health system spillovers• Cost-per-case averted
- India• Cost-per-case averted• Discounted costs
• Experts’ views of impacts- SA
Grasstops – Most useful types of evidence?
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Grasstops: Highly diverse views
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Grasstops snapshot
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ExpertLens
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What is an ‘ExpertLens’?
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TLC+ strongest science, ready for implementation,where experts would allocate funds
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ExpertLens snapshot
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THIS IS NOW.That was then…
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Knowledge Exchange Workshops
• Public health officials, researchers, policy experts, ASO leaders, prevention programmers
San Francisco – July 2013
Atlanta – October 2013
Washington, DC – 8 – 9 October 2013
Report!
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What is the future snapshot?
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• A scenario is a logical and consistent picture of the future
• Scenarios help to provide insight into future developments in a given area
– We will use them to assess the health and research systems which will impact effectiveness of ARVs as prevention
– Scenarios help us to prepare for the future
– Analysis of the scenarios helps to identify the implications of the choices we make today
• Scenarios highlight links among different aspects of the future
Using scenarios to unpack the future
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Three possible scenarios – a short introduction
• The ‘couture’ scenario
• The ‘ready to wear’ scenario
• The ‘one size fits all’ scenario
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The scenarios spanned a research continuum and were ‘pulled’ apart to exaggerate and illustrate the future
Social and behavioural research inputs
Sci
entif
ic r
esea
rch
inpu
ts Couture
Ready to wear
One size fits all
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The ‘couture’ scenario
CouturePersonalised view of the future
Individual risk profileGenetic sequencing and identification of
tumour specific pathwaysDiagnostics and/or treatment breakthrough
Specialisation of services
Prevention Awareness Early detection Diagnosis Treatment Survivors End of
life
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The ‘ready to wear’ scenario
Ready to wearGroup stratified view of the future
Group risk profilingTargeted screening and treatment
Social media and peer supportCommunity integration of services
Prevention Awareness Early detection Diagnosis Treatment Survivors End of
life
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The ‘one size fits all’ scenario
One size fits allPopulation view of the future
Prevention strategy and centralised regulationLongitudinal studies and behaviour change
Behavioural science and public health breakthrough
Patient empowerment
Prevention Awareness Early detection Diagnosis Treatment Survivors End of life
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• Learn from each other
• Build scenarios together
– Develop a PEST analysis
– Name and prioritize factors that relate to PEST
– Use prioritized factors to define a spectrum of outcomes
– Narrate scenarios
– Discuss actions within the scenarios
– Imagine ourselves as actors in the future
• Think about shaping actions and strategic next steps
What we’ll do over the next few days
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• Develop a PEST analysis
– Allows one to identify the main external factors and drivers that will impact effectiveness of ARV-based prevention strategies
• Political & Regulatory
• Economic
• Social & Cultural
• Technological & Scientific
A Mapping Pathways PEST
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• Why is the factor important to effectiveness of ARV-based prevention strategies?
– Is it more important for some strategies than for others?
• How would you rank the factors within each letter of the PEST?
– What is the most important political factor? What is least important? Why?
– What is the most important economic factor? What is least important? Why?
– What is the most important social factor? What is least important? Why?
– What is the most important technological factor? What is least important? Why?
Prioritising the PEST factors
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We have implemented ARV-based PX and…
…we have no
effectiveness, rate of
new infections
increases…
… we have effectivenes
s, and overall
infection rate
decreases …
…. It’s a mixed bag,
some reduction in rates among
some key pops, but not
all….
Dateline: 2025
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Reminder – ARV-based interventions
PrEP
PEP
Treatment
Microbicides
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• Name each scenario
• What is the mix of ARV strategies?
– PrEP, PEP, Treatment, Microbicides
• How does each factor play into the scenario?
• How do the factors intersect?
• Why have we reached different effectiveness
levels?
We have implemented ARV-based PX and…
Dateline: 2025
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• How were factors successfully addressed? What is in place to
make this happen?
• If factor was not successfully addressed, what goes wrong,
what doesn’t happen?
• What does “success” look like?
• What does “less than success” look like?
We have implemented ARV-based PX and…
Dateline: 2025
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• How were factors successfully addressed? What is in place to make this happen?
• If factor was not successfully addressed, what goes wrong, what doesn’t happen?
• What does “success” look like?
• What does “less than success” look like?
• Name each scenario• What is the mix of ARV
strategies?– PrEP, PEP, Treatment,
Microbicides• How does each factor
play into the scenario?• How do the factors
intersect?• Why have we reached
different effectiveness levels
We have implemented ARV-based PX and…
Dateline: 2025
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So now
what?
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If we are to toss AIDS into the dustbin, we must do our best to understand the intersections of scientific discovery and community wisdom, address the truths in both, and move forward with decisions that take into consideration a full, robust interpretation of the evidence base.
Let us be done with AIDS.
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www.MappingPathways.org [email protected]
Molly Morgan Jones - [email protected] Jim Pickett – [email protected]
Jessica Terlikowski – [email protected]
