PLENARY PREVIEW:

Understanding the task:

ART rollout and research issues in the
developing world
Debrework Zewdie
Robert Oelrichs
David Wilson

4th IAS Conference on HIV Pathogenesis, Treatment, and Prevention

 Progress to Universal Access

Geographical People receiving People needing cART cART

region cART cART coverage coverage
(Children)
Sub-Saharan 1 340 000 4 800 000 28% 13%
Africa
Latin America, 355 000 490 000 72% 67%
Caribbean
East, South, 280 000 1 500 000 19% 21%
South-East
Asia
Europe, 35 000 230 000 15% 20%
Central Asia
North Africa, 5 000 77 000 6% <1%
Middle East
GLOBAL 2 015 000 7 100 000 28% 15%
TOWARDS UNIVERSAL ACCESS: Progress Report, April 2007. WHO, UNAIDS, UNICEF
 Research in treatment roll out

Understanding
Discovery
our epidemics

Operational research

Cost-effectiveness research
Discovery
 Understanding the Epidemic
Heterosexual IDU

SW IDU
MSM SW
IDU
MSM

Heterosexual
 Research in treatment roll out

Operational Research
“learning by doing – how to do things better in the real
world”
“generating evidence specifically to inform operations”

Cost Effectiveness Research

“Measuring outcome against cost—usually the
prevention effect of a program versus no program or the
prevention effects of two programs against one another”
 Research in treatment roll out

• Research to inform treatment programs

– appropriate commencement and delivery of first line
therapy
– optimal sequencing to second line therapy
– accurate indicators of treatment failure
• Research for capacity building
– Support for key individuals
– International partnerships
– New systems for ethical review, monitoring and QC
• Research for evidence-based strategies and
sustainable funding
– Cost-effectiveness and planning
 Treatment builds health system capacity
The Haiti primary health care experience
Patient Visits: 7/2002–11/2003

Prenatal Care Visits: 7/2002–12/2003

Vaccine Administration: 1/2003–12/2003

Patients waiting for laboratory tests, including HIV

tests, at a clinic in central Haiti.

Ivers LC, et al. Increase in uptake of voluntary HIV testing in the setting of comprehensive
free healthcare in rural Haiti. Poster THPE0172, XVI IAC, Toronto 2006.
Integrated HIV Prevention and Care Strengthens Primary Health Care:
Lessons from Rural Haiti Walton DA et al, J Public Health Policy. 2004
 Priority Research Needs

• 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
WWW.WORLDBANK.ORG/AIDS

Thank you