An International Research
Consortium to Maximise
Benefits & Equity of HIV
Treatment & Care Systems

The ‘best’ package of HIV care will depend on the setting and the aims and objectives of the particular programme. How can the need for rapid scale up be balanced with capacity building and strengthening of health systems? Should second line treatment be included? What effect does decentralisation of treatment have on access and quality?

The consortium is examining what packages of care are provided and define these packages based on the populations, resources and infrastructures available. We are examining the influence of epidemiology and geographical situation on packages of care and seek to strengthen the evidence base on the cost effectiveness of anti-retroviral therapy.

Current Theme 1 Research Generated by Evidence for Action

Monitoring and Evaluation

The issue of how to monitor and evaluate HIV treatment and care systems is of great importance. Many country programmes have to report to multiple donors and stakeholders. These donors often recommend different data collection and calculation methods for outcome indicators. The lack of standardisation between donors and programmes results in the collection and reporting of multiple outcome data by clinics, which is costly and time-consuming, and also make it difficult to compare performance within and between programmes. Evidence for Action partners, led by MRC CTU, are working on a project to identify which outcome indicator(s) best predict long-term survival and the emergence of drug resistance. A Small-Initiative Grant-funded preliminary study is being carried out to identify sites, methods of data collection and to meet with key stakeholders from the donor community. A proposal for funding the main study, which will assess which outcomes and indicators best correlate with long-term patient survival, thereby identifying which should be collected for ARV programmes to monitor their performance within resource-limited settings, is being submitted to Wellcome Trust.

Guidelines

IHAA are leading the development of guidelines which will be published as WHO’s guidelines on the health sector’s essential package of HIV treatment, care and support, to be published later in 2008.

Other theme 1 research

The psychological and social determinants of common mental disorders among HIV positive patients in Uganda, and various Evidence for Action-related projects looking at the clinical management of HIV.