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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
Needs of specific population sub-groups Lighthouse, UCL, MRC CTU & LSHTM: Following the Paediatric Workshop held in May 2009, Evidence for Action partners have been working on developing a policy brief about the challenges of monitoring and evaluating paediatric HIV care. The policy brief is due to be published in time for the International AIDS Conference in Vienna in July 2010. The workshop and policy brief have been funded by Evidence for Action. MRC/UVRI have been studying the effects of HIV on the health and wellbeing of older people. An Evidence for Action small initiative grant (SIG) funded the protocol development and pilot study, which informed the design of a larger cross-sectional study that is funded by WHO and Cordaid. The study aims to determine the effect of HIV on both infected and affected elderly people in rural and urban Uganda. The main study is nearing completion. Preliminary results were presented at a HelpAge International meeting in London. The study will lead to at least one journal publication and information will be communicated to the MoH in Uganda.
LSHTM together with UNHCR are carrying out research into adherence to HAART in refugee and host populations. This aims to assess whether displacement is a barrier to adherence. The project is evaluating adherence to HAART and viral outcomes, and the reasons for sub-optimal adherence in refugee and local host communities who share clinics in Kuala Lumpur, Malaysia and Kakuma, Kenya. This work is funded by UNHCR. The data collection phase in Malaysia is nearing completion, and the work in Kenya will start in October 2010. Preliminary results of the research in both countries will be presented to stakeholders by June 2011.
IHAA have been working on a literature review of SRH rights of adolescents living with HIV. It aims to identify the gaps in services and interventions for adolescents living with HIV, analysed from a rights-based perspective. The first draft of this review has been compiled. This work was funded by Evidence for Action.
Mental health The mental health needs of people living with HIV in developing countries is an area where little is known. Work on mental health and HIV is being led by the Mental Health Community Practice. ZAMBART, MRC/UVRI, MRC CTU, LSHTM and University of Stellenbosch are analysing the results of a study of common mental disorders among TB and HIV-positive patients accessing treatment at Primary Health Care clinics in Zambia. The purpose of this study is to determine the prevalence of common mental disorders, and to evaluate the validity and clinical usefulness of screening tools for depression, psychological distress and alcohol dependence. This study will inform national health policy makers about the mental health needs of people living with HIV and TB, and may identify tools that can be used for screening by non-medically-trained health workers. This work is funded by an Evidence for Action SIG.
MRC/UVRI, MRC CTU, and LSHTM are investigating the potential need for integrating psychiatric care into HIV services in Uganda. The study aims to estimate the prevalence of common mental illnesses among people living with HIV in Uganda; assess risk factors for these mental illnesses; assess the impact of common mental illnesses on clinical outcomes and adherence to ART; and evaluate screening tools for use by lay interviewers. It is hoped that this will draw attention of policy makers to the burden of mental health disorders among people living with HIV in Uganda and help guide the government on whether to include screening for these mental illnesses in HIV care guidelines. The pilot study has been completed and data collection within the main study is underway. This work is funded by an Evidence for Action SIG. Monitoring and Evaluation
MRC CTU, UCL, Lighthouse and the Malawi MoH have started a project to evaluate methods for routine patient monitoring in Malawi, focusing on ART adherence and presence of TB. The site selection is complete and a local research assistant has been identified. This work is funded by Evidence for Action.
MRC CTU, UCL, Lighthouse, MRC/UVRI, IHAA, Wellcome Trust South Africa, and PPAI Ukraine have been continuing attempts to secure funding for a study on evaluating the validity and predictive value of ART monitoring indicators. Key stakeholders in MoHs and international organisations including WHO, UNAIDS and GFATM all support the study. However we still have not been able to secure funding for this work.
MRC/UVRI, IHAA, Uganda MoH and Entebbe Hospital have carried out preparatory work for a qualitative study of the lives of people living with HIV who have been taking ART for more than one year in Wakiso District, Uganda. This study will commence later in 2010. The study will provide an in-depth understanding of how PLHIV manage ART over a long period of time, and what the consequences of accessing ART are in relation to their personal experiences, relationships, social networks and livelihoods. A larger proposal will be submitted to ESRC on the basis of this pilot project. This pilot study is funded by Evidence for Action.
Living with ARTMRC/UVRI, IHAA, Uganda MoH and Entebbe Hospital have carried out preparatory work for a qualitative study of the lives of people living with HIV who have been taking ART for more than one year in Wakiso District, Uganda. This study will commence later in 2010. The study will provide an in-depth understanding of how PLHIV manage ART over a long period of time, and what the consequences of accessing ART are in relation to their personal experiences, relationships, social networks and livelihoods. A larger proposal will be submitted to ESRC on the basis of this pilot project. This pilot study is funded by Evidence for Action.
Research related to Evidence for Action • Lighthouse: Enrolment is continuing on the Trioped Trial, comparing outcomes of split dose Triomune with a paediatric formulation of a fixed-dose combination. This work is being carried out by Lighthouse and Baylor Centre of Excellence, funded by the Malawian National AIDS Commission, FHI, Clinton Foundation and GTZ.
• Lighthouse: data analysis is underway from an observational cohort study Lighthouse is working on comparing the clinical outcomes of TB patients who initiate ART early with those who start ART late. This work is funded by NAC and CDC.
• LSHTM: An article is in draft based on an evaluation of practices in screening for active TB in a community HAART programme in South Africa. The work is funded by PEPFAR.
• LSHTM are involved in a meta-analysis of studies of TB screening among HIV-infected individuals, working with WHO and CDC. The results were presented at a conference in November 2009, and have been widely discussed. They are already contributing to policy on Isoniazid Preventive Therapy roll out. A paper has been submitted to PLoS Medicine.
• LSHTM and Aurum Institute presented results from a study looking at the TB outcomes among people who have received isoniazid preventive therapy in South Africa at the IAS conference in 2009. The study won the TB/HIV prize, and was published in AIDS. This work is funded by the Bill and Melinda Gates Foundation and Colt Foundation.
• ZAMBART, LSHTM & UCL: ZAMBART are carrying out a Secondary Outcome Cohort Study within the ZAMSTAR Trial comparing HAART adherence and treatment outcomes in patients receiving or not receiving household counselling. The study is being done in collaboration with the Desmond Tutu TB Centre, UK Health Protection Agency and Tygerberg Medical Virology Department at Stellenbosch University. The project is at the data collection and analysis stage, and is funded by the Bill & Melinda Gates Foundation and Evidence for Action.
• LSHTM: In South Africa, LSHTM and Aurum Institute have carried out a cohort study to identify baseline factors predictive of poor outcomes at 6 months of ART. A paper on this work has been submitted to BMC Public Health. This work is funded by Aurum Institute.
• LSHTM and CAPRISA, South Africa, presented results from a randomised controlled trial of brief motivational counselling to promote adherence to ART at IAPAC in May 2010. Other elements will be presented at the International AIDS Conference in July 2010. It will contribute to policy on standard of care for ART counselling. This work is funded by Doris Duke Foundation.
• Lighthouse has conducted an evaluation of a real-time, point of care electronic data system (EDS) for ART management at Lighthouse. The EDS has been rolled out in 6 sites so far. The monitoring of the Lighthouse EDS informs national roll-out and policy. This work is funded by CDC.
• LSHTM and Aurum Institute presented the results of a study of predictors of early mortality on ART in South Africa at the IAS conference in 2009. A paper based on the results is under review by BMC Public Health. The study involved a retrospective review of programme data to determine predictors of early mortality on ART. The work was funded by the Aurum Institute.
• LSHTM and Aurum Institute have completed a qualitative study of ART clinic attenders in South Africa to investigate the impact of traditional medicines given alongside ART. Results from this study will be submitted to AIDS Care. This study was funded by Aurum Institute and LSHTM.
• LSHTM: and the Aurum Institute are also working on a study looking into predictors of clinical disease progression on first line ART, and determinants of outcome on second line ART in South Africa. This is a retrospective cohort study using Aurum Institute’s ART programme data. This study is funded by the Wellcome Trust.
• IHAA have submitted a proposal to Wellcome Trust for a public engagement project in India. This is based on a study carried out by IHAA to understand female sex workers’ risks associated with unprotected anal sex, frequency of demand by clients, and whether they feel equipped to protect themselves from associated harm. The aim of the public engagement project is to communicate findings by training sex workers in participatory and creative methods to communicate research through oral testimonies, in-depth interviews and focus group discussions using multimedia tools such as photography, video and audio.
• IHAA, ZAMBART and Alliance Zambia are working on a proposal to be submitted to the Wellcome Trust for a public engagement project that aims to disseminate the findings of studies related to SRH and access to ART via weekly radio programmes produced locally by ‘key correspondents’ in Zambia.
• IHAA, Alliance Uganda and MRC/UVRI have started preparing for a project to understand why married people in Uganda engage in high-risk sexual behaviours. The project is currently awaiting ethics approval. This work will inform national policies and help programmes to design appropriate messages targeted at discordant couples in particular, and married people in general. This work is funded by Alliance ARP.
Theme 1 publications |
