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

We are working to identify the appropriate roles of public, private and not-for-profit services, and communities in supporting the delivery of HIV treatment and care.

What are the entry points to provide ARV? How do countries best capitalise on PMTCT, TB and STI programmes? What level of integration is best?

Current Theme 2 Research Generated by Evidence for Action 

Access to care and the roll-out of HIV treatment and care

Strategies for ensuring access to treatment and care remains an issue of vital importance. The Wakiso Project MRC UVRI is carrying out is developing and evaluating a strategy to roll out ART integrated of HIV prevention to peripheral health centres. LSHTM, IHAA and ZAMBART are working together on a project looking at how home based care interventions shape the perceptions and experiences of treatment and care for PLWHA in the era of ART. NARI are also carrying out a study looking at the role of family members and health care providers in HIV care in India. In late 2008 in Malawi, Lighthouse and LSHTM will start a project looking at access to care for women identified as HIV positive by PMTCT programmes. IHAA are completing a literature review of studies on community involvement in HIV prevention, treatment and care in low income countries, and evaluating a community based ARV programme for key population groups in treatment in Andhra Pradesh. Work is being done in both Goa and in northern Karnataka (Belgaum) in India to map HIV services, focusing on access and quality.

Adherence

Adherence to HIV treatment is affected by both what is in the package of treatment and care, and how it is delivered. LSHTM are working on a UNHCR-funded project examining adherence to HAART among Displaced Populations in several countries in Africa. The International HIV/AIDS Alliance are carrying out work looking into the role of the extended family and home-based delivery in improving paediatric ART adherence in low-income neighbourhoods in Zambia. There are also several Evidence for Action-related projects examining issues around adherence.

Other Theme 3 research

Research is planned looking into the role of health workers in India and Zambia.

Other Evidence for Action-related research in this thematic area included:

• Work by MRC-CTU on the ARROW Trial to examine monitoring practice for 1200 children in Uganda and Zimbabwe, with sub-studies to examine issues related to adherence, pharmacokinetics of new formulations, acceptability of different formulations, and issues related to how children are treated in families within the study. This work is funded by DFID and MRC. Cost-effectiveness studies are planned.
• Work by MRC-CTU and collaborators is continuing on the CHAPAS and ARROW Trials to examine the appropriateness of new drug formulations for children, funded by EDCTP.
• Work by IHAA, LSHTM and collaborators has started on factors associated with dropping out of the Ukrainian HIV treatment programme, funded by IHAA.
• IHAA has continued work in Zambia on intervention and operations research into community support for ARV treatment and HIV prevention (the ACER study), funded by EU Care and USAID.
• IHAA has completed a study of community HIV treatment preparedness in India, funded by the Bill & Melinda Gates Foundation (BMGF).
• MRC-UVRI and collaborators have continued the Jinja ART Roll-Out Trial, funded by CDC and MRC.
• MRC-UVRI and collaborators have continued an evaluation of 50 commercial and not-for-profit laboratories in south and central Uganda to establish the quality of their ART monitoring services and potential needs for training and material support, funded by MRC.
• MRC-UVRI have continued an evaluation of HAART adherence in Uganda, as a sub-study of the DART trial, aiming to generate recommendations for HAART delivery in Uganda and elsewhere, funded by MRC.
• In India, Positive People and Sangath have started a longitudinal study to determine whether training, supervision and ongoing psychosocial support for informal care-givers of PLHIV improves clinical outcomes and the quality of life of PLHIV, funded by USAID. (Also mentioned under theme 1.)
• A PhD studentship in India will investigate what are the psychosocial determinants of accessing HIV care following a positive HIV result.
• Lighthouse is carrying out a study of the management of HIV treatment patient follow-up visits by non-medical staff which is known as the Lighthouse ART Assistants Study, funded by Lighthouse. The study will inform the current national debate on ‘task-shifting’ to manage the human resource crisis in the healthcare system, and regulatory authorities are eagerly awaiting the findings.
• Lighthouse is also carrying out operations research on the ‘Back-to-Care Programme’, based on data from early active follow-up for HIV patients on HAART who are overdue for their follow-up appointment, funded by Lighthouse. The study has already produced evidence that Back-to-Care Programme can help to retain HIV patients on treatment.
• The project in South Africa by LSHTM and collaborators which is researching screening for TB in HIV treatment programmes described under Theme 1 is also relevant to Theme 2.
• LSHTM and collaborators in South Africa are working on a cohort study of adults starting HAART to identify baseline factors predictive of poor outcomes at 6 months, which will provide data on predictors of ART adherence with a view to identification of individuals who may need additional adherence support, funded by AngloAmerican and PEPFAR.
• LSHTM and collaborators are carrying out a randomised controlled trial of brief motivational counselling to promote adherence to HAART in South Africa, funded by the Doris Duke Charitable Foundation.
• The TAZAMA project in Tanzania is developing plans to pilot test and evaluate community based service delivery with the Magu District Medical Office.