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

We are exploring several areas under this theme including the positive and negative effects HIV treatment and care scale up can have on health systems, the role of national AIDS councils in the co-ordination and monitoring of programmes and the relative merits of vertical compared to integrative programming on delivery and cost effectiveness. A key area of research is focusing on the important issue of human resources to delivering health services, decentralisation and task shifting. How have political processes influenced the distribution and allocation of human resources within the health sector? Is it possible to effectively use lower cadres of staff to deliver ARV? What role can the community play in delivery and support of ARV treatment? How does the system cope with the increasing number of patients and the different types of patients; those newly starting those who are stable and those who have failed or are suspected as failing treatment?

Current Theme 3 Research Generated by Evidence for Action 

Integration of HIV treatment and Care with the Health System

There are various studies looking at how HIV treatment and care is (or is not) integrated into the health system in general. This includes constructing a framework to map the level of integration of ART delivery in Zambia and the possible effects this has on equity, efficiency and effectiveness, which is being carried out by LSHTM and ZAMBART.  This information will then be used to develop a larger-scale study looking into integration in several countries.

Given the levels of co-infection with TB and HIV in most of our partner countries, the integration of HIV and TB treatment and care is of great significance. A pilot study to examine integration of TB and HIV services for the care of co-infected patients in Pune, Maharashtra is planned by NARI, LSHTM and MAAS. The IHAA are currently developing a proposal looking at the local realities, challenges and opportunities for integrating systems of care for TB/HIV co-infected patients.

In Zambia the IHAA will be investigating the integration of family planning and SRH services for adolescents living with HIV.

The Impact of ART Scale-up on the Health System

A pilot study is being developed in several core partner countries to identify what indicators might exist to attempt to answer questions on the impact ART provision and scale up is having on health systems. It is hoped that this will lead to a further, large-scale research project using these indicators to assess the impact of ART Scale-up.