Science put at heart of US global AIDS strategy

Science can be used to evaluate the effectiveness of HIV treatments Copyright: WHO

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Science is at the centre of efforts to design and implement more effective preventative and care programmes for HIV/AIDS set out in a blueprint published by a US government initiative that fights the disease.

Using science to evaluate initiatives, develop new interventions and find ways to keep people in treatment are some of the suggestions in the report, ‘Creating an AIDS-free Generation’, published by the President’s Emergency Plan for AIDS Relief (PEPFAR) last week (29 November). The document aims to help the global health community in the battle against HIV.

Recent evidence, such as that showing how existing treatment can dramatically reduce HIV transmission, demonstrates the value of a scientific approach to fighting the disease, says David Haroz, special assistant to the principal deputy US global AIDS coordinator, and a co-author of the report.

"The blueprint is an attempt to take this science and translate it into policy and programmes in a much more aggressive way," he tells SciDev.Net.

Since its launch in 2003, PEPFAR has spent nearly US$46 billion fighting HIV, AIDS and related infections such as tuberculosis, with President Barack Obama requesting a further US$6.4 billion from Congress for the coming financial year.

Working closely with government agencies such as the National Institutes of Health and other global health actors, PEPFAR aims to bring about an AIDS-free generation.

The document advises PEPFAR to collect comprehensive data on the performance of its programmes to allow them to be rapidly evaluated and improved.

The effectiveness of programmes that combine prevention therapies, including prevention of mother-to-child transmission and voluntary medical male circumcision, was one strategy singled out in the blueprint as being in need of evaluation.

An evidence-based approach to how testing and treatment programmes could best reach people early to reduce transmission rates and related infections such as tuberculosis should also be pursued, it says.

In addition, the blueprint calls for more research to develop new treatment and prevention methods, such as vaccines and microbicides.

Further focuses should be on decentralising and improving access to care facilities, ensuring people remain in treatment programmes and developing innovative technologies to reduce the burden on patients and the health system, the report urges.

The blueprint also rallies support for the development of suitable technologies that measure the concentration of HIV in the blood, which is vital to evaluate the success of antiretroviral therapy.

The guidelines will be incorporated into programmes in the 36 countries — predominantly in Sub-Saharan Africa — that PEPFAR currently concentrates.

Furthermore, they will help to insert more science into the annual joint action plans for combating HIV, due for revision in early 2013, that PEPFAR has signed separately with 20 national governments, says Haroz.

But, Haroz says, the blueprint was designed to have relevance beyond PEPFAR alone.

All actors, from regional governments to international organisations, such as the World Bank and the Global Fund, need to apply its principles if it was to have the necessary impact, he adds.

"PEPFAR is committed but they can’t and shouldn’t do it alone."

This need for united effort is echoed by Mitchell Warren, executive director of AVAC, an HIV prevention advocacy group.

The report could end up as "just another document on a bookshelf" if it is not taken up by ministries, programme implementers and civil society actors, he tells SciDev.Net.

But, Warren adds, despite important omissions such as a defined time frame for and the cost of activities, the blueprint should be praised for having its priorities "exactly right".