On September 14-15, Ambassador Eric Goosby, U.S. Global AIDS Coordinator, hosted the second meeting of the Scientific Advisory Board of the President’s Emergency Plan for AIDS Relief (PEPFAR).
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PEPFAR Scientific Advisory Board Recommendation for the Office of the U.S. Global AIDS Coordinator: Intensify Programmatic Activity and Implementation Science to Reduce HIV Burden, Increase Coverage and Improve PEPFAR's Impact for Key Populations. Click here for complete Recommendations Report» Recommendations
The Board serves the Global AIDS Coordinator in an advisory capacity concerning scientific, implementation, and policy issues related to the global HIV/AIDS response. These issues inform the priorities and direction of PEPFAR evaluation and research, the content of national and international strategies and their implementation, and the role of PEPFAR in the international discourse regarding appropriate and resourced responses.
Agenda topics for the meeting included an update on PEPFAR-funded evaluations, discussion about policy related to the recent studies treatment for prevention, and recommendations to the Ambassador on the future direction of evaluation and research within PEPFAR.
Inaugural Meeting: January 6-7, 2011, Washington, DC
The inaugural meeting of the PEPFAR Scientific Advisory Board was held on January 6 & 7, 2011 in Washington, DC. The meeting was convened by the Office of the U.S. Global AIDS Coordinator and hosted by OGAC Deputy Coordinator Paul Bouey and PEPFAR Senior Technical Advisor Nancy Padian. Topics for the January meeting included an overview of PEPFAR-funded evaluations, priority setting within HIV/AIDS care, treatment and prevention areas, and recommendations to the Ambassador on the future direction of evaluation and research within PEPFAR.
Presentations from each of the sessions are available below.
January 6, 2011- Day 1
Paul Bouey summarized PEPFAR-funded evaluations, including the history, current portfolio, and future directions for FY11. Following early support for Targeted Evaluations, since 2008 PEPFAR has focused on public health evaluations (PHEs) with more emphasis on global and country-driven research and a more stringent review process. These studies have addressed country-driven as well as globally significant priorities. Discussion resulting from the presentation centered on the importance of disseminating research results and using these results to inform policy and practice, the need for collaboration, scientific rigor, and a more streamlined process.
Implementation Science and Capacity Building
Nancy Padian defined implementation science as methods to improve the uptake, implementation, and translation of research findings into routine and common practices, with a focus on how to deliver, transfer, adapt, and make informed evidence-based choices, and choosing interventions strategically for what will yield maximum benefit. For PEPFAR, this means having a single framework for the spectrum of programs and evaluations, and a strategy for collecting and using information that permits evaluations at every level. Steps to build capacity will involve identifying existing programs and opportunities for training in research and evaluation, and working with country partners to offer capacity building assistance where needed.
PEPFAR Care, Treatment and PMTCT Programs: Results, Directions, Gaps & Opportunities
Charles Holmes presented an overview of funding, program results, and issues in care, treatment, and PMTCT programs within PEPFAR. Programmatic developments in ART coverage, co-infections, drug resistance, loss to follow-up, and orphans and vulnerable children were highlighted. Other PEPFAR priorities including moving toward country ownership, integration with other health programs serving targeted populations, and accelerating efficiency and impact were reviewed.
PEPFAR-Funded Evaluations: Overview of Care and Treatment and PMCT Evaluations
Stefan Wiktor continued the discussion of PEPFAR-funded evaluations and presented an overview of the Care and Treatment and PMTCT PHE studies, including results from prior studies. PEPFAR evaluation activities include PHE studies on HIV/TB, ART outcomes, adherence, retention, costing, clinical monitoring, and drug resistance. Strengths and challenges of the PHE program were also presented.
January 7, 2011- Day 2
Overview of PEPFAR Prevention
Caroline Ryan opened the day with an overview of PEPFAR's prevention efforts: Know your epidemic, Know your response, Know your portfolio: Scaling up what works. Current behavioral, biomedical, and structural prevention interventions were presented, as well as opportunities for expanding evidence-based HIV prevention for most-at-risk populations (MARPs). Critical questions for enhancing public health impact of ART for prevention and test to treat were discussed. Initiatives on male circumcision, gender programs, and the condom gap (stock-outs) were also highlighted.
PEPFAR-Funded Evaluations: Overview of Prevention and Counseling and Testing Evaluations
Benny Kottiri summarized PEPFAR's PHEs on prevention, counseling and testing. These evaluation activities include PHE studies on: effective behavior change communication; concurrent partnerships; discordant couples; HIV testing and counseling; male circumcision scale-up; ARV-based prevention; risk-reduction; condoms; sexually transmitted infections; community and economic empowerment; and combination prevention in populations which include MARPs, youth and orphans and vulnerable children, women and girls, and prevention with positives. Strengths and challenges of the PHE program were presented.
Public Health Evaluation: Health Systems Strengthening and Human Resources for Health
Paul Bouey reviewed PEPFAR's efforts to strengthen health systems and human resources for health, which support service delivery by the host government at all levels. Current examples are the Medical Education Partnership Initiative (MEPI) and the Nursing Education Partnership Initiative (NEPI), both formed to strengthen education and training and linked with evaluation programs.
Scientific Advisory Board Meeting Summary Recommendations
At the end of these two days of discussion, the Board recommended a variety of care, treatment and prevention research priorities to Ambassador Goosby in addition to recommendations related to streamlining funding and sharing data. These recommendations will inform the basis for setting PEPFAR's priority research agenda.
Ambassador Goosby concurred with the SAB's focus and thanked everyone for their time, effort, and ideas. Dr. Padian closed the meeting and noted several possibilities for continuing activity, some of which will be conducted in working groups. The next PEPFAR SAB meeting will be convened in approximately 6 months.