Research

1

• Research Evaluation Key Priorities
• Increased utilization, access and coverage
• Improved prevention outcomes from C T
• Cost-effectiveness and cost efficacy
• Linkages and integration (TC/other services)
• Service delivery implementation issues
• New approaches to testing and counseling
• Testing and laboratory issues

2

• Research Evaluation Priorities
• Increased Utilization
• What approaches are most effective in increasing
  partners and family members (including children)
  who are tested and counseled across different
  settings (PMTCT, Inpatient, Free-Standing, Care
  and Treatment)?
• How do you increase access and/or utilization
  among most-at-risk populations including MSM,
  IDUs, high-risk youth, and CSWs, etc.?

3

• Research Evaluation Priorities
• Improved prevention outcomes from C T
• How do we increase the effectiveness of
  prevention counseling among HIV negatives and
  positives? And at what cost?
• What interventions enhance disclosure and
  specifically what is the effectiveness of
  counselor assisted disclosure?
• What are the effective interventions for those
  who are acutely infected and are their protocols
  we can design to identify them and prevent them
  from spreading the disease.
• Who are the characteristics of repeat testers and
  their reasons for retesting? Are they at high
  risk?
• How do we best explain sero-discordance in C T
  settings? What are the protocols and scripts and
  messages that work best?
• Meta-analysis on vulnerability of pregnant women
  to HIV infection and explore reasons for
  vulnerability of pregnant women.

4

• Research Evaluation Priorities
• Cost Effectiveness Efficacy
• Cost efficacy analysis and cost-effectiveness
  analysis for various CT models and in different
  settings? Which ones results in behavior change
  and which ones link best to care and treatment?
  Which ones prevent new infections? What costs
  should be included? Which models result in the
  greatest numbers of people being tested and which
  result in the highest proportion of HIV infected
  identified?

5

• Research Evaluation Priorities
• Testing Issues
• Validation of risk score algorithms in field
  settings in high prevalence settings to identify
  people who may be acutely infected.
• P24 is something that has been dropped because
  its not commercially viable, but has it been
  pushed to its limit for usefulness. Could it be
  put into a strip for example, to diagnose acute
  infections in high prevalence settings? ?????

6

• Research Evaluation Priorities
• Linkages between CT and other services
• How many people that are referred from CT
  services are reaching the health care facilities
  and getting care and treatment services across
  various settings?
• Does offering low cost CD4 testing or clinical
  staging in a stand-alone VCT setting increase
  utilization of care and treatment services?

7

• Research Evaluation Priorities
• Implementation Issues for Testing and Counseling
• What impact does use of lay counselors have on
  quality of service?
• What are the social outcomes for women who are
  the positive partner in a discordant couple
  across different testing and counseling settings?
  (Literature review?)
• Parallel versus serial testing - can serial
  testing work with lay providers in provider
  initiated settings?

8

• Research Evaluation Priorities
• New Models
• Are there any quality related issues to self
  testing can people use and interpret the tests
  correctly?
• Can self testing be an effective model to
  increase peoples access to care and treatment?
• What are the implications of self testing and
  does it have behavior change implications?
• Program Evaluation for home testing What are
  standard operational procedures and what is the
  protocol that results in behavior change and
  links to care and treatment and high quality of
  testing and care?

9

• Research Evaluation Priorities
• Next Steps/Specific Action Items
• Share with donor organizations for possible
  funding
• Contact WHO operational research division
• Define questions that can be answered with
  existing data versus prospective work
• Create a working group to pull together existing
  data that might answer the questions
• Come up with a database for research questions
  that could be used by the group to influence
  research agendas in our specific countries
• Try to define core data collection questions and
  methods across C T testing sites and countries