Revising the research priorities for HIV/TB

1
Revising the research priorities for HIV/TB

• Haileyesus Getahun
• Delphine Sculier
• Stop TB Department

2
More implementationunmet research needs
Why to define the TB/HIV research priorities?
3
Defining TB/HIV research 2005

• Five major areas
• Preventive therapy
• Cotrimoxazole prophylaxis
• Antiretroviral therapy
• Intensified TB case finding
• Smear negative TB
• Cross cutting issues

4
Defining TB/HIV research agenda is it useful?

• Question
• How many peer reviewed research publications were
  produced addressing the research questions
  described in the 2005 document?
• Method
• Systematic search of Pubmed using key words
  pertinent for each priority question identified
  in the document (n30)

5
Defining TB/HIV research agenda is it useful?

• Results

Area Questions (n) Publications since 2005 (n)
Preventive therapy for TB 7 28
Cotrimoxazole prophylaxis 4 19
ART 7 42
Intensified case finding 5 45
Smear negative TB 7 58
Total 30 192
6
TB/HIV research prioritisation process -Guiding
principles

• Transparency
• Inclusiveness
• Objectivity

7
Transparency

• Review of the published evidence and gaps
  identified
• Six key areas
• TB prevention
• Intensified TB case finding
• TB treatment for PLHIV
• Drug resistant TB in PLHIV
• Childhood and maternal TB in PLHIV
• Integrated TB and HIV services
• Content and process much different from 2005

8
Inclusiveness

• Advisory Group (n14) from the WG assisted
  drafting and identification of gaps for each area
• Members of Review Committee (n48) reviewed and
  commented on the document
• Areas discussed and content was informed from
  discussion at the July 2009 TB/HIV research
  meeting in Cape Town.

9
Inclusiveness

• Advisory Group and Review Committee members
  provided their top three priority research
  questions in the six areas.
• 77 questions identified in all the areas for
  prioritisation
• Web based global consultation pending
• Finalisation after a face to face meeting with
  researchers, technical and research donor
  agencies pending.

10
Objectivity

• Prioritization assess the value added by the
  research question to
• Accelerate universal and effective implementation
• Prevent unnecessary morbidity and mortality
• Grading used pre-defined criteria effectiveness,
  deliverability, answerability and equity.
• Prioritization done by members of Advisory Group
  and Review Committee using web based survey
• Response rate by October 30, 2009 was 74 (46/62)

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Objectivity prioritisation scores
The top three questions with the highest scores
under each area (out of 12)
12
Objectivity prioritisation scores
The top three questions with the highest scores
under each area (out of 12)
13
Objectivity

• Strengths of method
• Legitimacy and fairness
• Questions scored against pre-defined criteria
• Expert independently score the research questions
• Final list of priorities is recorded, can be
  reviewed, challenged and revised at any time

• Weaknesses of method
• Limited role for non-experts
• No evaluation about the importance of the
  question relative to the other
• Require detailed individual questions

14
Next steps

• Web-based public consultation of the prioritised
  questions
• Face to face meeting to finalise the process
  after public consultation (co-sponsorship with
  lead research donor and technical agencies being
  sought)
• Reach out to garner support and endorsement
• Funding agencies and technical agencies
• Researchers and policy makers
• Activists and advocates