Translating research into policy & practice the way forward by Adeeba Kamarulzaman


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Translating research into policy & practice the way forward by Adeeba Kamarulzaman

  1. 1. Translating Research into Policy and Practice The Way Forward Adeeba Kamarulzaman University of Malaya
  2. 2. • Strategies that try to ensure that knowledge gained from the best evidence is actually used in practice.• Enhance the utility of research that involves making research evidence more usable and improving the capacity of management, policy, and clinical decision makers to use it.
  3. 3. Initial Reports• June 5, 1981: 5 cases of PCP in gay men from UCLA (MMWR)• July 3, 1981: 26 additional cases• Dec 10, 1981: 3 NEJM 3papers describe cases Gottlieb MS NEJM 2001;344:1788-91
  4. 4. Adults and children estimated to be living with HIV | 2009 Western & Eastern Europe Central Europe & Central Asia 820 000 1.4 million North America [720 000 – 910 000][1.3 million – 1.6 million] 1.5 million East Asia [1.2 million – 2.0 million] 770 000 Middle East & North Africa [560 000 – 1.0 million] Caribbean 460 000 240 000 [400 000 – 530 000] South & South-East Asia [220 000 – 270 000] 4.1 million Sub-Saharan Africa [3.7 million – 4.6 million] Central & 22.5 million South America [20.9 million – 24.2 million] Oceania 1.4 million 57 000 [1.2 million – 1.6 million] [50 000 – 64 000] Total: 33.3 million [31.4 million – 35.3 million]
  5. 5. HAART became available
  6. 6. HPTN 052• Participants – 1763 sero-discordant couples• HIV infected partners: 890 males, 873 females• HIV transmissions – 39 infections, 28 linked – 1 transmission in immediate ART group – 27 transmissions in deferred ART group – 96% protection in immediate ART groupNIH Press release May 2011
  7. 7. E-MTCT TargetsTowards the Elimination of New Paediatric HIV Infection among Children by 2015 and Keeping Their Mothers Alive, Global Plan 2011-2015 Launched June 20112015 Targets in the Global Plan:• 90% reduction in new child HIV infections• 50% reduction in HIV-related maternal deaths• <5% MTCT (final transmission)• Other targets for all 4 prongs of PMTCT
  8. 8. THE 4 KNOWS• Know Your Epidemic – Analysis of data on prevalence and incidence to prioritize populations and geographic areas that are most at risk for HIV.• Know Your Context – Data to contextualize the epidemic. Ensure cultural relevance.• Know Your Response – Tracking the epidemiological alignment, scope, coverage and effectiveness of prevention efforts.• Know Your Costs – Knowing what is spent, and what the output for investment is; prioritizing interventions based on cost-effectiveness.
  9. 9. Malaysian HIV Epidemic 1986-2010Cumulative no of reported cases 91362Cumulative no of deaths 12943Cumulative no of females with HIV 8759Children < 12 with HIV 909New HIV infections reported in 2010 3652HIV/AIDS related deaths 2010 904No of PLHIV receiving ARV 12000Estimated adult HIV prevalence 0.5%
  10. 10. Integrated Biobehavioural Surveillance: Kuala Lumpur 2009 Period of data collection: 2009 Respondent Driven Sampling, VDTS FSW TS IDU MSMN 552 541 630 517HIV 59 50 139 20Prevalence (10.5%) (9.2%) (22.1%) (3.9%)
  11. 11. BIOMEDICAL• ART treatment for eligible patients and PreP• Safe Male Circumcision• PMTCT• HIV Testing (routine/opt-out) linked to ART and behavioral change programs TLC• STI-screening and treatment of MARPs & PLHIV• Harm reduction programs
  12. 12. BEHAVIORAL• Condom Use Promotion Programs• Peer education HIV prevention programs addressing condom use, transactional sex targeting high risk groups• Couple counseling• Disclosure promotion programs• Delay sexual onset• Adherence to ART support programs• Positives Counseling Programs• Positive Health Dignity and Prevention (PHDP)• Abstinence and Faithfulness programs 14
  13. 13. SOCIAL/STRUCTURAL• Women Empowerment Programs• PLHIV programs addressing stigma• Human Rights and Empowerment Interventions for Sex Workers, IDU’s• Easing access to care for Sex Workers, IDU’s• Creating enabling environments through law and policy changes
  14. 14. WHY NEW HIV INFECTIONS REMAIN HIGH....Current HIV Low coverage of programs for sex workers and their clientsPreventionnot alwaysaligned to Low coverage of harm reduction programsepidemicdrivers: Socio-cultural and gender norms often neglectedCoverage of HIV testing not linked to access to care and serviceskey HIVpreventionservices still Over 50% of IDUs have no access to ARTsub-optimalto make Over half of risky sex not protected with condomspublic healthimpact Quality of HIV prevention services not optimal
  15. 15. SOCIAL/STRUCTURAL DRIVERS OF HIV• Socio-cultural drivers• Gender Norms• Socio-Economic – Poverty/wealth, Dependency , mobility• Human rights violations• Inequities in access to health services• Stigma and Discrimination
  16. 16. IMPLEMENTATION STRATEGY• Combination HIV Prevention – Referral linkages, Integration of services, Health Systems Strengthening• Realignment of funding priorities – Increased domestic and external resources• Improved Coordination – Multisectoral response, Health sector• Monitoring and Evaluation – Results-based, Strengthening of M&E systems, Alignment of M&E systems, Improved reporting and surveillance systems – Impact evaluation, Resource tracking, Improved information management and sharing
  17. 17. Challenges for Providing HIV Prevention to MARPS• Enabling environment – Legal barriers – Policy barriers – Stigma and discrimination – Community support – Hard to reach• Access to medical services – Stigma and discrimination – Lack of professional training – Lack of MARP friendly services – Drug and alcohol abuse treatment• Access to targeted prevention services – Understanding the community – Providing appropriate prevention services• Data – Identification of country specific MARPs – HIV prevalence – Behavioral risk data – Size estimation
  18. 18. Combination HIV Prevention Structural Biomedical Behavioral Cross-cuttingRef: The Lancet, Vol 372, August 9, 2008
  19. 19. MARP: Structural Prevention Approaches• Laws – Decriminalization of behaviors – Inheritance laws• Policy – 100% condom use – Care settings – HIV testing protocols – Allocation of resources – Task shifting• Community – Addressing stigma and discrimination – Empowering MARP groups• Economic – Income generation activities
  20. 20. MARP: Behavioral Prevention Approaches • Behavior change communication • Community outreach • Peer-based outreach programs • Increased condom availability • Increased condom use • HIV counseling and testing • Prevention for positives
  21. 21. MARP: Biomedical Prevention Approaches• ART• STI diagnosis and care• Medical male circumcision• HIV counseling and testing• Referrals to substance abuse counseling and treatment• Emerging technologies
  22. 22. MARP: Cross-cutting Prevention Approaches• Collection and use of epidemiologic data – Behavioral risk – Size estimation• Program Monitoring and Evaluation• Laboratory – Mobile services – Rapid tests• Care and treatment – Facility, community, and mobile services – Health care worker training to reduce stigma and sensitize to special needs
  23. 23. People Who Use Drugs• Community-based outreach• Needle Syringe Programs• Opioid substitution therapy (OST) and other drug dependence treatment;• HIV counseling and testing• ART for IDUs living with HIV;• Prevention and treatment of STIs• Condom programs for IDUs and their sexual partners;• Targeted information, education and communication (IEC) for IDUs and their sexual partners;• Vaccination, diagnosis and treatment of viral hepatitis• Prevention, diagnosis and treatment of tuberculosis.
  24. 24. Commercial Sex Workers• Target group participate in the development, implementation and monitoring of prevention programs• Promote consistent and proper use of condoms with clients and regular non-paying partners• Ensure consistent availability of male and female condoms and lubricant• Ensure availability of comprehensive health care services• Referral to other non HIV/AIDS services as appropriate.• Integrate violence reduction (both social and structural) in prostitution settings• Link with relevant social welfare services for the target group and their families• Provide vocational training
  25. 25. Men who have Sex with Men• Ensure participation of MSM in the development, implementation and monitoring of prevention programs• Promote consistent and proper use of condoms with both regular and non-regular partners• Ensure consistent availability of quality male and female condoms and lubricant• Ensure availability of comprehensive health care services with linkages to HIV treatment and care services
  26. 26. Clients of Persons Engaged in Sex Work• Ensure participation of target group in the development, implementation and monitoring of prevention programs• Promote consistent and proper use of condoms with both clients and regular non-paying partners• Ensure consistent availability of quality male and female condoms and lubricant• Ensure availability of comprehensive health care services; provision of or linkages to HIV treatment and care services; and referral to other non HIV/AIDS services as appropriate.• Integrate interventions addressing gender norms and violence
  27. 27. Scaling Up• Estimate population(s) size• Tailor prevention package for defined populations• Plan services• Monitor progress and refine activities
  28. 28. Wish List• Political Will – Funding – Legal and policy reviews• Multisectoral• Community Engagement• Capacity Building• Integration of Health Systems• Task Shifting• Addressing Stigma & Discrimination