This is the first international report on HIV prevention with antiretroviral (ARV) drugs that brings scientific evidence together with community perspectives. We show that ARV-based prevention needs to be tailored to local contexts and cultures.

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Mapping Pathways

Developing evidence-based, people-centred strategies for the use of antiretrovirals as prevention

by Molly Morgan Jones

with Jim Pickett, Joanna Chataway, James Swartz, Ohid Yaqub, Philip Smith, Kartika Palar, Jessica Terlikowski, Daniella Mark, William McColl, Petal Hackett, et al.

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Research Questions

  1. What does the scientific literature say about ARV-based prevention strategies?
  2. What do policymakers say about their concerns and evidence needs in the face of rapid scientific advances?
  3. What do the experts say about patient-related, social, economic and clinical delivery conditions?
  4. What are the 'grassroots' perspectives on the practical challenges of implementing strategies in different contexts?

Mapping Pathways is a multinational project to develop and nurture a research-driven, community-led global understanding of the emerging evidence base around the adoption of antiretroviral (ARV)-based prevention strategies to end the HIV/AIDS epidemic. The project is based on the premise that the current array of prevention options is not sufficient; new pathways to prevention, based on enhanced assessment and analysis of likely impact, are needed to address new infections adequately.

ARVs are opening up new options for HIV prevention, such as 'treatment as prevention' (often referred to as 'TLC+' [testing, linkage to care], plus treatment), microbicides, oral pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). There are multifaceted challenges associated with these new prevention strategies related to access, cost, behavioural and health impacts, and implementation.

Mapping Pathways: Developing evidence-based, people-centred strategies for the use of antiretrovirals as prevention is designed to support critical thinking and development of a new research agenda for the analysis of multiple policy options — the pathways — that should be considered by prevention planners, programmers and funders when addressing the opportunities and challenges of the new ARV paradigm.

Key Findings

  • Structural factors such as cost and access are as important as individual behaviours.
  • Policymakers and communities need more information to develop successful local strategies.
  • Local context shapes perception: the same scientific data will be viewed and interpreted differently by stakeholders in different countries and groups.
  • The science is dynamic and fast-changing. Providing insight from diverse communities and stakeholders will enrich policies to ensure that ARVs can reach their prevention potential at local and global levels.

Author Statement

Table of Contents

  • Chapter One

    The Mapping Pathways journey: snapshots from the beginning

  • Chapter Two

    Snapshots from the empirical literature

  • Chapter Three

    Snapshots from the grassroots evidence base

  • Chapter Four

    Snapshots from the grasstops evidence base

  • Chapter Five

    Snapshots from the ExpertLens survey

  • Chapter Six

    An integrated perspective: how to map pathways to good decisionmaking

Research conducted by

The research described in this report was sponsored by Merck & Co. and conducted by RAND Europe.

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