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.

Mapping Pathways

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

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.

ResearchPublished Jun 19, 2013

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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.

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RAND Style Manual
Morgan Jones, Molly, Mapping Pathways: Developing evidence-based, people-centred strategies for the use of antiretrovirals as prevention, RAND Corporation, RR-326-MERCK, 2013. As of September 13, 2024: https://www.rand.org/pubs/research_reports/RR326.html
Chicago Manual of Style
Morgan Jones, Molly, Mapping Pathways: Developing evidence-based, people-centred strategies for the use of antiretrovirals as prevention. Santa Monica, CA: RAND Corporation, 2013. https://www.rand.org/pubs/research_reports/RR326.html.
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The research described in this report was sponsored by Merck & Co. and conducted by RAND Europe.

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