Mapping Pathways Reveals Importance of Localised Strategies for Using ARVs to Prevent HIV/AIDS
Clinical trial data show great promise for antiretroviral (ARV) drug based strategies to fight HIV. However, the science is rapidly evolving and real-world implementation is complex, shaped by local political and social circumstances.
To provide a resource for policymakers and communities, RAND Europe is a partner in Mapping Pathways, a multinational project led by the AIDS Foundation of Chicago to develop and nurture a research-driven, community-led global understanding of the emerging evidence base around the adoption of ARV-based prevention strategies to end the HIV/AIDS epidemic.
Mapping Pathways produced the first study of its kind to synthesise evidence and views about ARV-based prevention strategies in diverse global contexts.
The project included a thorough review of the social, economic and clinical impact of four treatment regimes. Research, community engagement and policy work took place in three countries, the United States, India and South Africa.
Key Findings from the Initial Study
Key insights on ARV-based prevention:
- 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
As Archbishop Desmond Tutu says in the report's foreword, all science is local. Strategies must be successful at a local level before they can have a global impact.
The next step is to work directly with communities to map locally driven but globally informed pathways to effective decisions about ARV-based prevention strategies.
Key Findings from Three Scenario-Development Workshops
In 2013, a subset of the Mapping Pathways team conducted knowledge-exchange workshops in San Francisco, Atlanta, and Washington, D.C., to further share the findings of the report and to continue enhancing the community-driven, locally informed approach to the wider evidence base for ARV-based prevention. The cities were selected based on geographic diversity as well as the diversity of experience and expertise that can be found in each setting.
All three workshops included a mix of approximately 20 researchers, advocates, policy experts, public health officials, and service providers; they were diverse in terms of age, race, gender identity, sexuality, sero-status, and years in the field, with a blend of local to national experiences and perspectives. Participants collaboratively developed a range of future scenarios and potential strategies linked to prevention programming goals and objectives. They were asked to think ahead to the year 2025, and envision an array of outcomes associated with the implementation of ARV-based prevention.
Based on participant ideas and concepts synthesised across all three workshops, we developed a ‘Mapping Pathways’ scenario for the future which has a strongly integrated approach at its core. The main driver of this future scenario is one of integration across political, economic, social, educational, and technological factors, and integration across the broader scientific, healthcare, and delivery systems. This means that we integrate both treatment and prevention strategies, including how we develop them, how we fund them, and how we deliver them, into one holistic approach.
The Mapping Pathways scenario was informed by these key themes common to all the workshops:
- Participants emphasised the need for a more holistic approach to HIV services in which prevention and treatment were not seen as mutually exclusive.
- Social and behavioural research must be supported and integrated with biomedical research.
- Digital web and device-based technologies and information sharing will affect access, uptake, and adherence.
- The Affordable Care Act (ACA) offers major opportunities for expanding access to healthcare, and poses challenges in HIV prevention and care delivery as the landscape evolves.
- Community-based organizations have a leading role to play in the new healthcare paradigm being ushered in with the ACA. They can help generate political will, drive research agendas, and deliver integrated care to communities and populations in need.
- Diversified funding streams are needed, and many of the optimistic scenarios generated by participants included strategies to engage a wide range of funders.