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HIV/AIDS Related Research Agenda Workshop

HIV/AIDS Related Research Agenda Workshop. Phnom Penh, Sunway Hotel March 28-29, 2007. Group II-CARE & TREATMENT Room – WATPHNOM 18 - 20 participants SWOT analysis. Treatment and Care Research Strength 1. Clear National objectives for treatment and care

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HIV/AIDS Related Research Agenda Workshop

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  1. HIV/AIDS Related Research Agenda Workshop Phnom Penh, Sunway Hotel March 28-29, 2007

  2. Group II-CARE & TREATMENT Room – WATPHNOM • 18 - 20 participants • SWOT analysis

  3. Treatment and Care Research Strength 1 • Clear National objectives for treatment and care • Funding to HIV programs (including research) is relatively well resourced. • ART supply adequate (logistics / stock) • Laboratory capacity available • Electronic database - upscale in progress • minimum package of data reporting in place

  4. Treatment and Care Research Strength 2 • Structures in place for conduct of research • National Ethics Committee • NCHADS Research Unit • Collaboration with other institutions • Prioritize research that will inform National Policy • Cambodian collaborators • International collaborators • Cohorts of patients – now maturing (1st and 2nd line ART)

  5. Treatment + Care Research Weakness 1 • Funding largely for programs rather than for research • Cambodia dependent on external funds for conducting research • Different database/tools currently used in different organisations • Uncertainty re estimation as to number of PLHA require ART • No unique identifier for HIV + persons • Technology - limited VL and genotype testing available

  6. Treatment + Care Research Weakness 2 • Human resources – numbers of staff, competing (clinical) responsibilities • limited Cambodian staff with experience and training in clinical and qualitative / social research • Qualitative research – often performed by short term international consultants • Mainly observational retrospective and cross sectional design • Less resources are allocated to medical problems than HIV (research and clinical)

  7. Treatment and Care ResearchOpportunity 1 • Institutional frameworks – to build research on. • Clinical frameworks - 40 OI/ART clinics • Electronic database • Existing research experience • multiple Cambodian and international organisations • multiple projects • Inventory – to share experience / translate into program • Research Agenda

  8. Treatment and Care ResearchOpportunity 2 • WHO generic standardized tools, for local adaptation • Summary of existing knowledge (eg adherence, behaviour) • Agreed measures for evaluation /research • University of Washington - University of Phnom Penh collaboration • training of Social workers in USA

  9. Treatment and Care ResearchThreats 1 • Database • very resource intensive • quality issues (SOP, QA) • lack of standardization of tools • Human resource capacity, impact on quality – especially for multidisciplinary research • Research linked to care - sustainability of care and treatment after research and funding • Poverty - transportation – access, and may be a barrier to follow up in longer term studies.

  10. Treatment and Care Research Knowledge gaps 1 • Antiretroviral therapy • sequencing 1st , 2nd, 3rd line ART • viral load testing strategies • drug resistance • adherence over long term / ART switches • short and long term toxicities associated with current protocols • appropriateness of current protocols to Cambodian population (eg subtype) • Management of HIV co infection (esp children) (TB, hepatitis..) • Management of related diseases (hepatitis B, diabetes..) • HIV related illnesses • Neurological • Psychiatric / depression • Survival and determinants of survival

  11. Treatment and Care Research Knowledge gaps 2 • Stigma and discrimination of health care professionals and impact on testing / treatments/ adherence • Access to testing and care • Identifying HIV +ve women (not considered high risk) • Barriers to HIV testing and care of children • Particular populations (Sex workers, IDU..) • Poverty / transportation • Health system strengthening + integration of HIV care and treatment into mainstream health services • Post exposure prophylaxis (occupational, non occupational)

  12. Treatment and Care Research Knowledge gaps 3 • Impact of HIV on households – debt etc • Quality of life • Cost effectiveness of HIV programs • Health Insurance - HIV care package • Role of HEF and health insurance to assist access to care • Efficacy / efficiency of PMTCT program • Health care worker resource planning to cope with future workload

  13. Treatment and Care Research Knowledge gaps 4 • Positive prevention • behaviour change: impact of HIV diagnosis, ART, OI etc • discordant couples • HIV incidence • Palliative care

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