Table 1.

Specific task areas related to the HIV/AIDS epidemic and related operational research issues

Task 1: Sustain long-term HIV/AIDS financing Demonstrate how HIV/AIDS interventions contribute positively to improving healthcare services (directly or indirectly). Move from vertical to more integrated primary care delivery models. Show the positive impact of HIV/AIDS interventions at population level and clearly articulate how these link up with the achievement of the 2015 Millennium Development Goals and beyond. Perform economic analysis to show the economic gains of HIV/AIDS interventions on health services and beyond (HIV/AIDS interventions are cost effective?).

Task 2: Think of how to offer care to the ever growing cohort on ART ahead of time Enhance simplicity, efficiency and cost effectiveness of the delivery mechanism and adapt these to different contexts, for example: Design simpler and cheaper ART protocols that are less toxic (safer) and easier for patients and health services (for both first-line and second-line treatment). Pilot innovative models of delivery outside the health facilities (task shifting) and evaluate their effectiveness. Community-based models Expert patient-based models Workplace models. Find tangible solutions to the human resources shortage for health in Africa. Think of sustainable drug supply and commodity management chains that do not end up with drug stock outs Conduct social science research to better understand contextual issues influencing uptake of specific interventions.

Task 3: Think of those still waiting to get onto ART Offer ART earlier in line with revised WHO recommendations (41). Radically simplify ART eligibility assessment for patients in WHO stage 1 and 2 with point-of-care CD4 testing. Reduce high pre-ART attrition and test how to deliver specific packages of care (Cotrimoxazole preventive prophylaxis, , Isoniazid preventive therapy , Impregnated mosquito nets, nutritional support) that will support patients in pre-ART care and possibly keep them well and not yet needing ART.

Task 4: Monitor cohorts of people with HIV in care Develop and assess how to set up simple and robust monitoring and reporting systems to follow retention and attrition (pre-ART and on ART) of thousands and eventually millions of patients. Work out how to set quality indicators and acceptable quality thresholds for mass scale up. Use point-of-care viral load tests for monitoring adherence, as well as deciding the optimal time to switch to second-line therapy. Use available and new technology to boost adherence, e.g., telephones and online tools.

Task 5: Provision of HIV care that is associated with a minimal risk of tuberculosis Determine how best to implement TB case finding, infection control (air ventilation and patient flow organization) and isoniazid preventive therapy. Determine how to monitor these interventions.

Task 6: Invest in HIV prevention as this is a key to breaking the current epidemic Find innovative ways of improving HIV testing and knowledge of HIV status. Assess feasibility of male circumcision on a large scale: Through simpler and safer techniques Integrating circumcision into preventive services (e.g., WHO’s Expanded Programme on Immunization) Enhancing community and civil society acceptance through partnerships. Pilot the feasibility and effectiveness of ART for prevention in the general population and high-risk groups. Radically simplify the PMTCT approach and protocol for health service providers and the mother (e.g., a one-pill-a-day standardized approach). Assess feasibility of pre-exposure prophylaxis in high-risk groups and discordant couples. Understand the societal factors influencing uptake through social science research in relevant areas.

Task 7: Build capacity for conducting operational research: testing out new models of training Try out and assess different types of training models and curricula that are performance and/or output based.