In The Field

The devil is in the details

In recent weeks we’ve heard announcements about increases in funding towards the treatment HIV/AIDS. At the G8 summit in Hokkaido, Japan last month, world leaders set the target of spending $60 billion over the next five years towards tackling a handful of diseases, including HIV/AIDS. And just last week US President George W. Bush reauthorized an augmented version of the President’s Emergency Plan for AIDS Relief (PEPFAR), which will is slated to supply $48 billion through 2013 to help fight AIDS, tuberculosis and malaria in regions such as sub-Saharan Africa.

But with increased spending comes increased scrutiny of returns on investment—and that’s very much a topic of discussion here at the AIDS 2008 meeting.

I attended a session yesterday devoted entirely to exploring how HIV/AIDS interventions can be improved through what’s known as ‘operations research’ – a field focused on using mathematics and other analytical tools to optimize systems. At the session experts stressed that efforts to combat HIV/AIDS have to do a better job of tracking the distribution and use of resources. In other words, a business-like approach to collecting data is necessary to assess the efficiency of prevention and treatment measures.

At a talk today, this message was echoed by Stefano Bertozzi of the National Institute of Public Health in Cuernavaca, Mexico. He noted that some centers devoted to HIV prevention have a poor grasp on the number of people they serve. That makes it nearly impossible to know what it’s costing to reach each individual. “Imagine if Volkswagen didn’t know how much a car cost or McDonalds didn’t know how much a hamburger cost,” Bertozzi said. “We need to be much more efficient about our delivery” of HIV/AIDS interventions, he added.

Several people I’ve spoken with here have highlighted what they see as a very promising example of how to turn things around. They point to the Avahan India AIDS Initiative, an ambitious HIV prevention program funded by the Bill & Melinda Gates Foundation. The initiative takes an aggressive approach when it comes to collecting data from their campaigns, and then reassessing what changes need to be made immediately to optimize the impact their outreach efforts. For example, in programs designed to distribute condoms among sex workers this approach might mean involving more peers within these at-risk networks to help hand out condoms, rather than relying simply on outreach workers who remain somewhat on the periphery. The bottom line is that taking a closer look at the numbers and networks of people reached in intervention programs could add up to a much more effective strategy to fight HIV/AIDS.


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