PEPFAR advisory board applies implementation science, ethics to efforts

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In the life of the President’s Emergency Plan For AIDS Relief so far, the concept of exploring its efficiency, its impact, the relevance of it targets even, is relatively young. When all of those are weighed against intentions and costs, the discipline at work is called “implementation science,” and that is the science, PEPFAR leadership is hoping, that will bring the possibilities of biomedical advances and commitment to fruition.

It is only in the last couple of years that PEPFAR has had a scientific advisory board to guide its decisions. That board met for two days this week to consider the application of implementation science to the realities of combination prevention, reaching people deemed criminals in their own countries, and bringing testing for HIV, treatment for health and prevention, and care into a coherent flow.

Efforts that biomedical advances have made more promising than ever continue to be hampered because the people using services seldom get to talk to people planning services, U.S. Global AIDS Coordinator Ambassador Eric Goosby pointed out, as the Scientific Advisory Board opened its third annual meeting Tuesday.

“We’re acutely aware of that disconnect,” he said.

PEPFAR’s Implementation Science program came about under Goosby’s leadership, and it has awarded 74 grants for studies since, most of the first 36 of which are coming to completion.

They have so far come in five broad areas that have become some of the plans most promising priorities: Prevention of HIV transmission from mother to child, medical circumcision, early treatment for better health and to prevent transmission, forging stronger connections between testing, treatment and continuing care, and building better healthcare responses through HIV services. In 24 countries, the most so far have been awarded in the latter category, a clue that the talk of making PEPFARs gains sustainable is serious.

More Implementation Science grants are coming, including ones to answer Sec. Clinton’s call to address the needs of what are now called “key populations,” among whom are people who inject drugs, sell sex, are transgender, are men who have sex with men. These are people who used to be called MARPS – for Most At Risk Populations.

That is yet to come, with grants to address those needs pending in PEPFAR’s ninth year. This week, a working group presented their application of ethics to reaching people whose situations put them at risk for disease but also cause them to be considered criminals in their countries.

“These populations have been ignored,” Goosby said. “PEPFAR has not followed the epidemic in these groups and in their countries.”

He was grateful, he added, that this is changing.

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