mapping pathways - atlanta - knowledge exchange workshop

Knowledge exchange workshopLoudermilk Center, Atlanta2 – 3 October 2013

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Our agenda in brief

• Welcome – Dazon Dixon Diallo

• Introductions

• Overview of the Mapping Pathways project

– Who are we? What did we do? What did we learn?

– What are we doing now? Why is it relevant?

• Scenarios

– What do we need to consider for ARV-based strategies to be effective for women?

• PEST framework

– Political, Environmental, Social, Technological

• Using scenarios to develop plans for the future

• Next steps

– After the workshop – then what?

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We are a community-led research initiative

Unrestricted educational grants Merck & Co. NIH Be The Generation Bridge The Gilead Foundation

www.mappingpathways.org

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We are a community-led research initiative

Video

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Snapshot of interventions

PrEP

PEP

Treatment – TLC+ (TasP, T4P, TnT)

Microbicides

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WHAT DID WE LEARN?

What did we do?

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Yes, we have compelling results from clinical trials, and make no mistake, we will have more. But the opinions, perspectives and lived wisdom of communities, from the grassroots to the grasstops, matter just as much as the peer-reviewed scientific data that are coming at us fast and furiously. How communities absorb, understand and prioritise the science matters.

- Archbishop Desmond Tutu

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Literature review

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Literature review conducted 2011, 2012

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119 relevant articles fully read and synthesised

Summary of empirical papers included in the full text review, by strategy

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Literature snapshot

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The grassroots – online survey

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Grassroots: TLC+ very important

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Grassroots: Yes to PrEP, but…

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Grassroots: Microbicides important

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Grassroots: PEP views variable

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Need to take a cost-effectiveness point of view…Targeting

strategies is essential.

- US

How could we devise advocacy

and communications

campaigns to raise awareness of these

approaches?- India

Grassroots: In their own words

A tricky subject (PrEP) in a

community that is illiterate, poor, unemployed…

- SA

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Grassroots snapshot

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The grasstops – one-on-one interviews

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Things are moving fast, may find

ourselves chasing events…

- US

Behavioural change and education is

key, not treatment as prevention.

- India

I am concerned that we are not including other

sub-Saharan African countries in this

analysis.- SA

Grasstops – Views on Mapping Pathways

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This is the biggest mistake we can

make! Prevention is cheaper.

- US

In India, people don’t come in for

diagnosis early, so the question is if

you want to use it as a prevention strategy, how do you get them in

earlier?- India

Grasstops – Views on TLC+

We need to save lives and treat who needs treatment as

a first priority.- SA

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We need to reach the people who are so

vulnerable they can’t negotiate condom usage

regularly.- US

It will be hard for an individual to accept they are ‘high risk’ and

should take this treatment.

- IndiaI think we can look at targeted PrEP use in high-risk groups, but that won’t be easy.

- SA

Grasstops – Views on PrEP

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Discounted costs (making HIV rare relative to $

saved due to Tx and lost economic output)

- US

• Identification of main barriers

• Health system spillovers• Cost-per-case averted

- India• Cost-per-case averted• Discounted costs

• Experts’ views of impacts- SA

Grasstops – Most useful types of evidence?

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Grasstops: Highly diverse views

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Grasstops snapshot

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ExpertLens

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What is an ‘ExpertLens’?

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TLC+ strongest science, ready for implementation,where experts would allocate funds

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ExpertLens snapshot

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THIS IS NOW.That was then…

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Knowledge Exchange Workshops

• Public health officials, researchers, policy experts, ASO leaders, prevention programmers

• San Francisco – July 2013

• Atlanta – October 2013

• Washington, DC – October 2013

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Questions?

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What is the future snapshot?

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• A scenario is a logical and consistent picture of the future

• Scenarios help to provide insight into future developments in a given area

– We will use them to assess the health and research systems which will impact effectiveness of ARVs as prevention for women

• Scenarios help us to prepare for the future

– Analysis of the scenarios helps to identify the implications of the choices we make today

• Scenarios highlight links among different aspects of the future

Using scenarios to unpack the future

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Three possible scenarios – a short introduction

• The ‘couture’ scenario

• The ‘ready to wear’ scenario

• The ‘one size fits all’ scenario

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The scenarios spanned a research continuum and were ‘pulled’ apart to exaggerate and illustrate the future

Social and behavioural research inputs

Sci

entif

ic r

esea

rch

inpu

ts Couture

Ready to wear

One size fits all

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The ‘couture’ scenario

CouturePersonalised view of the future

Individual risk profileGenetic sequencing and identification of

tumour specific pathwaysDiagnostics and/or treatment breakthrough

Specialisation of services

Prevention Awareness Early detection Diagnosis Treatment Survivors End of

life

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The ‘ready to wear’ scenario

Ready to wearGroup stratified view of the future

Group risk profilingTargeted screening and treatment

Social media and peer supportCommunity integration of services

Prevention Awareness

Early detection Diagnosis Treatment Survivors End of life

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The ‘one size fits all’ scenario

One size fits allPopulation view of the future

Prevention strategy and centralised regulationLongitudinal studies and behaviour change

Behavioural science and public health breakthrough

Patient empowerment

Prevention Awareness

Early detection Diagnosis Treatment Survivors End of life

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• Learn from each other

• Build scenarios together

– Develop a PEST analysis

– Name and prioritize factors that relate to PEST

– Use prioritized factors to define a spectrum of outcomes

– Narrate scenarios

– Discuss actions within the scenarios

– Imagine ourselves as actors in the future

• Think about shaping actions and strategic next steps

What we’ll do over the next few days

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• Develop a PEST analysis

– Allows one to identify the main external factors and drivers that will impact effectiveness of ARV-based prevention strategies for women

• Political & Regulatory

• Economic

• Social & Cultural

• Technological & Scientific

A Mapping Pathways PEST

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• Why is the factor important to effectiveness of ARV-based prevention strategies?

– Is it more important for some strategies than for others?

• How would you rank the factors within each letter of the PEST?

– What is the most important political factor? What is least important? Why?

– What is the most important economic factor? What is least important? Why?

– What is the most important social factor? What is least important? Why?

– What is the most important technological factor? What is least important? Why?

Prioritising the PEST factors

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We have implemented ARV-based PX and…

…we have no effectiveness, rate of new infections increases among

women…

… we have effectiveness,

and overall infection rate

decreases among

women……. It’s a mixed

bag, some reduction in rates among

some key pops of

women, but not all….

Dateline: 2023

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Reminder – ARV-based interventions

PrEP

PEP

Treatment

Microbicides

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• Name each scenario

• What is the mix of ARV strategies?

– PrEP, PEP, Treatment, Microbicides

• How does each factor play into the scenario?

• How do the factors intersect?

• Why have we reached different effectiveness

levels?

We have implemented ARV-based PX and…

Dateline: 2023

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• How were factors successfully addressed? What is in place to

make this happen?

• If factor was not successfully addressed, what goes wrong,

what doesn’t happen?

• What does “success” look like?

• What does “less than success” look like?

We have implemented ARV-based PX and…

Dateline: 2023

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So now

what?

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If we are to toss AIDS into the dustbin, we must do our best to understand the intersections of scientific discovery and community wisdom, address the truths in both, and move forward with decisions that take into consideration a full, robust interpretation of the evidence base.

Let us be done with AIDS.

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www.MappingPathways.org MappingPathways@gmail.com

Molly Morgan Jones - mmjones@rand.org Jim Pickett – jpickett@aidschicago.org

Jessica Terlikowski – jterlikowski@aidschicago.org