Exploring New Policy Questions in HIV/AIDS Treatment | ||
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 Patients waiting for treatment at Kibuye Hospital, Rwanda
August 1, 2008— With more funding for large-scale treatment programs for HIV/AIDS, research on emerging policy questions related to treatment is increasingly in demand. In tandem with programs designed to step up access to anti-retroviral therapy (ART) and to deliver treatment through public-private partnerships, World Bank researchers are collecting and analyzing new treatment-related data to uncover evidence that could shape future health policy and improve the design of HIV/AIDS treatment programs. With continued funding—the World Bank alone has committed $1.5bn to over 30 Sub-Saharan African countries since 2000—and improved knowledge through research, the ultimate goal is to prevent further spread of the disease and to ensure its progress from being a "silent killer" to being widely treatable. Here are some of the key policy questions that World Bank HIV/AIDS research is attempting to address: Why is treating HIV so important? HIV/AIDS affects most adults in their prime, limiting their ability to work and provide for family members and contributing to high rates of premature death in developing countries. World Bank research has already shown significant impacts of HIV/AIDS and of adult mortality on poverty and living standards, orphanhood, and education in the developing countries most affected by the disease. Redoubling efforts to treat HIV patients appears to have a ripple effect, benefitting not only individuals, but also all those who depend on them. "Treating HIV/AIDS isn't only about counting the number of lives saved, critical as that is," said Elizabeth King, manager of the Human Development and Public Services team in the Bank's Development Research Group "It's also about improving the quality of life of those infected with the disease and the lives of the family members who share in carrying the burden of HIV/AIDS. " What determines adherence to HIV treatment?  Patients at the Rubona and Rusatira Health Center receiving education about ARV drugs Adhering to treatment is crucial for its effectiveness; it also prevents patients developing resistance to the drugs. Through new household surveys, World Bank researchers are now trying to identify what factors determine adherence to ART. In addition, researchers are using health facility surveys to measure treatment quality. Healthcare service delivery could also have an impact on ART adherence and the welfare of patients and their families. Longitudinal household surveys of HIV/AIDS patients and health facilities are in progress in Rwanda, Burkina Faso, Ghana, Mozambique, Kenya, South Africa, and India. Many of these baseline surveys are ongoing or are completed, as seen in this timeline, but the complete story won't be clear until the follow-up surveys, now in the field, are completed. Does treatment availability make people less cautious about protection? HIV/AIDS treatment is now more widely available in Africa. What impact does the availability of treatment have on prevention and on the future behavior of patients, family members, and society? The "disinhibition" hypothesis (or treatment optimism) has been seen in vulnerable groups in some developed countries. Some groups appear to have become less cautious about HIV transmission as treatment becomes more accessible and living with HIV/AIDS is more accepted in the mainstream. A major question that Bank researchers are studying is the link between scaling up treatment and the type of prevention steps that may be required. Efforts may need to include increasing prevention education campaigns along with access to treatment. "While access to treatment and its ultimate success are important, we also need to find out what works in terms of prevention," said David Wilson, lead health specialist in the World Bank's Global HIV/AIDS program. "Researchers are trying to identify and evaluate various innovative methods to strengthen prevention efforts and the most effective prevention messages for youth. " Has AIDS funding affected the quality of healthcare service delivery? "It is widely believed that the large amount of money given for HIV treatment has helped improve the capacity of the health system in general," said Damien de Walque, Economist in the Bank's Development Research Group, "but some will claim that other diseases have been neglected. " To ascertain the real picture, health facility surveys include questions about all other services, and exit interviews with patients both with HIV/AIDS as well as other diseases. An evaluation currently being carried out in Rwanda tests whether "performance-based contracting"—a form of funding that links performance with payments received for completed work—can enhance the effectiveness of service delivery and thus ultimately improve the health status of HIV-positive patients. This is an important policy question, as this form of funding is becoming more popular and is being increasingly used in Rwanda's health sector | ||
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