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July 25, 2019

Center for Global Health Practice and Impact Convenes Meetings on HIV/AIDS Work in Low-Resource Settings

Dr. Charles Holmes of Georgetown's Center for Global Health Practice and Impact worked with a network of partners to lead two successful global health events at the July 2019 International AIDS Society meeting in Mexico City.

Dr. Thoko Kalua, Deputy Director, Department of HIV/AIDS, Ministry of Health, Malawi
Dr. Thoko Kalua, Deputy Director, Department of HIV/AIDS, Ministry of Health, Malawi

Dr. Holmes, a former deputy U.S. global AIDS coordinator, partnered with the World Health Organization; governments from sub-Saharan Africa, South America, and the Caribbean; and the Bill and Melinda Gates Foundation, among others, to address issues related to the delivery of quality HIV/AIDS prevention, care, and treatment in low-resource settings.

Evaluating Data on HIV Prevention

The first event entitled, "Do We Know if it Works? Evidence to shape the future of HIV prevention measurement." It took place in a standing room-only auditorium on Sunday, July 21 as part of the International AIDS Society 2019 meetings. Sponsored by a grant Dr. Holmes received from the Gates Foundation, the event was co-chaired by Dr. Thoko Kalua, deputy director of the Department of HIV/AIDS in Malawi's Ministry of Health, and Dr. Irene Benech, branch chief for HIV prevention in the U.S. Centers for Disease Control and Prevention. The gathering was a follow-on to a three-day think tank meeting held earlier in the year at the Banbury Center of Cold Spring Harbor Laboratory.

Framing remarks by Drs. Kalua and Benech noted that despite years of fighting the disease, there were are still 1.7 million new HIV infections globally in 2018 according to a new UNAIDS report—a startling figure that is over three times the 2020 UN goal of less than 500,000 new infections. During the discussion, Dr. Mary Mahy of UNAIDS presented an analysis of prevention indicators that are used by UN member states with a high burden of HIV, and those that are required by five global agencies. The analysis found substantial heterogeneity differences across countries, with only 4 of 289 indicators common to 10 or more countries, and among global stakeholders 63 percent of indicators were measured by only one of the five agencies. Dr. Mahy noted that given the high burden of data collection in countries, these results represent a substantial opportunity which could be used to encourage greater streamlining and alignment.

Dr. Holmes presented the results of what is believed to be the largest ever analysis of HIV prevention measurements, including over 6,000 risk factors for HIV disease, drawn from a review of over 21,000 papers. The work was performed in collaboration with Drs. Brian Rice and James Hargreaves of the London School of Hygiene and Tropical Medicine, Boston Consulting Group, and the Gates Foundation. Dr. Holmes and his team reported on the strength of association for risk factors of HIV acquisition, noting strong associations with multiple sexually transmitted diseases, level of knowledge of HIV transmission, length of residence in the area, and other biomedical and demographic factors. The analysis was performed in support of ongoing efforts to streamline and improve the design, effectiveness, and measurement of HIV prevention programs moving forward.

Dr. Paul Mee of the London School presented a multi-country analysis of cohort data from the Alpha Network (on behalf of Dr. Millie Marston), also examining the strength of association of risk factors with HIV acquisition over time. Next, Dr. Celestine Mugambi of the Kenya National AIDS Control Council highlighted Kenya’s cutting edge approach to prevention, including collecting and using non-health facility data and using memoranda of understanding with major infrastructure companies to ensure attention to work site HIV prevention. Cooper / Smith Data Analyst Brandon Klyn and Dr. Nina Hasen, vice president of HIV and TB at PSI, concluded with a look at how new digital technologies and better defined sexual networks are well-positioned to help revolutionize HIV prevention programs and achieve much needed further reductions in new infections.

Improving Quality of Care

Georgetown University co-sponsored a second session with the World Health Organization entitled, "Addressing the Quality Gap within HIV Programmes: Improving clinical outcomes and preventing HIV drug resistance" on Monday, July 22, which opened with introductory remarks by Dr. Francois Kessner of the Haiti Ministry of Health. Dr. Holmes, who co-chairs the WHO’s Global Quality of HIV Services Working Group with Dr. Satvinder Singh, gave the lead-off plenary highlighting that quality responses, both in clinical services and in upstream programs, play a key role in achieving impact against the HIV epidemic. Holmes also noted that we’re not on track globally to achieve the reductions in mortality or new HIV infections that UN member states committed to achieving by 2020, and he stressed the need for improvements in quality called for in the recent Lancet Commission on Quality Health Systems.

Dr. Charles Holmes, Faculty Co-Director of Georgetown’s Center for Global Health Practice and Impact
Dr. Charles Holmes, Faculty Co-Director of Georgetown’s Center for Global Health Practice and Impact

Dr. Holmes joined Dr. Singh and Dr. Silvia Bertagnolio from the WHO in launching WHO’s new technical brief on maintaining and improving quality of care within HIV services, which is targeted to both policymakers and national program managers. The launch was followed by a powerful presentation by Dr. Dan Namarika, Malawi's Secretary of Health, who outlined the country's successful efforts to establish a model national quality program that has led to substantial declines in mortality and new infections. Malawi’s program includes a strong national quality framework and policy environment and technical quality implementation teams in the districts and at clinical sites.

The session ended with a panel discussion including International Treatment Preparedness Coalition Director Solange Baptiste, Dr. Filipe Perini of Brazil’s Ministry of Health, Dr. Aleny Couto from the Ministry of Health in Mozambique, Judy Khanyola with ICAP Kenya, and Dr. Bruce Agins of HealthQual and the University of California, San Francisco. The wide ranging discussion stressed the role of people-centered health systems, government leadership, the critical role of nurses in quality improvement and service delivery, and community responses to provide solutions and accountability to identified quality issues.

"We’ve come a long way since the beginning of the HIV response, and the next set of challenges are now in view—particularly the need to improve our prevention responses to reduce new infections," Dr. Holmes noted at the conclusion of the IAS Mexico City conference.

We’ve got to fight smarter, and that means using data and quality interventions in new ways and sharing innovation and ideas more quickly across communities and countries—our meetings over the last few days have given us new tools and inspiration to accelerate our work to end the HIV pandemic.