mapping pathways knowledge exchange workshop - san francisco - july 2013
DESCRIPTION
The 2-day workshop on ARV-based prevention strategies convened a select group of approximately 20-25 invited stakeholders in San Francisco who have interest in and/or play a role in policy, programming, and implementation issues around ARV-based prevention. Invitees included researchers, advocates, public health officials, and service providers, among others. The aim of the workshop was to provide participants with a range of future scenarios and potential strategies which link to goals and objectives for prevention programming. Drawing on the evidence base for ARV-based prevention already collected by the Mapping Pathways project, as well as each other’s knowledge and experience, participants developed a set of pathways they could take back to their communities and policy bodies for discussion and, if appropriate, implementation.TRANSCRIPT
Knowledge exchange workshop
San Francisco AIDS Foundation16 – 17 July 2013
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Our agenda in brief
• Welcome – Neil G. Giuliano
• Introductions
• Overview of the Mapping Pathways project
– Who are we?
– What did we do?
– What did we learn?
• Scenarios
• PEST framework
– Political, Environmental, Social, Technological
• Using scenarios to develop a theory of change
– Timelines, milestones, robust action plans
• Next steps
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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.blogspot.com
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We are a community-led research initiative
Video
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The bottom line
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WHAT DID WE LEARN?
What did we do?
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• PEP
• PrEP
• Microbicides
• TLC+ (Testing, Linkage to Care, PLUS Treatment)
– TASP
– TNT
– T4P
First, some definitions
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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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What is the future snapshot?
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• A scenario is a logical and consistent picture of the future which is credible and challenging to stakeholders
• Scenarios help to provide insight into future developments in the health and research systems which will impact effectiveness of ARVs as prevention.
• Analysis of the scenarios enables us to identify the potential implications of the choices we make today and prepare for the future
• The analysis highlights linkages among different aspects of the future which might not otherwise be apparent
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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• Learn from each other
• Build scenarios together
– Develop a PEST analysis
– Map uncertainty and impact of PEST factors
– Use factors to define a spectrum of outcomes
– ‘Draw’ scenarios
– Discuss timelines and milestones
– 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
• Political & Regulatory
• Economic
• Social & Cultural
• Technological & Scientific
A Mapping Pathways PEST
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Impact of factor on effectiveness
Un
cert
ain
ty
Different in each scenario
Can (probably) be ignored
Similar in each scenario
Optional (illustrative)
Low High
L
ow
Hig
h
Map uncertainty and impact
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Impact of factor on effectiveness
Un
cert
ain
ty
Different in each scenario
Can (probably) beignored
Similar in each scenario
Optional (illustrative)
Low High
L
ow
Hig
h
Map uncertainty and impact
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Storytime x 3: We have implemented ARV-based PX and…
…we have no
effectiveness, rate of
new infections same…
… we have effectivenes
s, and overall
infection rate
decreases…
…. It’s a mixed bag,
some reduction in rates among
some key pops but not
all….
Dateline: 2023
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• Name each scenario
• What is the mix of ARV strategies?
– All? One? Two? Three?
• What’s the mix of factors?
• How do the factors intersect?
• How have factors been addressed, not addressed?
• Key drivers, key assumptions, key certainties/uncertainties
• What does “success” look like?
• What does “less than success” look like?
Storytime x 3: We have implemented ARV-based PX and…
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• [add timeline figure]
Timelines and milestones
2013 2025
Milestone
Milestone
Milestone
Milestone
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How do you
connect with
others? Actions to get us there -
where are you in the system?
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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.blogspot.com [email protected]
Joanna Chataway – [email protected] Molly Morgan Jones - [email protected]
Jim Pickett – [email protected] Jessica Terlikowski – [email protected]