MHRP & PEPFAR

While MHRP’s primary focus is on developing a safe, globally effective HIV vaccine, the program provides prevention, care and treatment services in each of the communities in which research is conducted. These services, funded through the President’s Emergency Plan for AIDS Relief (PEPFAR), provide an ethical, non-coercive environment to conduct clinical research. The integration with research sites has created vibrant synergy that enhances clinical research and improves the public health infrastructure in Africa. As a result, MHRP has built strong and trusting relationships with the communities in which research is conducted, and has developed sustainable local healthcare capacity for HIV and other medical programs.

Our PEPFAR programs engage both civilian and military populations in sub-Saharan Africa. MHRP PEPFAR programs have developed robust in-country relationships with CDC, USAID, Peace Corps, and other stakeholders and have built powerful partnerships with host-country civil society, government, academia, and non-governmental organizations.

Goals

• Develop the capacity and infrastructure of indigenous partners to provide comprehensive and quality HIV prevention, care and treatment services for the communities participating in WRAIR-directed HIV research and vaccine studies.
• Ensure an ethical framework in which to conduct HIV vaccine research in resource-constrained settings.

Objectives

• Develop the local capacity to provide quality care and treatment services for HIV-positive individuals, including laboratory support. 
• Enhance networks with other institutions and the community to ensure continuum of care for all HIV-infected persons.
• Improve the technical and managerial knowledge and skills of indigenous staff and partners for long-term sustainability.

Catchment Populations

PEPFAR Research

The Office of the U.S. Global AIDS Coordinator (OGAC) leads overseas PEPFAR activities. OGAC has outlined a five-year plan of investment in innovation and operations research. The goal is to evaluate impact, improve service delivery, and maximize outcomes with our partners in country. The collaboration between research and PEPFAR programs at MHRP sites provides an excellent platform from which to implement operational research and public health evaluations. Such research will help MHRP and OGAC meet PEPFAR goals and the U.S. Government’s growing response to ensure the execution of a strong global health program. (All research activities are vetted through the MHRP’s institutional review board [IRB] of record and respective in-country IRB before initiation.)

Research Areas

Basic Program Evaluations (BPEs):

These activities, also interpreted as operational research, strive to inform program quality and mid-course corrections/improvements for a project, identify promising models or best practices for expansion within the program, and/or indicate whether a specific program model accomplishes its goals. Examples include measuring increased uptake of specific services after a community education campaign, retrospective chart analyses to track changes in morbidity and mortality as well as determine viral suppression among ART patients over time, or other studies that inform and improve upon program execution. Current MHRP BPEs include studies:

• Examining the linkage between Prevention of Mother-To-Child Transmission (PMTCT) efforts and early infant diagnosis in Tanzania (RV279)
• Evaluating the voluntary medical male circumcision roll-out program in Uganda (RV277)
• Evaluating the impact of incorporating HIV prevention messages in traditional male circumcision ceremonies in Kenya (RV293)
• Developing an HIV-malaria-TB point prevalence study in Kenya, in collaboration with the Kenya Department of Defence (RV292)

Public Health Evaluations (PHEs):

This hypothesis-driven research is intended to compare one program model, approach, or intervention to another on the expected outputs, outcomes, or impacts of the program. PHEs typically address a question applicable to a broader audience and produce generalizable knowledge that can be applied more broadly—to a country, geographic region, epidemic pattern, or globally—for the scale-up or improvement of HIV and PEPFAR programs.

For example, to increase PMTCT effectiveness, a PHE could compare several approaches to improving early infant diagnosis and patient tracking, so that more infected infants can be identified and brought into care and treatment along with their HIV-positive mothers.

• In 2010 in Kenya, MHRP began its first PHE—the “Clinic-based ART Diagnostic Evaluation” (CLADE) study (RV257).

Dr. Isaiah Tanui

Clinical Care Advisor, Department of International HIV Prevention, Care and Treament

Read the September 2011 Issue

see more