Revising the research priorities for HIV/TB Haileyesus Getahun Delphine Sculier Stop TB Department

11% 22%37% 48% More implementation=unmet research needs Why to define the TB/HIV research priorities?

Defining TB/HIV research: 2005 Five major areas  Preventive therapy  Cotrimoxazole prophylaxis  Antiretroviral therapy  Intensified TB case finding  Smear negative TB Cross cutting issues

Defining TB/HIV research agenda: is it useful? Question How many peer reviewed research publications were produced addressing the research questions described in the 2005 document? Method Systematic search of Pubmed using key words pertinent for each priority question identified in the document (n=30)

Defining TB/HIV research agenda: is it useful? Results AreaQuestions (n)Publications since 2005 (n) Preventive therapy for TB728 Cotrimoxazole prophylaxis419 ART742 Intensified case finding545 Smear negative TB758 Total30192

TB/HIV research prioritisation process - Guiding principles Transparency Inclusiveness Objectivity

Transparency Review of the published evidence and gaps identified Six key areas  TB prevention  Intensified TB case finding  TB treatment for PLHIV  Drug resistant TB in PLHIV  Childhood and maternal TB in PLHIV  Integrated TB and HIV services Content and process much different from 2005

Inclusiveness Advisory Group (n=14) from the WG assisted drafting and identification of gaps for each area Members of Review Committee (n=48) reviewed and commented on the document Areas discussed and content was informed from discussion at the July 2009 TB/HIV research meeting in Cape Town.

Inclusiveness Advisory Group and Review Committee members provided their top three priority research questions in the six areas. 77 questions identified in all the areas for prioritisation Web based global consultation pending Finalisation after a face to face meeting with researchers, technical and research donor agencies pending.

Objectivity Prioritization assess the value added by the research question to: Accelerate universal and effective implementation Prevent unnecessary morbidity and mortality Grading used pre-defined criteria: effectiveness, deliverability, answerability and equity. Prioritization done by members of Advisory Group and Review Committee using web based survey Response rate by October 30, 2009 was 74% (46/62)

Objectivity – prioritisation scores The top three questions with the highest scores under each area (out of 12)

Objectivity – prioritisation scores The top three questions with the highest scores under each area (out of 12)

Objectivity Strengths of method Legitimacy and fairness Questions scored against pre-defined criteria Expert independently score the research questions Final list of priorities is recorded, can be reviewed, challenged and revised at any time Weaknesses of method Limited role for non- experts No evaluation about the importance of the question relative to the other Require detailed individual questions

Next steps Web-based public consultation of the prioritised questions Face to face meeting to finalise the process after public consultation (co-sponsorship with lead research donor and technical agencies being sought) Reach out to garner support and endorsement  Funding agencies and technical agencies  Researchers and policy makers  Activists and advocates