1. 1 HIV/AIDS Related Research Agenda Workshop Phnom Penh, Sunway Hotel March 28-29, 2007

2. 2 Group II-CARE & TREATMENT Room – WATPHNOM 18 - 20 participants SWOT analysis

3. 3 Treatment and Care Research Strength 1 Clear National objectives for treatment and care Funding to HIV programs (including research) is relatively well resourced. ART supply adequate (logistics / stock) Laboratory capacity available Electronic database - upscale in progress –minimum package of data reporting in place

4. 4 Treatment and Care Research Strength 2 Structures in place for conduct of research –National Ethics Committee –NCHADS Research Unit Collaboration with other institutions Prioritize research that will inform National Policy –Cambodian collaborators –International collaborators Cohorts of patients – now maturing (1 st and 2 nd line ART)

5. 5 Treatment + Care Research Weakness 1 Funding largely for programs rather than for research Cambodia dependent on external funds for conducting research Different database/tools currently used in different organisations Uncertainty re estimation as to number of PLHA require ART No unique identifier for HIV + persons Technology - limited VL and genotype testing available

6. 6 Treatment + Care Research Weakness 2 Human resources – numbers of staff, competing (clinical) responsibilities –limited Cambodian staff with experience and training in clinical and qualitative / social research Qualitative research – often performed by short term international consultants Mainly observational retrospective and cross sectional design Less resources are allocated to medical problems than HIV (research and clinical)

7. 7 Treatment and Care Research Opportunity 1 Institutional frameworks – to build research on. Clinical frameworks - 40 OI/ART clinics Electronic database Existing research experience –multiple Cambodian and international organisations –multiple projects –Inventory – to share experience / translate into program Research Agenda

8. 8 Treatment and Care Research Opportunity 2 WHO generic standardized tools, for local adaptation –Summary of existing knowledge (eg adherence, behaviour) –Agreed measures for evaluation /research University of Washington - University of Phnom Penh collaboration –training of Social workers in USA

9. 9 Treatment and Care Research Threats 1 Database –very resource intensive –quality issues (SOP, QA) –lack of standardization of tools Human resource capacity, impact on quality – especially for multidisciplinary research Research linked to care - sustainability of care and treatment after research and funding Poverty - transportation – access, and may be a barrier to follow up in longer term studies.

10. 10 Treatment and Care Research Knowledge gaps 1 Antiretroviral therapy –sequencing 1 st, 2 nd, 3 rd line ART –viral load testing strategies –drug resistance –adherence over long term / ART switches –short and long term toxicities associated with current protocols –appropriateness of current protocols to Cambodian population (eg subtype) Management of HIV co infection (esp children) (TB, hepatitis..) Management of related diseases (hepatitis B, diabetes..) HIV related illnesses –Neurological –Psychiatric / depression Survival and determinants of survival

11. 11 Treatment and Care Research Knowledge gaps 2 Stigma and discrimination of health care professionals and impact on testing / treatments/ adherence Access to testing and care –Identifying HIV +ve women (not considered high risk) –Barriers to HIV testing and care of children –Particular populations (Sex workers, IDU..) –Poverty / transportation Health system strengthening + integration of HIV care and treatment into mainstream health services Post exposure prophylaxis (occupational, non occupational)

12. 12 Treatment and Care Research Knowledge gaps 3 Impact of HIV on households – debt etc Quality of life Cost effectiveness of HIV programs Health Insurance - HIV care package Role of HEF and health insurance to assist access to care Efficacy / efficiency of PMTCT program Health care worker resource planning to cope with future workload

13. 13 Treatment and Care Research Knowledge gaps 4 Positive prevention –behaviour change: impact of HIV diagnosis, ART, OI etc –discordant couples HIV incidence Palliative care