The impact of HIV scale-up on health systems: A priority research agenda.

The impact of HIV scale-up on health systems: A priority research agenda.

Collaborators: Abrams E, Cahn P, Coovadia H, De Cock KM, Dybul M, El-Sadr W, Freywhot S, Isbell M, Levine R, Melaku Z, Mermin J, Mugyenyi P, Mukherjee J, Perriens J, Rabkin M, Samb B, Sewankambo N, Sinkala M, Weil D, Zewdie D.

Although much has been learned about the implementation of HIV prevention, care, and treatment services in resource-limited settings, the broader impact of the rapid scale-up of HIV programs on fragile health systems has only recently been explored. A high-level working group identified priority research questions regarding the impact of HIV scale-up on key elements of health systems: service delivery; management; information, evidence, and strategic planning; medical products, vaccines, and technologies; health financing and payments; leadership and governance; and the behaviours of providers, consumers, and communities. Rigorous multisectoral studies are needed if HIV program expansion to the millions still needing care and treatment is to continue, and if the synergies between vertically funded HIV programs and the health systems of which they are a part are to be maximized to strengthen nations' ability to meet all their health challenges.

Citing the paucity of rigorous evidence to support a negative or positive impact of HIV scale-up on health systems and the fact that opinion has dominated the debate thus far, this paper lays out 38 priority research questions in 7 categories in what is a forward-looking research agenda. The answers to these questions will guide efforts to maximize the synergies between vertical programmes and the health systems of which they are a part in a ‘diagonal approach’ that attends to both disease-specific and systemic priorities.