Chapter 5
Sharing research & knowledge
Harnessing the power of research to achieve treatment targets and to build health systems that respond to the broad array of complex health issues requires an innovative approach to gathering and sharing information. Existing, classic methods of research and dissemination of new knowledge - while still necessary - will not be sufficient to achieve these goals. In the short term, new methods of assessing the performance of treatment programmes are essential. So, too, is the rapid sharing of information in order for countries to benefit from the most recent and most relevant experience elsewhere and adapt it to local circumstances.
The HIV/AIDS treatment initiative is generating many urgent new research questions for which answers must be found quickly and communicated without delay. The fast progress that is simultaneously occurring in information and knowledge technologies will help. Innovative routes are already beginning to overtake and bypass standard research publishing processes and other conventional forms of knowledge sharing.
Traditional notions of research and publication are insufficient to bridge the wide gap between current knowledge and its successful application. A new approach is required which recognizes that useful knowledge can expand beyond formal research designs and can be quickly shared and applied through social networks and other channels, rather than simply through traditional publication methods. These applications of knowledge management in the public health sector are relatively new, but early efforts show promise (1).
A modern approach to knowledge management strengthens existing information and research networks through the Internet and other means of communication, and builds vibrant new networks that allow the rapid sharing of knowledge and practical experience at the front line - among clinicians, researchers, health workers and others. Thus, the people most closely involved in achieving wider access to antiretroviral therapy can learn from each other's successes - and also from their failures - especially if this takes place in an atmosphere of transparency.
Both successes and failures have characterized much of the history of HIV/AIDS research in all its forms. Since scientists first identified the human immunodeficiency virus (HIV) as the cause of AIDS in 1983, many remarkable research achievements, spanning the understanding, treatment and prevention of the disease, have benefited many millions of people. Twenty years ago no effective treatment was known; today a range of antiretroviral drugs exists - treatments that dramatically improve patients' quality and length of life, though they are still reaching only a tiny fraction of those who need them. Meanwhile, despite high hopes 20 years ago for an HIV vaccine, the world is still waiting. Notwithstanding significant advances, it will be several years at least before a safe and effective vaccine becomes widely available.
The development, licensing and delivery of such a vaccine remains the greatest hope for the eventual control of HIV/AIDS, and realizing this hope depends on scientific research. In examining the continuing quest for a vaccine, this chapter reviews research into other important areas of HIV/AIDS prevention, treatment and care. Even while awaiting effective vaccines, the moral obligation is unambiguous: to scale up activities to treat and care for people living with HIV/AIDS - whoever they are and wherever they live - and to contain the spread of the disease. Such ethically sound actions require new tools that can be produced only by research of the highest quality, research which must extend far beyond the laboratory to include multidisciplinary operational and health policy research.
HIV/AIDS researchers face four broad categories of challenge, all crucial to present and future success:
- Prevention research – slowing down the growth and geographical expansion of the epidemic: a challenge for epidemiology and sociobehavioural aspects of prevention.
- Vaccine research – designing a safe and effective preventive vaccine: the best hope for the long-term prevention and control of HIV/AIDS.
- Treatment research – generating new antiretroviral drugs and designing new therapeutic strategies that would be active on “wild” and resistant strains of viruses, be easy to take and better tolerated than currently available drugs: a challenge for basic and clinical research.
- Delivery system research (operational research) – making care and antiretroviral treatment available to all those who need it worldwide: a multidisciplinary undertaking. This is the greatest research challenge because it must deliver results on the ground, often more complicated than the relatively straightforward task of scienti fi c discovery. Furthermore, this aspect of research has, until now, been largely neglected by both researchers and funding organizations. Here, too, a knowledge management framework may prove useful.