Progress has been accelerating in international collaboration and coordination in HIV/AIDS research, which is critical to achieving the Millennium Development Goal of halting and reversing the pandemic by 2015.
Joint innovative actions, through global research networks and partnerships between the public sector, academic institutions, communities, the private commercial sector and civil society organizations, bring benefits greater than the sum of current high-quality but separate research projects. The benefits include quicker generation of research findings, consensus on international standards for the conduct of research, and research capacity strengthening.
Collaboration permits parallel, concurrent efforts to obtain more timely answers to critical questions. Partnership across sectors through creative public-private alliances can contribute to faster progress in research by linking together diverse approaches and different stages of the research process (see Box 5.2).
International collaboration can lead to consensus on standards for the conduct of research which respect the human rights of study participants, support the research priorities of host countries, and promote community involvement in the design and conduct of research. Collaboration can also ensure that prevention and care interventions that are demonstrated to be safe and effective are rapidly made available to all study participants and to other members of the high-risk populations from which they were drawn.
International collaboration to strengthen research capacity enables the creation of a critical mass of researchers who can focus on national priorities, participate in policy-making bodies, and contribute to international research efforts. International and regional training partnerships must be complemented by active efforts to stem the brain drain from developing to developed countries, as Brazil, China and India are doing. This is achieved through investment in research and development to construct strategic knowledge-based industries that can employ nationals educated at home and abroad and attract expatriates to return.
Building national and international research infrastructures, laboratory capacity and improved surveillance systems; collecting, processing and disseminating data; and training basic and clinical researchers, social scientists, health care providers and technicians are all essential to efforts to accelerate knowledge creation. Such acceleration is required to respond to the scale of the HIV/AIDS pandemic. The substantial remaining challenge, and one to which the 3 by 5 initiative is directed, is to ensure that this knowledge immediately improves the lives of people most in need (34).
Extending treatment opportunities needs a faster research process than is available through traditional notions of research. The nature of the HIV/AIDS epidemic is changing quickly in many countries - too quickly to be effectively countered through standard research processes, whose timeline is typically measured in years. In addition, many of the decisions on which research projects are to be funded and pursued are made by policy-makers at some distance from the problem. As a result, resources and efforts are invested in work that may have little or no relevance to actual implementation in the field.
The public health community must rethink its definition of knowledge and the structure by which it is generated, shared and applied. The aims of knowledge management are to collect all relevant information and intellectual capital into a common system, and provide equal access to that information, ensuring that it can be synthesized with local needs. Such a system enables members of the public health community to communicate directly with their peers on matters of mutual interest, such as effective practice in their own localities.
The 3 by 5 goal prompts public health practitioners to share and exploit experiential knowledge in a much more direct way, for example through "communities of practice" - informal networks linking individuals and groups who share common professional interests and who benefit from frequent exchanges of knowledge through the Internet or other telecommunication methods. Progress in information and communication technologies and other learning systems such as communities of practice gives cause for optimism. Improved communication can spur a knowledge revolution that will particularly benefit poor countries and communities, through greater use of the Internet, e-mail and telephone, and better satellite and wireless technology. By whatever means, the promotion and improvement of learning systems at all levels should greatly assist the achievement of public health goals as well as helping to strengthen health systems in general.