The U.S. Agency for International Development (USAID) has been a leader in fighting HIV/AIDS globally since 1986. One of the key components of USAID's HIV/AIDS program has been to conduct biomedical and operational research to develop and evaluate new tools for providing antiretroviral therapy, preventing HIV transmission, and caring for people living with AIDS.
The major focus of USAID's research is to address needs for program implementation in resource-limited settings. USAID-funded research is comprehensive, from identifying a program problem to research and efficacy verification, to field testing and full implementation in developing countries.
There are many complex issues related to the introduction and impact of antiretroviral therapy. USAID invested in three learning sites to study the introduction of AIDS treatment in low-resource settings. Two of these sites are now completely integrated into the Emergency Plan. The third site (Ghana) is not an Emergency Plan focus country, but is built into the national strategy and is scaling up with resources from the Global Fund to Fight AIDS, Tuberculosis and Malaria. Ongoing studies of methods to improve treatment adherence are under way and providing useful information. A training manual for treatment adherence, developed for one of the studies, is now widely disseminated.
Preventing Mother-to-Child HIV Transmission (PMTCT)
USAID has been working to develop single-dose packaging options to improve access to nevirapine among newborns at risk of HIV through mother-to-child transmission. Over the past year, two main packaging options have been researched to determine drug stability, mothers' acceptance, and relative cost. USAID has also supported research that produced practical information on infant feeding and HIV transmission. Results have further supported the hypothesis that exclusive breastfeeding, as opposed to mixed feeding, decreases the risk of mother-to-child transmission. Additionally, studies are continuing in several countries to determine the feasibility and effectiveness of integrating PMTCT services with other maternal and child health services. Also under way are targeted evaluations of innovative approaches that use temporary clinics, peer psychosocial support, and traditional birth attendants to improve access and use of PMTCT services.
"Abstinence, Be faithful, and, as appropriate, correct and consistent use of Condoms" (ABC) Approach
USAID has carried out pioneering studies in behavior change for successful HIV prevention, including a recently funded six-country study on the ABC approach, and has published an important paper analyzing the success of the ABC approach in Uganda. New studies are being planned to optimize ABC implementation interventions for youth and at-risk groups.
Clinical trials are currently underway to review whether male circumcision has a protective effect on HIV transmission. USAID is supporting research in Haiti, Kenya, South Africa, and Zambia to learn more about issues of safety and complications, acceptability and feasibility, and the logistical issues involved in developing pilot demonstration services for safe and affordable male circumcision and male reproductive health programs.