How action helps to produce evidence: Factors influencing the production of systematic reviews conducted by the Cochrane HIV/AIDS group

Article type
Authors
Kennedy G, Rutherford G
Abstract
Background: By the end of 1999, 33.6 million people are living with HIV; 5.6 million people were infected with HIV in 1999 alone. Over 16 million people have died from the disease since the epidemic began. Every country has new infections, and the epidemic continues unabated in many parts of the world. One of the responsibilities of the Cochrane HIV/AIDS Group is to develop a sufficient number of HIV/AIDS reviews with sufficient breadth to be useful for clinicians, public health practitioners and policymakers. An additional goal is to disseminate the findings of reviews and to seek requests for high-priority reviews to be conducted. In order to ascertain HIV/AIDS topics of high priority for review, we have developed relationships with a variety of groups, private and federal, US-based and international, AIDS service organizations and professional, and consumer and governmental. * Requests from international AIDS program planners for evidence-based interventions. As part of the Leadership and Investment in Fighting an Epidemic (LIFE) initiative of the US-government, the Centers for Disease Control and Prevention (CDC) is increasing its support for HIV prevention in low-income countries. A Cochrane systematic review of the implementation and impact of behavioral interventions for preventing HIV infection has been commissioned to guide the design, tailoring and evaluation of new prevention programs. * Requests from policymakers for evidence-based interventions. In areas of limited health care resources, funding of evidence-based interventions, most preferably lower-technology interventions are required. The HIV/AIDS Group has been approached to synthesize the evidence of the effectiveness of HIV prevention and treatment interventions in order to determine the best use of resources. Examples of reviews to address those issues include condom effectiveness and interventions to improve condom use, lower-technology interventions for decreasing perinatal HIV transmission, the use of single versus multiple drugs for HIV treatment and interventions targeting minority populations in the United States. * Requests from clinicians to support clinical care guidelines. Because of the rapidly evolving field of HIV/AIDS care, clinicians require easily accessible and updated overviews of treatment options for HIV/AIDS-related illnesses. For instance, clinicians and professional organizations have contacted us to assist in their reviews of the use of antibiotics for prevention of opportunistic infections in developing countries, discontinuation of prophylaxis for opportunistic infections with highly active antiretroviral therapy (HAART) and disorders of lipodystrophy associated with the use of HAART. * Requests from consumers for descriptions of benefits and limitations of therapies. Consumers are eager to know about alternative therapies to treat HIV/AIDS including the role of complementary treatments, exercise and nutrition. In addition, consumers have requested information about potential side effects of HAART.

Conclusions: In this session we will offer examples of how collaboration from the international HIV/AIDS community has supplemented our own internal priority-setting process and led to the production of high-priority reviews.