ARV Treatment: Special Focus
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This is Michael Sweat from Johns Hopkins University in the United States writing. I want to take this opportunity to thank the organizers of the forum for their work. This has been a very stimulating exercise, and it was very well designed and maintained. I also have a few suggestions for future topics: (1) I think that decision analysis methods are in order for many of the issues that have been discussed regarding ARV therapy in developing countries. In this regard, what would be most helpful to policy makers regarding decisions of whether to provide fudning for ARV's would be analysis that incorporates both the cost-effectiveness of provision of anti-retroviral tharapy, as well as consideration and weighting of the attitudes towards the various decisions that could be taken. I would thus suggest future discussions on decision analysis methods. Policy decisions are always based on a combination of the empirical evidence of the likelihood of the outcome(s) and the attitude towards those outcomes. Decision analysis techniques are well suited to dealing with these dynamics. (2) it would be interesting to have a forum that allows a group process of working through a particular problem. For example, developing a simple hypothetical decision tree for use of ARV therapy that incorporates targeting issues, cost-effectiveness, and attitudes towards various options. In the current forum various participants developed their own hypothetical models for discussion purposes, which were very interesting. I think this might ground the discussion in a concrete way, and be educational to many participants. (3) as others have already suggested, I would like to see additional topics/forums on modeling the impact of HIV interventions such as ARVs. Specifically, issues on methods, validity of models, sources of data, and previous applications. Since cost-effectiveness analysis is usually dependent on modeling it would be helpful to hear from others on this topic. (4) finally, I agree with the organizers that keeping the forum closed was a good idea, but perhaps in future having the group work towards developing a product for external distribution would be valuable. I think this would encourage more active participation and would be of use to the wider community of people working in AIDS prevention. Maybe even just posting a report of sub-working groups on the internet. Again, thanks or providing this forum. |
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