'Details of implementation' critical to reaching goal of AIDS-free generation

Nov 3 2012

Noting the progress made since the beginning of the HIV/AIDS epidemic and the upcoming recognition of World AIDS Day on December 1, Ronald Valdiserri, deputy assistant secretary for health, infectious diseases at the Department of Health and Human Services, writes in a Public Health Reports opinion piece (.pdf), "[W]e would do well to keep in mind the following caution. No matter the elegance of the controlled trial, the statistical significance of the results, or the superiority of the science, we must confront this inevitable reality: We will never be able to take full advantage of our progress in HIV clinical and prevention science until we develop and sustain the human, organizational, and structural capacities necessary to implement these new scientific breakthroughs." He continues, "If we fail to attend to the 'on-the-ground' details of implementation, we risk dissipating the promise of new drugs, novel therapies, and enhanced interventions that could, in fact, lead us to an AIDS-free generation."

Valdiserri says in order "to achieve a generation free of AIDS ... [w]e must begin by accepting the premise that if we support scientific inquiry without attending to the details of downstream implementation, we will fall short of our goal." He outlines five key principles recently presented in an Institute of Medicine report on the integration of primary care and public health and "repurpose[s]" and expands on them in the context of AIDS: "Address the social determinants that fuel the HIV/AIDS epidemic"; "Engage communities in finding solutions to HIV/AIDS"; "Align leadership across various sectors to overcome HIV/AIDS"; "Engineer public health and medical systems so they can incorporate emerging HIV research findings"; and, "Anticipate and adapt to changes in the epidemic." Valdiserri continues, "Certainly, there are gaps in our knowledge base -- not the least of which is the lack of a curative treatment or a vaccine to prevent HIV infection," and he concludes, "[W]e can make a difference" with the "formidable" knowledge and tools on hand, "if we are willing to pay attention to the details of implementation" (November-December 2012).