Kevin de Cock of WHO, introduced the objectives of the session as reviewing the priorities and approaches for HIV operations research; and discussing building OR capacities in resource-poor settings.  He said that the Sydney Declaration (July 2007) called for allocation of 10% of funds for HIV programming for research.  He spoke of the WHO consultation (March 2008) that identified OR priorities in ART, non-ART care, laboratory monitoring and health systems strengthening.

Deborah Cotton of Center for Strategic HIV Operations Research spoke of the importance of modelling to inform decision making on resource allocation. She said challenges to HIV OR include the lack of reliable data management systems; the growing integration of HIV care; and lack of understanding what OR can do to improve health systems.  Jim Kim of Harvard School of Public Health speaking of their work on a framework for global health delivery research; emphasized the importance qualitative information; and of involving people with diverse expertise e.g., business, systems engineering, etc. in OR.  Lydia Mungherera of TASO advocated for involving HIV-positive people in OR. She recommended developing research networks; training PLHIV as researchers; involving PLHIV in monitoring OR; and more funding for OR in Africa. Vonthanak Saphonn of Cambodia spoke of challenges to OR in developing countries that included lack of national research agenda; lack of career for young researchers; ‘brain drain’; lack of institutions; and lack of political will.  Other challenges included international donor priorities that often do not match that of the developing country; and the lack of exact definition of what constituted ‘community participation’.  Debrework Zewdie of the World Bank Global HIV/AIDS Program reiterated that OR was part of World Bank Program of Action. At close, audience and panellists discussed challenges of transforming OR into policy; the challenge of ‘scientific legitimacy’ of OR; and the question of public-private partnership in research.

This session reviewed the current status of the HIV Operations Research (OR) at global level and discussed the priorities, strategies and approaches to implement this issue at country level. Kevin de Cock gave an overview of the basic concepts of OR, addressing the knowledge gaps in the Public Health Approach. He highlighted that the attention to OR is still low despite the international commitment to allocate 10% of all resources for HIV programming for scaling up research, as established in the "Sydney Declaration". He finalized his presentation commenting about the need to better document and learn from ART scale up process and the importance of identifying the right questions  and adequately address the knowledge gaps.Debbie Cotton,  from Clinton  HIV/AIDS Initiative (CHAI), reviewed the use of  modelling simulations to facilitating global health delivery. There are four major areas related to OR that CHAI are currently involved:  1) Global forecasting using simulating model, in partnership with WHO; 2) Modelling of financial impact of ART protocol revision, in partnership with the MoH of Botswana; 3) Assessing human resources needs for male circumcision, in partnership with the Governments of Kenya and Zambia; and 4) Quantifying physician time saved in task shifting, with the Government of Rwanda and FHI. In this last project, the modelling analysis showed that the task shifting approach can reduce the demand for physicians in  78% and promote a 183% increase in the health system capacity.Jim Kim, discussed the use of case study models to approach operational research. He listed the major implementation bottlenecks that international community face, particularly in resource limited settings. He highlighted that the global health strategy to deal with HIV/AIDS to date clearly need a better approach. He also briefly described the Global Health Delivery Project, a collaboration between Harvard University and other academic institutions, that proposes to  systematize the study of global health delivery and better inform policy decisions.Lydia Mungherera, from TASO, Uganda, gave the African perspective of PLHIV involvement on research. She said that more resources are needed for operational research in Africa. She asked for more involvement of the HIV community in research advisory committees and resources for training PLHIV in research skills. She also stated the need for more research in children and that OR in Africa should be carried out  from the regional perspective, with support of local researchers and consider cultural gender and socio-dynamics of African settings.Dr. Vonthana Saphonn from MoH of Cambodia discussed the obstacles to OR  and  the way forward in an Asian perspective. He listed several obstacles for OR implementation. Human resources was considered one of the major barriers, characterized by lack of appropriate trained personnel and the "brain drain".  Strong political advocacy is necessary, because the weak links between policy makers and researchers at country level and the lack of cohesive political advocacy at national and international levels. Finally, lack of funding for research and competing priorities are also important barriers. He also emphasized the importance of community. He finalized his presentation  proposing an equal and transparent cooperation between North and South in OR area.Dr Debrework Zwedie, discussed the role of OR in sustaining HIV treatment programmes. She commented that despite the "Sydney Declaration", investments in AIDS research has been poor. According to a recent  report, OR received only 0.4% of funds in GFTAM rounds 1 to 6 in the 2002-2006 period.  She commented that World Bank is supporting a network of treatment researchers from RLS. She also commented that  the initiatives to integrate research into programmes, such as the evaluation of  clinical efficacy of village health workers held in Lesotho and the evaluation of the impact of food crisis  in the adherence to ART Haiti.This session  clearly show that the success to control AIDS is likely to arise from operational research within AIDS directed programmes. Furthermore, there is a clear movement towards more funding and consensus agenda on HIV research area. However the current arrangements are not supporting OR. New approaches to OR, involving private and public partnerships in research is necessary in order to adequately face the current implementation bottlenecks in this area.