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Research priorities for advanced HIV disease in Latin America and the Caribbean region: a modified Delphi study
Evelina Chapman1, Omar Sued1, Jorge O Maia Barreto1,2
1Department of Communicable Diseases, Prevention, Control and Elimination, Pan American Health Organization, Washington, DC, USA.
Insights
Advanced HIV disease research in Latin America and the Caribbean needs urgent attention. This study prioritizes key questions on opportunistic infections and health systems to reduce mortality in vulnerable populations.
Area of Science:
- Public Health
- Infectious Diseases
- Health Systems Research
Background:
- Advanced HIV disease (AHD) is a major cause of death in Latin America and the Caribbean (LAC).
- Late diagnosis, treatment gaps, and structural barriers disproportionately affect key populations and children.
- Healthcare access disparities and stigma necessitate targeted research for improved AHD outcomes.
Purpose of the Study:
- To establish a prioritized research agenda for Advanced HIV disease in Latin America and the Caribbean.
- To identify critical research questions addressing public health relevance, feasibility, and equity.
- To guide future research, policy, and funding for AHD in the region.
Main Methods:
- A modified Delphi process involving 74-69 participants from 17 LAC countries.
- Systematic reviews and expert consultations informed question assessment.
- An in-person workshop refined and validated 77 high-priority research questions.
Main Results:
- Identified 77 high-priority research questions (60 for adults, 17 for children).
- Key areas include opportunistic infections (OIs) like tuberculosis, HIV-related cancers, and health system interventions.
- Short-term priorities focus on reducing late diagnosis, improving care retention, and strengthening health systems for vulnerable groups.
Conclusions:
- A comprehensive research agenda for AHD in LAC has been established.
- The agenda emphasizes interventions for OIs, health system strengthening, and support for at-risk populations.
- Regional collaboration and political commitment are crucial for implementing research findings and reducing HIV mortality.
Introduction:
Advanced HIV disease (AHD) remains a leading cause of mortality in Latin America and the Caribbean (LAC), driven by late diagnosis, treatment gaps and structural barriers, particularly among key populations and children. Persistent disparities in healthcare access, stigma, and limited health system capacity highlight the need for targeted research to improve AHD outcomes in the region.
Methods:
The modified Delphi process to prioritize AHD research questions in LAC was conducted between August and November 2024. Systematic reviews, expert consultations and two Delphi rounds involving 74 and 69 participants from 17 LAC countries assessed questions based on public health relevance, feasibility and equity. A subsequent in-person workshop with 24 experts refined and validated the results, organizing the prioritized questions into short-, medium- and long-term priorities.
Results:
Seventy-seven high-priority research questions were identified, 60 focused on adults and 17 on children. These questions centred on opportunistic infections (OIs), HIV-related cancers and health system interventions. Tuberculosis was the most frequently addressed OI (44% of OI-related questions), followed by cryptococcosis, histoplasmosis and HIV-related malignancies. Short-term priorities included interventions to reduce late diagnosis, improve retention in care and strengthen health systems, particularly for vulnerable populations such as children, pregnant women and incarcerated individuals.
Conclusions:
This study presents a comprehensive research agenda for AHD in LAC, emphasizing interventions to address OIs, strengthen the health system and support at-risk populations. The prioritized questions provide a roadmap for researchers, policymakers and funders to allocate resources effectively, ultimately improving AHD outcomes and reducing HIV-related mortality. Strengthening regional collaboration and political commitment will be critical to translating research into actionable policies and interventions.
