Getting Research into Policy - Herpes Simplex Virus Type-2 (HSV-2) Treatment and HIV Infection: International Guidelines Formulation and the Case of Ghana

"Policy networks may serve as the primary driving force of change in both international context and in the case of Ghana. Communication among researchers and policy-makers is critical for uptake of evidence and opportunities may exist to formalize policy networks and engage donors in a productive and ethical way."

This paper examines the process through which the evidence related to HIV-HSV-2 interactions (whereby herpes simplex virus type 2 (HSV-2) enhances the potential for HIV acquisition or transmission) influences policy at the international level and then the mechanism of international to national policy transfer, with Ghana as a case study. To better understand the context within which national policy change occurs, special attention was paid to the relationships between researchers and policymakers as integral to the process of getting evidence into policy. Data from this study were then collected through interviews conducted with researchers, programme managers, and policymakers working in sexual health/sexually transmitted infections (STIs) at the 2008 World Health Organization (WHO) Expert Meeting in Montreux, Switzerland, and in Accra, Ghana. This research was commissioned by the Department for International Development (DFID)-funded Research Project Consortium (RPC) on Research and Capacity Building in Sexual & Reproductive Health and HIV in Developing Countries.

The major findings of this study indicate that investigations into HSV-2 as a co-factor of HIV generated the political will necessary to reform HSV-2 treatment policy. Playing a pivotal role at both the international level and within the Ghanaian policy context were "policy networks" formed either formally (WHO) or informally (Ghana) around an issue area. These networks of professionals serve as the primary conduit of information between researchers and policymakers. The Montreux interviewees suggested that the comparatively high profile of HIV generated the political will necessary for HSV-2 to be brought on to the international research agenda. According to the researchers, this indicates that, in order to address issues which receive little political attention, linking to a larger, more popular issue may be necessary in order to gain political traction. In addition, there was a call from policymakers and programme managers for researchers to engage in helping to bridge the divide between research and practice through indicating the programmatic and policy relevance of both their research and their findings.

On the Ghanaian national policy front, according to WHO interviewees, it often takes as long as 2 years, or sometimes even longer, for changes in treatment guidelines to be disseminated through national governments to practitioners working in low-income countries. Multiple competing priorities appeared to influence the uptake of research findings into national policy reform. Three mechanisms emerged:

1. "Many of the researchers in Ghana also have a clinical practice. Therefore, the distance between research and practice can be shortened, as compared to the distance between research and policy. Bypassing policy as a rule will not, however, support provision of care for all who need it."
2. "Both policy networks and policy entrepreneurs (often working within this group), were described as critical to bridging the gap between research and policy. In the case of Ghana, policy networks are cited as the only functional communication channel between researchers and policy-makers."
3. "At the national level, donor attention to a particular issue, or lack thereof, heavily influences the likelihood of policy reform. In the case of HSV-2, it was predicted that a lack of donor attention combined with competing donor priorities, would impede the inclusion of acyclovir in national syndromic management guidelines. "

Based on the research findings, which are outlined in detail within this result, the authors present recommendations for increasing the likelihood of research uptake into policy/guidelines at both the national and international levels in the field of STIs and HIV.

• "The entire sexual health/STI research to policy continuum lives within the apparent confines of the WHO STI policy network. This is a formalized community and one that is recognized for its contribution to policy change. Researchers may wish to proactively target this network, particularly in communicating the practical application of their findings (the 'so what factor' of their work). Ideally, such communication would begin at the outset of research work and continue throughout the duration of any study, thereby building up to any potential recommendations for change, and establishing legitimacy of the researchers to the network members when their findings become available."
• "In the case of Ghana, the policy network is entirely informal, and yet is still a powerful contender in affecting policy change. The existence of this group presents an opportunity to disseminate study findings and exert pressure on policy-makers in an effective manner. In this way, often difficult to reach policy-makers may be included in research from the outset of a study, instead of as an endpoint for the presentation of research findings....Also key to the national research-to-policy continuum are donors....The possibilities then for ethical donor engagement in research-uptake at the national level, and particularly in the case of research conducted locally, deserves further study."