National Blood Borne Viruses and Sexually Transmissible Infections Research Strategy - FIRST

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National Blood Borne Viruses and Sexually Transmissible Infections Research Strategy - FIRST

National Blood Borne
Viruses and Sexually
Transmissible Infections
Research Strategy

National Blood Borne Viruses and Sexually Transmissible Infections Research Strategy - FIRST
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                             First National Blood Borne Viruses and Sexually Transmissible Infections Research Strategy 2021-25      ii

The First National Blood Borne Viruses (BBV)        The National Strategies recognise the
and Sexually Transmissible Infections (STI)         considerable work already being progressed
Research Strategy 2021-2025 will ensure that        collaboratively by governments, community-
future funded research activities best align        based organisations, researchers, health
with the priorities of the BBV and STI              professionals and communities. The success
research agenda, and support measurable             of the National Strategies relies on continuing
progress towards the goals and targets of the       to build a strong evidence base to better
five National BBV and STI Strategies.               inform our responses, evaluating our
Importantly, BBV and STI research will help         approaches to identify what is most effective,
to focus actions that improve the quality of life   and further strengthening our workforce,
for people living with BBV and/or STI, and          partnerships and connections to priority
address barriers to services and supports that      populations. There is a critical need to
affect health seeking behaviours.                   improve knowledge and awareness of BBV
                                                    and STI to identify emerging issues and
The First National BBV and STI Research             challenges. Maintaining our momentum is
Strategy will capitalise on the significant         essential – we now have the potential to
progress that has been made in recent years         considerably advance our response across
in our responses to BBV and STI. This               some critical areas and inform future
includes the listing of pre-exposure                health policy.
prophylaxis for HIV prevention, additional HIV
treatments, and ensuring the broadest               The development of the First National BBV
possible access to direct acting antiviral          and STI Research Strategy has highlighted
treatments for hepatitis C on the                   the significant collegiality and commitment of
Pharmaceutical Benefits Scheme. Despite             all stakeholders to strengthen our BBV and
this progress, BBV and STI remain significant       STI response. With this foundation, Australia
public health issues.                               can continue to strive to achieve great things,
                                                    and build on our reputation as a world-leader
                                                    in both research and practice.

The Hon Greg Hunt MP
Minister for Health and Aged Care
1.   Introduction .................................................................................. 3
2.   The Strategy ................................................................................. 6
3.   Guiding Principles ........................................................................ 7
4.   Opportunities and Benefits ....................................................... 13
5.   Key Areas for Action .................................................................. 14
6.   Governance and Implementation .............................................. 15

                     First National Blood Borne Viruses and Sexually Transmissible Infections Research Strategy 2021-25   2
1. Introduction
The five National Blood Borne Viruses (BBV)         evaluation, innovation, and use of data to
and Sexually Transmissible Infections (STI)         develop and implement integrated,
Strategies1 set the direction for Australia’s       evidence-based health policies.
continuing response, and represent the
                                                    Responses to BBV and STI have been
commitment of Australian governments,
                                                    underpinned and strengthened by a
researchers and health and community
                                                    partnership approach between the Australian
organisations to address the impact of BBV
                                                    and state and territory governments,
and STI on the Australian community.
                                                    community organisations, researchers, health
The First Blood Borne Viruses and Sexually          professionals, people at risk of, living with
Transmissible Infections Research Strategy          and/or affected by BBV and STI. Supported
2021 –-2025 (the Strategy) aims to support          by continued investment from governments,
nationally relevant research and innovation,        high quality and rigorous research conducted
and capacity building in reducing the               by the national centres of research excellence
incidence and impact of BBV and STI in              and other organisations is critical to
Australia. The Strategy builds on the               Australia’s robust response to BBV and STI.
considerable work already being progressed
collaboratively by governments, community-          The ambitious targets and goals outlined in
based organisations, researchers, health            the five National Strategies (the National
professionals and communities to improve            Strategies) will continue to guide Australia’s
health outcomes for people at risk of, and          efforts to significantly reduce the transmission
living with, BBV and STI.                           of BBV and STI, increase rates of diagnosis,
                                                    and improve access to prevention, harm
Australia supports the World Health                 reduction, treatment and care services. The
Organization’s (WHO) Global Health Sector           National Strategies also include guiding
Strategies on Sexually Transmissible                principles to support a high quality, evidence-
Infections, HIV and Viral Hepatitis 2016–21,        based and equitable response to BBV and
which have an overarching goal of eliminating       STI. They are drawn from Australia’s efforts
BBV and STI as a public health concern by           over time to respond to the challenges,
2030. Meeting and exceeding the international       threats and impacts of hepatitis B, hepatitis C,
obligations and targets is a critical part of       HIV, and STI. Importantly, they also focus on
Australia’s response.                               improving the quality of life for people living
The Australian Government supports health           with BBV and STI, addressing the barriers to
and medical research through increased              services and supports that affect health
investment and work to strengthen safety and        seeking behaviours and overall access.
quality across the health system to reduce
risks to patients and generate efficiencies.
This aims to ensure Australia’s health system
is better equipped to meet current and future
health needs by applying research,

1   Third National Hepatitis B Strategy 2018-2022   Fifth National Aboriginal and Torres Strait Islander
    Fourth National STI Strategy 2018-2022          BBV and STI Strategy 2018-2022
    Fifth National Hepatitis C Strategy 2018-2022   Eighth National HIV Strategy 2018-2022
This includes stigma and discrimination                         support a comprehensive understanding of
experienced by marginalised and priority                        BBV and STI in Australia. This includes
populations including:                                          understanding the social drivers that influence
    Aboriginal and Torres Strait Islander                      the rates of and responses to BBV and STI,
        people                                                  evaluating surveillance data to monitor the
    culturally and linguistically diverse                      impact of prevention interventions and harm
        populations                                             reduction approaches, and identifying trends
    people who inject drugs and/or living                      of concern and gaps in the current response.
        with HIV, hepatitis B and/or hepatitis C                Conducting independent research to inform,
    sex workers                                                improve and monitor government policy is a
    gay men and other men who have sex                         challenge for both policy makers and
        with men                                                researchers alike. The use of research in
    trans and gender diverse populations                       policy development can be encouraged by
    people in custodial settings or history                    enabling timely access to relevant data and
        of incarceration.                                       research findings, encouraging interaction
                                                                between policy makers, healthcare providers,
Significance of BBV and                                         researchers, affected communities and
STI Research                                                    consumers, and increasing individual and
                                                                organisational capacity to use research.
Australia has continued to make significant
                                                                The Ottawa Charter for Health Promotion
progress in the prevention and management
                                                                provides the framework for effective actions
of BBV and STI. However, diseases like
                                                                under this Strategy. It facilitates the active
hepatitis B, hepatitis C, HIV, syphilis,
                                                                participation of affected communities and
gonorrhoea, human papilloma virus (HPV)
                                                                individuals to increase their influence over the
and other sexually transmissible infections
                                                                determinants of their health, and the
remain significant public health issues.
                                                                formulation and application of laws and public
Persistent and emerging issues, such as anti-
                                                                policies to support and encourage healthy
microbial resistance among key STI and
                                                                behaviours and respect for human rights.
human T-cell lymphotropic virus type 1
                                                                The Australian and international community
(HTLV-1) also require an ongoing and
                                                                expects research to be conducted
concerted effort.
                                                                responsibly, ethically and with integrity.
Social, behavioural, epidemiological and                        The Australian Code for the Responsible
clinical research is important in developing                    Conduct of Research articulates the broad
a strong evidence base for managing and                         principles that characterise an honest, ethical
preventing BBV and STI in the community.                        and conscientious research culture. It
Research is an essential part of the health                     establishes a framework for responsible
system, spanning a pipeline from concept to                     research conduct that provides a foundation
laboratory through to translational and                         for high-quality research, credibility and
implementation research, clinical and social                    community trust in the research endeavour.
application, and community benefit.
Policy relevant research needs to be
responsive to changing evidence and
emerging issues and be aligned to support
the delivery of government’s strategic goals.
Continuous improvement of data collection
and systems is also important to better

                       First National Blood Borne Viruses and Sexually Transmissible Infections Research Strategy 2021-25   4
Close collaborations between research
agencies and funders, such as government
and knowledge users2, have been shown to
be effective in generating policy-relevant
research, particularly where funders are
involved in decisions that drive the strategic
directions of the program to deliver on priority
outcomes. Partnerships between researchers,
health professionals, and community and
peer-led organisations are essential and
valuable. Such organisations are often the
first to identify cultural influences, social
interactions, demographics of priority
populations, and changes in behaviours
due to their direct contact with affected
communities and are therefore critical to
a research-driven targeted response.

The Australian Medical Research and
Innovation Strategy 2016–2022 identifies and
articulates a number of challenges facing the
health and medical research sector in
Australia, including the BBV and STI
landscape. These challenges need to be
addressed, through applied and social
research, to reduce the morbidity, mortality
and impact of disease, and in turn lift and
accelerate the social, health and economic
gains to be made from research at individual
and population levels.

  knowledge user is defined as an individual who is likely           trainee, health practitioner, policy maker, educator,
to use knowledge generated from research to make                     decision maker, health care administrator, national peak
informed decisions about health research, health                     organisation, community organisation, person living with
policies, programs and/or practices. A knowledge user                or at risk of BBV and STI and affected community,
can be, but is not limited to, a researcher, research                private sector organisation, or media outlet.

                            First National Blood Borne Viruses and Sexually Transmissible Infections Research Strategy 2021-25   5
2. The Strategy
The Strategy sets out the aims and                             Objectives
objectives of the multi-disciplinary
research activities undertaken within                                Embed and foster research and
Australia and supports the                                            innovative program design that directly
                                                                      addresses and implements goals and
implementation of the five National
                                                                      targets in the five National BBV and STI
BBV and STI Strategies by identifying                                 Strategies.
challenges, barriers and
                                                                     Generate a holistic evidence base,
opportunities to achieve the agreed                                   informed by multi-disciplinary research,
goals and targets. The Strategy also                                  to guide policy development and co-
identifies a series of Guiding                                        designed health promotion, prevention
Principles that have the potential to                                 strategies, and health services and
advance the BBV and STI policy                                        programs.
landscape and increase the                                           Address gaps in data and knowledge to
community use of research, creating                                   identify emerging issues and
greater impacts on prevention and                                     challenges, and inform future priorities,
                                                                      meet new challenges and develop
diagnosis of infections, treatment and
                                                                      effective health policy.
care of people living with infection. It
                                                                     Drive collaboration and linkage across
will also address social barriers i.e.
                                                                      research programs, and encourage
stigma and discrimination, thereby                                    future adoption of research outcomes in
improving health outcomes both now                                    policy and practice.
and into the future.                                                 Support a continuum of service delivery
The Strategy builds on the substantial                                (i.e. Community and peer-led prevention
advances that have been made in BBV and                               interventions, diagnosis, treatment, care
STI research programs over the last 20-30                             and social support services) to
years, through sustained investments made                             maximise impact and improve
by Australian governments, in research                                population health outcomes.
conducted by National Centres of Research                            Improve the impact of BBV and STI
Excellence and other organisations.                                   research to inform effective social and
                                                                      health policies and programs.
To guide BBV and STI research and
innovation to effectively inform the
implementation of priority actions outlined in
the five National BBV and STI Strategies,
focused on reducing morbidity, mortality,
stigma and discrimination, increasing access
to new biomedical interventions and improving
quality of life and health outcomes for people
living with, or at risk of, BBV and STI.

                      First National Blood Borne Viruses and Sexually Transmissible Infections Research Strategy 2021-25   6
3. Guiding Principles
The four guiding principles provide a                           There have been a number of advances in the
framework for identifying BBV and                               prevention and treatment of BBV and STI in
STI research priorities:                                        recent years. Some of note are:

1.   Translation: focus on translation and                             the advent of and unrestricted access to
     implementation of research and                                     new direct acting antivirals (DAA) for
     innovation in the BBV and STI landscape                            curative treatment of hepatitis C and
     to reform services and systems.                                    methods for monitoring antiviral
2.   Data and infrastructure: build on the
     strong evidence-base to identify and                              the widespread availability of
     address gaps in knowledge and integrate                            antiretroviral drugs to reduce the risk of
     BBV and STI translational,                                         transmission and prevent acquisition of
     epidemiological, behavioural, clinical and                         HIV
     social research to inform future health                           access to and successful rollout of a
     policies and programs, and ensure                                  highly efficacious vaccine for managing
     linkage and alignment with priority areas                          the prevalence and prevention of
     of action.                                                         hepatitis B, particularly improving uptake
3.   Health services and systems: to                                    among Aboriginal and Torres Strait
     discover, trial and evaluate innovative                            Islander people
     and sustainable models of healthcare to                           point-of-care tests for HIV, hepatitis C
     support the continuum of prevention                                and STI, which have been instrumental
     interventions and care services for people                         in providing same-day testing and
     at risk of or living with BBV and STI.                             treatment for vulnerable and
4.   Capacity and collaboration: encourage                              marginalised populations
     collaboration between researchers,                                dried blood spot testing for HIV and
     research centres, health providers,                                hepatitis C, allowing self-testing among
     community partners and peer-led                                    target populations
     organisations, and                                                the introduction of Gardisal®9, which
     key stakeholders focusing on policy and                            protects against nine types of human
     practice solutions.                                                papilloma virus
                                                                       the use of pathogen genomics and
Translation                                                             molecular epidemiology to enhance the
The elimination of BBV and STI as a public                              public health response.
health concern requires new technologies and
                                                                High-quality research from a broad range of
innovative approaches informed by up-to-date
                                                                perspectives (clinical, epidemiological, social,
research and evaluation. It also requires
                                                                and behavioural), has guided the
effective engagement with affected persons
                                                                development and implementation of these
and their communities to address
                                                                advances. However, there is scope for further
longstanding disparities and issues such as
                                                                research and innovation in practice to support
stigma and discrimination, the current lack of
                                                                the optimal adoption and scale-up by
treatment and prevention activities in custodial
                                                                identifying novel ways to engage the BBV and
settings, and challenges in connecting with
                                                                STI affected communities and remove barriers
marginalised and priority populations.
                                                                to diagnosis, testing and treatment uptake.

                     First National Blood Borne Viruses and Sexually Transmissible Infections Research Strategy 2021-2025   7
Ongoing research and innovation is required                      and STI control and prevention is the lack of
along the entire continuum of BBV and STI                        reliable, low-cost, point-of-care tests,
prevention, education, health promotion,                         particularly in rural and remote communities,
diagnosis, and treatment, cure and care                          and access to safe and effective self-tests.
services. This includes research that supports
                                                                 Research is measured as having impact when
targeting, simplifying and adapting services
                                                                 research findings are translated and
and programs with community needs,
                                                                 implemented to inform, drive and evaluate
removing barriers to accessing care, and
                                                                 effective social policies and health programs.
supporting entry into care and retention.
                                                                 Most health systems are faced with high
Innovation is not only required to develop new                   demand but have a limited budget with which
technologies, interventions, improved models                     to provide the necessary services. A cost-
of care and other approaches, but is also a                      effectiveness analysis can help determine the
key to nationwide scale-up of existing                           best use of limited funds available to promote
interventions proven to be effective and to use                  health, optimise prevention interventions and
existing tools more efficiently; adapting them                   care to maximise value for money.
for different populations, settings and                          Transforming and communicating the purpose
purposes. Research that delivers new                             and role of BBV and STI research and
methods to avoid wasteful interventions,                         effectively marketing its products and services
adopts best practice and fosters information                     to target marginalised and priority populations,
exchange will allow community organisations                      including through knowledge translation will
and clinicians to benchmark with peers and                       lead to positive clinical behavioural and
lead to continuous quality improvement. This                     societal changes.
includes the importance of data analyses,
mathematical modelling and health economics                      Data and Infrastructure
research and assessment of the efficiency of
                                                                 The National BBV and STI Strategies are
interventions at delivering outcomes.
                                                                 critical in guiding Australia’s ongoing health
Innovation in new diagnostics, prevention                        sector and community response, significantly
interventions, vaccines and curative                             reducing the transmission of BBV and STI,
treatments for BBV and STI will enhance                          improving clinical management, and reducing
impact and lead to improved health outcomes                      the impact of infection, stigma and
for people living with at risk of, or living with                discrimination. The costs of these
BBV and STI. Despite the major advances in                       interventions are assumed to be shared
the safety, potency and acceptability of                         across different parts of the health sector.
medicines and regimens, a number of areas                        However, the total costs of implementation to
remain where improvements are required and                       achieve the goals and targets set out in the
possible. For example, the current approach                      five National Strategies are unknown.
to treatment for chronic hepatitis B infection is
                                                                 Costing data, drawn from research across
complex, reflecting a risk-benefit approach
                                                                 demographic and population estimates,
driven by the lack of an effective curative
                                                                 including the costs of stigma, discrimination,
regimen. Also, while the advent of direct-
                                                                 human rights and legal issues, must be
acting anti-virals that cure hepatitis C
                                                                 reviewed and an evaluation of future costs
infections has been highly successful, there
                                                                 provided to Government. This will help inform
remains an urgent need for a prophylactic
                                                                 and build on the existing evidence-base, and
vaccine for the prevention of HIV and hepatitis
                                                                 translate research and costing data into future
C, to help reach elimination targets set by the
                                                                 investments from different levels of
WHO in Australia and globally. Additionally,
                                                                 government in the BBV and STI landscape.
one of the major barriers to advancing BBV

                        First National Blood Borne Viruses and Sexually Transmissible Infections Research Strategy 2021-25   8
Continuous improvement of data collections                             disaggregated to the regional,
and systems is important to support a                                  community and facility levels by age,
comprehensive understanding of BBV and                                 sex, population and location to better
STI in Australia. Cost-effective and systematic                        understand subnational epidemics,
solutions, including the better use of existing                        assess performance along the
data linkage resources, are required to                                continuum of BBV and STI services
facilitate continued improvement in the                                and guide more focused investments
completeness of reporting and accuracy of                              and services
estimates for notifiable BBV and STI in                               improve reporting of Aboriginal and
Australia. This will build on the strong                               Torres Strait Islander status in clinical
evidence-base, and the ongoing surveillance                            and pathological settings i.e. all relevant
and monitoring frameworks that are used to                             data and administrative collections
integrate BBV and STI data to support                                  including pathology request forms,
healthcare delivery, service improvement                               laboratory results and disease
and best practice.                                                     notifications.
Accurate data that are easily accessible in a                   An integrated national data framework, linking
timely fashion are critical to responsive                       and providing access to clinician and
research. This Strategy will support                            community captured data and surveillance
development and application of new                              information, will improve the effectiveness,
methodologies and opportunities for the                         efficiency, and quality and safety of clinical
research and analysis of factors that lead to                   service delivery to people living with BBV and
the transmission of BBV and STI as well as                      STI and yield benefits for consumers, the
the testing and evaluation of policies and                      community and the broader health system. It
interventions to improve health outcomes.                       will also allow a more accurate assessment of
Specialised research methods capable of                         the cascades of care, and evaluation of the
collecting meaningful data about population                     quality of monitoring and care provided to
groups that are often too small to be visible in                people living with BBV and STI.
population datasets are needed to understand
                                                                This research will not only address gaps in
community and cultural drivers of BBV and
                                                                existing data but will also identify, examine
STI transmission and opportunities for
                                                                and evaluate key changes in the epidemiology
prevention and enhanced intervention
                                                                of BBV and STI within priority populations,
engagement at the local level.
                                                                emerging issues and concerns and influences
This includes research to:
                                                                on people’s decisions with respect to risk
     identify gaps in policy and practice, and                 taking and seeking testing, treatment
      deliver tools to inform, monitor and                      and care.
      evaluate population health responses to
      BBV and STI. There is a need to                           Any data and infrastructure improvements,
      improve the timeliness and consistency                    however, will need to adhere to the National
                                                                Statement on Ethical Conduct in Human
      of data and knowledge at the national
      and state and territory levels to better                  Research (2007) and best practice
      support completeness and comparability                    governance along with the jurisdictional
                                                                guidelines on cultural security and
     improve the level of detail and                           competency.
      granularity of collected data to better
      identify trends and issues of concern in
      relation to specific priority and sub-
      populations. Data, where ethically
      permissible, should be appropriately

                       First National Blood Borne Viruses and Sexually Transmissible Infections Research Strategy 2021-25   9
Social research plays a significant role in                     The inclusion of primary care and affected
investigating the experiences and needs of                      communities in this research is of utmost
priority populations, and supports the                          importance to encourage well-designed,
targeting and outreach of services and                          culturally appropriate and impactful health
programs. Responding to the BBV and STI                         and social outcomes.
epidemics requires an in-depth understanding
                                                                Research is also not complete until the results
of where, when, how and among whom new
                                                                and findings are reported back to community
infections are occurring. This includes
                                                                groups and key stakeholders involved in the
identifying the social, cultural and structural
                                                                research. Ideally a partnership approach
factors that facilitate transmission of BBV and
                                                                should be taken from the conceptualisation
STI, and individual and community needs and
                                                                stage of research, with meaningful
preferences in terms of access to and use of
                                                                consultation and collaboration prioritised
relevant services. Prevention interventions,
                                                                throughout the research timeline. Participants
treatment and care programs can then be
                                                                should also have access to the data collected
prioritised and focused accordingly.
                                                                and be empowered to apply the research
A robust strategic and research led                             findings and recommendations. Strengthening
information system that analyses and                            research translation to guide interventions at
translates up-to-date research data on BBV                      the local and national level will better support
and STI into usable information can leverage                    the primary care and community sector
much needed political commitment. It will also                  workforce and ensure equitable and
create awareness and advocate for action                        appropriate access to care and services.
and resources, to set national targets, plan                    A cascade analyses of different populations
for a focused response, and implement                           and settings for BBV and STI to determine the
programs most efficiently in order to                           quality of services, service utilisation and
achieve greatest impact.                                        acceptability will identify gaps and
                                                                weaknesses in care services, inform possible
Health services and systems                                     remedial actions and help assess the effect of
The National BBV and STI Strategies include                     interventions, care and management. More
priority areas for action designed to support                   broadly, research into the social context of the
the achievement of goals and targets.                           lives of service users and those not engaged
Achievement of the WHO 2030 global health                       in care, investigating the specific experiences
targets requires a robust and flexible health                   and needs of marginalised and vulnerable
system with accessible and effective service                    populations will provide insight into effective
delivery models, and timely access to                           models of engagement. For example,
accurate health information. People living with                 research indicates that greater integration and
BBV and STI must receive the full range of                      linkage of BBV and STI primary care services
relevant health services they need along with                   with other relevant health services (broader
the prevention initiatives, both within the                     sexual and reproductive health, harm
community and in correctional facilities.                       reduction and alcohol and other drug use
                                                                disorders, blood safety, cancer prevention and
Research must be focused on discovering                         management, and non-communicable
innovative and sustainable community-                           diseases including mental health services)
centred models of service delivery, and                         can speed up progress towards key
identifying opportunities to improve patient                    milestones and targets and increase
management systems with a view to                               efficiency, access, acceptability
encounter future challenges, as well as                         and savings.
future costs and benefits.

                       First National Blood Borne Viruses and Sexually Transmissible Infections Research Strategy 2021-25   10
Identifying the best methods and approaches                      Research can sometimes be perceived as an
for delivering the continuum of BBV and STI                      imposition on communities and resources
services to different populations and in                         rather than as a means to reduce risk,
different locations, will help achieve equity,                   increase access and service delivery, and
ensure access to quality, and culturally                         improve health outcomes. It is important to
appropriate services, remove barriers to                         develop and foster a research culture in BBV
service access and maximise impact.                              and STI across Australia that embeds
A dynamic and informed community                                 research outputs as core business in strategic
engagement mechanism in BBV and STI                              planning, policy, capacity building and
research, particularly with priority populations,                workforce development strategies. Research
will also address stigma and discrimination                      activities must be valued and recognised as
and minimise the impact on the health of                         high quality and serving community needs.
people at risk of or living with BBV and STI.                    This will strengthen and enhance research
                                                                 literacy to enable and support national and
Overall health impact is boosted when service
                                                                 international collaborations, which will in turn
delivery approaches fit the realities and needs
                                                                 facilitate research translation to benefit
of consumers (especially marginalised and
                                                                 research participants.
priority populations) and end users, explore
opportunity costs and minimise inefficiencies,                   The success of BBV and STI research
use simplified and standard protocols, and                       depends largely on workforce capacity and
fully engage communities. There are                              talent. Building research and workforce
opportunities for further research and                           capacity includes enhancing the abilities of
innovation in all those respects.                                individuals, organisations and systems to
                                                                 undertake and disseminate high quality
Capacity and Collaboration                                       research efficiently and effectively, and the
                                                                 capacity of other sectors and stakeholders to
The Australian Government encourages
                                                                 engage with research and utilise knowledge
research whereby researchers, community
                                                                 derived from this process. In Australia,
organisations, affected communities and
                                                                 workforce capacity in BBV and STI research
policy makers are meaningfully involved in all
                                                                 has been built through long-term investments
stages of research priority setting and co-
                                                                 by governments in research centres so that
design – from development to application,
                                                                 skills, knowledge and mentorship occurs, and
building an understanding of the way
                                                                 relationships are built across communities
evidence is generated to allow for greater
                                                                 and research centres rather than just
integration between research and the use of
                                                                 individual researchers. This has been core to
evidence. Collaborative BBV and STI
                                                                 successful community-engaged research in
research can guide and respond to future
                                                                 BBV and STI prevention, treatment and care
health policy and programs. A strong and
                                                                 over many decades.
concerted approach increases the likelihood
that research will be timely, co-produced,                       BBV and STI responses in recent years, in
policy aligned and applied in practice to                        Australia and globally, have utilised research
improve lives and outcomes. This                                 breakthroughs in basic science and
collaboration can occur at inter- and intra-                     technologies, and demonstrated that it is
government levels, within primary care                           feasible to scale-up clinical and public health
settings, health services, community                             programs in challenging settings.
organisations and research centres, and
incorporate meaningful community
partnerships and consultation.

                        First National Blood Borne Viruses and Sexually Transmissible Infections Research Strategy 2021-25   11
It is vital that research be undertaken in
partnership with community-based
organisations and service providers, and that
a partnership approach is always taken in
identifying and pursuing research priorities.
Research collaboration with affected
communities must continue,
with the intent to stimulate innovation and
effectiveness, as this is crucial to achieve
targets and improved health and well-being
outcomes. This includes social, behavioural,
clinical and structural drivers for and barriers
to achieving optimal health outcomes across
areas of social impact such as sexual and
reproductive health, harm reduction, drug and
alcohol use disorders, sex work, mobility and
migration, stigma and discrimination,
particularly for marginalised and vulnerable
population groups.
Research training and skills development
should also be integral to the education of all
health service providers. Infectious disease
modelling, discovery, development, and
commercialisation of research cannot occur
without appropriate workforce capacity,
effective implementation and a means to
evaluate the impact this work has on quality
of life for people living with or at risk of BBV
and STI and the wider community.
The Government is willing to maximise
ongoing and effective partnerships and
shared goals amongst levels of government,
national peak organisations, the clinical
workforce, researchers, affected communities
and all funding bodies. Through collaboration,
researchers can be encouraged to adopt
entrepreneurial approaches, test the
implementation of science applications, and
look for opportunities to deliver tools to inform,
monitor and evaluate the population health
responses in Australia.

                        First National Blood Borne Viruses and Sexually Transmissible Infections Research Strategy 2021-25   12
4. Opportunities and Benefits
Research is vital in both supporting                            The Australian Medical Research and
the health system and community-                                Innovation Strategy 2016–2021 notes that an
based organisations towards a                                   improvement in health and well-being
                                                                provides additional benefits to the economy
tailored BBV and STI response. While
                                                                and to society. It:
research is sometimes invisible to the                             enhances productivity gains by
larger community on the frontline of                                  avoidance of premature mortality
care, these activities are often                                      and morbidity
operating behind the scenes to make                                    reduces care, carer and aids costs
a difference in the type, quality and                                  reduces loss associated with
effectiveness of health services, and                                   government transfers such as taxation
the care delivered.                                                     revenue forgone and welfare and
The National BBV and STI Strategies have                                disability payments.
capitalised on the significant headway in                       Targeted BBV and STI research will enable
technological advances, testing, care and                       researchers to answer questions about the
treatment approaches that have been made in                     causes, prevention, treatment, management
recent years in response to BBV and STI. The                    and minimisation of impact of disease. In
National Strategies for many years have also                    doing so, it will also provide comprehensive
prioritised high quality and innovative                         advice to governments, both at the
translational, epidemiologic and social                         Commonwealth and state and territory levels,
research that has enabled us to understand                      to provide certainty for research funding and
cultural and behavioural drivers of BBV and                     longer-term investment in this sector to
STI transmission, testing and treatment                         ensure improved outcomes. Long-term
uptake and engagement in care. Despite                          investment in BBV and STI research also has
efforts, the National Strategies identify trends                the potential to benefit the quality of research
of concern and gaps in the response. It is                      by retaining research expertise and engaging
critically important to continue to build on the                communities in a sustained manner.
strong evidence base for effectively
                                                                Collaborative efforts between communities,
responding to existing and emerging BBV
                                                                organisations, researchers and health
and STI issues and challenges.
                                                                professionals offer opportunities to combine
Maintaining a strong multi-disciplinary                         the strengths of all partners to identify
research agenda to inform and support the                       research priorities of most value to
implementation of the National BBV and STI                      communities, policy and practice.
Strategies is essential.

                     First National Blood Borne Viruses and Sexually Transmissible Infections Research Strategy 2021-2025   13
5. Key Areas for Action
This Strategy provides direction for                                    understand and address the barriers to
researchers to define, innovate and                                      services and support that affect health
accelerate the existing BBV and STI                                      seeking behaviours and overall access,
                                                                         e.g. stigma and discrimination
research agenda, requiring the
                                                                         experienced by marginalised and
research community to break new                                          priority populations
ground to:
                                                                        promote dynamic and informed
    support research that directly addresses                            community engagement in BBV and
     the National Strategies targets and                                 STI research, particularly that of
     uses process and impact evaluation                                  priority populations
     for validation
                                                                        encourage pioneering methods of
    address knowledge gaps to build the                                 evaluation, and research that validate
     evidence base to inform future priorities                           improved clinical testing and treatment
     for health policies and programs, and                               efficacy, leading to improved mortality
     ensure linkage and alignment with                                   rates, and quality of life outcomes
     priority areas of action
                                                                        address gaps in research literacy
    evaluate processes and impacts to
                                                                         among the BBV and STI sector
     validate proactive and new approaches
                                                                         workforce and support research
     to BBV and STI prevention, treatment,
     care, education and health promotion.
                                                                        ensure equitable and effective treatment
    deliver new methodologies and curative
                                                                         in all health service contexts,
     treatments, use existing tools more
                                                                         recognising the dignity of all, and the
     efficiently, and to adapt them for
                                                                         right and responsibility of individuals to
     different populations, settings
                                                                         own and participate in the achievement
     and purposes
                                                                         of their own health goals and outcomes
    encourage translational research aimed
     at preventing and eradicating BBV                                  understand the social contexts that
     and STI                                                             shape or influence health related
                                                                         practice and healthcare engagement
    evaluate the efficiency and affordability
     of interventions including cost-                                                 --------------------
     effectiveness analysis, return on                                  strengthen ongoing effective
     investment and budget impact                                        partnerships and shared goals amongst
     assessment through health                                           governments, community sectors, peak
     economics research.                                                 organisations, researchers, the
              ----------------------                                     workforce, communities and all
                                                                         funding bodies.

                      First National Blood Borne Viruses and Sexually Transmissible Infections Research Strategy 2021-2025   14
6. Governance and Implementation
The research and evaluation                                     Research entities make a valuable
underpinning the BBV and STI                                    contribution to the promulgation of evidence-
service environment over many years                             based policy. This Strategy defines the
                                                                process for validating the benefit of funded
has ensured substantial progress in
                                                                research towards the implementation of the
clinical, personal and social                                   National BBV and STI Strategies and ensures
responses to key issues. This has                               that research funded by the Commonwealth
resulted in greater clinical testing and                        supports the aims, objectives and targets of
treatment efficacy, population-level                            the current National Strategies, and beyond.
effectiveness, more socially informed
                                                                Grants are widely used to achieve
discourse towards addressing issues                             government policy outcomes that support
such as stigma and discrimination,                              Australia’s jobs, growth and innovation. The
and increased personal                                          Commonwealth Grants Rules and Guidelines
empowerment.                                                    (CGRGs) establish the whole-of-Government
                                                                grants policy framework, under which non-
The research pathway must follow a targeted
                                                                corporate Commonwealth entities undertake
approach to improve the availability,
                                                                grants administration. The CGRGs contain
appropriateness, effectiveness, efficiency,
                                                                key legislative and policy requirements, and
quality and safety of service delivery to yield
                                                                explain the better practice principles of
substantial benefits for consumers, the
                                                                grants administration.
community and the health system – one from
which future generations will benefit.                          The seven key principles for grants
The Australian Government is committed to                       administration that apply to the grants lifecycle
providing strong leadership by working across                   and all grant opportunities are:
portfolios, jurisdictions and key stakeholders                         robust planning and design
including community-based organisations to                             collaboration and partnership
achieve the goals of the National Strategies.
                                                                       proportionality
The Australian Government Department of
Health will ensure that the BBV and STI                                an outcomes orientation
research agenda remains responsive and                                 achieving value with relevant money
transparent and promote translation of                                 governance and accountability
research outputs into evidence-based policy
                                                                       probity and transparency
and practice.
                                                                Ensuring that the requirements of the CGRGs
The Strategy also recognises the                                are understood and effectively incorporated
considerable work already being progressed                      will ensure that potential grantees best suited
and encourages flexibility on how research                      to undertake grant activities apply for and
funds are distributed by Government. This can                   receive a grant. This will facilitate the
occur via an approach to market to undertake                    achievement of outcomes that align with the
a limited or open tender process, by an                         targets and priority areas for action in the
independent expert selection process, or by                     National BBV and STI Strategies.
direct funding to any eligible organisation.

                     First National Blood Borne Viruses and Sexually Transmissible Infections Research Strategy 2021-2025   15
The success of this Strategy is contingent
on productive partnerships between
Commonwealth, state and territory
governments, community-based
organisations, health professionals
and researchers.

Evaluation of effective research programs and
policies will also provide a more definitive
evidence base and inform the development of
subsequent National BBV and STI Strategies.
It also aims to enhance the conduct and use
of research to advance the BBV and STI
policy landscape, thus creating greater
impacts on BBV and STI outcomes, both now,
and into the future. This will further reduce the
rates of morbidity and mortality that impact
affected communities and the health system.

The Strategy will be reviewed in 2025, to align
with the National BBV and STI Strategies,
and ensure alignment with identified goals
and targets.

With this foundation, Australia can continue to
achieve great things, building on its reputation
as a world-leading model of best practice,
particularly in BBV and STI research
and innovation.

                        First National Blood Borne Viruses and Sexually Transmissible Infections Research Strategy 2021-25   16
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