| کلیدواژههای انگلیسی مقاله |
HIV, Acquired immune deficiency syndrome, Health priorities, Research, Iran, What&,rsquo s Known HIV/AIDS continues to be a major public health challenge, particularly in low- and middle-income countries. Iran is experiencing a concentrated epidemic, requiring specifically tailored research and interventions. While key research areas, including prevention, treatment, epidemiology, and co-infections, are being studied, a comprehensive assessment of their quality and relevance is lacking. What&,rsquo s New This study identified 11 key research areas and 60 specific sub-areas to guide targeted HIV/AIDS research in Iran. It emphasized the critical need to enhance the quality of studies, particularly in laboratory research and co-infections. HIV/AIDS research priorities in Iran were identified using a systematic review, a tailored research matrix, and a rigorous three-round Delphi consensus process involving national experts. IntroductionHuman immunodeficiency virus (HIV), the causative agent of acquired immune deficiency syndrome (AIDS), has remained one of the most critical global health challenges for the past four decades since its emergence. 1, According to the World Health Organization (WHO), approximately 39 million people were living with HIV in 2022, with 1.3 million new infections reported that year. 2, The infection has profoundly impacted millions of lives, contributing to poverty, homelessness, school dropout rates, discrimination, and loss of opportunities, with low- and middle-income countries being disproportionately affected. HIV has also impeded critical development goals, including poverty reduction, lower child mortality, improved maternal health, increasing access to primary education, and promoting equal rights for all. 3, According to the latest available report from the Iranian Ministry of Health, as of June 2023, the national HIV electronic data system had registered a total of 46,320 HIV cases (82% men, 18% women) and 22,415 documented deaths. 4, Current evidence indicates that the HIV epidemic in Iran remains concentrated, with a prevalence of less than 1% in the general population. 5, However, without timely and effective interventions, the conditions are highly favorable for a broader spread of the virus. 6, Despite the relatively low general prevalence, Iran faces unique challenges in HIV control. These challenges include persistent social stigmas surrounding HIV, inadequate access to harm reduction programs for people who inject drugs (PWID), a shift in transmission patterns from injection drug use to sexual transmission, and limited care availability for marginalized populations. 7, - 9, These challenges underscore the need for nuanced, contextualized research and targeted interventions to address the epidemic effectively.As HIV infection spans various dimensions, from molecular to social and political, its control necessitates a comprehensive approach involving active collaboration among policymakers, healthcare providers, and researchers. Effective prevention and care for individuals living with HIV and AIDS requires an in-depth understanding of the epidemic&,rsquo s profile in each region, 10, which can only be obtained through rigorous and standardized research. 11, In Iran, this need is particularly critical due to unique challenges, including stigma, shifting transmission patterns, and inadequate access to harm reduction programs. Despite these pressing issues, a significant lack of data in the current literature hinders a comprehensive response, underscoring the urgent need for targeted research to inform evidence-based interventions. 12, Health research is a cornerstone of public health advancement and the pursuit of equity, especially in low- and middle-income countries. 13, However, conducting research requires skilled personnel, substantial financial resources, and time. Given the scarcity of resources alongside extensive health needs, prioritizing research activities is crucial to ensure their optimal allocation. 14, Thus, prioritization is a key management process for enhancing the effectiveness and impact of health research.The Medical Commission conducted the first national health research prioritization in Iran between 1992 and 1994. Since 1995, this responsibility has been held by the Deputy of Research at the Ministry of Health and Medical Education. 15, A notable subsequent effort was a study led by Owlia and colleagues, which was conducted in collaboration with all medical universities and key stakeholders using the enhanced national health research strategy (ENHRS). This initiative identified national health research priorities through needs assessments at the university level, identifying HIV as a priority communicable disease. 16, Another study by Haghdoust and colleagues in 2008 aimed to determine research priorities for HIV and AIDS. It highlighted key areas, including education, national-level management, estimating the size and prevalence of HIV among high-risk groups and the general population, and exploring innovative prevention methods. 17, Similarly, a 2014 systematic review of HIV-related studies in Iran, which searched national and international databases, emphasized prioritizing epidemiological research on high-risk groups. 18, While these studies have provided valuable insights, they do not fully address the evolving dynamics of the HIV epidemic in Iran, such as the shift in transmission patterns and the needs of marginalized populations. Updated and targeted research prioritization is urgently required to address these gaps and to develop contextually relevant and effective interventions. 19, This study aimed to identify and prioritize research needs in the field of HIV/AIDS in Iran. Despite the recognized importance of such research, prior studies have been limited, highlighting the urgent need to address gaps and establish priorities, particularly within the context of constrained resources. The main innovation of this study lay in its combined application of a systematic review and a three-stage Delphi method, aligned with a locally contextualized research matrix. Unlike previous studies that relied solely on expert opinions or single-method approaches, this study integrated quantitative evidence mapping with expert consensus to identify research gaps and local priorities tailored to the Iranian context.Materials and MethodsThis study, conducted by epidemiologists at Isfahan University of Medical Sciences between May 2018 and March 2023, employed a multi-method approach to identify and prioritize HIV/AIDS research priorities in Iran. The methodology integrated a systematic review of peer-reviewed literature, a three-round Delphi technique to establish expert consensus, and expert consultations to gather practical insights from field practitioners. Phase 1, Preparation of the HIV Research Matrix The preparation of the HIV research matrix was conducted in two stages to ensure a comprehensive and contextualized framework for identifying research priorities in Iran. In the first stage, a structured search was performed in international databases to identify global and regional HIV research areas and sub-areas, including guidelines, protocols, and international reports. Recognized global resources were included to ensure alignment with evidence-based practices and internationally accepted standards. These resources included WHO guidelines, which provide a globally recognized framework for health policies and practices UNAIDS reports, which serve as key references for coordinating the global HIV response guidelines from the International AIDS Society (IAS) and the International :union: against Sexually Transmitted Infections (IUSTI) for insights into clinical management. Furthermore, official resources from the Centers for Disease Control and Prevention (CDC) and various government portals were selected to reflect diverse national and regional HIV policies.A broad search of peer-reviewed literature was conducted using major academic databases, including Medline, PubMed Central, Embase, the Cochrane Library, Scopus, Web of Science, Ovid, NICE, and SIGN. This comprehensive search ensured coverage of medical, pharmacological, clinical, and interdisciplinary studies, as well as evidence-based guidelines. A structured search strategy employed relevant keywords related to HIV/AIDS, interventions, services, and prioritization. The search process involved two components, a broad search of all areas of HIV research globally and a targeted search focused specifically on HIV research in Iran. The global search encompassed interventions, services, and prioritization, while the Iran-specific search concentrated on high-risk groups, behaviors, research methods, and surveillance.The search process was conducted without time constraints to include both historical and recent studies. Two independent epidemiologists screened and reviewed the documents based on pre-defined inclusion and exclusion criteria. Any disagreements regarding document inclusion were resolved through discussion. If a consensus could not be reached, a third senior epidemiologist was consulted to make the final decision. The inclusion criteria encompassed documents directly related to HIV/AIDS research, including guidelines, protocols, or strategic reports providing data on HIV research priorities in global settings. Study designs spanning clinical, social, and epidemiological research were included. Exclusion criteria involved removing duplicate records, inaccessible full-text documents, and publications unrelated to HIV research priorities. Non-English or non-Persian documents were also excluded after the initial screening. Based on the extracted information, a multidimensional HIV research matrix was developed to detail global areas and sub-areas of HIV research.In the second stage, the draft HIV research matrix was reviewed and refined during three expert meetings with HIV specialists and researchers. These sessions involved a detailed analysis of national-level documents, such as the national HIV program, strategic HIV reports, international expectations for Iran, priorities identified by the AIDS department, and inputs required for specific estimation models. Various aspects of the HIV research matrix were modified and contextualized to align with Iran&,rsquo s unique needs and challenges. This phase, which lasted from May 2018 to February 2020, resulted in a tailored HIV research matrix that integrated global best practices with national priorities and served as the foundation for subsequent phases of the study. Phase 2, Mapping of Studies Conducted in Iran In this phase, a structured review was conducted following the PRISMA protocol to examine all documents and studies related to HIV and high-risk groups in Iran, published up to March 2023. The review was performed by two HIV research experts who searched both domestic (SID, IranMedex, and Magiran) and international databases and search engines (PubMed, Scopus, Google Scholar, and Web of Science). Keywords were selected using MeSH and Emtree terms, and a comprehensive search strategy was developed (table 1,).Part A. Keywords used to prepare research matrix |