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Combination Prevention and Evaluation . Introduction Sam McPherson International HIV/AIDS Alliance. Recap of this morning’s Plenary on ‘Combination HIV Prevention’ by Carlos F. Cáceres. Frontiers Prevention Program. INTERMEDIATE OUTCOMES. PURPOSE. GOAL. Enabling Environment.
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Combination Prevention and Evaluation Introduction Sam McPherson International HIV/AIDS Alliance
Recap of this morning’s Plenary on ‘Combination HIV Prevention’ by Carlos F. Cáceres
Frontiers Prevention Program INTERMEDIATE OUTCOMES PURPOSE GOAL Enabling Environment Decrease in KP risky behaviour Empowerment for prevention for KPs Decrease in HIV Incidence in site Decrease in HIV Incidence amongst KPs Service and Commodity provision for KPs Decrease in KP STI Prevalence Presented by H. Gayle in Bangkok 2002 – similar to Avahan and APSACS
What is Combination Prevention? • Recapitulating: Analogy to combination treatment Cited by Coates et al., 2008
“The strategic, simultaneous use of different classes of prevention activities (biomedical,behavioral, social/ structural) that operate on multiple levels (individual, relationship, community, societal), to respond to the specific needs of particular audiences and modes of HIV transmission, and to make efficient use of resources through prioritizing, partnership and engagement of affected communities”
Biomedical intervention strategies: • Improved STI services; Appropriate & accessible clinical services; • Opiod substitution therapy, detox; • Male circumcision • PMTCT services – ARV prophylaxis • ART for prevention • Etc. • ; Biomedical Behavioural Structural (Social and cultural, Political and economic; Physical) Behavioural interventionstrategies: Behaviour change communication School based HIV education; Peer-led advocacy and persuasion Couseling Influence cost of access to services Etc. • Political andeconomic intervention strategies: • Human rights programming; • Prevention diplomacy with leaders at all levels; • Community Microfinance/microcredit • Training/advocacy with police, judges; • Engaging leaders • Stakeholder analysis & alliance building; • Strategic advocacy; • Regulation/deregulation; • Etc. • ; • Social and cultural intervention strategies: • Community dialog and mobilization • Advocacy and coalition building for social justice • Media and interpersonnal communication to clarify values, change harmful social norms; • Education curriculum reform, expansion and quality control • Etc. SYNTHESIS Gap Analysis Biomedical • Intervention strategies addressing physical environment: • Housing policy and standards • Access to land; subsistence; • Infracstructure development – transportation, communications, etc. 7
The challenge for evaluation… • ‘Null’ evaluations • ‘crisis of confidence’ for prevention AND a ‘crisis of confidence’ for evaluation • Combination prevention requires ‘combination evaluation’ (UNAIDS, 2009)…
How do we ‘DO’ combination evaluation?? • Clarity on the ‘theories of change’ • - What are the causal relationships (impact pathways) that we need to evaluate? • Measurement issues • - Can we measure these interventions and their outcomes ? • Attribution • - How do we know what causes change? • Dosage • What kind of mix of interventions work in different contexts? • Scale • How can we evaluate large-scale combination prevention programmes?