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A Review of HIV Prevention in National Strategic Plans in 12 African Countries with Generalized HIV Epidemics Is our focus in line with the evidence?. Questions. PMTCT in NSPs. Male circumcision in NSPs. Condom programming in NSPs. Multiple including concurrent sexual partnerships.

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  1. A Review of HIV Prevention in National Strategic Plans in 12 African Countries with Generalized HIV EpidemicsIs our focus in line with the evidence?

  2. Questions

  3. PMTCT in NSPs

  4. Male circumcision in NSPs

  5. Condom programming in NSPs

  6. Multiple including concurrent sexual partnerships

  7. ART for prevention in NSPs

  8. Targeted programs for key populations

  9. HIV testing in NSPs(HCT, CT, VCT, etc)

  10. Key issues • Overlapping agendas and fragmentation • Focus on interventions, for which HIV prevention impact is limited /indirect (VCT, STI) or which are generic • Justified focus on PMTCT (narrow) and blood safety, which, however, will not have major effects on trajectory of the epidemic • Little focus on proven high-impact interventions (male circumcision) with the potential to change the course of generalized epidemics of Southern/East Africa • Too little focus on key populations in mixed epidemics of West/Central Africa Source of data: Amicoet al. 2012: (using 2008 National AIDS Spending Assessments)

  11. HIV Prevention (excl. ART): Funding (USD) per Estimated Expected New HIV Infection in Africa

  12. Synthesis: Are we doing the right things? (Focus) • All NSPs based on reviews of evidence (KYE/KYR) • Most NSPs do not omit core interventions (exception: MCP reduction formulated vaguely within SBCC) • Limited prioritization: • “Basket of services” instead of focused combination of high-impact interventions • Some NSPs addressing wide social causes rather than specific action to prevent HIV (comparative advantage of HIV programs?) • Consensus-based process favours broad inclusive interest-based strategies (rather than focused evidence-based ones)

  13. Synthesis: Are we designing prevention plans well? (Quality) • All plans apply a results-based methodology, include M&E frameworks, targets and operational plans • Partially vague activity-impact pathways (eg demand, behavior change) • Costing often external to the process -> lack of reality check during shaping delivery models, lack of benchmarks for cost-efficiency comparison

  14. Synthesis: Are our strategies suitable for scale up? • Clear drive towards scale up in all NSPs, but many plans more aspirational than practical • Activities detailed in operational plans (or sub-strategies) • Limitations in transforming targets in service utilization and SBCC into realistic process targets (eg required number of health and community workers etc.) • Management: reference to co-ordination/M&E at decentralized levels, but no consistent performance-based (business-style) models of decentralization

  15. Acknowledgements Research team: • Allison HerlingRuark • Norman Hearst • Nicole Fraser • Helen Jackson • MarelizeGorgens

  16. Thank youTatendaSiyabonga

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