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Introduction to Impact Evaluation: What is it and why do we use it Male Circumcision Impact Evaluation Meeting Johannes

Efficacy vs. Effectiveness . Efficacy ? the effect under ideal circumstances (i.e. laboratory, clinical trials)Effectiveness ? the effect under real world circumstances ; aka Impact Evaluation. Efficacy Trials for HIV Prevention: Measuring Progress. Source: Padian, McCoy, Balkus,

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Introduction to Impact Evaluation: What is it and why do we use it Male Circumcision Impact Evaluation Meeting Johannes

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    1. Introduction to Impact Evaluation: What is it and why do we use it? Male Circumcision Impact Evaluation Meeting Johannesburg, South Africa January 18-23, 2010 Nancy Padian UC Berekeley

    2. Efficacy vs. Effectiveness Efficacy – the effect under ideal circumstances (i.e. laboratory, clinical trials) Effectiveness – the effect under real world circumstances ; aka Impact Evaluation

    3. Efficacy Trials for HIV Prevention: Measuring Progress More than 25 years since the advent of the HIV epidemic, few prevention interventions have been implemented at scale. In 2007, for every 2 patients that initiated antiretroviral therapy, five more were infected. And the gap between the need for HIV prevention programming and its availability is staggering. For example, in the generalized epidemics in sub-Saharan Africa, only 12% of men and 10% of women know their HIV status. (Only one third of HIV positive pregnant women in low- & middle-income countries received ARV prophylaxis to prevent MTCT (2007)) More than 25 years since the advent of the HIV epidemic, few prevention interventions have been implemented at scale. In 2007, for every 2 patients that initiated antiretroviral therapy, five more were infected. And the gap between the need for HIV prevention programming and its availability is staggering. For example, in the generalized epidemics in sub-Saharan Africa, only 12% of men and 10% of women know their HIV status.

    4. What did the efficacy trials tell us about MC? Efficacy data from three countries Reduces female-to-male transmission Acceptable procedure Negligible short term risk compensation in the context of a method of unknown efficacy

    5. Efficacy vs. Effectiveness Efficacy – the effect under ideal circumstances (i.e. laboratory, clinical trials) Effectiveness – the effect under real world circumstances / the effect at scale; aka Impact Evaluation

    6. Why might effectiveness/impact be different at scale in the real world? EXERCISE: Identify 3 reasons why an effectiveness trial results would be different from those in an efficacy trial.

    8. What effects/outcomes might be relevant or different in a real-world effectiveness trial? EXERCISE: Identify 3 other outcomes you would be interested in assessing in an effectiveness trial

    9. What might we measure in effectiveness trials? Direct effects on female partners Population level effects of the program at scale Effectiveness on other outcomes: STIs, cervical cancer Data on behavioral dis-inhibition now that it has proven efficacy (especially long term effects) and exactly what behavioral messages to pair with promotion Most effective and cost effective methods of delivery

    10. How can we turn this… This graph illustrates the global percentage of most-at-risk populations reached with HIV prevention programs. Of the countries reporting these data, only 60% of sex workers and 40% of MSM knew where they could receive an HIV test and obtain condoms. And only 46% of IDUs reported knowing where they could receive an HIV test and be provided with condoms and sterile injecting needles and syringes.This graph illustrates the global percentage of most-at-risk populations reached with HIV prevention programs. Of the countries reporting these data, only 60% of sex workers and 40% of MSM knew where they could receive an HIV test and obtain condoms. And only 46% of IDUs reported knowing where they could receive an HIV test and be provided with condoms and sterile injecting needles and syringes.

    11. …into this? This graph illustrates the global percentage of most-at-risk populations reached with HIV prevention programs. Of the countries reporting these data, only 60% of sex workers and 40% of MSM knew where they could receive an HIV test and obtain condoms. And only 46% of IDUs reported knowing where they could receive an HIV test and be provided with condoms and sterile injecting needles and syringes.This graph illustrates the global percentage of most-at-risk populations reached with HIV prevention programs. Of the countries reporting these data, only 60% of sex workers and 40% of MSM knew where they could receive an HIV test and obtain condoms. And only 46% of IDUs reported knowing where they could receive an HIV test and be provided with condoms and sterile injecting needles and syringes.

    12. The Evaluation Gap in Scaling Up Scaled-up programs are rarely evaluated systematically Inhibits documentation of success and prevents distinction between fact and story Rigorous evaluation methods link inputs and impact (i.e. Impact Evaluation) Without such evaluations, policy decisions are based on scanty information from small-scale experiences combined with a large doses of opinions and politics More than 25 years since the advent of the HIV epidemic, few prevention interventions have been implemented at scale. In 2007, for every 2 patients that initiated antiretroviral therapy, five more were infected. And the gap between the need for HIV prevention programming and its availability is staggering. For example, in the generalized epidemics in sub-Saharan Africa, only 12% of men and 10% of women know their HIV status. (Only one third of HIV positive pregnant women in low- & middle-income countries received ARV prophylaxis to prevent MTCT (2007)) More than 25 years since the advent of the HIV epidemic, few prevention interventions have been implemented at scale. In 2007, for every 2 patients that initiated antiretroviral therapy, five more were infected. And the gap between the need for HIV prevention programming and its availability is staggering. For example, in the generalized epidemics in sub-Saharan Africa, only 12% of men and 10% of women know their HIV status.

    13. This graph illustrates the global percentage of most-at-risk populations reached with HIV prevention programs. Of the countries reporting these data, only 60% of sex workers and 40% of MSM knew where they could receive an HIV test and obtain condoms. And only 46% of IDUs reported knowing where they could receive an HIV test and be provided with condoms and sterile injecting needles and syringes.This graph illustrates the global percentage of most-at-risk populations reached with HIV prevention programs. Of the countries reporting these data, only 60% of sex workers and 40% of MSM knew where they could receive an HIV test and obtain condoms. And only 46% of IDUs reported knowing where they could receive an HIV test and be provided with condoms and sterile injecting needles and syringes.

    14. How can we address these gaps? Educated estimates about the translation between efficacy and effectiveness (it will almost always be lower) Use modeling to estimate effectiveness as well as the other parameter values and outcomes of interest Use study designs and analytic techniques that permit empirical assessments of impact

    15. What does impact mean? Impact originally means “effect of something on something else” In impact evaluation, is it the portion of the observed change in an outcome caused by or attributed to the intervention of interest

    16. Impact Evaluation Answers… More than 25 years since the advent of the HIV epidemic, few prevention interventions have been implemented at scale. In 2007, for every 2 patients that initiated antiretroviral therapy, five more were infected. And the gap between the need for HIV prevention programming and its availability is staggering. For example, in the generalized epidemics in sub-Saharan Africa, only 12% of men and 10% of women know their HIV status. (Only one third of HIV positive pregnant women in low- & middle-income countries received ARV prophylaxis to prevent MTCT (2007)) More than 25 years since the advent of the HIV epidemic, few prevention interventions have been implemented at scale. In 2007, for every 2 patients that initiated antiretroviral therapy, five more were infected. And the gap between the need for HIV prevention programming and its availability is staggering. For example, in the generalized epidemics in sub-Saharan Africa, only 12% of men and 10% of women know their HIV status.

    17. When can you do Impact Evaluation (IE)? More than 25 years since the advent of the HIV epidemic, few prevention interventions have been implemented at scale. In 2007, for every 2 patients that initiated antiretroviral therapy, five more were infected. And the gap between the need for HIV prevention programming and its availability is staggering. For example, in the generalized epidemics in sub-Saharan Africa, only 12% of men and 10% of women know their HIV status. (Only one third of HIV positive pregnant women in low- & middle-income countries received ARV prophylaxis to prevent MTCT (2007)) More than 25 years since the advent of the HIV epidemic, few prevention interventions have been implemented at scale. In 2007, for every 2 patients that initiated antiretroviral therapy, five more were infected. And the gap between the need for HIV prevention programming and its availability is staggering. For example, in the generalized epidemics in sub-Saharan Africa, only 12% of men and 10% of women know their HIV status.

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