The Role of Community in the HIV and AIDS Response

1. OVERVIEWWhere the Tide Will Turn: How is Community Level Participation Most Effective in Turning the Tide?Roxana Rogers, DirectorOffice of HIV/AIDS, Global Health BureauUnited States Agency for International Development (USAID) Washington

2. The Role of Community in the HIV and AIDS Response • The role of Community has been essential and multifaceted. • Community-based leaders, volunteers, workers and networks contribute immensely to the response and the achievements at different stages of the epidemic. • Over three decades, USAID has supported strategic community programs to ensure a sustained response.

3. Spectrum of Effective Community Interventions • In sub-Saharan Africa the community is uniquely positioned to effectively engage in the global HIV response through a spectrum of interventions: • Creating linkages between community and clinic • Care and support of people living with and affected by HIV, including orphans, women and families • Adherence support • Innovative economic strengthening activities • Facilitating the scale-up of treatment and prevention interventions

4. Evidence Summit Three evidence review teams were formed to review both peer‐reviewed and gray literature

6. Effects of CHW Program Factors on CHW Performance • Most studies limited in scope – only 1 or 2 program factors at most and few studies used rigorous methods • Key findings include: • Role definition important both for training needs and for how integrated into health system delivery • Training necessary but not sufficient to translate knowledge into practice • Motivation key to ensuring ongoing productivity and quality of CHW performance

7. Effects of Health System Factors on CHW Performance • Most literature focused on health workforce and service delivery building blocks • Findings indicate that CHWs: • Expand access to services in resource poor areas • Do not replace the need for facility-based services • Need clearly defined roles and responsibilities • Need an adequate supply chain • Need supportive management and supervision • Should have strong linkages with formal health system

8. Systematic Reviews Conclusions • Consistent common themes: • Well designed and clearly defined job descriptions • Appropriate pre-service and continuing in-service training • Supportive supervision and constructive feedback • Adequate financial and non-financial incentives • Adequate resources to ensure that CHWs are properly equipped and supplied • Systematic monitoring and evaluation of CHW performance • AND: • Support from local and national government • Effective linkages with formal health system

9. Assessment of the Reviewed Literature • No rigorous evidence on how formal health systems can do better to improve CHW performance • Very scarce evidence on the role of program design, launch, scale-up and continuous improvement in improving CHW evidence Yeah, but good luck getting it peer-reviewed

10. Finally …. While the tide cannot turn without clinical services; without the community, clinical services alone cannot turn the tide