program – science initiatives: scope and applications james blanchard, md, mph, phd director,...
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Program – Science Initiatives:Scope and Applications
James Blanchard, MD, MPH, PhDDirector, Centre for Global Public Health
University of Manitoba
Program-Science Initiatives: Overview
• Purpose:– To improve the impact of HIV/STI prevention
programs by optimizing the design, implementation and management processes
• Program-centered• Dynamic interaction between program and
policy leaders and implementers and the science community:– Multiple program domains– Multiple science domains
Program-Science Initiatives: Purpose and Objectives
• “Internal” Objectives:– To identify and address the key knowledge gaps related
to program design, implementation and management– To establish an interactive and iterative process of
knowledge translation to optimize program impact on the population level
• “External” Objectives:– To expand the knowledge base with respect to HIV
prevention program planning, implementation and management
– To facilitate knowledge translation to other contexts– To build capacity in research and program domains for
linking programs to science, and science to programs• Methodology development for knowledge development and
translation• Program management processes and tools
Different Contexts for Program-Science Initiatives
• Epidemic typology
• Status of the program response
Concentrated Epidemics
• Transmission dynamics relatively well-defined, with strategic uncertainty related to the mix and interaction of key populations
• Implementation issues related to the right combination of intervention components, changing dynamics with key populations, etc.
• Program management issues related to scaling up, program quality, monitoring and evaluation, sustainability, etc.
• Methods for evaluating population-level impact• External value in translating knowledge from
successful large-scale programs (e.g. India) to other contexts
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Pakistan – Relative Size of Key Populations, per 1000 Adult Men
Estimated Total Number of Sex Partnerships per Month, x 1,000
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10 16 25
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Karachi Lahore Faisalabad Multan
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FSW MSW Hijra
Pakistan – Sexual Partnerships for Key Populations in Different Cities
Existence of a targeted intervention project is not enough… Sargodha
• Experienced NGO implementing IDU intervention
• Focus on fixed site needle/syringe exchange, clinical services, etc.
• HIV counseling and testingNGO Project Data (2005-6)
Mapping and IBBA Data (2007)
Estimated # IDU 1,050 2100-2800
Number of IDU spots Approx. 100 216
IDUs per spot Approx. 10 11
HIV prevalence 9.5% 51.5%
Sargodha… Data to action
• Outreach micro-planning based on hotspot mapping
• Recruit “street doctors” for outreach, safer injection
• Within 1 month the total # of IDUs contacted doubles
• HIV prevalence at VCT increases to 40% in the next few months
Mixed and Generalizing Epidemics
• Key strategic questions:– Methods for assessing the epidemic and transmission
dynamics– Focusing on the right populations, networks and behaviours– Resource allocation and mix of targeted and generalized
prevention initiatives• Implementation / effectiveness issues:
– Translation of programs for high risk key populations from other contexts, scaling up, etc.
– Choosing and/or testing methods for altering the sexual structure for prevention impact
– Evaluating the impact of combined / complex interventions• Program management issues:
– Optimizing management structures for combination / complex interventions
– Health system issues and approaches– Processes for scaling up
Country/State Level Program-Science Initiative: Basic Structure
(straw man)Program / Polic
yGrou
p
Science
Group
Program-
Science
Group
Country / State led Selected externals
Multi-disciplinary Purpose-built Includes country scientists
Program Science Components – Activity Diagram
Population FocusPrevention
Objectives
Strategic Planning
EpidemiologyTransmission
Dynamics
Coverage
Quality
Impact
Program Management
Scale-up
Operations ResearchHealth Services
Evaluation
Intervention Design & Mix
ImplementationPlanning
EfficacyEffectiveness
Program-
Science Group
Externalizing concepts, knowledge, methods, tools, etc.
Population
Focus
Prevention
Objectives
Strategic Planning
EpidemiologyTransmission
Dynamics
Coverag
eQualityImpact
Program Management
Scale-up
Operations ResearchHealth Services
Evaluation
Interventi
on Design & Mix
ImplementationPlanning
EfficacyEffectiveness
Program-
Science Group
Dissemination
Program and Policy
Constituencies
Science Constituenci
es
Program Science Initiative(s)
Some issues to consider…
• Where can we begin “in vivo”…– Region?– Country?– State / province?
• How is a “program science consortium” comprised?
• What is the pathway and milestones?• How do initiatives and structures in N.
America and Europe intersect with other global initiatives?
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