kevin kelly - cadre, south africa

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Management Sciences for Health

MSH Building Local Capacity Project

Stronger health systems. Greater health impact.

HIV Prevention Communication Training: New evidence, new thinking

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BLC Project Overview:

• BLC supports local and regional institutions to

improve health care and HIV prevention services by

strengthening both technical leadership and

management capacity

• Regional and country activities

• 6 countries

• Regional organizations• Key Program Areas

• Capacity Building,

• Care & support for

OVC

• HIV prevention

• Community-based

care

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BLC Project: HIV prevention

• BLC supports the SADC HIV Unit to strengthen

its strategic leadership role for HIV Prevention

and build the HIV prevention capacity of

member states.

• Partnership with SADC HIV Unit and Centre for

AIDS Development Research and Evaluation

(CADRE)

• Target group: HIV program managers in

Government

( Ministry of Health, Education), National AIDS

Council, and CSO partners

• Pilot in Swaziland prior to roll out in the region

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New evidence – new thinking

• Based on extensive review of literature and existing materials

• Facilitation processes and communication materials piloted in five trainings in Tanzania, Zimbabwe, and South Africa

• 115 individuals involved representing 50 CSOs, international NGOs, and government departments

• Modularized training curriculum with 10 half-day presentations and workshop processes with exercises

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What have we learned about

existing prevention capacity?

• Significant gaps and missed opportunities: HIV care and support, HBC, OVC programs, family planning, HCT

• Widespread difficulty in grasping more abstract concepts: partial protection, targeting general population, sero-discordance

• Significant variation by country

• Little diffusion of understanding of new thinking to local levels and little evidence of learning from or sharing of experiences

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What have we learned (Cont)

• Direct community prevention interventions are usually project-based rather than strategic or continuous

• Low dose, opportunistic, event-focused HIV prevention efforts with little consideration of local dynamics of transmission, selection, or targeting

• Largely information based; little understanding or use of communication or social and behavioural methodologies, multilevel or combination strategies, results-based management, or local level collaboration or long-term strategic thinking

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Foundations of prevention

thinking in the training programOriented and focused on:

• Theory of change, combination prevention, social ecology framework, results-based management approaches

• Addressing modes and dynamics of transmission

• Role of communication in social and behavioralchange

• Evidence-based thinking at local level (KYE, KYR)

• ‘Options’ for prevention and offering combination prevention options

• Basic science of HIV/AIDS

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Format

• Participants seated at tables of four people to allow for small group discussion at key moments in the presentations

• Each presentation is followed by a practical exercise conducted in small groups to localize, contextualize, and develop practical understanding of key concepts

• Each day begins with a review of overnight questions and ends with a reflection on the day’s learning experiences

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Structure

BLOCK 1 – Know your epidemic - Know your response

Module 1: Know your epidemic - Big picture and country picture

Module 2: How HIV works

Module 3: Reviewing prevention options - Know your response

BLOCK 2 – Plan your response

Module 4: A social ecology approach to prevention planning

Module 5: Communication for HIV prevention

Module 6: Combination prevention

Module 7: Managing for outcomes

BLOCK 3: Targeting key drivers of infection

Module 8: Addressing dynamics of generalized epidemics

Module 9: Addressing the needs of high-risk populations

Module 10: PHDP

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BLOCK 1 –Know your epidemic -Know your response

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BLOCK 2 –Plan your response

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MSH Building Local Capacity ProjectImage: Faraja Trust

BLOCK 3: Targeting key drivers of infection

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Challenges

• National strategic frameworks may reflect new advances

in HIV prevention, but may not outline how advances

may be incorporated in implementation plans at a

programme, project and community level.

• Need for concerted efforts to translate new evidence

about HIV prevention needs and effectiveness into

practice

• This may require departure from standard approaches;

and the need to ‘reboot’ in some areas (paradigm shift)

rather than ‘infuse’ new understanding

• Approach may require some departure from existing

commitments and programmatic approaches and this

can prove challenging to secure.

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Solutions

• Adapt the program in each country, keeping with local

HIV dynamics and implementation conditions or

opportunities

• Allow for considerable lag-time before capacity building

efforts to support the approach are adopted by most-

relevant country-level agencies

• Approach appears to be best supported by existing plans

to implement combination prevention and existing

communication frameworks which cut across a range of

implementing agencies

• Social ecology approach allows bridging the gap

between developmental and ‘topical’ approaches to

prevention in country level prevention approaches

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Stronger health systems. Greater health impact.

Saving lives and improving the health

of the world’s poorest and most vulnerable people

by closing the gap between knowledge and action in public

health.

kevin kelly - cadre, south africa

Health & Medicine