Making HIV prevention programmes work

Instituto Nacional de Salud Pública, Cuernavaca, Mexico
The Lancet (Impact Factor: 45.22). 10/2008; 372(9641):831-44. DOI: 10.1016/S0140-6736(08)60889-2
Source: PubMed

ABSTRACT Even after 25 years of experience, HIV prevention programming remains largely deficient. We identify four areas that managers of national HIV prevention programmes should reassess and hence refocus their efforts-improvement of targeting, selection, and delivery of prevention interventions, and optimisation of funding. Although each area is not wholly independent from one another, and because each country and epidemic context will require a different balance of time and funding allocation in each area, we present the current state of each dimension in the global HIV prevention arena and propose practical ways to remedy present deficiencies. Insufficient data for intervention effectiveness and country-specific epidemiology has meant that programme managers have operated, and continue to operate, in a fog of uncertainty. Although priority must be given to the improvement of prevention methods and the capacity for the generation and use of evidence to improve programme planning and implementation, uncertainty will remain. In the meantime, however, we argue that prevention programming can be made much more effective by use of information that is readily available.

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    • "vention distribution will require the revitalization of sustainable national pri - mary health care systems . Long programmatized in iso - lation from systems for sexual and reproductive health , HIV policy implementation is inhibited by an absence of systemic infrastructures for the targeting , selection and delivery of prevention interventions ( Bertozzi et al . , 2008 ) . With the weakening of health systems and work - force resources limiting HIV testing and treatment ( Schneider et al . , 2006 ) , health system strengthening will be necessary to undertake interdependent interven - tions for universal testing , treatment and prevention – further integrating these services to sustain funding for all "
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    ABSTRACT: Given current constraints on universal treatment campaigns, recent advances in public health prevention initiatives have revitalized efforts to stem the tide of HIV transmission. Yet, despite a growing imperative for prevention-supported by the promise of behavioral, structural and biomedical approaches to lower the incidence of HIV-human rights frameworks remain limited in addressing collective prevention policy through global health governance. Assessing the evolution of rights-based approaches to global HIV/AIDS policy, this review finds that human rights have shifted from collective public health to individual treatment access. While the advent of the HIV/AIDS pandemic gave meaning to rights in framing global health policy, the application of rights in treatment access litigation came at the expense of public health prevention efforts. Where the human rights framework remains limited to individual rights enforced against a state duty bearer, such rights have faced constrained application in framing population-level policy to realize the public good of HIV prevention. Concluding that human rights frameworks must be developed to reflect the complementarity of individual treatment and collective prevention, this article conceptualizes collective rights to public health, structuring collective combination prevention to alleviate limitations on individual rights frameworks and frame rights-based global HIV/AIDS policy to assure research expansion, prevention access and health system integration.
    Public Health Ethics 11/2012; 5(3):263-282. DOI:10.1093/phe/phs034 · 1.27 Impact Factor
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    • "Consequently, there is a need for strategies that maximise their programmatic effectiveness , when introducing additional resources (Bertozzi, Laga, Bautista-Arredondo, & Coutinho, 2008). A growing body of evidence has identified a range of constraints to successful scaling up of global health initiatives at the country level, such as a lack of resources, weak policies at the health and cross-sectoral levels, weak systems and regulations, weak incentives to use inputs efficiently and bureaucratic and capacity problems (Bertozzi et al., 2008; Bourguignon & Sundberg, 2006; Brugha, Donoghue, & Starling, 2005; De Renzio, 2009; Halmshaw & Hawkins, 2004; Hanson, Ranson, Oliveira-Cruz, & Mills, 2003; Lu, Michaud, Khan, & Murray, 2006; Oomman et al., 2007; Radelet & Siddiqi, 2007; Stillman & Bennett, 2005). Others have pointed out the constraints generated by donor behaviour, such as un-harmonised donor interventions, long and tedious negotiation procedures with new donors and unclear and changing donor guidelines (Brugha et al., 2005, 2004). "
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    ABSTRACT: One of the biggest challenges in scaling up health interventions in sub-Saharan Africa for government recipients is to effectively manage the rapid influx of aid from different donors, each with its own requirements and conditions. However, there is little empirical evidence on how governments absorb knowledge from new donors in order to satisfy their requirements. This case study applies Cuellar and Gallivan's (2006) framework on knowledge absorptive capacity (AC) to illustrate how recipient government organisations in Lesotho identified, assimilated and utilised knowledge on how to meet the disbursement and reporting requirements of Lesotho's Round 5 grant from the Global Fund to Fight AIDS, TB and Malaria (Global Fund). In-depth topic guided interviews with 22 respondents and document reviews were conducted between July 2008 and February 2009. Analysis focused on six organisational determinants that affect an organisation's absorptive capacity: prior-related knowledge, combinative capabilities, motivation, organisational structure, cultural match, and communication channels. Absorptive capacity was mostly evident at the level of the Principal Recipient, the Ministry of Finance, who established a new organisational unit to meet the requirements of Global Fund Grants, while the level of AC was less advanced among the Ministry of Health (Sub-Recipient) and district level implementers. Recipient organisations can increase their absorptive capacity, not only through prior knowledge of donor requirements, but also by deliberately changing their organisational form and through combinative capabilities. The study also revealed how vulnerable African governments are to loss of staff capacity. The application of organisational theory to analyse the interactions of donor agencies with public and non-public country stakeholders illustrates the complexity of the environment that aid recipient governments have to manage.
    Social Science [?] Medicine 08/2011; 74(3):381-9. DOI:10.1016/j.socscimed.2011.07.020 · 2.56 Impact Factor
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    • "complexity and unclear implementation conditions encourage the use of irrelevant selection criteria like the public visibility of decision-makers and their agencies, the image and customer loyalty of health insurance companies, and personality profiling of managers (Bertozzi et al. 2008; Kliche 2011 "
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    ABSTRACT: AimDisease prevention and health promotion programs are standardized behavioral interventions that may be combined with contextual interventions. With optimized methods, they offer proven efficacy, efficiency, transparency, manageability, and rapid transfer of knowledge. Subject and methodsThis review summarizes their central barriers and success factors based on current research. ResultsImportant barriers to effective use of disease prevention and health promotion programs are low implementation fidelity, exaggerated flexibility subject to political change, inadequately trained and overworked personnel, disregard of context, change of implementation frameworks, lack of supportive contextual interventions, a plethora of programs, scarce resources and weak organizational support, resistance to social technologies, choices based on marketing criteria instead of effectiveness, and research gaps. Solutions include robust intervention plans, clear and comprehensive manuals, definition of intervention core and periphery, organizational and leadership support, qualification of users, systematic adaptation to local conditions, and quality assurance/monitoring of acceptance and effectiveness. ConclusionBoth users and decision-makers should demand proof of effectiveness of program choices and should adhere to quality assurance procedures during implementation. Program development and evaluation should ensure (1) the definition of core intervention components, (2) instructions for adaptation of programs to specific contexts, (3) basic data on resources required for implementation, and (4) evidence of program effectiveness. KeywordsDisease prevention–Health promotion–Health education–Program–Implementation–Quality assurance
    Journal of Public Health 08/2011; 19(4):283-292. DOI:10.1007/s10389-011-0413-7 · 2.06 Impact Factor
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