Transcript Title… - University of Manitoba

Program – Science Initiatives:
Scope and Applications
James Blanchard, MD, MPH, PhD
Director, 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
Pakistan – Relative Size of Key Populations,
per 1000 Adult Men
10
8
FSW
HSW/MSW
IDU
6
4
2
Fa
n
ul
ta
M
is
a
la
ba
d
ho
re
La
ar
ac
hi
0
K
Population per 1000 Adult Men
12
Pakistan – Sexual Partnerships for Key
Populations in Different Cities
Partners per Month, Thousands
Estimated Total Number of Sex Partnerships per
Month, x 1,000
700
653
600
500
400
300
200
219 200
192
107
100
10
22
31
16 25
25 21
0
Karachi
Lahore
FSW
Faisalabad
MSW
Hijra
Multan
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 testing
NGO Project Data Mapping and
(2005-6)
IBBA Data
(2007)
Estimated # IDU
1,050
2100-2800
Number of IDU spots
Approx. 100
216
IDUs per spot
Approx. 10
11
9.5%
51.5%
HIV prevalence
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)
 Country / State led
 Selected externals
Program
/ Policy
Group
ProgramScience
Group
 Multi-disciplinary
 Purpose-built
 Includes country
scientists
Science
Group
Program Science Components –
Activity Diagram
Epidemiology
Strategic
Planning
Transmission
Dynamics
Population
Focus
Prevention
Objectives
Program
Management
Coverage
Program
-Science
Group
Scale-up
Quality
Impact
Operations
Research
Health Services
Evaluation
Intervention
Design & Mix
Implementation
Efficacy
Planning
Effectiveness
Externalizing concepts, knowledge,
methods, tools, etc.
Program Science Initiative(s)
Epidemiology
Strategic
Planning
Transmission
Dynamics
Population
Focus
Program and
Policy
Constituencies
Prevention
Objectives
Dissemination
Program
Management
Coverage
Program
-Science
Group
Scale-up
Quality
Impact
Operations
Research
Health Services
Evaluation
Science
Constituencies
Intervention
Design & Mix
Implementation
Planning
Efficacy
Effectiveness
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?
The “Big Picture”
Program
Science
Initiative
• Health systems research
• Implementation science
• Health services research
• Continuous quality improvement
• Knowledge translation
• Evidence based practice
• Public health