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Transitioning a Large Scale HIV/AIDS Prevention Program to Local Stakeholders: Findings from the Avahan Transition Evaluation.

Bennett S, Singh S, Rodriguez D, Ozawa S, Singh K, Chhabra V, Dhingra N - PLoS ONE (2015)

Bottom Line: Service coverage outcomes were sustained at least six months post-transition.The study suggests that significant investments in transition preparation contributed to a smooth transition and sustained service coverage.Five key lessons for transition design and implementation are identified.

View Article: PubMed Central - PubMed

Affiliation: Johns Hopkins Bloomberg School of Public Health, International Health Department, 615 North Wolfe St, Baltimore, MD, United States of America.

ABSTRACT

Background: Between 2009-2013 the Bill and Melinda Gates Foundation transitioned its HIV/AIDS prevention initiative in India from being a stand-alone program outside of government, to being fully government funded and implemented. We present an independent prospective evaluation of the transition.

Methods: The evaluation drew upon (1) a structured survey of transition readiness in a sample of 80 targeted HIV prevention programs prior to transition; (2) a structured survey assessing institutionalization of program features in a sample of 70 targeted intervention (TI) programs, one year post-transition; and (3) case studies of 15 TI programs.

Findings: Transition was conducted in 3 rounds. While the 2009 transition round was problematic, subsequent rounds were implemented more smoothly. In the 2011 and 2012 transition rounds, Avahan programs were well prepared for transition with the large majority of TI program staff trained for transition, high alignment with government clinical, financial and managerial norms, and strong government commitment to the program. One year post transition there were significant program changes, but these were largely perceived positively. Notable negative changes were: limited flexibility in program management, delays in funding, commodity stock outs, and community member perceptions of a narrowing in program focus. Service coverage outcomes were sustained at least six months post-transition.

Interpretation: The study suggests that significant investments in transition preparation contributed to a smooth transition and sustained service coverage. Notwithstanding, there were substantive program changes post-transition. Five key lessons for transition design and implementation are identified.

No MeSH data available.


Related in: MedlinePlus

Organizational arrangements for the transition of the Avahan initiative to government.
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pone.0136177.g001: Organizational arrangements for the transition of the Avahan initiative to government.

Mentions: During the second phase (2009–2013) BMGF transferred the programs to the Government of India (Fig 1). Avahan handed high-level responsibility for management and funding of the program over to the National AIDS Control Organization (NACO). State Lead Partners (SLPs), typically large international or national NGOs, handed over their management and implementation responsibilities to State AIDS Control Societies (SACS) and their associated Technical Support Units (TSU). Implementation of program activities continued to be conducted by much the same pool of NGOs and community based organizations (CBOs), now under contract to government rather than Avahan. The transition process occurred in three rounds, with 10% of TI programs transitioning in 2009, 20% in 2011 and the remaining 70% in 2012. While Avahan made a significant contribution to the scale-up effort, by 2009 government funded and managed TI programs numbered approximately 1200, and combined, government and donors covered 53% of FSWs, 78% of MSM and 74% of IDUs [12].


Transitioning a Large Scale HIV/AIDS Prevention Program to Local Stakeholders: Findings from the Avahan Transition Evaluation.

Bennett S, Singh S, Rodriguez D, Ozawa S, Singh K, Chhabra V, Dhingra N - PLoS ONE (2015)

Organizational arrangements for the transition of the Avahan initiative to government.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4556643&req=5

pone.0136177.g001: Organizational arrangements for the transition of the Avahan initiative to government.
Mentions: During the second phase (2009–2013) BMGF transferred the programs to the Government of India (Fig 1). Avahan handed high-level responsibility for management and funding of the program over to the National AIDS Control Organization (NACO). State Lead Partners (SLPs), typically large international or national NGOs, handed over their management and implementation responsibilities to State AIDS Control Societies (SACS) and their associated Technical Support Units (TSU). Implementation of program activities continued to be conducted by much the same pool of NGOs and community based organizations (CBOs), now under contract to government rather than Avahan. The transition process occurred in three rounds, with 10% of TI programs transitioning in 2009, 20% in 2011 and the remaining 70% in 2012. While Avahan made a significant contribution to the scale-up effort, by 2009 government funded and managed TI programs numbered approximately 1200, and combined, government and donors covered 53% of FSWs, 78% of MSM and 74% of IDUs [12].

Bottom Line: Service coverage outcomes were sustained at least six months post-transition.The study suggests that significant investments in transition preparation contributed to a smooth transition and sustained service coverage.Five key lessons for transition design and implementation are identified.

View Article: PubMed Central - PubMed

Affiliation: Johns Hopkins Bloomberg School of Public Health, International Health Department, 615 North Wolfe St, Baltimore, MD, United States of America.

ABSTRACT

Background: Between 2009-2013 the Bill and Melinda Gates Foundation transitioned its HIV/AIDS prevention initiative in India from being a stand-alone program outside of government, to being fully government funded and implemented. We present an independent prospective evaluation of the transition.

Methods: The evaluation drew upon (1) a structured survey of transition readiness in a sample of 80 targeted HIV prevention programs prior to transition; (2) a structured survey assessing institutionalization of program features in a sample of 70 targeted intervention (TI) programs, one year post-transition; and (3) case studies of 15 TI programs.

Findings: Transition was conducted in 3 rounds. While the 2009 transition round was problematic, subsequent rounds were implemented more smoothly. In the 2011 and 2012 transition rounds, Avahan programs were well prepared for transition with the large majority of TI program staff trained for transition, high alignment with government clinical, financial and managerial norms, and strong government commitment to the program. One year post transition there were significant program changes, but these were largely perceived positively. Notable negative changes were: limited flexibility in program management, delays in funding, commodity stock outs, and community member perceptions of a narrowing in program focus. Service coverage outcomes were sustained at least six months post-transition.

Interpretation: The study suggests that significant investments in transition preparation contributed to a smooth transition and sustained service coverage. Notwithstanding, there were substantive program changes post-transition. Five key lessons for transition design and implementation are identified.

No MeSH data available.


Related in: MedlinePlus