The President s Emergency Plan for AIDS Relief. Public Health Evaluations

Transcription

1 The President s Emergency Plan for AIDS Relief Public Health Evaluations

2 PEPFAR Evaluation Timeline Targeted Evaluations Public Health Evaluation Evaluation / Operations Research Country 1. Priorities 2. Submissions 3. Funding Central

3 Targeted Evaluation (TE): FY05-06 Studies that provide rapid answers to specific, measurable, and focused questions about health program implementation to improve services and identify best practices. Sensitivities on use of PEPFAR funds for research Less rigorous study design Country-driven priority setting process Funded through the COP

4 TE Study Focus: Studies focused on programs on the ground or beginning implementation, not for the evaluation of fundamentally new models Studies also centered on the development of methodologies where they did not exist and building of research capacity Program results were to move beyond program assessment and toward program enhancement Determine effect of PEPFAR intervention on PEPFAR program clients Improve service delivery in PEPFAR program Explain if, how, or why PEPFAR program is working Demonstrate replicability of PEPFAR program Establish the cost/benefit or cost-effectiveness of PEPFAR programs

5 Public Health Evaluation (PHE): FY07 Studies based on a rigorous, scientifically based process to collect information about program activities, characteristics, outcomes, and impact to determine the effectiveness of a program, compare program models, and answer operational questions related to program implementation. These studies focus on populations rather than individuals, and produce data to improve programs and inform decisions about future resource allocations. Improved concept approval process Establishment of PHE Subcommittee and Evaluation Teams PHE is distinct from, and does not replace, ongoing program monitoring or basic program evaluation PHE does not extend to basic or investigational clinical research activities

6 PHE Structure Within PEPFAR

7 PHE: FY08-09 Encouraged multi-country or harmonized studies where advantageous Increased HQ support for PHE development, coordination, implementation and data management PHE funding process PHEs funded centrally rather than through COPs New timeline for PHE submission and review, separate from country planning cycle Prioritized PHEs of global-significance, retained support for country-priority PHEs Made PHE funds available beyond previously defined focus countries

8 Identified Priorities for Globally Significant PHEs 1. What are the effects of available interventions (e.g., ART, male circumcision, behavior change communications) on incidence in serodiscordant couples? 2. What interventions reduce early mortality in patients initiating ART? 3. What are the effects of task-shifting for prevention, care, and treatment service delivery on quality, outcomes, cost effectiveness, etc? 4. How can barriers to national scale-up of PMTCT programs be overcome to maximize program impact while maintaining or improving overall maternal and child health? 5. Which models of provider-initiated HIV counseling and testing in clinical settings result in more people tested, higher percentage of HIV infected persons identified and linked to care, and a reduction in risk behaviors? 6. What are the optimal approaches to infant feeding and nutrition (e.g., feeding method, weaning strategy, ART and ARV prophylaxis for mother and child) among HIV-exposed children to maximize PMTCT and HIV-free survival?

9 Identified Priorities for Globally Significant PHEs (cont d) 7. Can intensified behavioral interventions reduce HIV incidence among high-risk HIV-negative clients attending counseling and testing sites? 8. What are the most effective service delivery models to improve outcomes (e.g., retention in pre-art, time to initiation of ART) among those receiving comprehensive pre-art care? 9. What are the effective individual and mass behavioral change communication models to reduce concurrent partnerships? 10. What is the impact of provision of HIV-related services on the broader health system in a country (e.g., on healthcare personnel, services in non-hiv facilities, healthcare infrastructure, national health funding, etc)? 11. What is the impact of wide-spread ART on prevalence/incidence on a population basis?

10 PHE Programmatic Review: FY08 FY08 PHE program review High volume of discrete activities (195 PHE activities identified) Slow progress on many continuation activities Recommendations for FY09 Focus on collaborative (multisite) PHE activities Improve coordination among similar studies to allow comparability and aggregability of results Address six identified priorities (early mortality, PMTCT effectiveness, PICT, task-shifting for ART, MC, health systems effects of PEPFAR scale-up) Facilitate partnering between scientifically stronger and weaker sites

11 Priority Setting for PEPFAR Phase II: Evaluation / Operations Research PEPFAR s experience in the field must contribute to the base of research and be translated into programmatic improvements. PEPFAR prioritizes the appropriate collection and use of quality data along the entire monitoring-to-research continuum Dissemination and use of M&E and research findings is critical to the operation of PEPFAR programs. PEPFAR commits to strengthening country capacity to conduct research and M&E.

12 Evaluation / Operations Research Identify critical questions generated by partner governments, country PEPFAR teams, and civil society, Address questions that PEPFAR is uniquely poised to research, Provide clear answers about the efficiency, effectiveness, and impact of programs in a timely manner, Create linkages that will allow the use of evaluation results to identify best practices and inform programmatic decision-making, Involve multiple countries and coordinated methodologies where appropriate, Assist countries in building capacity of trained personnel to engage in M&E and research, Focus on information dissemination, including publication of peer-reviewed articles.

13 FY2010: Evaluation / Operations Research (OR) Responding to PEPFAR programmatic evaluation needs Facilitating broader participation to encourage innovation from outside the PEPFAR community Ensuring scientific rigor through additional support Administration of Evaluation / OR program Central tracking system that is coordinated with agencies systems; Central repository for protocols, instruments, abstracts, manuscripts; More detailed budgeting and reporting requirements; Dissemination processes and mechanisms. (requirement that data be made publicly available)

14 THANK YOU