Rolling out new biomedical HIV prevention tools: what can be learned from Avahan, the India AIDS initiative?
Gina Dallabetta A F , Padma Chandrasekaran B , Tisha Wheeler B D , Anjana Das C , Lakshmi Ramakrishnan C E , Sameer Kumta B and James Moore B
+ Author Affiliations
- Author Affiliations
A Bill & Melinda Gates Foundation, P.O. Box 6176, Ben Franklin Station, Washington, DC, 20044, USA.
B Bill & Melinda Gates Foundation, Capital Court Building, 3rd Floor, Left Wing, Olof Palme Marg, Munirka, New Delhi 110067, India.
C FHI 360, H-5 (Ground Floor), Green Park Extension, New Delhi 110016, India.
D Present address: United States Agency for International Development, Global Health Fellows, 1201 Pennsylvania Avenue, NW, Suite 315, Washington DC, 20004, USA.
E Present address: Mathematica Policy Research, 14 Pataliputra Colony, Patna, India.
F Corresponding author. Email: gina.dallabetta@gatesfoundation.org
Sexual Health 11(2) 207-216 https://doi.org/10.1071/SH14064
Submitted: 2 April 2013 Accepted: 23 May 2014 Published: 3 July 2014
Journal Compilation © CSIRO Publishing 2014 Open Access CC BY-NC-ND
Abstract
More than 30 years after HIV was first identified as a disease, with disastrous consequences for many subpopulations in most countries and for entire populations in some African countries, it continues to occupy centre stage among the world’s many global health challenges. Prevention still remains the primary long-term focus. New biomedical tools such as pre-exposure propyhlaxis (PrEP) and treatment hold great promise for select groups such as key populations (KPs) who are critical to transmission dynamics, and serodiscordant couples. Programs delivering these new tools will need to layer them over existing services, with potential modifications for increased and sustained engagement between health services and beneficiaries owing to the nature of the interventions. Avahan, an HIV prevention intervention for KPs in six states in India, achieved population-level impact with conventional prevention programming, which, however, required high program–beneficiary engagement. Avahan’s implementation strategy included articulating clear service definitions and denominator-based targets; establishing routine data systems with regular, multilevel supervision that allowed for cross-learning across the program; and developing a cadre of frontline workers through KP peer outreach workers who addressed structural issues and provided viable and sustainable mechanisms for sustained interaction between health services and KPs. This basic prevention implementation infrastructure was used to expand clinical services over time. Many of the lessons from programs such as Avahan can be applied to KP programs that are expanding service scope, including PrEP and treatment.
Additional keywords: interventions, key populations, peer outreach, programs, syphilis.
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