Program – Science Initiatives:Scope and Applications

James Blanchard, MD, MPH, PhDDirector, 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

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Pakistan – Relative Size of Key Populations, per 1000 Adult Men

Estimated Total Number of Sex Partnerships per Month, x 1,000

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Pakistan – Sexual Partnerships for Key Populations in Different Cities

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 testingNGO Project Data (2005-6)

Mapping and IBBA Data (2007)

Estimated # IDU 1,050 2100-2800

Number of IDU spots Approx. 100 216

IDUs per spot Approx. 10 11

HIV prevalence 9.5% 51.5%

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)Program / Polic

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Country / State led Selected externals

Multi-disciplinary Purpose-built Includes country scientists

Program Science Components – Activity Diagram

Population FocusPrevention

Objectives

Strategic Planning

EpidemiologyTransmission

Dynamics

Coverage

Quality

Impact

Program Management

Scale-up

Operations ResearchHealth Services

Evaluation

Intervention Design & Mix

ImplementationPlanning

EfficacyEffectiveness

Program-

Science Group

Externalizing concepts, knowledge, methods, tools, etc.

Population

Focus

Prevention

Objectives

Strategic Planning

EpidemiologyTransmission

Dynamics

Coverag

eQualityImpact

Program Management

Scale-up

Operations ResearchHealth Services

Evaluation

Interventi

on Design & Mix

ImplementationPlanning

EfficacyEffectiveness

Program-

Science Group

Dissemination

Program and Policy

Constituencies

Science Constituenci

es

Program Science Initiative(s)

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?

ProgramScienceInitiative

The “Big Picture”

• Health systems research• Implementation science• Health services research• Continuous quality improvement• Knowledge translation• Evidence based practice• Public health