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

<div><p>Background</p><p>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.</p><p>Methods</p><p>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.</p><p>Findings</p><p>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.</p><p>Interpretation</p><p>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.</p></div

Change in Avahan practices post transition.

<p>Change in Avahan practices post transition.</p

Sustained outcomes: High risk groups contacted by peer educators.

<p>Sustained outcomes: High risk groups contacted by peer educators.</p

Avahan transition evaluation logic model.

<p>Avahan transition evaluation logic model.</p

Organizational arrangements for the transition of the Avahan initiative to government.

<p>Organizational arrangements for the transition of the Avahan initiative to government.</p

Data sources and type of analysis by Study Question.

<p>Data sources and type of analysis by Study Question.</p

Prevalence of Current Male Alcohol Drinkers: SFMS 1998 versus NFHS-2 1998–1999

<p>Prevalence of Current Male Alcohol Drinkers: SFMS 1998 versus NFHS-2 1998–1999</p

SRS VA Activities

<p>SRS VA Activities</p

Expected Number of Deaths by Age Group Using VA (Thousands), 2001 to 2003

<p>Expected Number of Deaths by Age Group Using VA (Thousands), 2001 to 2003</p

Prevalence of Current Male Smokers: SFMS 1998 versus NFHS-2 1998–1999

<p>Prevalence of Current Male Smokers: SFMS 1998 versus NFHS-2 1998–1999</p