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Research and Technical Assistance Research Technical Assistance and Methodologies
Research Evaluation of ART Outcomes
HB-AC Male Circumcision Pregnancy and HIV Sexual and Reproductive Health Coccidioidomycosis (Valley Fever) Philippines Child Health Experiment The Philippine Child Health and Policy Experiment, also called the Quality Improvement Demonstration Study (QIDS) in the Philippines, is a unique, randomized experiment that follows the long-term effects of health policy interventions on child health. In 2003, with the cooperation of the Philippine National Health Insurance Corporation (PhilHealth), QIDS collected baseline data and then randomized 30 matched provincial districts to one of three policies: (1) expanded health care coverage by PhilHealth to all children, (2) bonus payments to physicians providing higher quality care, and (3) a control policy, where there is no change to the existing PhilHealth insurance or reimbursement schemes. The research aim of QIDS is to assess the changes in provider and patient behavior and subsequent changes in child health and cognitive outcomes, measured using blood biomarkers, subjective self-reported health status assessments, and age-specific measures of cognitive development. Scientifically demonstrating that health policies have lasting effects on health supports the use of evidence-based policy and, thus, the translation of scientific findings from the bedside to the community. Tobacco Control Dr. Tom Novotny is coordinator of global tobacco control activities at the UCSF Center for Tobacco Control Research and Education. The CTCRE is a World Health Organization Collaborating Center on Tobacco Control, and focuses primarily on research regarding secret tobacco industry documents, training of post-doctoral scholars from multiple disciplines, and collaborative research with China, Brazil, and the Former Soviet Union. CTCRE also provides short-term training opportunities to international tobacco control workers and scholars, as well as consultations to various countries on tobacco control policy.
Technical Assistance and Methodologies Data Analysis, Use, and Interpretation In order to address the problem of underutilization of existing data for program decision-making, IGH aims to help countries take stock of what data are available and determine whether they can more effectively use them. Because the continuum of data analysis, use, and dissemination activities is broad, so is the range of activities that a country may request. Examples of activities include the following: assessment and analysis of existing single source of data; rapid multiple-source data synthesis for program planning; GIS and mapping; development of data analysis, use, and dissemination plan; and capacity-building for future data analysis, use, and dissemination. Triangulation Triangulation is broadly defined as the synthesis and integrated analysis of data from multiple sources for program decision-making. Whereas purely academic research is often conducted to definitively answer a pre-formed hypothesis, triangulation seeks to quickly examine existing data to strengthen interpretations and improve policy and programs based on the available evidence. Triangulation is a powerful tool that can be used to demonstrate program impact, identify areas for improvement, direct new programs and enhance existing programs, and help direct policy changes. It can strengthen the understanding of complex health issues and provide support for making evidence-based public health decisions. For more detailed information about our triangulation activities in Botswana, Malwai and other countries: http://www.igh.org/triangulation/ Botswana QA The goal of this study is to better understand the complexity of sexual risk and protective behaviors contributing to differing HIV prevalence rates observed among young adults in Botswana. Qualitative data are collected from youth and young men and women, as well as from youth service providers, in three districts in Botswana with differing prevalence patterns. Focus groups and in-depth interviews provide valuable insights regarding sexual health, general sexual practices, HIV testing and treatment access, HIV-related beliefs, and descriptive information on the types of sexual relationships occurring among Botswana youth.
Evidence-Based and Translational Literature Digest The Literature Digest highlights recently published studies of HIV behavioral, policy and prevention interventions that have one or more of the following aims: to reduce sexual or drug-related risk behaviors, to decrease primary or secondary transmission, to improve health service delivery and quality of life, or to improve HIV treatment and adherence. Included studies were conducted in, or have applications to, resource-limited settings. The most novel, relevant, and rigorous studies are summarized in the digest; descriptive studies, and those less rigorous, are listed at the end of the document. SRH Linkages In recent years there has been significant support for policy and programmatic linkages between sexual and reproductive health (SRH) and HIV/AIDS, in the hope that such linkages will yield important public health benefits. However, the evidence supporting this viewpoint has not yet been systematically compiled. IGH, in conjunction with the Johns Hopkins Bloomberg School of Public Health, conducted a systematic review to identify articles in the peer-reviewed literature that assessed the efficacy of programs that link SRH and HIV, and compiled a report identifying existing studies and promising programs that integrated SRH and HIV. SMAP This project, in collaboration with the State of California Department of Health Services, Office of AIDS (DHS/OA), in conjunction with the University-Wide AIDS Research Program (UARP) in their Community Collaborative Projects, aims to develop and maintain a database of the best evidence of behavioral HIV prevention interventions conducted with people of color. To date, the SMAP team has conducted systematic reviews and meta-analyses of interventions targeting people of color, prepared modules focusing on effective interventions targeting African-American heterosexuals and men of color who have sex with men (MSM), and worked with the HIV Intervention Enhancement Project (HIEP) to promote the concept of intervention enhancement, with the goal of facilitating the translation of successful, evidence-based interventions from the research realm into formats that are more easily utilized by community-based organizations and/or local health jurisdictions.
GIS, or Geographical Information Systems, helps data users to think spatially about available information, and assists in the guidance of strategic decision-making. GIS can be used in a variety of different capacities and tailored to a range of different needs to create a more accurate representation of the real world, link features to information, and assist in solving public health-related questions. Examples of geographic data used in the field of international public health typically include boundaries of administrative areas (i.e., region, province, and district level), health facility locations, roads, rivers, census data, programmatic information, surveillance data, and qualitative information.
Monitoring and Evaluation (M & E) Capacity Assessment and Strength Cost-Effectiveness Analysis National Evaluation Agenda Setting The purpose of National Evaluation Agenda Setting is to develop an evaluation agenda that represents a variety of HIV-related disciplines, is country-driven and integrated into the national M&E plan, improves the quality of evaluation research to enhance policy, planning, and program management, and includes a concrete short and long-term action plan. The roles and responsibilities of the task force (led by IGH and ORC-MACRO staff members) include the following: assisting with communication and advocacy, assisting with cataloguing data, identifying stakeholders, providing leadership during workshop, disseminating final reports and projects, and participating in follow-up activities. Patient Monitoring (Development of Protocol) UCSF staff have developed a guidance document to assist countries in evaluating electronic patient monitoring (EPM) systems. The goal of this targeted evaluation is to assess the effectiveness of an EPM system with regard to the following: completeness of patient data, provider and staff acceptability, time-flow of patient visit, time needed to generate reports, and data quality. The document outlines the methodology for conducting an evaluation, starting with conducting a stakeholders' meeting in order to decide the objectives of the evaluation, the scope of the evaluation, and the study design that will be used to evaluate the EPM system.
HB-AC L-STIK Longitudinal Surveillance of Treatment in Kenya (L-STIK): The goal of the L-STIK study is to assess the clinical success of the National Antiretroviral Therapy Program in Kenya through the use of programmatic and clinical indicators: determining compliance with national ART guidelines during rapid scale-up, assessing factors associated with patient retention and clinical treatment success, and identifying program areas that require strengthening. Male Circumcision IGH is assisting CDC Kenya in developing a study on male circumcision and positive prevention in Kisumu, Kenya. The primary goal of this study is to test the effectiveness of two community-based enhanced HIV prevention and care programs (male circumcision and the comprehensive care and treatment package) in reducing all-cause and HIV-related mortality and HIV incidence in a high-HIV prevalence area of rural Kenya. Ped L-STIK
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