Combination prevention: four promising approaches
S. Stash1, H. Begman2, P. Okaalet3, B. Rau4, L. Romocki5
1John Snow Inc., AIDSTAR-One, Arlington, United States, 2John Snow Inc., Arlington, United States, 3MAP, Nairobi, Kenya, 4EnCompass LL, Washington DC, United States, 5AIDSTAR-One, Yaoundé, Cameroon
Considerable international momentum has gathered in
support of combination prevention programming. Although developed earlier,
combination prevention came to the forefront at the IAS Conference in Mexico
City and in the 2008 Lancet Prevention series. Combination prevention was the
focus of a recent UNAIDS Prevention Reference Group meeting and featured in the
PEPFAR II Strategy. This paper describes
the elements of combination prevention as implemented by four very different
programs: Avahan, India; APHIA, Kenya; Alliance, Ukraine; and a national
consultation in Namibia.
In 2009-2010, AIDSTAR-One completed a series of
case studies on combination prevention (Romocki and Okaalet, 2010; Rau, 2010; Stash and Bergmann, 2010; Stash, 2010).
Four exemplary programs were selected using a common definition. Case studies
were systematically developed based on observational site visits, key informant
interviews, and programmatic data.
Results: Local organizations developed
the optimal mix of services through commitment to local ownership, application
of data, adaptive planning, and empowered local-level advocacy. Community-level
workers serve as the critical link between people and a full-range of prevention
services. Programs determined the right mix of services using timely
applications of “best-available” data. Organizations encouraged planning from
the community-level up and understood the local context of risk. Strong, adaptive
management structures and partnerships enabled programs to be responsive.
Programs exemplified concern for issues in the social and economic context and structural
elements were key.
Because epidemics are dynamic, as is the
environment of risk, programs must empower local learning and decentralized decisionmaking.
Complexity can be managed but it takes serious program commitment to developing
management structures that support it. Coordination and linkages are essential
since no one organization or sector can support all the functions that are
required. Approaches are needed to determine the optimal mix of services, elaborate
costs, and understand the effectiveness of programs.
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