Program – Science Initiatives: Scope and Applications James Blanchard, MD, MPH, PhD Director, 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

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

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 testing NGO Project Data (2005-6) Mapping and IBBA Data (2007) Estimated # IDU1, Number of IDU spotsApprox IDUs per spotApprox HIV prevalence9.5%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 / Policy Group Science Group Program- Science Group  Country / State led  Selected externals  Multi-disciplinary  Purpose-built  Includes country scientists

Program Science Components – Activity Diagram Program -Science Group

Externalizing concepts, knowledge, methods, tools, etc. Program -Science Group Dissemination Program and Policy Constituencies Science Constituencies 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?

Program Science Initiative The “Big Picture” Health systems research Implementation science Health services research Continuous quality improvement Knowledge translation Evidence based practice Public health