Reports Series
In 2012, AIDSTAR-One created a Toolkit for Transition of Care and Other Services for Adolescents Living with HIV to provide tools and guidance to health care providers and community care providers as well as to the adolescents and their families and caregivers. To test the usefulness of this Toolkit and to gather information on how to adapt it to increase its utility, a pilot program was carried out from October 2012 through April 2013 at four health facilities in Kenya. This training was followed in March and April 2013 by a mixed-methods rapid evaluation that gathered information on provider satisfaction and the toolkit's utility and feasibility. This report summarizes the results of that evaluation.
Sexual violence and exploitation against children is steeped in contextual determinants, such as the socio-economic development and legacy of war-time sexual violence, the intersections of HIV and sexual and gender-based violence (SGBV), gender relations in Mozambique, and the social vulnerability of children to sexual and economic exploitation. This assessment focused on current availability and practices of post-rape care (PRC) for children in two provinces of Mozambique, Zambezia and Sofala, and in the capital city of Maputo.
The United States President’s Emergency Plan for AIDS Relief (PEPFAR) Caribbean Regional Program seeks to help countries achieve sustainable and epidemic-relevant national HIV programs in the region. This midterm performance evaluation explores PEPFAR’s Caribbean Regional Program’s processes and progress toward country ownership and sustainability. The Caribbean Regional Program, its country partners, and its technical assistance partners will use this evaluation to help plan for the remaining two years to strengthen these efforts.
AIDSTAR-One conducted a situational analysis to determine factors that support or hinder effective care for children who have experienced sexual violence and exploitation in Lesotho. The analysis will provide information on how to move forward with activities for children who have experienced sexual violence and exploitation. The activity was designed to prioritize learning about clinical care within the broader package of services needed by children who have experienced sexual violence.
From March to September 2012, AIDSTAR-One, in collaboration with the Jane Goodall Institute, the Kigoma Local Government Authority, and the Ministry of Health and Social Welfare, implemented a six month demonstration project on PMTCT in 10 dispensaries in a rural district in Tanzania's Kigoma Region. The goal of the project was to pilot a service delivery model designed to improve the competency and motivation of community health workers as a way of increasing access to and uptake of PMTCT services and strengthening community linkages to facility-based PMTCT services in rural areas. This report summarizes the project’s goals, challenges, and successes.
AIDSTAR-One, en colaboración con el Centro de Investigación y Estudios de la Salud (CIES), la Red Trans de Nicaragua, Asociación Nicaragüense de Transgénera (ANIT), y la Asociación por los Derechos de la Diversidad Sexual Nicaragüense (ADESENI), llevó a cabo un diagnóstico en Nicaragüa a fin de explorar los factores que aumentan la vulnerabilidad de las mujeres trans locales, las necesidades de atención médica, los servicios de prevención, asistencia y apoyos disponibles y las barreras que impiden el acceso a ellos. También se incluyeron en el diagnóstico a los proveedores de salud a fin de examinar sus percepciones en cuanto a las personas trans y la capacidad de ofrecerles servicios de calidad.
In the last decade, donors have increased their funding levels and capacity-building efforts to community groups that address the needs of children and families affected by HIV and AIDS. This literature review identifies and summarizes existing research, assessments, and initiatives addressing resource flows to these community groups. As the research on funding flows to these groups is limited, literature that also provides an overview of general funding flows to community-based organizations providing HIV services more broadly has also been included.
In 2012 and 2013, AIDSTAR-One piloted the South-to-South Technical Exchange on Integrating PEPFAR Gender Strategies: Framework and Toolkit in collaboration with PEPFAR, Stepping Stones International in Botswana, and the Sonke Gender Justice Network in South Africa. This report summarizes the results of the assessment.
In collaboration with the Zimbabwe Ministry of Health and Child Welfare and the PEPFAR Care and Support and Treatment Technical Working Groups, AIDSTAR-One implemented an integrated mental health and HIV pilot activity in Zimbabwe. In December 2012, AIDSTAR-One conducted a small, mixed-methods assessment to understand the feasibility of integrating the mental health and substance use screening tools and the stepped-care approach into routine services. While areas for strengthening are discussed, results demonstrated that integrating mental health care services was feasible and generally beneficial in identifying mental health needs of people living with HIV, as well as the general population.
Para conocer mejor a la población trans de Panamá y sus necesidades de salud, así como los factores que les impiden acceder a una adecuada atención, se llevó a cabo un estudio que combina recolección de datos de dos grupos de informantes clave: las propias mujeres trans y proveedores de salud de los sectores públicos y privados. La edad promedio de las participantes es 29 años y la mayoría se identifica como del género femenino o con las diversas categorías trans. Pese a ello y a que sus parejas son casi siempre varones, la orientación sexual reportada por la gran mayoría es la de homosexual, existiendo así una incongruencia entre los términos que emplean para describirse a sí mismas. Sus experiencias sobre la transformación corporal son heterogéneas, aunque abunda el uso de hormonas u otras sustancias a lo largo de su vida adulta. Este grupo presenta niveles educativos no excesivamente bajos, aunque manifiesta no haber completado todos los estudios que hubieran deseado. Sin embargo, ocupa posiciones laborales inferiores a las que les corresponderían por su formación, lo que también se refleja en ingresos por debajo de los considerados mínimos por la legislación local. Aunque la dedicación al trabajo sexual a tiempo completo es menor del 20%, es frecuente que recurran a él como una manera de complementar sus salarios procedentes de sus otras ocupaciones. El uso regular del condón con los clientes es muy alto, del 90%, frente al 65% con sus parejas no comerciales, ya que éstas tienden a ser percibidas a través del filtro del ideal de amor romántico. No obstante, las encuestadas mostraron un muy alto conocimiento sobre las prácticas de riesgo y la prevención del VIH/SIDA. Las trans participantes en este estudio relatan frecuentes casos de violencia a lo largo de su vida, incluyendo el abuso sexual. También han experimentado estigmatización y discriminación, incluso en los centros de salud.
Para conocer mejor a la población trans de Guatemala y sus necesidades de salud, así como los factores que les impiden acceder a una adecuada atención, se llevó a cabo un estudio que combina recolección de datos de dos grupos de informantes clave: las propias mujeres trans y proveedores de salud. El análisis arroja que nos encontramos ante una población relativamente joven (promedio de 29 años), que se identifica primordialmente como del género femenino y heterosexual, estando a disgusto con la documentación legal que la identifica como varón. Sus percepciones sobre la transformación corporal son heterogéneas, aunque es habitual el uso de hormonas u otras sustancias a lo largo de su vida adulta. Este grupo ha abandonado el sistema educativo tempranamente y tiene serias dificultades para integrarse en el mercado laboral. Es frecuente que se dediquen al trabajo sexual, aunque también lo es, según las informantes, el uso del condón con sus clientes. Por el contrario, la protección durante la actividad sexual cae casi un 25% con las parejas no comerciales, que son percibidas a través del filtro del ideal de amor romántico. Ello a pesar de que las encuestadas mostraron un muy alto conocimiento sobre las prácticas de riesgo y la prevención del VIH/SIDA. Las participantes reportaron frecuentes casos de violencia a lo largo de su vida, además de estigmatización y discriminación, también en los centros de salud: negación de la asistencia, postergación en el orden de espera, humillación pública, aislamiento, y acoso e intento de abuso sexual, entre otros.
Many children, and the families and communities who care for them, are directly and indirectly affected by HIV and by the contexts of poverty, inequality, and social instability in which the disease has flourished. To respond to the needs of families and communities, AIDSTAR-One has conducted a literature search focusing on children, parenting, and caregiving. This review summarizes the findings of interventions to support and strengthen caregiving and identifies general principles and lessons learned to support and strengthen child-caregiver relationships in contexts in which children and families are affected by HIV.
In 2012, AIDSTAR-One conducted a study using geographic information systems in order to determine the location and condition of waste treatment equipment in Nigeria's health facilities. This report, which outlines the results of the study, will assist the Government of Nigeria and other program planners in considering how best to allocate resources to repair present facilities and construct new ones. The mapping will also help stakeholders to create and properly implement HCWM plans within facilities, local government areas, and states.
This program review is a direct response to the urgent need to strengthen and expand HIV prevention for men who have sex with men and sex workers in West Africa. The review furthers PEPFAR’s renewed emphasis on matching interventions and investments with epidemiological trends and needs in order to improve impact.
Continuing work from the Making Medical Injections Safer project, USAID/Nigeria asked AIDSTAR-One to provide injection safety technical assistance to the government of Nigeria and PEPFAR implementing partners. AIDSTAR-One conducted this follow-up assessment of injection safety in five USAID priority states: Bauchi, Benue, Cross River, Lagos, and Sokoto. Using an adaptation of the Revised Injection Safety Assessment Tool (Tool C-Revised) developed by the World Health Organization, AIDSTAR-One's assessment covered all injection and blood-drawing procedures in 80 public sector health care settings and laboratories. Findings from this study will be used to set priorities for project interventions in public sector health care settings and laboratories across the five states.
A gender assessment was conducted in Kyrgyzstan to inform and guide the design and formulation of the PEPFAR/Central Asia Region gender strategy. The assessment provides a set of practical recommendations for incorporating a gender perspective in a concentrated HIV epidemic to address gender-based factors that hinder access to HIV prevention, care and treatment services by key populations.
Linkages to and retention in HIV care for people living with HIV has emerged as a priority under the U.S. President’s Emergency Plan for AIDS Relief. To learn more about the current state of linkage and retention and to identify country best practices in the sub-Saharan African region, AIDSTAR-One conducted a literature review and an online survey focusing on fourteen countries: Botswana, Ethiopia, Kenya, Malawi, Mozambique, Namibia, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe.
Para conocer mejor a la población trans de El Salvador y sus necesidades de salud, así como los factores que les impiden acceder a una adecuada atención, se ha llevado a cabo un estudio que combina recolección de datos de dos grupos de informantes clave: las propias mujeres trans y proveedores de salud de los sectores públicos y privados. El análisis arroja que nos encontramos ante una población joven (promedio de 26 años), que se identifica primordialmente como del género femenino y heterosexual, estando a disgusto con la documentación legal que la identifica como varón. Sus percepciones sobre la transformación corporal son heterogéneas, aunque abunda el uso de hormonas u otras sustancias a lo largo de su vida adulta. Este grupo ha abandonado precozmente el sistema educativo y tiene serias dificultades para integrarse en el mercado laboral. Las trans participantes en este estudio relatan frecuentes casos de violencia a lo largo de su vida y recientemente, además de estigmatización y discriminación, también en los centros de salud: negación de la asistencia, postergación en el orden de espera, humillación pública, aislamiento, acoso e intento de abuso sexual, entre otros. El conjunto de los profesionales de la salud entrevistados muestran una actitud ambivalente frente a la población trans. Una parte defiende y dice practicar la atención en salud a las trans igual que debe otorgarse a toda persona. Otra reconoce su desconocimiento o confusión, expresa prejuicio o directamente rechazo hacia la población trans y minusvalora o desprecia sus necesidades de salud. Con todo, declaran estar muy abiertos a recibir capacitación sobre el tema, lo que puede ayudarles a entender mejor a las usuarias y redundar en un servicio de mayor calidad.
In 2011, AIDSTAR-One developed a Capacity Assessment Tool to assist PEPFAR program managers in facilitating the transition of care and treatment programs to national and local ownership. In 2012, the capacity assessment tool was piloted in Nigeria to determine how the tool could be adapted to better assist PEPFAR partners with the transition process. This report summarizes the methodology and findings of the pilot. It also recommends modifications and improvements to the tool based on lessons learned from the pilot.
Early access to antiretroviral therapy (ART) is particularly important for HIV-infected children. In Nigeria, a disparity exists between pediatric (7%) and adult (26%) ART coverage rates. To better understand barriers to pediatric treatment scale-up, AIDSTAR-One conducted an assessment of 23 treatment sites throughout Nigeria. This report summarizes site-level barriers to providing high-quality pediatric HIV care and treatment services and how these barriers affect patients' clinical outcomes.
This document aims to facilitate an understanding of the bi-directional relationship between HIV and food and nutrition security. It illustrates the causes of HIV-related food and nutrition insecurity, and points to a list of programmatic interventions and resources to consider for addressing each cause in detail.
AIDSTAR-One developed and piloted educational tools to increase appropriate prescription and use of co-trimoxazole for eligible people living with HIV. Before and after the pilot, AIDSTAR-One conducted a mixed-methods assessment to analyze the effectiveness and acceptability of the co-trimoxazole tools. This report recommends adoption and scale-up of the tools in Uganda and other countries.
AIDSTAR-One conducted a 3-year demonstration project in Namibia to reduce heavy drinking and risky sexual behavior among bar patrons in a low-income neighborhood on the outskirts of Namibia's capital, Windhoek. This report describes how the intervention was implemented, monitored, and evaluated, and reports the final assessment results. It also offers key recommendations for future research and programming.
In Ethiopia, ensuring a sufficient and sustainable supply of infection prevention and patient safety (IPPS) commodities is an important strategy to combat the high risk of transmission of health care–associated infections. However, there is a lack of awareness on the proper utilization of IPPS commodities by health care workers, and a lack of accurate data on the quantity of essential IPPS commodities needed by the health care system to adequately protect workers, patients, and the community from health care-associated infections. This assessment used a consultative approach to develop a national standardized and prioritized list of IPPS commodities for all levels of health care facilities, and quantified the annual need of IPPS commodities for the four levels of health care facilities in Ethiopia. This report summarizes the findings of the assessment.
Healthcare-acquired infections lead to death, disability, and excess medical costs. Infection prevention and control (IPC) measures maximize patient outcomes and are essential to providing effective, efficient, and quality health care services. In Ethiopia, AIDSTAR-One provides supportive supervision including observation, discussion, support, and guidance of IPC program management, standard practices, equipment, supplies, and infrastructure. Based on the national IPC guidelines in Ethiopia, a standard supportive supervision checklist that addresses a comprehensive IPC program was developed and used for data collection in three rounds. This report summarizes the results of the assessment.
In April 2011, AIDSTAR-One, with support from the Federal Ministry of Health (FMOH), piloted a training curriculum in Ethiopia that aims to address water, sanitation, and hygiene (WASH) issues at health facilities to improve the quality of life of people living with HIV and their families. This report summarizes the results of that assessment.
In 2011, AIDSTAR-One conducted a rapid assessment of pediatric HIV treatment scale-up in Zambia to better understand the barriers to providing and/or expanding high quality pediatric HIV care and treatment services.
In guidelines released in 2010, the World Health Organization recommends that health facilities integrate prevention of mother-to-child transmission (PMTCT) with maternal, newborn, and child health (MNCH) services to improve patient follow-up and adherence. This report describes the results of an assessment conducted across 70 randomly sampled PMTCT facilities in 14 regions of Tanzania, and the effect of integration on health quality.
In February 2011, AIDSTAR-One, with support from the Ministry of Public Health and Sanitation (MOPHS), piloted a training curriculum in Kenya that aims to address water, sanitation, and hygiene (WASH) issues at health facilities to improve the quality of life of people living with HIV and their families. This report summarizes the results of that assessment.
HIV and mental illness are significant global public health concerns in Zimbabwe. A coordinated and comprehensive response, particularly between HIV treatment, care, and support services and mental health care can improve health outcomes among people living with HIV. In collaboration with the U.S. President’s Emergency Plan for AIDS Relief Care and Support and Treatment Technical Working Groups, AIDSTAR-One is implementing a pilot activity that will integrate mental health and harmful substance use screening, counseling, and referral into HIV treatment and care sites in Zimbabwe. This country situational analysis was conducted as a first step in the pilot activity.
This document provides key findings for guiding programming for most-at-risk populations in mixed epidemic settings.
This study, conducted in six states in Nigeria, explores community perceptions of PMTCT and safe male circumcision (SMC) services and identifies barriers to uptake of services. In addition, the study explores attitudes and barriers regarding male partner involvement, which increases women’s participation in and adherence to PMTCT services and improves infant health outcomes. The study will inform the development of behavior change communication messages to promote PMTCT and SMC in a few states that can later be replicated across Nigeria.
This report uses case studies to review HIV treatment programming during complex emergencies that are both short- and long-term in nature and the result of both natural and man-made disasters. The goal of the report is to identify steps that can be taken before, during, and after an emergency to help ensure the continuity of HIV treatment.
While there is emerging literature on the gender-related needs of MARPs, how programs are addressing these needs or integrating gender strategies into their activities is not well documented or disseminated. AIDSTAR-One developed nine case studies that expand on the Integrating Gender into Programs with Most-at-Risk Populations technical brief, providing an in-depth look at HIV programs working with and for MARPs in South and Southeast Asia, Eastern Europe, Latin America, and the Middle East. AIDSTAR-One also developed a report, featured below, that includes findings and recommendations that apply across all nine case studies.
Because gender-based violence (GBV) is widely recognized as both a cause and a consequence of HIV infection, the President's Emergency Plan for AIDS Relief (PEPFAR) has identified reducing GBV as one of its five high-priority gender strategies. As part of this effort, AIDSTAR-One conducted case studies in three countries where GBV services were available: Swaziland, Vietnam, and Ecuador. The case studies and this accompanying findings report aim to identify and share promising programmatic approaches and disseminate key elements of success for replication and scale-up.
Community-based early childhood development (ECD) centers can be an important focal point for delivering comprehensive services to young children while enhancing the capacity of caregivers, families, and communities to support young children's development. When done well, these programs can be sustainable because of their emphasis on fostering community ownership. This issue paper is intended to provide OVC program managers with examples of best practices in community-based ECD center programming to best meet the children they serve.
This literature review assesses the existing evidence base on integrated models for HIV-positive women and their HIV-positive/-exposed infants. It focuses on health and social services necessary to provide comprehensive care for HIV-positive mothers and their HIV-positive/-exposed children over time.
AIDSTAR-One conducted this baseline assessment of injection safety in five USAID priority states: Bauchi, Benue, Cross River, Lagos, and Sokoto. Using an adaptation of the Revised Injection Safety Assessment Tool (Tool C-Revised) developed by the World Health Organization, AIDSTAR-One's assessment covered all injection and blood drawing procedures in 80 public sector health care settings and laboratories. Findings from this study will be used to set priorities for project interventions in public sector health care settings and laboratories across the five states.
A growing body of epidemiological and social science research links alcohol consumption with sexual behaviors that put people at risk for HIV and other sexually transmitted infections. To better understand this connection, AIDSTAR-One is conducting a 2-year demonstration project in Namibia—a country with high HIV prevalence and heavy alcohol use. To inform project design, AIDSTAR-One undertook formative research to understand how bar owners, staff, patrons, and community members perceive the risks and benefits of alcohol consumption and to solicit ideas about approaches for mitigating the negative effects of alcohol. The results of the formative research are reported here.
Despite increased understanding of the link between gender and HIV and, more recently, the value of using multiple gender strategies to mitigate women’s and men’s vulnerability, little is known about how HIV programs are applying these insights to improve programs and services. This findings and recommendations report reviews how five programs in Africa are combining strategies and identifies gaps, lessons learned, common experiences, and recommendations for future work.
This report, Equipping Parents and Health Providers to Address the Psychological and Social Challenges of Caring for Children Living with HIV in Africa, provides information to better understand the psychological and social challenges faced in Africa by perinatally-infected children (aged 0-12 years), their parents/caregivers, and their health providers. It explores factors that contribute to the ability of children living with HIV to cope and thrive, and identifies the tools and approaches being used to help parents/caregivers and health providers provide psychosocial support (PSS) to these children.
This technical report examines a nutritional assessment, counseling, and support (NACS) program in Uganda that uses a quality improvement approach to services.
An assessment was conducted in Kenya in October 2009 in order to examine the national Food by Prescription (FBP) program, study program strengths and challenges, and document lessons learned and promising practices. AIDSTAR-One conducted the assessment at the request of the President's Emergency Plan for AIDS Relief (PEPFAR) Care and Support Technical Working Group (TWG) and with the participation of the USAID Mission in Kenya, the National AIDS and STI Control Programme (NASCOP) and Academy for Educational Development (AED).
The following tables are the product of a focused effort to collect and present information on hospice and palliative care drugs included in the list of medicines compiled by the International Association of Hospice and Palliative Care (IAHPC) for 11 PEPFAR countries: Botswana, Côte d'Ivoire, Ethiopia, Mozambique, Nigeria, Rwanda, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe.
This effort was undertaken by a consultant to AIDSTAR-One at the request of the PEPFAR Care and Support Technical Working Group (TWG). The deliverable described in the scope of work (SOW) is a brief summary report, consisting mostly of tables, of country-specific characteristics of the medicines included in the IAHPC list.
This document is intended to explore strategies to protect children orphaned or made vulnerable by HIV (OVC) from abuse, exploitation, violence, and neglect. The report draws from lessons learned by OVC program managers, designers, and policy developers—particularly those associated with the President’s Emergency Plan for AIDS Relief (PEFPAR).
July 2010 - At the request of PEPFAR’s Technical Working Group and USAID, AIDSTAR-One facilitated its first south-to-south (S2S) exchange of technical assistance (TA) in support of Swaziland’s pilot of home-based HIV testing and counseling (HBHTC). Expert trainers well-versed in HBHTC from The AIDS Support Organization in Uganda (TASO) conducted HBHTC training and provided technical guidance. As a result, Swaziland launched a six-month HBHTC pilot project to determine feasibility and acceptability for potential national scale-up.
In 2007, Cambodia initiated “Healthcare Provider-Initiated Testing and Counseling,” in which health care providers in specialty clinics would recommend routine referral for HIV testing at a voluntary confidential counseling and testing site. The approach varied from WHO guidelines in that it offered routine “referral” and not routine “testing.” AIDSTAR-One conducted a rapid assessment of Cambodia’s approach to identify the following: 1) promising practices in HIV testing and counseling; 2) challenges experienced implementing routine referrals; 3) opportunities and barriers to the WHO PITC approach; and 4) opportunities to address unmet needs. Included in this report are recommendations that define activities aimed to fill current gaps and could lay groundwork for implementing the WHO’s PITC approach in Cambodia.
With the scale-up of HIV treatment programs, substantial funding has been committed to guarantee an uninterrupted supply of co-trimoxazole for persons living with HIV (PLHIV), but access to this key intervention remains inconsistent. This technical report provides a summary of key challenges and innovations arising from 15 countries.
This technical report discusses the many services needed throughout the prevention of mother-to-child transmission (PMTCT) and infant care services continuum and identifies potential barriers to service coverage, access, and utilization. AIDSTAR-One provides examples of evidence-based and emerging practices to mitigate these barriers.
The countries of Central Asia are witnessing one of the fastest growing HIV epidemics in the world. AIDSTAR-One, at the request of USAID/Central Asia, conducted a mapping exercise of HIV services in selected oblasts in Kyrgyzstan. The report presents critical findings and makes recommendations for addressing gaps based upon input from public and NGO service providers and clients. The report includes the interviewer's and moderator's guides used in the HIV mapping activity.
Although Thailand has made significant improvement in mitigating its HIV epidemic, it has not effectively reached men who have sex with men (MSM), who account for a significant proportion of those affected by HIV.
AIDSTAR-One conducted a situational analysis in Thailand that focused on addressing issues affecting uptake of HIV testing and counseling (HTC) services for MSM.