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. 2015 Sep 1;10(9):e0136177.
doi: 10.1371/journal.pone.0136177. eCollection 2015.

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

Sara Bennett  1 , Suneeta Singh  2 , Daniela Rodriguez  1 , Sachiko Ozawa  1 , Kriti Singh  2 , Vibha Chhabra  2 , Neeraj Dhingra  3
Affiliations

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

Sara Bennett et al. PLoS One. .

Abstract

Background: 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.

Methods: 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.

Findings: 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.

Interpretation: 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.

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Conflict of interest statement

Competing Interests: Some members of the research team (SS, KS and VC) are employed by Amaltas Consulting Pvt Ltd, a private for-profit research and consulting firm. This work was conducted by Amaltas under a contract with Johns Hopkins University (supported by the Bill and Melinda Gates Foundation). The authors have no further competing interests or financial disclosures to make in this respect. This does not alter the authors’ adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Organizational arrangements for the transition of the Avahan initiative to government.
Fig 2
Fig 2. Avahan transition evaluation logic model.
Fig 3
Fig 3. Sustained outcomes: High risk groups contacted by peer educators.
Fig 4
Fig 4. Sustained outcomes: Condom distribution to members of high risk groups.
See this image and copyright information in PMC

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