Abstract:ObjectivesIn 2013, Kenya’s National AIDS and STI Control Programme established a Learning Site (LS) in Mombasa County to support and strengthen capacity for HIV prevention programming within organisations working with sex workers. A defining feature of LS was the use of a Programme Science approach throughout its development and implementation. We provide an overview of the key components of LS, present findings from 23 months of programme monitoring data, and highlight key Programme Science lessons from its i… Show more
“…Routine programme monitoring data collected by these implementing partners between July 2017 and June 2018 were used to develop national and county level cascades. We also used data from NASCOP Learning Sites for HIV Prevention for FSWs implemented between 2013 and 2014 in Nairobi and implemented between August 2014 and July 2015 in Mombasa to characterize a hotspot‐based programme cascade and sub‐population level programme cascade desegregated by age at implementation partner level respectively.…”
Introduction
HIV prevention cascades have emerged as a programme management and monitoring tool that outlines the sequential steps of an HIV prevention programme. We describe the application of an HIV combination prevention programme cascade framework to monitor and improve HIV prevention interventions for female sex workers (FSWs) in Kenya.
Methods
Two data sources were analysed: (1) annual programme outcome surveys conducted using a polling booth survey methodology in 2017 among 4393 FSWs, and (2) routine programme monitoring data collected by (a) 92 implementing partners between July 2017 and June 2018, and (b) Learning Site in Mombasa (2014 to 2015) and Nairobi (2013). We present national, sub‐national and implementing partner level cascades.
Results
At the national level, the population size estimates for FSW were 133,675 while the programme coverage targets were 174,073. Programme targets as denominator, during the period 2017 to 2018, 156,220 (90%) FSWs received peer education and contact, 148,713 (85%) received condoms and 83,053 (48%) received condoms as per their estimated need. At the outcome level, 92% of FSWs used condoms at the last sex with their client but 73% reported consistent condom use. Although 96% of FSWs had ever tested for HIV, 85% had tested in the last three months. Seventy‐nine per cent of the HIV‐positive FSWs were enrolled in HIV care, 73% were currently enrolled on antiretroviral therapy (ART) and 52% had attended an ART clinic in the last month. In the last six months, 48% of the FSWs had experienced police violence but 24% received violence support. National and sub‐national level cascades showed proportions of FSWs lost at each step of programme implementation and variability in programme achievement. Hotspot and sub‐population level cascades, presented as examples, demonstrate development and use of these cascades at the implementation level.
Conclusions
HIV prevention programme cascades, drawing on multiple data sources to provide an understanding of gaps in programme outputs and outcomes, can provide powerful information for monitoring and improving HIV prevention programmes for FSWs at all levels of implementation and decision‐making. Complexity of prevention programmes and the paucity of consistent data can pose a challenge to development of these cascades.
“…Routine programme monitoring data collected by these implementing partners between July 2017 and June 2018 were used to develop national and county level cascades. We also used data from NASCOP Learning Sites for HIV Prevention for FSWs implemented between 2013 and 2014 in Nairobi and implemented between August 2014 and July 2015 in Mombasa to characterize a hotspot‐based programme cascade and sub‐population level programme cascade desegregated by age at implementation partner level respectively.…”
Introduction
HIV prevention cascades have emerged as a programme management and monitoring tool that outlines the sequential steps of an HIV prevention programme. We describe the application of an HIV combination prevention programme cascade framework to monitor and improve HIV prevention interventions for female sex workers (FSWs) in Kenya.
Methods
Two data sources were analysed: (1) annual programme outcome surveys conducted using a polling booth survey methodology in 2017 among 4393 FSWs, and (2) routine programme monitoring data collected by (a) 92 implementing partners between July 2017 and June 2018, and (b) Learning Site in Mombasa (2014 to 2015) and Nairobi (2013). We present national, sub‐national and implementing partner level cascades.
Results
At the national level, the population size estimates for FSW were 133,675 while the programme coverage targets were 174,073. Programme targets as denominator, during the period 2017 to 2018, 156,220 (90%) FSWs received peer education and contact, 148,713 (85%) received condoms and 83,053 (48%) received condoms as per their estimated need. At the outcome level, 92% of FSWs used condoms at the last sex with their client but 73% reported consistent condom use. Although 96% of FSWs had ever tested for HIV, 85% had tested in the last three months. Seventy‐nine per cent of the HIV‐positive FSWs were enrolled in HIV care, 73% were currently enrolled on antiretroviral therapy (ART) and 52% had attended an ART clinic in the last month. In the last six months, 48% of the FSWs had experienced police violence but 24% received violence support. National and sub‐national level cascades showed proportions of FSWs lost at each step of programme implementation and variability in programme achievement. Hotspot and sub‐population level cascades, presented as examples, demonstrate development and use of these cascades at the implementation level.
Conclusions
HIV prevention programme cascades, drawing on multiple data sources to provide an understanding of gaps in programme outputs and outcomes, can provide powerful information for monitoring and improving HIV prevention programmes for FSWs at all levels of implementation and decision‐making. Complexity of prevention programmes and the paucity of consistent data can pose a challenge to development of these cascades.
“…Kenyan sex workers not only collected geographic and enumerative data that aided the intervention planning of experts, they also received training on how to make their own calculations to perform highly systematized outreach activities (see Figures 3–5), through a process known as “micro‐planning” (McClarty et al. 2018). Leigh McClarty and colleagues (2018, 347) describe microplanning as follows: a peer‐based model in which peer educators [are] responsible for enrolling sex workers in an outreach programme, developing personalised outreach plans through hotspot‐based microplanning strategies.…”
Section: Encountering Program Sciencementioning
confidence: 99%
“…2018). Leigh McClarty and colleagues (2018, 347) describe microplanning as follows: a peer‐based model in which peer educators [are] responsible for enrolling sex workers in an outreach programme, developing personalised outreach plans through hotspot‐based microplanning strategies. … Through microplanning, peer educators recorded information from outreach activities in weekly tracking sheets, reviewed the data in monthly meetings with other peer educators, then, when necessary, implemented modifications to outreach plans based on microplanning data.…”
In Kenya, globally circulating HIV surveillance techniques are implicated in an emergent experimental terrain that merges scientific interest with health administration agendas. Sex worker activists reroute and repurpose this technocratic knowledge to more precisely pinpoint and defy the undemocratic imperatives of an encroaching experimental order that aims to govern the health of key populations. Reconstructing the conditions of emergence of these evidentiary politics reveals growing interdependencies between sex workers and scientific and technical experts as they are brought into increasing interaction with each other.
“…Programs at the national and sub-national level [ 1 , 2 , 17 , 18 ], HIV prevention researchers [ 19 , 20 ], policy makers [ 21 , 22 ], and community-based organizations [ 23 , 24 ] have implemented a Program Science approach to tackle issues of public health importance [ 19 , 20 , 25 ] and this approach has generated important scientific contributions, as shown in Table 1 and discussed here.…”
BackgroundProgram Science is an iterative, multi-phase research and program framework where programs drive the scientific inquiry, and both program and science are aligned towards a collective goal of improving population health.DiscussionTo achieve this, Program Science involves the systematic application of theoretical and empirical knowledge to optimize the scale, quality and impact of public health programs. Program Science tools and approaches developed for strategic planning, program implementation, and program management and evaluation have been incorporated into HIV and sexually transmitted infection prevention programs in Kenya, Nigeria, India, and the United States.ConclusionIn this paper, we highlight key scientific contributions that emerged from the growing application of Program Science in the field of HIV and STI prevention, and conclude by proposing future directions for Program Science.
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