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
10
8
FSW
HSW/MSW
IDU
6
4
2
Fa
n
ul
ta
M
is
a
la
ba
d
ho
re
La
ar
ac
hi
0
K
Population per 1000 Adult Men
12
Pakistan – Sexual Partnerships for Key
Populations in Different Cities
Partners per Month, Thousands
Estimated Total Number of Sex Partnerships per
Month, x 1,000
700
653
600
500
400
300
200
219 200
192
107
100
10
22
31
16 25
25 21
0
Karachi
Lahore
FSW
Faisalabad
MSW
Hijra
Multan
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 Mapping and
(2005-6)
IBBA Data
(2007)
Estimated # IDU
1,050
2100-2800
Number of IDU spots
Approx. 100
216
IDUs per spot
Approx. 10
11
9.5%
51.5%
HIV prevalence
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)
 Country / State led
 Selected externals
Program
/ Policy
Group
ProgramScience
Group
 Multi-disciplinary
 Purpose-built
 Includes country
scientists
Science
Group
Program Science Components –
Activity Diagram
Epidemiology
Strategic
Planning
Transmission
Dynamics
Population
Focus
Prevention
Objectives
Program
Management
Coverage
Program
-Science
Group
Scale-up
Quality
Impact
Operations
Research
Health Services
Evaluation
Intervention
Design & Mix
Implementation
Efficacy
Planning
Effectiveness
Externalizing concepts, knowledge,
methods, tools, etc.
Program Science Initiative(s)
Program and
Policy
Constituencies
Program
Management
Dissemination
Science
Constituencies
Program
-Science
Group
Coverage
Scale-up
Quality
Impact
Operations
Research
Health Services
Evaluation
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?
The “Big Picture”
Program
Science
Initiative
• Health systems research
• Implementation science
• Health services research
• Continuous quality improvement
• Knowledge translation
• Evidence based practice
• Public health