Building the evidence base for prevention in HIV health promotion - Dr Graham Brown


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Presentation from the AFAO National Symposium on Prevention, held in Sydney, Thursday 27 May, 2010.

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Building the evidence base for prevention in HIV health promotion - Dr Graham Brown

  1. 1. Building the evidence base for prevention in HIV health promotion. Dr Graham Brown
  2. 2. Evidence: A thing or things helpful in forming a conclusion or judgment <ul><li>Building evidence </li></ul><ul><li>Why all the fuss now? </li></ul>“ We know its working, just not sure why”
  3. 3. Five factors driving this need <ul><li>Epidemiological and biomedical developments; </li></ul><ul><li>Community and cultural expectations; </li></ul><ul><li>Policy developments in preventative health generally and HIV specifically; </li></ul><ul><li>Politics of what is evidence; and </li></ul><ul><li>Evidence is not enough </li></ul>
  4. 4. Epidemiological and biomedical developments <ul><li>Changing trends in HIV transmission. </li></ul><ul><li>More complex conditions for PLHIV. </li></ul><ul><li>Closer relationship developing between treatments and prevention (PEP, PrEP, viral load, other biomedical prevention); </li></ul><ul><li>Emerging epidemics while needing to sustain and enhance current initiatives </li></ul>
  5. 5. Community changes and expectations; <ul><li>Shifts in the way peer and social influence occurs in priority communities, and impact on peer based approaches </li></ul><ul><li>Social meanings and engagement with risk, community, and networks </li></ul><ul><li>Increasing investment within community based organisation for clearer evidence of impact of programs </li></ul><ul><li>Demands from our own communities for outcomes </li></ul>
  6. 6. Policy developments in preventative health generally and HIV specifically <ul><li>“ Where the evidence is still developing or is hotly debated, we seek to learn by doing – to build evidence for future action” (PHTF Overview) </li></ul><ul><li>“ The Commonwealth Government is committed to building the evidence base for effective preventative health interventions”(Taking preventative action). </li></ul>
  7. 7. Policy developments in preventative health generally and HIV specifically <ul><li>“ Invest in evaluation and evidence-building approaches to support evidence based and innovative policy and program decisions” 6NS </li></ul><ul><li>“ A process to establish research priorities will be established by a consultative process in the following areas : </li></ul><ul><ul><li>Social, behavioural and epidemiological research in prevention, diagnosis, treatment, care and support, including into effectiveness of interventions and drivers of the increasing rates of new infections; </li></ul></ul><ul><ul><li>Clinical research on treatment and care; </li></ul></ul><ul><ul><li>Program evaluation research ; and </li></ul></ul><ul><ul><li>Cost-effectiveness studies to assess the value for money to government and the community of HIV programs”. 6NS </li></ul></ul>
  8. 8. Politics of ‘what is evidence?’ <ul><li>Evaluation and research is about using the best and most practical method to answer the question. </li></ul><ul><li>However </li></ul><ul><li>Pressure to define evidence only as product of an RCT, or ‘something done by a research centre’ </li></ul><ul><li>Assumptions that rigorous evidence is impossible within social interventions . </li></ul>
  9. 9. Politics of ‘what is evidence?’ <ul><li>This leaves us vulnerable to…. </li></ul><ul><ul><li>Interventions that lend themselves to RCT dominating and theoretically sound but less evaluated integrated programs unable to determine their level of effectiveness. </li></ul></ul><ul><ul><li>Approaches that require the intervention itself to change to meet the demands of the evaluation. </li></ul></ul><ul><ul><li>Approaches like RCT rejected outright (they have their place, but like all forms of evaluation they can be misused and inappropriately applied). </li></ul></ul><ul><ul><li>CBO disengaging from evaluation or handing over the building of their own evidence base because too hard or lack of resources. </li></ul></ul><ul><ul><li>Evaluation is the tool of the program, not the other way around. </li></ul></ul>
  10. 10. Evidence is not enough <ul><li>There are areas in HIV where I don’t believe we could have more evidence than we do </li></ul><ul><ul><li>Need to expand NSP programs </li></ul></ul><ul><ul><li>Impact of reduced leadership and funding </li></ul></ul><ul><ul><li>‘ Pilot’ projects that have been running for over a decade </li></ul></ul><ul><li>While building evidence we need to ask </li></ul><ul><ul><li>Who is asking for the evidence / Why do we need more evidence? </li></ul></ul><ul><ul><li>Where is the evidence that more evidence will change the policy? </li></ul></ul><ul><li>What we need is better translation of evidence into policy and practice, not just more evidence </li></ul>
  11. 11. What we need <ul><li>Evidence building approaches that are seen by the community, research and policy sector as credible, practical and useable in the reality of the limited resources of most programs. </li></ul><ul><li>Evidence informed practice needs practice informed evidence </li></ul>
  12. 12. What we need <ul><li>A practice based and field-tested toolkit of well articulated, validated and practical methods for community agencies to evaluate the range of peer based, social influence and community development initiatives; </li></ul><ul><li>Collaborative approaches that draw on the expertise of the partnership – community, policy and research. </li></ul><ul><li>Build on the current investments into evaluation and building evidence (both HIV and health promotion generally). </li></ul><ul><li>Developed and tested on the ground, within an Australian HIV context. </li></ul><ul><li>Pooling of not just the results but the evaluation approaches </li></ul>
  13. 13. Benefits would include… <ul><li>Clear, theory and practice driven objectives that place programs within the context of a comprehensive approach to HIV; </li></ul><ul><li>Capacity to identify what needs to be evaluated and to what extent –not everything needs to be evaluated to the same depth, or in every location, to build evidence </li></ul><ul><li>Capacity to articulate and advocate what is required to effectively manage, supervise, evaluate and sustain the programs and be better able to demonstrate the impact. </li></ul><ul><li>Achieving programs of better quality and more responsive to community / target group needs. </li></ul>
  14. 14. How? <ul><li>Need initial heavy investment </li></ul><ul><li>Clearly not starting from </li></ul><ul><ul><li>Significant but separate investments in different states and territories. </li></ul></ul><ul><ul><li>AFAO evaluation audit and other foundation work. </li></ul></ul><ul><ul><li>Many other initiatives </li></ul></ul><ul><li>Possibly a collaborative ARC linkage grant focused on building a sector resource </li></ul>
  15. 15. <ul><li>We need to develop the evidence </li></ul><ul><li>not because we are being pressured, </li></ul><ul><li>not because funding requires it, and </li></ul><ul><li>not because we want to be listed to and respected </li></ul><ul><li>but because we want better outcomes for our communities </li></ul><ul><li>Evidence that does not lead to this has little value. </li></ul>