Ayala monitoring and evaluation talk pcb june 2012
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This document discusses the advantages of meaningful community involvement in monitoring and evaluation (M&E) of HIV prevention programs. It notes that community members are often relegated to peripheral advisory roles rather than active contributors. However, involving the community results in more precise questions, stronger validity of interventions and measures, and a focus on feasibility and sustainability. A case study of a global online survey of men who have sex with men found that factors like connection to community and comfort with providers influenced HIV testing and PrEP access. The implications are that tailoring approaches to different sub-groups and ensuring enabling prevention environments will help scale up PrEP and treatment.
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Ayala monitoring and evaluation talk pcb june 2012
- 1. Linking Data to Decision Making: Advantages to Meaningful Community Involvement in M & E Dr. George Ayala, Executive Director Global Forum on MSM & HIV (MSMGF) Working world wide against HIV for the health and human rights of men who have sex with men
- 2. About This Talk • Challenges to community participation in M&E • Advantages to meaningful community participation • Case illustration • Implications for programs and policy Working world wide against HIV for the health and human rights of men who have sex with men
- 3. Challenges to Community Involvement in M&E • Community is often relegated only to peripheral advisory roles rather than as an active contributors to the intellectual development of research • Outcome indicators are often not well matched to prevention strategies employed in the field, restricting the role community can play in M&E – effect lag is important to keep in mind • Capacity development needs of both researchers and community may undermine strong M&E Working world wide against HIV for the health and human rights of men who have sex with men
- 4. Advantages to Community Involvement in M&E Involving community results in : • The formulation of more precise questions linked to implementation issues and better methods for gathering data from end users (both clients and providers) • Strengthened reliability and validity of the interventions studied and measures used to study them • A focus to program feasibility, acceptability and sustainability - reflexivity Working world wide against HIV for the health and human rights of men who have sex with men
- 5. Advantages to Community Involvement in M&E Conducted correctly, community involvement: • Creates bridges between researchers and communities • Facilitates reciprocal learning, and • Assists in the culturally appropriate measurement instruments, indicators and interventions (thus making programs more relevant, effective and efficient) Working world wide against HIV for the health and human rights of men who have sex with men
- 6. Case Illustration: GMHR Survey • GMHR survey designed to assess the barriers to and facilitators of HIV prevention services • 30-minute global online survey of conveniently recruited MSM (n=2,197; to date) offered in 5 languages from all regions of the world: – PrEP knowledge and acceptability – HIV-testing , condom, lubricant and treatment access – Perceived stigma – Connection to community – Comfort with provider – Experiences of homophobia Working world wide against HIV for the health and human rights of men who have sex with men
- 7. GMHR Survey: Findings to Date • HIV testing access was associated with connection to gay community and comfort with health provider • Among HIV-negative respondents, PrEP acceptability was associated with knowledge about PrEP, perceived stigma related to PrEP; and being out and open about being gay • Among HIV-positive respondents, homophobia was associated with decreased access HIV treatment • Adjusting for facilitators and barriers, compared to high-income countries, respondents in low and middle-income countries were less likely to have access to prevention services Working world wide against HIV for the health and human rights of men who have sex with men
- 8. Program and Policy Implications • Successful roll out of PrEP for MSM will be dependent on how well we reinforce facilitators and address barriers to service access (effectiveness of PrEP is dependent its acceptability and on access to testing and ARVs) • Target communities need to be carefully segmented given within group differences in the predictors of access • Context matters: must work to ensure enabling prevention environments Working world wide against HIV for the health and human rights of men who have sex with men
- 9. Summary Community involvement for this project will result in: • More nuanced understandings about factors that help and hinder HIV prevention access as well as acceptability of prevention interventions - these may vary within target communities • Better tailoring of approaches and matching of intervention combinations to sub groups • Increased likelihood of ownership if community members are engaged early and in a meaningful way Working world wide against HIV for the health and human rights of men who have sex with men
- 10. Acknowledgements Sonya Arreola Keletso Makofane Patrick Wilson Tri D. Do Jack Beck Pato Hebert Glen Milo Santos Bill and Melinda Gates Foundation Working world wide against HIV for the health and human rights of men who have sex with men
Editor's Notes
- Community involvement is often reduced to the formation of CABs, and while important, is often tokenistic and condescendingIf we as community providers, are working to eliminate stigma or enhance treatment adherence we should create measures that can detect decreases stigma and increases in treatment adherence. Instead, providers are asked to prove decreases in HIV incidence or document 100% condom use.Researchers are not always knowledgeable about community concerns. Community members not always knowledgeable about evaluation methods.
- As an advocacy organization, we are interested in having our policy positions and advocacy approach be informed by systematically collected data. We do this in several ways: literature reviews, survey research, qualitative interviewing, policy audits, and collection of testimonies. This is the way for us to be accountable to our constituents and more specifically to the frontline experiences of MSM.Key underlying motivation of this research is to understand new HIV prevention interventions like PrEP in the context of broader concerns about knowledge, acceptability, discrimination and service access.We have a particular interest in understanding factors that help or hinder access to services – this is what is meant by facilitators of and barriers to access to services.We used E-blast to MSM networks and web banners to promote the survey. In addition, paper and pen versions of survey are being implemented across a network of community-based organizations in Africa and the Pacific Islands, regions where internet access among gay men may be a challenge.Survey was designed with significant input from constituents
- Compared with men who reported limited HIV testing access, MSM who had access to HIV testing were more likely to be connected to gay community and feel comfortable with their health provider.Knowledge linked to greater acceptability.Homophobia possibly hindering access to treatment.When we control for these factors, MSM in low and middle income countries had less access to prevention services than MSM in high income country.