The Drum Beat 81: Horizons - Operational Research

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There is work to be done to improve global communication on research in development and health. In HIV/AIDS research, communicators can play a critical role in transforming research results into powerful tools to counter the epidemic, particularly in hard-hit regions. Of particular interest is operations research (OR), which studies the operational aspects of programmes and policies and proposes cost-effective solutions to problems in service delivery. This issue highlights an international OR effort that examines many of the key issues in HIV/AIDS prevention, care, and support.

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THE HORIZONS PROJECT: Global HIV/AIDS Operations Research



1. More than 20 years into the global HIV/AIDS pandemic, research has revealed a great deal about how the HIV virus is transmitted, opening the door to the development of drug therapies, behavior change strategies, and other approaches to preventing HIV and mitigating AIDS. Yet far less research has been devoted to understanding the basic operational, policy, and cost barriers that affect whether and how HIV/AIDS prevention, care, and support services are delivered. In developing countries - where more than 90% of HIV-infected people live - such interventions remain the primary tools for addressing the pandemic.



2. The Horizons Project is a comprehensive research effort that applies operations research (OR) to many of the most pressing global issues affecting HIV/AIDS service delivery programmes. Launched in 1997, Horizons sponsors more than 60 research activities in 21 countries in Africa, Asia, Latin America, and the Caribbean. The project's teams use qualitative and quantitative methods to identify barriers to effective programme design and delivery, test new approaches, and recommend best practices to improve policies and programmes. Cost-effectiveness is often a major element of the research. Because OR is applied research that places a premium on involving key stakeholders, Horizons builds partnerships with NGOs, community-level service delivery programmes, universities, research institutes, governments, and health organizations in every country where it works. Please note that several of the research studies below are still in progress.



ACTIVITIES



3. Prevention of Mother-to-Child Transmission (MTCT) of HIV - New research has shown that antiretrovirals administered to pregnant HIV-positive women can lower the risk of transmission to the infant. What are the feasibility, acceptability, cost, and impact of a package of medical and psychosocial services to prevent MTCT in resource-poor regions? In 6 antenatal clinics in Kenya and Zambia, a study tests a potential model. Click here for study. Contact Dr. Ruth Nduati (Kenya) nduati@iconnect.co.ke or Dr. Margaret Siwale (Zambia) mtct@zamnet.zm



4. HIV & Partner Violence: Implications for HIV Voluntary Counseling & Testing (VCT) Programmes - A key part of VCT programmes is encouraging disclosure of test results to partners. Does the fear of violence inhibit women from telling their partners their serostatus, and do women experience violence when they do reveal test results? A study in Tanzania examines these issues. Click here for study. Contact Dr. Suzanne Maman smaman@jhsph.edu



5. Youth & HIV Voluntary Counseling & Testing (VCT) Programmes - VCT programmes for adults have been shown to increase the adoption of safer sexual behaviors and link them with care and support services. But is VCT appropriate for young people? If so, how can it be adapted to their needs? In Kenya and Uganda, researchers have found that current programmes don't always serve young people effectively. Click here for more information. Contact Dr. Edward Kirumira Click here for study.
Contact Dr. Rebecca Nyonyintono anppcan@infocam.co.ug



7. 100 Percent Condom Use in Sex Establishments - In Thailand, a government policy helped lower STI rates by requiring condom use for all acts of commercial sex. Can this policy success story be adapted to other settings? An intervention study in the Dominican Republic examines 2 different models. Click here for study. Contact Luis Moreno coin@codetel.net.do



8. The Female Condom: Dynamics of Use - Zimbabwe was the 1st country in Africa where the female condom was widely marketed. How has social marketing affected women's and men's views of the female condom? For what reasons and with which types of partners have they used the device? A study in Harare analyzes attitudes and patterns of use. Click here for study. Contact Dr. Deanna Kerrigan dkerrigan@pcdc.org



9. Involving People Living with HIV/AIDS (PLHA) in Community-based Programmes - PLHA are becoming increasingly involved as providers and managers of prevention, care, and support activities. What kinds of PLHA participation are associated with high-quality and effective community programmes? A research project looks at PLHA involvement in 5 organizations in Burkina Faso. The study is also investigating similar organizations in Zambia, India, and Ecuador. Click here for study. Contact Christophe Cornu ccornu@aidsalliance.org



10. Prevention & Treatment of Sexually Transmitted Infections (STIs) - The presence of other STIs increases vulnerability to HIV and is a often a key factor for the spread of the virus. How can resource-poor governments create effective and affordable STI management programmes? 2 large-scale studies in southern Africa test different hybrid approaches. Click here for more information. Contact Dr. Lewis Ndhlovu lndhlovu@pcjoburg.org.za



11. HIV/AIDS Peer Education - Peer education has long been a pillar of HIV/AIDS prevention. Which components and principles of peer education are important for programme quality and effectiveness, and what challenges remain to be addressed? A global workshop examined these issues and recommended new directions for research. Click here for more information. Contact Ellen Weiss eweiss@pcdc.org



12. Male Circumcision & HIV Prevention - Interest is growing in the hypothesis that male circumcision may reduce HIV transmission. What has biomedical and social science research shown so far about male circumcision and HIV/AIDS? An international consultation examined the evidence and suggested new directions for research. Click here for more information. Contact Dr. Johannes van Dam jvandam@pcdc.org



13. Promoting Reproductive Health by Radio - Radio is one of the best and most cost-effective ways to reach a wide audience in developing countries. How can this medium be used to promote better reproductive health, including HIV/AIDS prevention? A popular call-in show in Kenya answers some sensitive questions. Click here for more information. Contact Kwame Asiedu kasiedu@popcouncil.org.ke



14. Horizons AIDSQuest: The HIV/AIDS Library - This on-line library of AIDS-related surveys and other data collection tools covers such topics as risk and prevention behaviors, stigma, care and support, and gender and sexuality. Also includes information on methodological and survey design issues. With contributions from NGO, academic, and governmental institutions, the library is an excellent resource for researchers. AIDSQuest Library site. Contact Sherry Hutchinson shutchinson@popcouncil.org or Scott Geibel sgeibel@pcdc.org



15. Gender, Sexuality, & HIV/AIDS: The What, the Why, and the How - We know that gender and sexuality are significant factors in the sexual transmission of HIV. How can programmes transform gender roles and create more equitable sexual relationships between women and men? A plenary address at the 13th International AIDS Conference in Durban by Dr. Geeta Rao Gupta provides concrete examples. Plenary address online. Contact info@icrw.org



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Material for this issue provided by the Horizons Project.

Funded by the U.S. Agency for International Development, the project is implemented by the Population Council in collaboration with the International Center for Research on Women (ICRW), the Program for Appropriate Technology in Health (PATH), the International HIV/AIDS Alliance, the University of Alabama at Birmingham, and Tulane University. Visit the Horizons web page or e-mail horizons@pcdc.org View the Horizons Report, the project's newsletter.

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Please send items for The Drum Beat to the Editor - Deborah Heimann dheimann@comminit.com