Combination HIV Prevention

Tailoring programs to stop transmission

In the last few years, scientists have given policymakers several new tools to prevent the transmission of HIV at the individual, community and population levels. Futures Groups ecological approach takes those tools and works with a variety of stakeholders from the national decision makers to the leaders in local communities, using local data to target populations who are most at risk for HIV transmission. Combination HIV prevention programs cover all modes of HIV transmission, including sexual transmission, injection drug use and mother-to-child transmission, and match the most appropriate tools to the predominant mode of transmission in a community. Futures Group draws upon the vast cumulative experience and data sets from similar epidemics and populations and fills gaps in local data with modeling and estimation. We delve into the unique characteristics and conditions of the epidemic in communities, not just looking at national statistics. We consider biomedical, behavioral, social, and structural factors. And we closely examine the risk factors around sexual networks, mother-to-child transmission, injecting drug use, and commercial sex work. Our approach allows for more efficient use of resources because we help set priorities, integrate prevention services with other initiatives, and form partnerships with affected communities.

Program Areas
population and family planning sexual and reproductive health maternal and child health hiv and aids infectious diseases gender poverty and equity

futures group offerings:

W  e design, develop and help implement prevention programs, combining biomedical, behavioral, social, and structural interventions. B  ased on identified needs in a community, we assist local decision makers in carrying out prevention activities that focus on sexual transmission, injecting drug use, and mother-to-child transmission. W  e have a proven track record of sourcing and collecting data and analyzing it to uncover nuances in a particular locality. We understand that each country has sub-epidemics and different local contexts that demand a more finely tuned response to specific epidemiological and population needs and conditions. Our Local Epidemic Assessment for Prevention (LEAP) process gathers key information from a locality, district or sub-district, fills data gaps through estimation, and adds a wrapper of strategic and operational planning. W  hen gaps in local data prevent this tailored approach, we draw on our

Technical Services
policy and advocacy research and strategic information  health markets and private sector engagement modeling and economic analysis health systems strengthening strategic consulting program management

m  odeling expertise to devise innovative solutions. These solutions use resources efficiently by engaging local leaders, and prioritizing interventions and populations. We model outcomes with precision and predict the impact of prevention services on HIV prevalence, incidence, and unmet need for prevention services. We forge partnerships among decision makers at all levels, from the national to the local, through a participatory process that provides supportive technical assistance. W  e have an extensive adaptable toolbox - including LEAP, GOALS, Resource Needs Model, AIDS Impact Model, PLACE and Epi Probe - and we capacitate on the ground personnel use to them.

Record of Results:
Established a South African government multi-sectoral collaboration strategy and plan, and identified key counterparts in each stakeholder agency. Provided important technical and operational support to South African programs to know your epidemic and know your response. Supported the development of the new National Strategic Plan 2011-2015 for HIV/AIDS, STIs and TB. Completed a synthesis and analysis paper on sexual HIV prevention in South Africa and in the three of the countrys provinces - Gauteng, Mpumalanga, and KwaZulu Natal.

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Supported roll out of the South African Department of Basic Educations HIV and AIDS Strategy and Policy. Worked with local organizations and launched combination prevention planning in Gauteng, Mpumalanga and KwaZulu Natal provinces.

Approach in Action: South Africa

Working with the South African government and community leaders, Futures Group is implementing the USAID | Sexual HIV Prevention Program (SHIPP) 2010-2014. The program focuses on getting more impact from prevention programs today and tomorrow by studying behavioral risks and social and gender norms to determine who is transmitting the disease and how best to reduce new infections. Our strategies are driven by evidence and local realities, and they include biomedical interventions and school-based programming in the countrys three highest-incidence provinces. Under the project, we are closely collaborating with key South African partners, including the Department of Health, Department of Basic Education, Department of Public Service Administration, the South African National AIDS Council, the University of the Witwatersrand Reproductive Health & HIV Institute, and the Centre for AIDS Development, Research, and Evaluation, Engender Health, and Futures Institute.

Principles Used in Setting the HIV Prevention Agenda

Understand the Epidemic: We constantly monitor, analyze and research the disease at the local level to ensure our knowledge and prevention programs are up to date and relevant. Understand Culture and Context: Countries are complex and diverse, and cultural norms, practices and conditions can significantly modify risks and interventions. Understand Costs: We help to determine the resource needs for and impediments to a successful program. Conduct Monitoring and Evaluation: In order for programs to succeed, we closely monitor the outcomes and when necessary make refinements to improve results. Understand the Available Intervention Tool Box: We work to achieve high impact and cost effective programs by using and adapting all available tools and models for decision making. Use an Adaptive Learning Agenda: Through local partnerships, we distribute successful prevention lessons to ensure lasting change and healthier communities.

Evidence-based prevention means basing the response on the known facts of the epidemic and providing prevention services where risk is occurring. Farley Cleghorn Chief Technical Officer Futures Group

Partnering to Meet HIV Prevention Needs

Mrs. Magwaza Msibi is the mayor of Zululand, a collection of rural communities of 1 million people in South Africa with high levels of poverty and HIV/AIDS. In the past, the governments response to the epidemic has not succeeded in reducing HIV transmission. Recognizing the challenge, Mrs. Msibi revamped the Zululand District AIDS Council with the help of Futures Group to better understand and address the HIV prevention needs of her citizens. Following a suggested district plan of action, the Council now is setting targets for prevention programming and working with organizations best suited to help it execute its combination prevention programs. With real statistics in hand, Mrs. Msibi is meeting with local leaders and citizens to figure out which programs make sense and how to allocate funds. The prevention program components arent new they include HIV testing, medical male circumcision, providing treatment, counseling and changing behavior. But for the first time, the government is bringing leaders and practitioners together and setting priorities based on current information that showcases the most important issues. The district is looking forward to playing a role in the fight against HIV, Mrs. Msibi said.
Zululand District AIDS Council launch . Photo by: Cyril Myaka

Futures Group, the global health consulting firm, helps to protect and promote peoples well-being around the world. For 40 years, Futures Group has created lasting solutions to some of the most pressing public health challenges facing nations. For more information, please visit www.futuresgroup.com, www.facebook.com/FuturesGroup, and www.twitter.com/FuturesGroupGbl.