Linking the Evidence to Practice

1. Linking the Evidence to Practice Melanie Croce-Galis

2. Goals • Use research in your planning and proposals • Getting comfortable with research • Where to get it, how to evaluate it • Review best practices • Linking programs to evidence • Passing it on

3. Interpreting Research • Name/affiliation • Abstract • Goals and objectives • Methods • Results • Limitations • Discussion • Conclusions

4. Key Questions to Ask about a Research Study • What makes the study important? • Do the findings make sense? • Who conducted the research and wrote the report? • Who published the report?

5. Key Questions to Ask about a Research Study • Did the researcher select an appropriate group for the study? • If comparison groups are used, how similar are they? • What has changed since the information was collected? • Are the methods appropriate to the research purpose?

6. Key Questions to Ask about a Research Study • Does the study establish causation? • Is the time frame long enough to identify an impact? • Could the data be biased as a result of poor research design? • Are the results statistically significant?

7. Bottom line • Look at the conclusions first • …then look for a reliable author/publisher • …then give the methods a closer look

8. Preventing HIV in women and girls Reducing violence against women Education for girls Community-based care Female-controlled prevention Livelihood, property and inheritance rights Access to treatment, care and support At-risk populations: Sex workers and women and girls in conflict situations Global Fund Priority Areas

9. Overview • Review best practices • Identify additional program ideas • Make the links between programs and evidence

10. Making the Link Programs Evidence HIV Impact

11. Best Practices:Reducing Violence Against Women • Training teachers • Media campaigns • Workshops to change gender norms • Training for HIV counselors • Access to credit

12. 1. Coercive sex with infected partner 2. Limited ability to negotiate safe sex 3. Pattern of sexual risk taking among those assaulted in childhood/adolescence GBV program HIV Impact Making the Link Violence increases women’s risk for HIV infection through:

13. Preventing HIV in Women & Girls • Perinatal transmission • Abstinence, fidelity, partner reduction • Male condom use • STI management • Female partners of men at risk or partners in stable relations with unknown status • Adolescents

14. Best Practices:Perinatal Transmission • Support groups for male partners/community education • Voluntary counseling and testing during antenatal care • Use of rapid HIV testing during labor • Detecting STIs that may co-facilitate HIV • HIV counseling for women and their sexual partners • Timely and optimal ARV therapy • Advocacy and legal challenges • Providing PMTCT plus treatment for the mother

15. 1. Reducing mother-to-child transmission 2. Providing treatment to HIV+ mothers 3. Perinatal program HIV Impact Making the Link Reducing perinatal transmission directly impacts HIV by:

16. Best Practices:Abstinence, Fidelity, Partner Reduction • Nationwide efforts to decrease sexual activity among adolescents • Sexuality education (especially prior to the onset of sexual activity) Note: evidence that abstinence-only education is not a best practice • Media campaigns about delaying sex • Peer education with AIDS awareness campaigns • HIV education by HIV-positive people

17. 1. Reducing/minimizing exposure to the virus 2. Increasing awareness 3. BC program HIV Impact Making the Link Behavior change programming directly impacts HIV by:

18. Best Practices:Male Condom • Consistent use • Inconsistent use • Promoting national acceptability • Providing ART (can increase condom use) • Promotion among male partners of HIV-positive women • Making condom use the responsibility of brothel owners and customers • Community-wide social discussions

19. 1. Reducing/minimizing exposure to the virus 2. Reducing/minimizing exposure to other STIs that increase HIV vulnerability 3. Condom program HIV Impact Making the Link Male condom use directly impacts HIV by:

20. Best Practices:STI Management for Women • Testing for STIs (without actual testing, women are incorrectly treated) • Periodic screening for sex workers • Access to counseling, diagnosis and treatment • Increasing the number and accessibility of STI clinics • Rapid testing for syphilis

21. 1. Reducing HIV incidence rates 2. STI program HIV Impact Making the Link STI services directly impact HIV by:

22. Best Practices:Female Partners of Men at Risk or Where Status is Unknown Female partners of men at risk: • None – just gaps in programming Where status is unknown: • Degree of concern or worry about HIV infection can cause behavior change

23. 1. Creating open dialogue about serostatus • Promoting behavior change High-risk relationship program HIV Impact Making the Link Programming for high risk relationships directly impacts HIV by:

24. Best Practices:Adolescents • Nationwide efforts to increase age at first sex • Peer Education • Education • Access to condoms • Affordable and confidential VCT at clinics that are user-friendly for female adolescents • Mass media campaigns • Social marketing campaigns to increase condom use

25. 1. Increasing age at first sex • Encouraging protective behaviors • before infection • 3. Adolescent program HIV Impact Making the Link Programming for adolescents directly impacts HIV by:

26. Best Practices:Female-Controlled Prevention • Direct promotion of female condom use • Media campaigns

27. Empowering women • 2. Improving women’s ability to practice safer sex • 3. Female-control program HIV Impact Making the Link Female-controlled prevention programs directly impact HIV by:

28. Best Practices:Education for Girls • Eliminating school fees • Community dialogue to promote education for girls • Providing life-skills based education • Creating child-friendly, health promoting schools

29. 1. Improving knowledge of HIV 2. Better understanding of ways to avoid infection 3. Greater likelihood of changing behavior Education program HIV Impact Making the Link Access to education directly impacts HIV by:

30. Best Practices:Community-Based Care • Training men in home-based care • Provide credit and training on sustainable agriculture • Strengthen communities capacity to help PLWAs and OVCs

31. 1. Caring for those infected, including OVCs 2. Community program HIV Impact Making the Link Community-based care programs directly impact HIV by:

32. Thursday • Practice making the links Programs Evidence HIV Impact

33. Best Practices:Livelihood, Property and Inheritance Rights • Enforce laws that allow widows to control property • Provide access to education and employment opportunities for women and girls

34. Best Practices:Access to Treatment, Care & Support • Providing ARV treatment increases preventive behaviors • Gynecological care is an important entry point for HIV+ women into treatment • Provider training • Changing community attitudes

35. Best Practices:At-Risk Populations - Sex Workers • Clinic-base interventions • Comprehensive programs for sex workers and their boyfriends • Support groups/group counseling for sex workers • Direct outreach • Requiring brothels to mandate condom use • Condom negotiation skills • Routine STI testing • Peer education

36. Best Practices:At-Risk Populations - Women and Girls in Conflict Situations • None

37. Best Practices:Positive Women’s Leadership and Involvement in the Response • Involve PLHA in a meaningful way • Peer support groups for HIV+ women