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Program – Science Initiatives: Scope and Applications

Program – Science Initiatives: Scope and Applications. James Blanchard, MD, MPH, PhD Director, Centre for Global Public Health University of Manitoba. Program-Science Initiatives: Overview. Purpose:

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Program – Science Initiatives: Scope and Applications

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  1. Program – Science Initiatives:Scope and Applications James Blanchard, MD, MPH, PhD Director, Centre for Global Public Health University of Manitoba

  2. Program-Science Initiatives: Overview • Purpose: • To improve the impact of HIV/STI prevention programs by optimizing the design, implementation and management processes • Program-centered • Dynamic interaction between program and policy leaders and implementers and the science community: • Multiple program domains • Multiple science domains

  3. Program-Science Initiatives: Purpose and Objectives • “Internal” Objectives: • To identify and address the key knowledge gaps related to program design, implementation and management • To establish an interactive and iterative process of knowledge translation to optimize program impact on the population level • “External” Objectives: • To expand the knowledge base with respect to HIV prevention program planning, implementation and management • To facilitate knowledge translation to other contexts • To build capacity in research and program domains for linking programs to science, and science to programs • Methodology development for knowledge development and translation • Program management processes and tools

  4. Different Contexts for Program-Science Initiatives • Epidemic typology • Status of the program response

  5. Concentrated Epidemics • Transmission dynamics relatively well-defined, with strategic uncertainty related to the mix and interaction of key populations • Implementation issues related to the right combination of intervention components, changing dynamics with key populations, etc. • Program management issues related to scaling up, program quality, monitoring and evaluation, sustainability, etc. • Methods for evaluating population-level impact • External value in translating knowledge from successful large-scale programs (e.g. India) to other contexts

  6. Pakistan – Relative Size of Key Populations, per 1000 Adult Men

  7. Pakistan – Sexual Partnerships for Key Populations in Different Cities

  8. Existence of a targeted intervention project is not enough… Sargodha • Experienced NGO implementing IDU intervention • Focus on fixed site needle/syringe exchange, clinical services, etc. • HIV counseling and testing

  9. Sargodha… Data to action • Outreach micro-planning based on hotspot mapping • Recruit “street doctors” for outreach, safer injection • Within 1 month the total # of IDUs contacted doubles • HIV prevalence at VCT increases to 40% in the next few months

  10. Mixed and Generalizing Epidemics • Key strategic questions: • Methods for assessing the epidemic and transmission dynamics • Focusing on the right populations, networks and behaviours • Resource allocation and mix of targeted and generalized prevention initiatives • Implementation / effectiveness issues: • Translation of programs for high risk key populations from other contexts, scaling up, etc. • Choosing and/or testing methods for altering the sexual structure for prevention impact • Evaluating the impact of combined / complex interventions • Program management issues: • Optimizing management structures for combination / complex interventions • Health system issues and approaches • Processes for scaling up

  11. Country/State Level Program-Science Initiative: Basic Structure (straw man) • Country / State led • Selected externals • Multi-disciplinary • Purpose-built • Includes country • scientists

  12. Program Science Components – Activity Diagram Program-Science Group

  13. Externalizing concepts, knowledge, methods, tools, etc. Program Science Initiative(s) Dissemination Program-Science Group

  14. Some issues to consider… • Where can we begin “in vivo”… • Region? • Country? • State / province? • How is a “program science consortium” comprised? • What is the pathway and milestones? • How do initiatives and structures in N. America and Europe intersect with other global initiatives?

  15. The “Big Picture” • Health systems research • Implementation science • Health services research • Continuous quality improvement • Knowledge translation • Evidence based practice • Public health Program Science Initiative

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