Chandrasekaran Padma, Dallabetta Gina, Loo Virginia, Mills Stephen, Saidel Tobi, Adhikary Rajatashuvra, Alary Michel, Lowndes Catherine M, Boily Marie-Claude, Moore James
Bill and Melinda Gates Foundation, New Delhi, India.
AIDS. 2008 Dec;22 Suppl 5:S1-15. doi: 10.1097/01.aids.0000343760.70078.89.
Closing the HIV prevention gap to prevent HIV infections requires rapid, worldwide rollout of large-scale national programmes. Evaluating such programmes is challenging and complex, requiring clarity of evaluation purpose and evidential approaches substantively different to those employed for pilots and small programmes.
This paper describes the evaluation design for the implementation phase of Avahan, the India AIDS initiative, a large HIV prevention programme funded by the Bill and Melinda Gates Foundation. Avahan, which began in December 2003, has a 10-year charter to impact the Indian epidemic and its response by implementing an HIV prevention programme targeting core and bridge groups in 83 districts of six Indian states, transferring the programme to the Government of India, and disseminating programme learning.
The foundation commissioned an external process to design Avahan's evaluation framework. An independent advisory group oversees and guides course corrections in the execution of this framework.
Avahan's evaluation framework comprises: trend and synthetic analysis of data from core, bridge and household biobehavioural surveys in a subset of intervention districts, denominator estimates and programme monitoring from all intervention districts, and government's antenatal surveillance (two sites per district in all districts); bespoke transmission dynamics modelling to estimate infections averted (subset of districts); cost effectiveness studies (subset of districts). In addition, there are other knowledge-building and quality-monitoring activities.
Rather than a small set of monofocal outcome measures, scaled programmes require nuanced evaluations that approximate programmatic scale by collecting data with different levels of geographical scope, synthesize multiple data and methods to arrive at a composite picture, and can cope with continuous environmental and programme evolution.
缩小艾滋病预防差距以防止艾滋病毒感染需要在全球迅速推广大规模国家项目。评估此类项目具有挑战性且复杂，需要明确评估目的以及与试点项目和小型项目所采用方法截然不同的证据收集方法。
本文描述了由比尔及梅琳达·盖茨基金会资助的大型艾滋病预防项目“印度艾滋病倡议”（Avahan）实施阶段的评估设计。Avahan于2003年12月启动，其为期10年的章程旨在通过在印度六个邦的83个区针对核心群体和桥梁群体实施艾滋病预防项目、将该项目移交给印度政府并传播项目经验，来影响印度的艾滋病疫情及其应对措施。
该基金会委托外部机构设计Avahan的评估框架。一个独立咨询小组监督并指导该框架实施过程中的纠正措施。
Avahan的评估框架包括：对部分干预区核心群体、桥梁群体和家庭生物行为调查数据的趋势和综合分析，所有干预区的分母估计和项目监测，以及政府的产前监测（所有区每个区两个地点）；定制传播动力学模型以估计避免的感染数（部分区）；成本效益研究（部分区）。此外，还有其他知识构建和质量监测活动。
大规模项目需要的不是一小套单一重点的成果指标，而是细致入微的评估，即通过收集不同地理范围的数据来近似项目规模，综合多种数据和方法以形成综合情况，并能够应对不断变化的环境和项目发展。
