Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, USA.
Global Health. 2013 Nov 7;9:57. doi: 10.1186/1744-8603-9-57.
In 30 years of experience in responding to the HIV epidemic, critical decisions and program characteristics for successful scale-up have been studied. Now leaders face a new challenge: sustaining large-scale HIV prevention programs. Implementers, funders, and the communities served need to assess what strategies and practices of scaling up are also relevant for sustaining delivery at scale.
We reviewed white and gray literature to identify domains central to scaling-up programs and reviewed HIV case studies to identify how these domains might relate to sustaining delivery at scale.
We found 10 domains identified as important for successfully scaling up programs that have potential relevance for sustaining delivery at scale: fiscal support; political support; community involvement, integration, buy-in, and depth; partnerships; balancing flexibility/adaptability and standardization; supportive policy, regulatory, and legal environment; building and sustaining strong organizational capacity; transferring ownership; decentralization; and ongoing focus on sustainability. We identified one additional potential domain important for programs sustaining delivery at scale: emphasizing equity.
Today, the public and private sector are examining their ability to generate value for populations. All stakeholders are aiming to stem the tide of the HIV epidemic. Implementers need a framework to guide the evolution of their strategies and management practices. Greater research is needed to refine the domains for policy and program implementers working to sustain HIV program delivery at scale.
在应对艾滋病流行的 30 年经验中，已经研究了成功扩大规模的关键决策和项目特征。现在，领导者面临着新的挑战：维持大规模的艾滋病预防计划。实施者、资助者和所服务的社区需要评估扩大规模的战略和做法对于维持大规模交付的适用性。
我们回顾了白色和灰色文献，以确定与扩大项目相关的核心领域，并回顾了艾滋病案例研究，以确定这些领域如何与维持大规模交付相关。
我们发现了 10 个被确定为成功扩大项目的重要领域，这些领域对于维持大规模交付具有潜在的相关性：财政支持；政治支持；社区参与、整合、认同和深入；伙伴关系；平衡灵活性/适应性和标准化；支持性政策、监管和法律环境；建立和维持强大的组织能力；转移所有权；权力下放；以及对可持续性的持续关注。我们确定了另一个对于维持大规模交付的项目具有潜在重要性的领域：强调公平。
如今，公共和私营部门都在审视其为人群创造价值的能力。所有利益相关者都旨在遏制艾滋病流行的趋势。实施者需要一个框架来指导其战略和管理实践的演变。需要进行更多的研究，以完善政策和方案实施者在努力维持艾滋病方案大规模交付方面的领域。
