Liverpool School of Tropical Medicine, Liverpool, UK.
Centre for Sexual Health and HIV AIDS Research Zimbabwe, Harare, Zimbabwe.
J Int AIDS Soc. 2024 Jul;27 Suppl 2(Suppl 2):e26262. doi: 10.1002/jia2.26262.
We used a Programme Science platform, to generate evidence to support the implementation of programmes for sex workers in Africa. Female sex workers are estimated to make up 1.6% (1.3%-1.8%) of the population of women aged 15-49 years in Zimbabwe. We highlight how programme science can be used to help distinguish between when, where and with whom programmes need to be implemented and discuss two case studies that exemplify implementing better (Case study 1 (1 June 2019-30 June 2021) Optimizing implementation of a risk differentiated microplanning intervention) and implementing differently (Case study 2 (1 October 2016-30 September 2022) Reorientating implementation of DREAMS for young women selling sex).
Zimbabwe's nationally scaled programme for sex workers was established in 2009 in partnership with sex workers to provide comprehensive services for sex workers and generate evidence for programme design, implementation and scale up. Since inception, comprehensive data have been collected from all sex workers seeking services. As the scope of service provision has expanded so has the scope of data collection and analysis. At enrolment, sex workers are assigned an alphanumeric unique identifier which links consultations within and across programme sites. We conduct descriptive analyses of the Key Population (KP) programme data to guide programme implementation and redesign, embedding programmatic qualitative enquiry as required.
Two case studies describing different approaches to programme optimization are presented. In the first, an optimization exercise was used to strengthen programme implementation ensuring that the KP programme got back on track after SARS-COV-2. In the second, an in-depth review of research and programme data led to a re-orientation of the DREAMS programme to ensure that young women at the highest risk of HIV acquisition were enrolled and had access to DREAMS social support interventions in turn strengthening their uptake of HIV prevention.
Optimizing and sustaining HIV care and treatment programmes requires effective delivery with sufficient scale and intensity for population impact. Our programme science approach guided the scale up of the KP programme in Zimbabwe, providing evidence to support strategy, implementation and ongoing management, and importantly helping us distinguish between when we needed to just implement, implement better or implement differently.
我们利用一个项目科学平台，生成支持在非洲实施性工作者项目的证据。据估计，在津巴布韦，15-49 岁的女性人口中，性工作者占 1.6%（1.3%-1.8%）。我们强调了项目科学如何帮助区分何时、何地以及与谁需要实施项目，并讨论了两个案例研究，这些案例研究体现了更好地实施（案例研究 1（2019 年 6 月 1 日至 2021 年 6 月 30 日）优化风险差异化微观规划干预措施的实施）和不同地实施（案例研究 2（2016 年 10 月 1 日至 2022 年 9 月 30 日）重新定位年轻性工作女性梦想计划的实施）。
津巴布韦全国范围内的性工作者项目于 2009 年与性工作者合作成立，旨在为性工作者提供全面服务，并为项目设计、实施和扩大提供证据。自成立以来，已从所有寻求服务的性工作者那里收集了全面的数据。随着服务提供范围的扩大，数据收集和分析的范围也在扩大。在登记时，性工作者会获得一个字母数字唯一标识符，该标识符将在项目站点内和站点之间的咨询联系起来。我们对重点人群（KP）项目数据进行描述性分析，以指导项目实施和重新设计，根据需要嵌入计划定性研究。
介绍了两个描述不同方案优化方法的案例研究。在第一个案例中，进行了优化练习，以加强项目实施，确保 KP 项目在 SARS-COV-2 之后重回正轨。在第二个案例中，对研究和项目数据进行了深入审查，导致重新调整了 DREAMS 计划，以确保艾滋病毒感染风险最高的年轻女性能够参加并获得 DREAMS 社会支持干预措施，从而加强她们对艾滋病毒预防措施的接受程度。
优化和维持艾滋病毒护理和治疗项目需要有效的交付，以达到人口影响所需的足够规模和强度。我们的项目科学方法指导了津巴布韦 KP 项目的扩大，提供了支持战略、实施和持续管理的证据，重要的是，帮助我们区分何时只需要实施、更好地实施或不同地实施。
