Supported self-assessments led to improvements in national HIV prevention programming and more efficient use of donor support.‍

When national HIV programmes know their gaps, they do better. A new and innovative approach to finding those gaps is changing programmes for the better in East and Southern Africa — and leading to more strategic uses of donor funding and technical assistance.

Globally, the scale-up of antiretroviral treatment may have helped put the world on track to meet targets in reducing AIDS-related deaths but declines in new HIV infections have lagged, shows UNAIDS’ 2020 HIV Prevention Roadmap.

In 2017, the Global HIV Prevention Coalition (GPC) was launched to kick start the world’s HIV prevention efforts. More than 30 countries have since joined the coalition. Some coalition member countries such as South Africa, Eswatini and Zimbabwe have seen recent declines in new HIV infections, according to the coalition’s 2020 progress report.

Still, less than half of sex workers and only about a third of men who have sex with men (MSM) and people who inject drugs — groups that are known as key populations — in GPC countries have regular access to HIV services.

In the vast majority of GPC African member states, these populations are also criminalised - making it even more difficult for national HIV programmes to reach these groups with services.

When countries reflect on their own work, new opportunities emerge

In 2020, Genesis Analytics teamed up with the University of Manitoba to begin a small proof of concept project called the South-to-South Learning Network to improve condom and key population HIV prevention programming in 10 GPC African member countries, namely: Ghana, Kenya, Malawi, Mozambique, Nigeria, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe.

As part of the project, South-to-South Learning Network countries became the first in the world to use newly developed UNAIDS’ HIV Prevention Self-Assessment Tools (PSATs) in the areas of condom provision, key populations, and adolescent girls and young women. These self-assessments became the starting points for months of deliberate peer-to-peer learning facilitated by the South-to-South Learning Network team as countries shared lessons learned and challenges. But the project also revealed that although self-assessment is not typically used within global health, the subjective and country-led nature of this process allowed countries to achieve new levels of honest reflection. This kind of reflection led to tangible programmatic improvements — both in national policies but also in their use of donor funds and technical assistance.

In its first year, the South-South Learning Network — and its facilitated use of innovative new UNAIDS tools — has already:

• Demonstrated proof of concept
• Shaped key population policies in Uganda and Nigeria
• Informed national funding applications to the Global Fund to AIDS, TB and Malaria in several countries
• Fed into national strategic plan processes in South Africa
• Led to targeted requests for technical assistance in response to demonstrated gaps

“The South-to-South Learning Network condom PSAT tool has been an eye-opener for our country programme,” says James Njobvuyalema, biomedical policy officer at Malawi’s National AIDS Commission. “It has helped us to identify critical areas that need improvement, which we have often overlooked.”

‍

Finding gaps, charting - and costing - solutions

With funding from the Bill & Melinda Gates Foundation, the South-to-South Learning Network team supported country delegations — including government, AIDS councils, civil society, implementing partners, donors and United Nations agencies — to complete PSATs. These extensive Excel-based tools evaluate aspects of HIV programme management, implementation, and outcomes and sustainability.

In some countries, the South-to-South Learning Network’s support took the form of direct technical assistance in completing the tools or synthesising the results into user-friendly reports. In others, the South-to-South Learning Network team provided basics such as laptops, speakers and headphones to ensure that civil society partners could fully engage in the process.

In Uganda, the rate of new HIV infections has fallen in the last decade. Still, the country’s latest national HIV strategic plan notes that condom use in the East African nation is falling, in part because of stockouts and “condom fatigue.” Only about one in three Ugandans used a condom the last time they had, what the country defines as, a risky sexual encounter, the plan reveals, a far cry from the national target of 75%.

“The condom PSATs were quite informative and quite revealing,” said one Ugandan official, who added she believes the country should use the tool on other aspects of its HIV prevention programmes. “The PSATs put the programmes into manageable bits [that were easy to review].”

Uganda was on the verge of publishing a new key population strategy when it completed its PSATs. After PSATs revealed new gaps in programming, the country decided to delay launching the strategy and instead, worked with the South-to-South Learning Network team to revise — and also cost — the strategy.

“Participating in the South-to-South Learning Network created a necessity to stop and first reflect… [on] how we have been conducting business,” said another Ugandan official, “and understand how we can address gaps in a deliberate and structured way.”

Similarly, Kenya used its PSAT to identify gaps in programming for MSM, transgender people and inmates. Kenya then actioned this information and re-drafted its application to the Global Fund to Fight AIDS, TB and Malaria to address shortfalls in these key population groups.

Kenya has approached the South-to-South Learning Network team for assistance to undergo a similar process in self-evaluating its programming for adolescent girls and young women between the ages of 15 and 24 and who make up one-third of all new HIV infections in the country.

‍

A new tool for global AIDS reporting

Ultimately, the South-South Learning Network afforded countries to self-assess their progress on HIV prevention programming. Although this is undoubtedly a subjective process, undertaking the self-assessment provided countries the chance to self-reflect on programmes, increasing their level of ownership and confidence in those programmes.

Self-assessment tools play a complementary — but no less important — role in global AIDS reporting alongside more traditional assessments.

Importantly, self-assessments like the PSATs allow for holistic self-reflection not often found in traditional HIV prevention programme management, which can often be driven by results and donor requirements. Building self-assessments into programmes may allow countries to better respond to gaps but also to more effectively inform donor targets.

And as the South-to-South Learning Network has already shown in its first year, these kinds of reviews — when paired with thoughtful facilitation and peer learning — can unlock powerful new programmatic insights by policymakers that have the very real potential to make HIV prevention programmes more responsive and people-focused.

-

Interested in learning more about this project? Contact Kerry Mangold, South-South Learning Network Programme Director, at KerryM@genesis-analytics.com

‍