Data is a perishable good. Timely and relevant use of data to guide decision-making, though challenging, is critical, particularly for large and complex programs. Programs need to invest resources not just to gather and report data, but also to create and stimulate a culture that emphasizes appropriate data analysis and use at all levels.
Avahan was started in 2003 with the aim of helping slow the transmission of HIV in India by raising prevention coverage to scale in populations most at risk (high-risk groups*) and bridge populations by achieving saturation levels (over 80 percent) across large geographic areas. Avahan works in six highprevalence states—Andhra Pradesh, Tamil Nadu, Maharashtra, Karnataka, Manipur, and Nagaland—which in 2003 accounted for 83 percent of India's estimated HIV infections. Avahan has three primary goals:
1. Build an HIV prevention model at scale in India
2. Catalyze others to take over and replicate the model
3. Foster and disseminate learnings within India and worldwide
Working within a ten-year timeframe, the initiative has built a large-scale HIV prevention intervention program in the first five-year "build and operate" phase. Avahan operates in six high prevalence states and across major national highways of India. Avahan, as part of the second five-year "transfer and replicate" phase and in keeping with its second goal, is now beginning to hand over the program to "natural owners" like the Government of India and the communities served by the program.
Gathering and using data is critical for all of Avahan's goals—to continuously refine the program and its many moving parts, to inform other HIV prevention efforts including the national prevention program and its direction, and to capture results and best practices.
Data sources relevant to the generated through Avahan program can be grouped into two categories: (1) data generated by the implementation programs; and (2) data relevant to implementation and evaluation collected by evaluation or knowledge building partners funded by Avahan. Data streams generated by implementation programs include:
Formal mapping and size estimation related to most-atrisk (high-risk) populations; needs assessment studies; and community led mapping of the high-risk populations.
Behavioral data from surveys of high-risk populations and men at risk. Routine program monitoring indicators on service provision, service uptake, and community activities. Several of these indicators are reported monthly since late 2004. These indicators aggregate data captured from communities' interactions with peer educators and utilization of program-owned and -supported STI clinics. They also provide information on other operational and infrastructure aspects reported by the NGOs. Qualitative measures of STI clinical services and community mobilization. Data streams generated primarily for evaluation or knowledge building purposes include:
Two rounds of a cross-sectional behavioral and biological survey (called the Integrated Behavioral and Biological Assessment—IBBA). This assessment covered: (1) about 27,000 female sex workers, high-risk men who have sex with men, injecting drug users, and male clients of female sex workers, in 29 districts; and (2) 2,000 long-distance truckers along four national highway route corridors.3 These surveys capture an array of data elements—sociodemographic, HIV risk behavior including condom use, and presence of several STIs and HIV infection.Surveys of general population
in five districts to capture sociodemographic behavior, condom use, and prevalence of several STIs and HIV.Data from other knowledge building grants
in areas such as migration and mobility, validation of STI treatment algorithms, and community mobilization and structural interventions.
Over time, Avahan has consciously emphasized analysis and use of data by all stakeholders in the program. Data analysis is used to guide program decisions and activities in areas such as resource allocation, implementation scale-up, course corrections and shifts in implementation, program redesign, impact evaluation, and advocacy.
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