1. Key evaluation findings from the Frontiers Prevention Program
Alliance, INSP
February 2008

2. 2. FPP: conceptual framework
GOAL
Decrease
In HIV
incidence
amongst
KPs
Decrease in
HIV
Incidence
in site
Decrease
in HIV
Incidence
in site
Five country focused prevention programme funded by BMGF.
Ran from 2003 to 2007.
Talk through model

3. 2. FPP: conceptual framework
INTERMEDIATE
OUTCOMES
GOAL
Decrease
in KP risky
behaviour
Decrease
in HIV
Incidence
amongst
KPs
Decrease
in HIV
Incidence
in site
Talk through model
Decrease
in KP STI
Prevalence

4. 2. FPP: conceptual framework
PROCESS MONITORING
INTERMEDIATE
OUTCOMES
GOAL
Enabling
Environment
Decrease
in KP risky
behaviour
Empowerment
for prevention
for KPs
Decrease
in HIV
Incidence
amongst
KPs
Decrease
in HIV
Incidence
in site
Service and
Commodity
provision for
KPs
Talk through model
Decrease
in KP STI
Prevalence

5. 2. FPP: Interventions to saturate sites
MSM community in Ecuador with SWs enjoying asocial event after a participatory site assessment workshop
MSM & FSW at a social event after participatory site assessment, Ecuador

6. 2. FPP: Interventions to saturate sites
Sex worker group in AP discussing their barriers to access to services in a safe space provided by a local CBO
Sex workers discussing barriers to access, AP

7. 2. FPP: Interventions to saturate sites
FSW outreach worker providing HIV education and commodities for prevention and treatment
FSW outreach worker providing HIV education and commodities

8. 2. FPP: Interventions to saturate sites
Condom demo by for SWs in Ecaudor
Condom demo, Ecuador

9. 2. FPP: Interventions to saturate sites
Standalone KP focused clinic (called Mythri clincs) in AP providing STI counselling diagnosis, treatment and referral
KP focused clinic provides STI diagnosis, treatment and referral, AP

10. 2. FPP: Interventions to saturate sites
Transgender receiving peer care and support in AP…
Transgender receiving peer care after violent attack, AP

11. 2. FPP: Interventions to saturate sites
Transgender receiving peer care and support in AP…
President of the national FSW network in dialogue with police, Ecuador

12. 3. FPP evaluation model (1)
Initially designed with comparable intervention (FPP) and comparison (no FPP) sites
Qualitative study, India (Horizons, HIS Hyderabad)
2 observations: baseline (2004) and follow-up (2006)
IDIs & FGs to compare the main sub-categories of:
SWs (brothel-, street-, and home-based)
MSM (Kothi, Panthi and Double-deckers)
Only begun to cross-check with quantitative results
The FPP was developed with a build-in impact evaluation component that was commissioned to an external institution, INSP.
The evaluation was conceptualized to estimate the effect of the FPP interventions on behavioural and objective variables, and implemented in in two of the five FPP countries, India (Andhra Pradesh) and Ecuador.
In order to do this, the evaluation measured behavioural (e.g condom use) and objective variables (STIs – Syphilsi and HSV2) before and after the intervention and in intervention and comparison communities. Quantitative / qualitative

13. Quantitative evaluation
3. FPP evaluation model (1)
Quantitative evaluation
Survey instrument developed by a multidisciplinary team of researchers & validated with the KPs
Socioeconomic, demographic, behavioral, knowledge
Biomarkers (HSV2 & syphilis pre/post + HIV at end)
Baseline (Q  Q1 2004):
India: 2,182 FSW & 2,929 MSM in 24 evaluation sites
Follow-up (Q2-Q3 2007). Same questionnaire, revised to include data on exposure to interventions
India: FSW: 2,374 & MSM: 2,014

14. 4. Results (1). India MSM Condom last Condom female Syphilis HSV-2
100%
45%
58%
96%
91%
80%
60% 12 15 29 41 22 26 8 9 27 37 14 13
40%
20% 0%
NFPP
FPP
NFPP
FPP
Baseline
Baseline
Follow-up
Follow-up
Condom last
Condom female
Syphilis
HSV-2

15. 4. Results (2). India FSW Condom last client Condom regular Syphilis
74%
70%
99%
98%
100%
80%
60% 17 23 5 10 40 50
40% 7 6 23 22
20% 0%
NFPP
FPP
NFPP
FPP
Baseline
Baseline
Follow-up
Follow-up
Condom last client
Condom regular
Syphilis
HSV-2

16. 5. Conclusions / discussion (1)
Focused interventions associated with rapid, large increase in reported KP condom use:
FSW - AP: from 70% to 99% with clients
but still <30% with regular partners
MSM – AP: from 47% to 96%,
but only up to 42% with female partner.

17. 5. Conclusions / discussion (2)
Why are these changes so much bigger than ones that have been seen in previous studies?
One hypothesis is that the relationship between level of saturation of a site is associated with behavior change in a non-linear fashion.
Another hypothesis is that accountability / supervision in these interventions was significantly greater than the norm. i.e. $ were more efficiently translated into service delivery

18. 5. Conclusions / discussion (3)
In AP, focused interventions associated with rapid, large decrease in STI prevalence
MSM (AP). Syphilis 24%  10%
HSV2 32%  12%
FSW (AP). Syphilis 19%  8%
HSV2 45%  20%
NOTE: HSV2 is a lifetime infection (cumulative prevalence) so the reduction must be associated with high turnover (analysis pending). Similar situation for syphilis because the test used was for seropositivity (cumulative prevalence)

19. 6. Acknowledgements
Sam McPherson: director of evaluation at the Alliance
Stefano Bertozzi: PI of external evaluation
Juan Pablo Gutierrez: Project manager of external evaluation
Shumon, Prabhakar and others in AP team
BMGF
LEPRA staff
Jeff O’Malley, UNDP