Resources for Systems Strengthening Available at UCSF

HIV/AIDS research activities at the University of California, San Francisco stimulate innovation and support interdisciplinary collaboration aimed at all aspects of the HIV epidemic around the world. UCSF is dedicated to improving health and reducing the burden of disease in the world’s most vulnerable populations through applied public health research, education, and program improvement. Social, behavioral and policy scientists work in tandem with epidemiologists and clinical researchers to improve the quality of HIV prevention and care worldwide. We promote the use of evidence-based methods to build capacity in surveillance, monitoring and evaluation, public health evaluations and scientific best practices. We work with academic, governmental and community partners throughout the world to accomplish these goals. Currently, UCSF has over 30 scientists working in 37 countries engaged in the following activities:

• Surveillance: Training and technical assistance in surveillance methodology, design and implementation for routine surveillance activities (ie., second-generation surveillance in antenatal care clinic attendees). Training and technical assistance in advanced surveillance methods, design and implementation including HIV incidence surveillance, development of HIV case reporting systems, Time Location Sampling (TLS) and Respondent Driven Sampling (RDS) methods for reaching Most At-Risk Populations (MARPS). Training and capacity building in data analysis and use of surveillance data including assistance in producing surveillance reports.

• Evidence-Based HIV Prevention in Resource Limited Settings: UCSF’s expertise includes the capacity to leverage findings (i.e. strategic information) from rapid appraisals, surveillance activities, evaluation and research at the regional, country and local levels to promote sustainable, evidence-based HIV/AIDS prevention and treatment programs. During the planning process, we work with country stakeholders to identify optimal methods for collecting and using strategic information with the goal of harmonizing its use for country and global AIDS efforts. We support intensive technical assistance on using strategic information for planning, including developing country plans to guide diverse efforts from behavior change communication to palliative care programs.

• Technical Assistance for Program Implementation: UCSF has developed specific capacity to conduct rapid appraisals to better understand the context of integrating prevention and care interventions and programs into diverse settings. This activity often involves rapid assessment, in which multi-disciplinary teams conduct 5-day site visits where they develop observations and recommendations based on review of secondary data, observations of clinical and community settings, and in-depth interviews with key informants such as patients and providers. The report of the observations and recommendations is developed and distributed to appropriate stakeholders one week following the site visit. Local sites then have the opportunity to use the information as they see fit for their planning purposes.

• Monitoring & Evaluation: UCSF is a center of excellence for evaluation science. We provide guidance and services to develop, design, produce, and test evaluation information systems. Training and technical assistance (TA) in various aspects of M&E include effective use of data and strategic information for program planning and program improvement. TA in data use activities includes: helping sites develop data collection strategies and training staff to collect and clean study data; ensuring high quality datasets through local or remote database infrastructure; helping sites generate reports and translate results into strategic information; assisting in data analysis activities and developing an understanding among program staff regarding the use of data about key indicators collected routinely for program evaluation and improvement. The TA planning process allows us to assess program needs for monitoring and evaluation capacity and establish flexible solutions for collecting, managing, analyzing and returning information to country programs.

Monitoring & Evaluation Activities include:

• Triangulation: the synthesis and integrated analysis of data from multiple data sources to inform public health program decision-making. Whereas purely academic research is often conducted to definitively answer a pre-formed hypothesis, triangulation is a method to quickly examine existing data to strengthen interpretations and improve policy and programs based on the available evidence. Triangulation is a powerful tool that can be used to demonstrate program impact, identify areas for improvement, direct new programs and enhance existing programs, and help direct policy changes. UCSF has pioneered the use of this emerging approach for HIV programs in Africa and is currently conducting triangulation analyses in Botswana, Malawi, Mozambique, Tanzania and Rwanda and has taught the method for states in India, Eastern European countries and countries of the former Soviet Union. VISIT OUR TRIANGULATION SITE

• Patient Monitoring: technical assistance and capacity building is provided to countries to assess their ability to provide HIV care and treatment to those in need. TA in development and implementation of retrospective chart reviews of patients on ART to assess patient outcomes including morbidity, mortality, adherence and retention and TA in the planning, implementation and evaluation of patient monitoring systems (paper and electronic) of patients in care.

• Prevention with Positives in Clinical Care Settings: UCSF has extensive expertise in planning, developing and implementing a series of activities to improve the integration of HIV prevention into global care and treatment programs. Quality technical assistance is based on the model developed for the technical assistance and evaluation center for a twenty-clinic project which successfully integrated prevention with positives in clinical care settings. Our international work has identified three basic models for prevention with positives – provider-based, specialist-based and peer-based – each of which can be adapted to local settings. UCSF works with each country and clinical setting to refine and tailor technical assistance materials and plans. Training teams assist with implementing programs based on country or local plans.

• HIV Voluntary Counseling and Testing: UCSF has extensive experience in monitoring and evaluating the provision of voluntary counseling and testing in resource-limited settings. As part of a Phase III community-level randomized controlled study (Project Accept), UCSF is currently providing quality assurance services to study sites in Tanzania, Zimbabwe, South Africa and Thailand. The study intervention is premised on community-based behavior change strategies, and includes the provision of mobile VCT services, community mobilization, and post-test support services. Specialist staff at UCSF conduct site visits and provide ongoing feedback and support to local project management.

• Assistance with dissemination of lessons learned: UCSF has pioneered some of the most innovative research synthesis methods and dissemination vehicles for HIV prevention, care and treatment. UCSF is skilled at taking research findings and outcomes and developing materials for particular audiences in the forms of fact sheets, interactive websites, science to the community reports, journal articles, conferences and other methods developed in collaboration with local, national and international collaborators.

• Scientific Best Practice: The Cochrane Collaboration is the international organization that collates, summarizes and disseminates the best evidence for medical and public health practice around the world through a quarterly on-line and CD-ROM electronic library. The Cochrane HIV/AIDS Group, which is based at UCSF, covers evidence related to behavioral, social and policy interventions; biomedical prevention interventions, such as microbicides and male circumcision; treatment and care; and organization of care. The group has satellite centers in Brazil and South Africa, and the groups’ associate editors come from Australia, Canada, Greece, Mexico, Peru, and South Africa. In a field evolving as rapidly as HIV and AIDS, the best evidence for treatment and prevention decisions may not always be clear. This is especially true outside of the major urban AIDS centers in the developing world and in countries in the developing world. Cochrane systematic reviews on HIV/AIDS topics assist clinicians, public health practitioners, policy makers and consumers in making evidence-based decisions about HIV/AIDS prevention and treatment and provide direct translation of cutting-edge research into practice. VISIT OUR COCHRANE SITE

• Epidemiology and Prevention Fellowships and Traineeships: In collaboration with the Fogarty International AIDS Training Program of the University of California at Berkeley, UCSF has sponsored the International Traineeship in AIDS Prevention Studies (I-TAPS) Program since 1988. Up to ten junior and mid-level scientists from academic, governmental and non-governmental organizations from the developing world are selected each year to work with UCSF scientists in San Francisco. During the 10-week program, each visiting scientist develops a protocol for a specific research project with relevance to AIDS prevention to be carried out in his or her own country. There is also a follow-on course that assists students to write up and publish their study results. The most recent class came from Argentina, Brazil, China, Croatia, Iran, Peru and Russia. The program also delivers this instruction in short courses that can be adapted to individual country research and training needs.

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