Frontiers Prevention Project evaluation

A third of people living with HIV in the world are in countries that do not yet have generalised epidemics. Even a small increase in infection rates in countries without generalised epidemics, especially populous ones, would represent a dramatic worsening of the global AIDS burden. For this reason, there is an urgent need to reduce HIV infections in relatively low-prevalence countries put at risk by the growing HIV pandemic. In these lower-prevalence countries, we have a critical opportunity (depending on project implementation) to answer the following key questions about the impact of a comprehensive package of HIV prevention activities:

  • To what extent do HIV prevention interventions bring about positive change in the course of the epidemic within key populations and the communities in which they live?
  • Does community participation provide an additional impact beyond that of traditional prevention interventions?
  • What is the effect of existing prevention coverage provided by related services in the implementation of the new interventions?

The Frontiers Prevention Project (FPP), funded by the Bill and Melinda Gates Foundation and implemented by the Alliance and local partners, provides an opportunity to answer these questions.

The FPP works to reduce HIV infection in relatively low-prevalence countries through comprehensive, community-based HIV prevention interventions focused on key populations critical to the dynamics of the epidemic. The FPP operates in several geographic sites in India, Ecuador and Cambodia.

Evaluation objectives

The research and evaluation unit aims to evaluate and measure the impact and change as a result of HIV prevention interventions in the three programme countries. It also aims to establish a well-functioning monitoring and evaluation system in each, measuring outcomes, outputs and costs within sites.

The research and evaluation unit and its partners (Mexico’s National Institute of Public Health and the Population Council’s Horizons Project) have prepared a monitoring and evaluation framework for the programme protocol. This gives an overview of the evaluation approach that will be adopted.

Internal evaluation

An internal Monitoring and Evaluation programme will apply to all three countries. The internal evaluation will track behavioural and contextual change for direct and identifiable project beneficiaries – such as clients of a sexually transmitted infection treatment centre or members of a peer support group – rather than for key populations or the population as a whole. Internal monitoring data will correspond to the Alliance’s standard reporting requirements, measuring numbers of people reached, activities conducted and so on. The internal evaluation will include:

  • the development of a non-governmental organisation capacity assessment tool
  • a dosage component
  • geographic site assessments
  • outcome evaluations of each country
  • process monitoring
  • participatory site assessments
  • a costing component to measure process and intervention costs.

External evaluation

Some of the data collected by the Alliance and its partners as part of the internal monitoring and evaluation process will also correspond to data collected by an external evaluation. This is being led by the National Institute of Public Health and Horizons, in co-operation with local research institutions in each participating country. The local research institutions will implement the in-country external evaluation, which will include:

  • collection of baseline and programme data from the programme and comparison sites
  • collection of biomarkers
  • development of a questionnaire
  • sample size
  • data sets
  • an ethical review.