Evaluation Study Of A HIV/AIDS/STI Integrative Community-based Intervention Programme

Backgrounds The HIV/AIDS/STI prevention and control subproject of the ninth health project funded by the World Bank Loan, H9-HIV/AIDS/STI, is the first large-scaled comprehensive project in combating HIV/STI epidemics in China. It was launched in response to the souring HIV/STI epidemics in China in the late 1980s. It was designed to build key facilities for HIV/STI prevention and control, promote earlier implementation of China's First Ten Year HIV/AIDS Control Plan in areas hardest hid by or at the highest risk for HIV/STIs and explore effective policies and measures to inform nation-wide battle against the epidemics. The project was implemented in 35 prefectures and 55 counties in Xinjiang, Guangxi, Fujian, and Shanxi province or autonomous regions and China Central CDC. The project total budget was $39.99 million including $25.00million (62.52%) from World Bank Loan and $14.99 million (37.4%) counterpart fund from Chinese governments at different levels. The project was formally initiated in November, 1999 and ended in June, 2008.Objectives To evaluate the fulfillment of the planned project goals, effectiveness and impacts of the project implementation. To summarize the accomplished achievements and lessons learned.Methods We employed a combination of both qualitative and quantitative methods including record/document reviews, key informant qualitative interviews, focus group meetings, structured KAP surveys, knowledge examinations, case studies. Historical comparisons among different time points and case-control study between project and non-project counties were used. Results More than 65% policies in four provinces and 98% policies developed in project counties were supported by H9. These regional policies target long-term planning, political commitment, social mobilization, skill support, general population health education, high risk/vulnerable population intervention, aids for AIDS patients and HIV infectors, blood management, STI clinical comprehensive service management, HIV surveillance, condom spread. 209 HIV surveillant sentinels were established in four project provinces and among them, 146 were financed directly by H9. By the end of 2007, 30 national HIV/AIDS/STI technological formulations providing national guidelines were developed by H9.The rate of correct responses to HIV/AIDS/STI questions among the general public increased from 3.1% in 2002 to 17.4% in 2007 in project areas contrasted with 0.8% to 3.8% in non-project counties. Knowledge and behavior of local government officers are also better than non-project counties– the awareness rate of basic HIV knowledge in project counties is 83.6% versus 81.1% (P<0.05). Knowledge and attitude to HIV/AIDS/STIs among the clinical medical professionals in the project counties are better than those of the non-project counties with important and significant difference in STI diagnosis and treatment and clinical behavior intervention. Condom use (during the last sexual event) among the general population increased from 19.8% in 2002 to 30.1% in 2007contrasted with 11.4% to 25.6% in non project counties in the same period.The prevalence rate of Gonorrhea, Chlamydia infection, Syphilis, Verruca Acuminata and Herpes Genitals among female sexual workers in project counties was lower than that in the control counties (15.1% versus 25%, P<0.001) The expert team members developed in H9 began to provide extend technology and skill to the non-project regions. Some project regions with good intervention experiences were introduced nationally from 2006.Conclusions The overall goals of the project and the main objectives in each component have been realized with some areas even have surpassed the original design.The experience concluded and lessons learned provides a unique opportunity to explore the long term comprehensive STI/HIV intervention in a low-middle income country setting. Project plays a very important role in policy development and implementation, leadership development, HIV knowledge-behavior-attitude change, skill development. At the same time, the local economic, culture and policy transition promote and deepened the project implementation. The evaluation suggests that good governance and a conducive culture are important prerequisites for incorporating a new project within an existing system. Integrated project planning played an important role in shared value introduction and spread. Robust policy-making helps to systematize and institutionalize the planning mechanisms. The interactive effect of project and political commitment is another key factor that contributed to the success of project. Systematic management and technology staffs training promote the providers'skill and attitude. Active collaboration between researchers and service agencies results in successful program adoption. A unified resource allocation mechanism was efficient in strengthening resource linkage in fighting AIDS.The evaluation also suggests that the HIV/STI prevention and control does not extend to all the regions currently. Low income and rural area should be received high attention in the next stage concerning the equity of health intervention. Making full use of family planning and maternal and children health service net in HIV control is the practicable mechanism in future health service system strengthening. HIV/AIDS surveillance level was improved recently, unified understanding toward surveillance and unified flowing chart of the HIV surveillance is essential for the grass-root institution and staff. Developing the AIDS policies, intervention package and relevant resource distribution scheme targeting diversified HIV risk population will help to enhance the resource efficiency.