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From scaling up to sustainability in HIV: potential lessons for moving forward

BACKGROUND: In 30 years of experience in responding to the HIV epidemic, critical decisions and program characteristics for successful scale-up have been studied. Now leaders face a new challenge: sustaining large-scale HIV prevention programs. Implementers, funders, and the communities served need...

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Autores principales: Hirschhorn, Lisa R, Talbot, Julie R, Irwin, Alexander C, May, Maria A, Dhavan, Nayana, Shady, Robert, Ellner, Andrew L, Weintraub, Rebecca L
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3826849/
https://www.ncbi.nlm.nih.gov/pubmed/24199749
http://dx.doi.org/10.1186/1744-8603-9-57
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author Hirschhorn, Lisa R
Talbot, Julie R
Irwin, Alexander C
May, Maria A
Dhavan, Nayana
Shady, Robert
Ellner, Andrew L
Weintraub, Rebecca L
author_facet Hirschhorn, Lisa R
Talbot, Julie R
Irwin, Alexander C
May, Maria A
Dhavan, Nayana
Shady, Robert
Ellner, Andrew L
Weintraub, Rebecca L
author_sort Hirschhorn, Lisa R
collection PubMed
description BACKGROUND: In 30 years of experience in responding to the HIV epidemic, critical decisions and program characteristics for successful scale-up have been studied. Now leaders face a new challenge: sustaining large-scale HIV prevention programs. Implementers, funders, and the communities served need to assess what strategies and practices of scaling up are also relevant for sustaining delivery at scale. METHODS: We reviewed white and gray literature to identify domains central to scaling-up programs and reviewed HIV case studies to identify how these domains might relate to sustaining delivery at scale. RESULTS: We found 10 domains identified as important for successfully scaling up programs that have potential relevance for sustaining delivery at scale: fiscal support; political support; community involvement, integration, buy-in, and depth; partnerships; balancing flexibility/adaptability and standardization; supportive policy, regulatory, and legal environment; building and sustaining strong organizational capacity; transferring ownership; decentralization; and ongoing focus on sustainability. We identified one additional potential domain important for programs sustaining delivery at scale: emphasizing equity. CONCLUSIONS: Today, the public and private sector are examining their ability to generate value for populations. All stakeholders are aiming to stem the tide of the HIV epidemic. Implementers need a framework to guide the evolution of their strategies and management practices. Greater research is needed to refine the domains for policy and program implementers working to sustain HIV program delivery at scale.
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spelling pubmed-38268492013-11-14 From scaling up to sustainability in HIV: potential lessons for moving forward Hirschhorn, Lisa R Talbot, Julie R Irwin, Alexander C May, Maria A Dhavan, Nayana Shady, Robert Ellner, Andrew L Weintraub, Rebecca L Global Health Research BACKGROUND: In 30 years of experience in responding to the HIV epidemic, critical decisions and program characteristics for successful scale-up have been studied. Now leaders face a new challenge: sustaining large-scale HIV prevention programs. Implementers, funders, and the communities served need to assess what strategies and practices of scaling up are also relevant for sustaining delivery at scale. METHODS: We reviewed white and gray literature to identify domains central to scaling-up programs and reviewed HIV case studies to identify how these domains might relate to sustaining delivery at scale. RESULTS: We found 10 domains identified as important for successfully scaling up programs that have potential relevance for sustaining delivery at scale: fiscal support; political support; community involvement, integration, buy-in, and depth; partnerships; balancing flexibility/adaptability and standardization; supportive policy, regulatory, and legal environment; building and sustaining strong organizational capacity; transferring ownership; decentralization; and ongoing focus on sustainability. We identified one additional potential domain important for programs sustaining delivery at scale: emphasizing equity. CONCLUSIONS: Today, the public and private sector are examining their ability to generate value for populations. All stakeholders are aiming to stem the tide of the HIV epidemic. Implementers need a framework to guide the evolution of their strategies and management practices. Greater research is needed to refine the domains for policy and program implementers working to sustain HIV program delivery at scale. BioMed Central 2013-11-07 /pmc/articles/PMC3826849/ /pubmed/24199749 http://dx.doi.org/10.1186/1744-8603-9-57 Text en Copyright © 2013 Hirschhorn et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Hirschhorn, Lisa R
Talbot, Julie R
Irwin, Alexander C
May, Maria A
Dhavan, Nayana
Shady, Robert
Ellner, Andrew L
Weintraub, Rebecca L
From scaling up to sustainability in HIV: potential lessons for moving forward
title From scaling up to sustainability in HIV: potential lessons for moving forward
title_full From scaling up to sustainability in HIV: potential lessons for moving forward
title_fullStr From scaling up to sustainability in HIV: potential lessons for moving forward
title_full_unstemmed From scaling up to sustainability in HIV: potential lessons for moving forward
title_short From scaling up to sustainability in HIV: potential lessons for moving forward
title_sort from scaling up to sustainability in hiv: potential lessons for moving forward
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3826849/
https://www.ncbi.nlm.nih.gov/pubmed/24199749
http://dx.doi.org/10.1186/1744-8603-9-57
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