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Evaluation of HIV prevention programmes: the case of Avahan
  1. Stefano M Bertozzi1,
  2. Nancy Padian2,
  3. Tyler E Martz1
  1. 1Instituto Nacional de Salud Publica, Av. Universidad, Cuernavaca, Morelos, Mexico
  2. 2University of California, Berkeley, California, USA
  1. Correspondence to Dr Stefano M Bertozzi, Instituto Nacional de Salud Publica, Av Universidad 655, Cuernavaca, Morelos, Mexico; bertozzi{at}

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Current calls to action for HIV prevention programming stress the need for more strategic, combination prevention strategies along with evaluation components to measure effectively the impacts of such efforts. The Avahan project, implemented since 2003, is one example of a combination prevention programme for a concentrated epidemic that offers a clear example of what can be achieved when a programme is based on significant ‘know your epidemic’ research before implementation, and when data are used to optimise a delivery programme to maximise coverage of services. The rapid scale-up, the documentation of quality and coverage indicators, and perhaps most importantly, the application of modern, data-driven management tools to the delivery of a large-scale public health programme, are Avahan's most exemplary qualities.

Avahan is surely the world's largest HIV prevention programme in a country with a concentrated epidemic and perhaps the largest anywhere. It focuses on reaching the populations key to the spread of HIV in India: sex workers and their clients, men who have sex with men (MSM) and drug users. The team's experience with management information systems allowed them to monitor closely the implementation of services and in close to real-time adjust their practices to improve the quality and coverage of their services.

In addition to the ‘know your epidemic’ mapping of populations at risk, Avahan used market research to inform the design of their service delivery, ensuring that the facilities were conveniently located, that they were responsive to the specific needs of the population being served, etc. Had they been selling shoes or software, they would have been able to measure their success from the day they opened for business based on revenues minus expenses. Unfortunately, however, the connection between sales of HIV prevention services (coverage and uptake) and revenue (HIV infections averted) is far less clear. As a …

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