title: Scale-up and coverage of Avahan: a large-scale HIV-prevention programme among female sex workers and men who have sex with men in four Indian states.
abstract: OBJECTIVE
  Documenting the implementation of a public health programme as per its design is critical to interpretation of results from survey-led outcome and impact evaluation activities, the authors describe the scale-up and coverage of large-scale HIV-prevention services provided to female sex workers (FSWs) and high-risk men who have sex with men (HR-MSM) during the first 5 years of the Avahan programme in India.
  
  
  METHODS
  Implementing NGO partner-generated denominator estimates from 70 districts were used to estimate the programme's intended coverage. Routine programme-monitoring data until December 2008 were used to describe the service and commodity availability, service utilisation to generate internal estimates of coverage. Coverage was validated in few districts using data from a cross-sectional survey.
  
  
  RESULTS
  In December 2008, the estimated denominators for intended services were about 217,000 FSWs and 80,000 HR-MSM. By January 2007, 79% of eventual total clinics and 75% drop-in centres were established, and 83% of eventual peer educators were active. By month 48, sufficient condoms to cover all estimated FSW commercial sex acts were distributed free. By month 60, 75% of the estimated denominator intended to be covered was met monthly. 86% of FSWs and 67% of HR-MSM ever contacted had used sexually transmitted infections services at least once. Cross-sectional survey generated coverage results suggest that programme-monitoring data provide a proxy to coverage of services.
  
  
  CONCLUSIONS
  Avahan's monitoring data show that Avahan achieved infrastructure scale by year 3 and high contact coverage through peers and with commodities by year 5 of implementation as per the design.
authors.affiliation: Family Health International, New Delhi, India. rverma@fhiindia.org
authors.forename: Ruchi
authors.initials: R
authors.lastname: Verma
authors.forename: Abhijeet
authors.initials: A
authors.lastname: Shekhar
authors.forename: Sharmistha
authors.initials: S
authors.lastname: Khobragade
authors.forename: Rajatashuvra
authors.initials: R
authors.lastname: Adhikary
authors.forename: Bitra
authors.initials: B
authors.lastname: George
authors.forename: Banadalkoppa M
authors.initials: BM
authors.lastname: Ramesh
authors.forename: Virupax
authors.initials: V
authors.lastname: Ranebennur
authors.forename: Sudipta
authors.initials: S
authors.lastname: Mondal
authors.forename: Rajesh Kumar
authors.initials: RK
authors.lastname: Patra
authors.forename: Sandhya
authors.initials: S
authors.lastname: Srinivasan
authors.forename: A
authors.initials: A
authors.lastname: Vijayaraman
authors.forename: Sushena Reza
authors.initials: SR
authors.lastname: Paul
authors.forename: Nabesh
authors.initials: N
authors.lastname: Bohidar
mesh_terms: D017280:Condoms / Q000706:statistics & numerical data; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D006293:Health Promotion / Q000458:organization & administration*; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D007194:India; D008297:Male; D009938:Organizations; D015397:Program Evaluation; D011477:Sex Work / Q000706:statistics & numerical data*