title: Assessment of population-level effect of Avahan, an HIV-prevention initiative in India.
abstract: BACKGROUND
  The aim of Avahan, the India AIDS Initiative, was to reduce HIV transmission in the general population through large-scale prevention interventions focused on high-risk groups. It was launched in 2003 in six states with a total population of 300 million and a high HIV burden. We assessed the population-level effect of the first phase of Avahan (2003-08).
  
  
  METHODS
  Population prevalence was estimated by use of adjustment factors from the national HIV sentinel surveillance data obtained annually from antenatal clinics. A mixed-effects multilevel regression model was developed to estimate the association between intervention intensity and population HIV prevalence trends, taking into account differences in the underlying epidemic trends in states and other potential confounders, and to estimate the number of HIV infections averted with Avahan.
  
  
  RESULTS
  80 (61%) of 131 districts in the six Avahan states received funding from Avahan for HIV prevention, as the only or shared source. Greater intensity of Avahan, measured as amount of grant per HIV population (medians US$24-432 in the six states), was significantly associated with lower HIV prevalence in Andhra Pradesh (p=0·004), Karnataka (p=0·004), and Maharashtra (p=0·008) states; this association was not significant in Tamil Nadu (p=0·06), Manipur (p=0·62), and Nagaland (p=0·67). Overall, we estimated that 100,178 HIV infections (95% CI 25,897-207,713) were averted at the population level from 2003 up to 2008 as a result of Avahan.
  
  
  CONCLUSIONS
  The results of our analysis suggest that Avahan had a beneficial effect in reducing HIV prevalence at the population level over 5 years of programme implementation in some of the states. With stagnating funding for HIV prevention globally, our findings support investment in well planned and managed HIV prevention programmes in low-income and middle-income countries.
  
  
  BACKGROUND
  Bill & Melinda Gates Foundation.
authors: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98121, USA.
authors: Marie
authors: M
authors: Ng
authors: Emmanuela
authors: E
authors: Gakidou
authors: Alison
authors: A
authors: Levin-Rector
authors: Ajay
authors: A
authors: Khera
authors: Christopher J L
authors: CJ
authors: Murray
authors: Lalit
authors: L
authors: Dandona
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control*; D006289:Health Planning Support; D006293:Health Promotion; D006801:Humans; D007194:India / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D015397:Program Evaluation; D018571:Sentinel Surveillance; D060386:Sex Workers; D055815:Young Adult