"From me to HIV": a case study of the community experience of donor transition of health programs.
BACKGROUND
Avahan, a large-scale HIV prevention program in India, transitioned over 130 intervention sites from donor funding and management to government ownership in three rounds. This paper examines the transition experience from the perspective of the communities targeted by these interventions.


METHODS
Fifteen qualitative longitudinal case studies were conducted across all three rounds of transition, including 83 in-depth interviews and 45 focus group discussions. Data collection took place between 2010 and 2013 in four states: Andhra Pradesh, Karnataka, Maharashtra and Tamil Nadu.


RESULTS
We find that communication about transition was difficult at first but improved over time, while issues related to employment of peer educators were challenging throughout the transition. Clinical services were shifted to government providers resulting in mixed experiences depending on the population being targeted. Lastly, the loss of activities aimed at community ownership and mobilization negatively affected the beneficiaries' view of transition.


CONCLUSIONS
While some programmatic changes resulted in improvements, additional opportunity costs for beneficiaries may pose barriers to accessing HIV prevention services. Communicating and engaging community stakeholders early on in future such transitions may mitigate negative feelings and lead to more constructive relationships and dialogue.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Rm. E-8612, Baltimore, MD, 21205, USA. drodri17@jhu.edu.
Daniela C
DC
Rodríguez
Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
Vandana
V
Tripathi
Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
Meghan
M
Bohren
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
Amy
A
Paul
Amaltas Consulting Pvt Ltd, Delhi, C 20 Hauz Khas, New Delhi, 110 016, India. ksingh@amaltas.asia.
Kriti
K
Singh
Amaltas Consulting Pvt Ltd, Delhi, C 20 Hauz Khas, New Delhi, 110 016, India.
Vibha
V
Chhabra
Amaltas Consulting Pvt Ltd, Delhi, C 20 Hauz Khas, New Delhi, 110 016, India.
Suneeta
S
Singh
Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Rm. E-8612, Baltimore, MD, 21205, USA.
Sara
S
Bennett
D003695:Delivery of Health Care / Q000191:economics* / Q000458:organization & administration; D005380:Financing, Government; D017144:Focus Groups; D005582:Foundations; D015658:HIV Infections / Q000517:prevention & control*; D006293:Health Promotion / Q000191:economics* / Q000458:organization & administration; D061889:Healthcare Financing; D006801:Humans; D007194:India; D008137:Longitudinal Studies; D036301:Qualitative Research