Transitioning a Large Scale HIV/AIDS Prevention Program to Local Stakeholders: Findings from the Avahan Transition Evaluation.
BACKGROUND
Between 2009-2013 the Bill and Melinda Gates Foundation transitioned its HIV/AIDS prevention initiative in India from being a stand-alone program outside of government, to being fully government funded and implemented. We present an independent prospective evaluation of the transition.


METHODS
The evaluation drew upon (1) a structured survey of transition readiness in a sample of 80 targeted HIV prevention programs prior to transition; (2) a structured survey assessing institutionalization of program features in a sample of 70 targeted intervention (TI) programs, one year post-transition; and (3) case studies of 15 TI programs.


RESULTS
Transition was conducted in 3 rounds. While the 2009 transition round was problematic, subsequent rounds were implemented more smoothly. In the 2011 and 2012 transition rounds, Avahan programs were well prepared for transition with the large majority of TI program staff trained for transition, high alignment with government clinical, financial and managerial norms, and strong government commitment to the program. One year post transition there were significant program changes, but these were largely perceived positively. Notable negative changes were: limited flexibility in program management, delays in funding, commodity stock outs, and community member perceptions of a narrowing in program focus. Service coverage outcomes were sustained at least six months post-transition.


CONCLUSIONS
The study suggests that significant investments in transition preparation contributed to a smooth transition and sustained service coverage. Notwithstanding, there were substantive program changes post-transition. Five key lessons for transition design and implementation are identified.
Johns Hopkins Bloomberg School of Public Health, International Health Department, 615 North Wolfe St, Baltimore, MD, United States of America.
Sara
S
Bennett
Amaltas Consulting Pvt. Ltd., C-20 Hauz Khas, New Delhi, 110016, India.
Suneeta
S
Singh
Johns Hopkins Bloomberg School of Public Health, International Health Department, 615 North Wolfe St, Baltimore, MD, United States of America.
Daniela
D
Rodriguez
Johns Hopkins Bloomberg School of Public Health, International Health Department, 615 North Wolfe St, Baltimore, MD, United States of America.
Sachiko
S
Ozawa
Amaltas Consulting Pvt. Ltd., C-20 Hauz Khas, New Delhi, 110016, India.
Kriti
K
Singh
Amaltas Consulting Pvt. Ltd., C-20 Hauz Khas, New Delhi, 110016, India.
Vibha
V
Chhabra
Department of Aids Control, Ministry of Health & Family Welfare, Government of India, 6th Floor, Chandralok Building, 36 Janpath, New Delhi, 110001, India.
Neeraj
N
Dhingra
D006078:Government Programs / Q000458:organization & administration / Q000592:standards; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D007194:India; D009938:Organizations / Q000458:organization & administration / Q000592:standards; D015397:Program Evaluation