In April 2017, researchers from the Health Systems Program traveled to East Africa to launch data collection for a study under Project SOAR (Supporting Operational AIDS Research). Dr. Sara Bennett, professor, Dr. Daniela Rodriguez, assistant scientist, Jess Wilhelm, PhD student, and Mary Qiu, senior research program coordinator, went to Kenya and Uganda to examine the health systems impact in regions of both countries that are transitioning their HIV/AIDS programs to government support as part of Phase III of the United States President’s Emergency Plan for AIDS Relief (PEPFAR)’s sustained control of the AIDS epidemic.

Project SOAR is a five-year program funded by the United States Agency for International Development (USAID) and led by the Population Council that conducts HIV and AIDS operational research. The evaluation of the Geographic Pivot is a specific component of the project, led by Dr. Bennett.

HIV/AIDS continues to be a significant burden on low- and middle-income countries, and funding for the epidemic has plateaued in recent years. PEPFAR’s geographic prioritization strategy focuses on intensifying support to regions where the HIV/AIDS burden is highest, and phasing support to the government in regions where the burden is less severe. The objective of this shift is to increase efficiency of available funds and to achieve the UNAIDS 90-90-90 goal of having 90% of all HIV+ individuals aware of their status, 90% all people diagnosed with HIV on sustained antiretroviral therapy, and 90% of all people receiving antiretroviral therapy to have viral suppression, by 2020.

The Health Systems team is examining how the transition is being implemented and what the impact is on transitioned regions. Their research consists of a facility survey; document reviews from USAID and governments in Kenya and Uganda; and primary interviews with ministry of health employees, patients, and government officials in order to get a multi-perspective account of the impact of these changes.

As part of their effort to understand how health systems are affected by the change in support allocation, they are deploying a large-scale survey across the transitioned regions and are training in-country partners to conduct the survey. In addition to the survey, the in-country teams are conducting in-depth interviews with specific health facilities in Kenya and Uganda to get a more thorough understanding of the transition effects across all levels of health care, from delivery to how it is affecting business operations, such as human resources and available commodities.

The goal of the project is to help guide both donors and in-country government on how to implement programmatic transitions while limiting any adverse effects on how health systems function and care is delivered. Findings from the Program’s researchers will inform future efforts to manage HIV/AIDS investment and create a more targeted response to the epidemic. Read more about the programmatic transition process here