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International Health

Supporting Operational AIDS Research (SOAR): Assessing the Geographic Pivot

Project SOAR—Supporting Operational AIDS Research—conducts HIV operations research around the world to identify practical solutions to improve HIV prevention, care, and treatment services. This collaborative six-year project (2014–2020), funded by the U. S. President’s Emergency Plan for AIDS Relief and the U. S. Agency for International Development (Cooperative Agreement OAA-A-14-00060), helps strengthen the skills of local research institutions and individuals to conduct and use high-quality research to improve programs and policies, and ensure more efficient and effective delivery of critical HIV services.

Dr. Sara Bennett, a professor in International Health at the Johns Hopkins Bloomberg School of Public Health, is leading the Assessing the Geographic Pivot Activity, one of Project SOAR’s numerous components.

In studies based in Kenya and Uganda, Bennett’s team is evaluating PEPFAR’s geographic prioritization strategy, whereby PEPFAR is intensifying support in “scale up” areas and phasing out its support to “centrally supported” areas. The JHSPH team is focused on understanding the effects of the pivot in areas in the centrally supported areas which will be transitioned to government. In collaboration with USAID, MEASURE Evaluation, and in-country partners, Dr. Bennett and her team are working to better understand the effect of USAID’s changing HIV/AIDS investment strategy on the facility and subnational unit (SNU) health system function.

As the USAID investment profile changes, HIV programs may need to find new sources of support. Programs that relied primarily on PEPFAR funding may need to rely to varying degrees on government and other non-US government donors. These funding changes could have effects on any element of the health system function that has been supported with USAID investment, including human resources, commodities, health information (availability, quality, and use), total expenditures, and how facilities function. These effects could also be seen, ultimately, in health outcomes for HIV and non-HIV services that have previously been leveraged using USAID HIV funds (e.g. family planning and maternal and child health).

Findings from the project will provide guidance to USAID and other US government partners on how to minimize risks to past investments in HIV/AIDS response and health system strengthening. Results from the project will also help USAID and other donors manage future HIV investments, and highlight where additional support and resources may be needed to support SNUs affected by changes in US government policy.

The Population Council leads Project SOAR in collaboration with Avenir Health, Elizabeth Glaser Pediatric AIDS Foundation, Johns Hopkins University, Palladium, and The University of North Carolina at Chapel Hill. Project SOAR’s portfolio consists of 70 activities in 21 countries. Through our research, SOAR is working to:

By linking solid science with practical applications, our research is contributing to the achievement of UNAIDS’ global 90-90-90 testing and treatment goals.

Project SOAR Final Report: Evaluating the impact of PEPFAR’s geographic prioritization on centrally supported health facilities