Quarterly recap of FHI 360’s blog on research and evaluation, January–March 2018

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We are officially knee-deep into 2018, although many of us are still waiting for Spring! The R&E Search for Evidence blog already has 13 new posts written by FHI 360 thought leaders and focused on innovative tools, research and evaluation methodologies, and new evidence related to some of our most pressing human development needs. Here are some of the highlights.

Recent research contributes to ending TB

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Tuberculosis (TB) is a top 10 global killer. HIV/AIDS no longer tops the list thanks to a global response focused on diagnosis and treatment. TB, however, remains one of the world’s deadliest infectious diseases and its impact is disproportionately felt in low- and middle-income countries. According to the World Health Organization (WHO), more than 95% of TB deaths occur in these resource-limited settings.

Despite the scary statistics, progress has been made over the last few decades. Diagnosis and treatment saved more than 50 million lives between 2000 and 2016. The public health community built on that foundation and adopted the End TB strategy, which aims to end the epidemic by 2030 as part of the Sustainable Development Goals. The strategy uses a blueprint based on three pillars: 1) integrated, patient-centered care and prevention, 2) bold policies and supportive systems, and 3) intensified research and innovation.

Most readers might rightfully think that controlling TB is simply about making sure patients receive their medication, but there are other spokes in the wheel working to create a comprehensive and effective response to the epidemic. These equally important spokes can include things like transporting viable patient samples to the testing laboratory, using appropriate medications in proper doses, or developing shorter treatment regimens. In the spirit of rolling a complete wheel down the road, I want to highlight three innovative research papers that address these sometimes overlooked issues within resource-limited settings.

Generating evidence for going to scale in multisectoral nutrition programming

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How many proven effective public health projects have you been involved in that have been scaled-up to have national – or even global – impact? Those of us working in this field know it’s all too rare for an intervention to catch on and spread like wildfire. Rather, most successful interventions fizzle out when project funds dry up or donor interest is gone.

So, what can we do to increase the chances that an effective intervention is adopted? At FHI 360, we are trying to answer this question using the USAID-funded Strengthening Multisectoral Nutrition Programming through Implementation Science Activity (MSNP) as the foundation for two new multisectoral research studies.

Increasing HIV detection with incentive-based, peer-referral approach known as Risk Tracing Snowball Approach

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Cambodia has achieved measurable success in its fight against HIV. Prevalence has dropped more than 60% from 1998 to 2015, and the number of new HIV cases fell more than 80% over the same period. However, as in many countries, going the last mile to fully eliminate the AIDS epidemic requires innovative approaches to reach individuals unaware of their HIV status – especially among hard-to-reach key populations – and link them to treatment to achieve viral load suppression.

A consortium comprised of three NGOs – KHANA, FHI 360, and Population Services International (PSI) – working with the HIV/AIDS Flagship Project funded by USAID came up with an intervention study idea. Would we detect more newly identified HIV cases if we asked people that walked-in for HIV testing (presumably high-risk) to refer their peers whom they think are at risk for HIV infection for testing? We hypothesized yes. If we were right, it would be brilliant and we could help Cambodia’s National Centre for HIV/AIDS, Dermatology and STD (NCHADS) scale-up the intervention and avert hundreds of new infections every year. The same Risk Tracing Snowball Approach (RTSA) had proven to be successful among high-risk heterosexuals in the United States, among drug users in Greece, and heterosexual couples in China. We set out to determine if it would work in Cambodia, and I describe our intervention design and evaluation outcomes in this blog post.

New research on open government data in developing countries: What we can learn from case studies

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A group of advocates met outside San Francisco in 2007 to pen eight principles of open government data with the intent of initiating a new era of democratic innovation and economic opportunity. In the decade since, governments are slowly opening up their data sets as a public resource, and even adopting other open data as their official data. More than 15 national governments (and 25 local governments) have now adopted the principles of open data and its potential to foster greater transparency, empower citizens, combat corruption, and generally enhance governance. Despite the gradual movement towards open government data, very little is actually known about its impact – what, where, how and under what conditions does open data work?

To address this aperture, the Development Informatics (DevInfo) team of USAID’s Global Development Lab and FHI 360’s Mobile Solutions Technical Assistance and Research (mSTAR) project, in collaboration with a research consortium from The GovLab and New York University, embarked on a research project to clarify the value of existing open data initiatives in developing countries. In this blog post, I will use examples from our team’s recent research to highlight what people have done with open government data in developing countries.

Research improves handwashing programs by uncovering drivers of behavior change

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Evidence on the health and social benefits of handwashing is strong. We know that handwashing can prevent up to 40% of diarrheal diseases, and can lead to fewer school absences and increased economic productivity. However, many people don’t wash their hands at critical times, even when handwashing facilities are available. While research on behavior change has shown examples of approaches that lead to increased rates in handwashing, we’re still seeking to understand why people wash their hands, and how motivation for handwashing can be translated into programs that result in effective behavior change.

In celebration of Global Handwashing Day on October 15, USAID and the Global Handwashing Partnership – an international coalition with a Secretariat hosted by FHI 360 – organized a webinar on drivers for handwashing behavior change. The Partnership’s work focuses on promoting handwashing with soap as key to health and development, with an emphasis on connecting practitioners with research findings to inform their work. Our webinar speakers provided two examples of how research is exploring behavior change from cognitive (how we think about and understand handwashing) and automatic (how we can be unconsciously prompted to wash our hands) standpoints. In this blog post, I’ll summarize how the two examples show different ways of understanding human behavior and discuss how the findings help us understand what drives behavior change for handwashing.

Call for papers: Optimizing the impact of key population programming across the HIV cascade

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Key populations – including men who have sex with men, sex workers, transgender people, and people who inject drugs – shoulder a disproportionate burden of HIV. UNAIDS estimates that between 40 and 50 percent of all new HIV infections among adults worldwide occur in these key populations and among their sex partners. Reaching members of these communities with evidence-based interventions that improve their access to and uptake of services across the HIV prevention, care, and treatment cascade is essential to achieving the UNAIDS 90-90-90 goals. In this post, I highlight a new call for papers that will focus on new evidence and data-driven strategies for improving key population programming across the HIV cascade.

Show me the evidence: Cultivating knowledge on governance and food security

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I recently participated in a salon on integrating governance and food security work to enhance development outcomes. Convened by the LOCUS coalition and FHI 360, the salon gathered experts in evaluation, governance and food security to review challenges and best practices for generating evidence and knowledge. A post-salon discussion recorded with Annette Brown and Joseph Sany speaks to the gaps in evidence and the need to more accurately measure how governance principles influence food security outcomes.

I came out of the salon conversation thinking that while there was a hunger for evidence, there are still large gaps and significant differences within the literature on things as basic as definitions. That being said, I wanted to dig a bit more into what evidence was actually out there and think about what needs to be done to move this budding evidence base forward. In this post, I highlight three pieces of interesting research that contribute to the evidence base on governance and food security integration, and then propose a few suggestions on how to grow that knowledge base.

Teasing apart stigma and knowledge as barriers to HIV testing: A study with young Black adults in Durham, North Carolina

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What experiences do young Black adults in Durham, North Carolina, have with HIV testing? And what influence does stigma play on those experiences? To answer these questions, my co-authors and I recently published the results of a community-based participatory research (CBPR) study: Relationship between HIV knowledge, HIV-related stigma, and HIV testing among young Black adults in a southeastern city. Our cross-sectional survey examined barriers, facilitators and contributors to HIV testing. This blog post summarizes our findings and provides guidance on HIV prevention strategies.

LINKAGES research digest highlights ability of young key populations to access and remain in the HIV care cascade

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On a quarterly basis, the LINKAGES project releases a research digest comprised of the latest peer-reviewed article abstracts related to HIV and key populations (KPs) – sex workers, men who have sex with men (MSM), transgender people, and people who inject drugs. LINKAGES is PEPFAR and USAID’s largest global project dedicated to using evidence-based approaches for reducing HIV transmission among KPs and improving their enrollment and retention in care. KPs have the highest risk of contracting HIV and often face formidable barriers to accessing prevention, care, and treatment services. The research digest keeps implementers and researchers up to date on the rapidly expanding evidence base pertaining to HIV services for KPs on a global scale. So, what did we learn about young KPs and HIV in the past quarter?