Tevi Troy Spring Over the course of the 20th century, the United States faced three major public-health crises: Each of these crises took place over a multi-year period, and multiple presidents dealt with both their effects and the national response to them.
Indeed, goal setting should precede the design and implementation of a program.
This chapter provides an overview of goal setting, the strengths and weaknesses of various outcome objectives, and the measurement of outcomes for AIDS prevention programs. For the media program, campaign efforts were to be focused on the Evaluating polio and hiv aids treatment campaigns population "for an improved understanding of the risk factors [for HIV diffusion, and].
The stated national program goals of the new direct grants program that will fund CBOs and the goals of the testing and counseling project network were: The overall goal of reducing the spread of HIV is appropriate from a "big picture" perspective, but as stated it is inadequate as an evaluation objective.
First, it is too general: Furthermore, it is too distant: Finally, focusing on HIV alone can be misleading in some contexts: In addition to the overarching goal of eliminating HIV transmission, the panel recommends that explicit objectives be written for each of the major intervention programs and that these objectives be framed as measurable biological, psychological, and behavioral outcomes.
Objectives should be framed as proximate outcomes of behavior—that is, as near-term or intermediate outcomes that are linked to long-term goals. In fact, when an intermediate goal is known to lead to a long-term outcome, the need to evaluate results beyond the first stage is obviated Weiss, The long-term goal, of course, is the elimination of the transmission of HIV, or at least its reduction to a reproductive rate of less than 1.
Biological outcomes are not on this list because their interpretation is much more problematic than these three see discussion below.
Of these three intermediate objectives, the panel believes that valid and reliable indicators of the frequency of both risk-associated and protective behaviors the second and third objectives are the most appropriate proximate outcomes for AIDS prevention efforts.
The hope of an intervention program is that any changes that occur as a result of its efforts will show up rapidly in these indicators and that those changes, if maintained, will lead to the achievement of the program's long-term goal of reducing HIV transmission.
One of the guidelines Suchman suggests for setting objectives addresses the side effects or unwanted and sometimes unanticipated consequences that may attend efforts to achieve a particular goal. Side effects are not a trivial concern, and the panel believes that the negative effects of AIDS interventions should be assessed along with the positive outcomes.
Negative side effects—such as excessive fear or psychological distress—can often be anticipated at the time of program design from data derived from comparable studies or from anecdotal evidence. A side effect that has received attention recently is the impact of AIDS-related stressors on individuals' mental health.
In the case of testing and counseling, in particular, there is increasing evidence that for some individuals, learning about one's seropositivity is associated with certain types of psychological distress symptoms e.
It is generally not the test itself that is the source of the distress; rather, it is the message an individual receives that he or she has tested positive for HIV and is susceptible to developing a fatal disease.
The panel recommends that all evaluation protocols provide for the assessment of potential harmful effects as well as the assessment of desired effects.
Outcomes for Evaluations of HIV Prevention Programs There are a wide range of possible evaluation outcome variables, the choice of which will vary among projects. For example, the cognitive or behavioral outcomes that are appropriate to a counseling and testing session at a gay men's health clinic will be different from those associated with an information program offered in a drug treatment center.
The objective for the former project may be abstinence from anal intercourse; for the latter project, it may be the adoption of using bleach with drug paraphernalia.
The specific objective or objectives selected by a community-based organization or a testing and counseling center should be consonant with the overarching goal of reduced HIV transmission, but this does not mean that they must or should be identical from project to project. Indeed, the panel believes that CDC should seek advice from project staffs and communities concerning potential outcome variables.
We discuss potential outcome variables in three categories: Before discussing the strengths and weaknesses of each type of outcome, the variables in each category are described below. Table summarizes the evaluation outcome measures discussed in the following pages.
Summary of Possible Evaluation Outcome Measures. Biological Outcomes New HIV infection in the form of seroconversion rates in specific populations is the most informative biological outcome variable to indicate the spread of the disease among adults or adolescents.
This variable is quite appealing as an outcome measure because it relates directly to the overarching goal of CDC's prevention programs. If reliable data from representative samples of the target populations could be collected, HIV incidence rates might prove to be useful indicators of program effectiveness.
However, incidence data on HIV infection must be used with caution because so many factors other than risk reduction efforts—such as the saturation of the virus in a given population—influence these rates.
While incidence rates for AIDS might also be used, they could lead to faulty inferences because they reflect HIV infections contracted several years prior to the onset of the disease.
The most recent estimated mean incubation period for AIDS is 9. Rates of sexually transmitted diseases STDs may also be useful, as they should respond other things being equal to changes in sexual behaviors that risk HIV transmission.HIV AIDS: The human immunodeficiency virus (HIV) is a retrovirus that infects cells of the immune system, destroying or impairing their function.
As the infection progresses, the immune system becomes weaker, and the person becomes more susceptible to infections. The most advanced stage of HIV infection is acquired immunodeficiency syndrome (AIDS).
HIV AIDS: The human immunodeficiency virus (HIV) is a retrovirus that infects cells of the immune system, destroying or impairing their function.
As the infection progresses, the immune system becomes weaker, and the person becomes more susceptible to infections. The most advanced stage of HIV infection is acquired immunodeficiency syndrome (AIDS). Beginning in all directly funded health departments and CBOs will report on measures of HIV prevention planning, service delivery, and evaluation activities.
The performance indicators will be used to monitor progress in critical areas of HIV prevention. Campaigns. Many Federal agencies have developed public awareness and education campaigns to address HIV prevention, treatment, care, and research.
In this section, you’ll find a snapshot of these Federal HIV campaigns and links to help you access more information as . of people with Hiv, and facilitate early access to Hiv care, treatment and prevention services, and psychosocial support.
in generalized epidemics, this includes all people attending health-care facilities. in concentrated and low-level epidemics, piTC is offered to target groups (e.g. antenatal.
political events, petitions, and letter/email campaigns. COMMUNICATION aims to improve knowledge about TB and TB services and change attitudes and practices to encourage people to seek care and complete TB treatment.