Population Briefs | February 2003, Vol. 9, No. 1 | Study Design: New Operations Research Handbook Targets HIV/AIDS

Population Briefs February 2003

February 2003, Vol. 9, No. 1

Study Design
New Operations Research Handbook Targets HIV/AIDS

As the impact of the HIV/AIDS epidemic increases, but resources to fight it remain limited, it becomes ever more important to develop cost-effective programs to prevent, treat, and mitigate its effects. To address these needs, Population Council public health and operations research experts Andrew A. Fisher and James R. Foreit have coauthored Designing HIV/AIDS Intervention Studies: An Operations Research Handbook. The book, written for program administrators and researchers, is a step-by-step guide to creating operations research projects that could yield improved HIV/AIDS programs.

Fisher is director of the Population Council’s Horizons program, which conducts research into ways of preventing the spread of HIV/AIDS, for example with services to prevent mother-to-child transmission, and mitigating its impact on individuals and communities, for example with programs to help AIDS orphans. Foreit is a senior program associate with the Council’s Frontiers in Reproductive Health program, which seeks methods of improving the delivery of family planning and reproductive health services in developing countries.

What is operations research?
Operations research focuses on the day-to-day activities, or operations, of programs. Because these operations are under managerial control, it is possible for program administrators to make substantive improvements based on research findings. In the context of health service delivery, the goal of operations research is to increase the efficiency, effectiveness, and quality of services delivered by providers, and the availability, accessibility, and acceptability of services desired by users. Operations research is a continuous process with five basic steps: problem identification and diagnosis, strategy selection, strategy testing and evaluation, information dissemination, and information utilization. Findings from operations research studies can be used to improve or expand existing programs as well as to develop new approaches.

“HIV/AIDS programs are complex because the disease is complex,” say Fisher and Foreit. HIV/AIDS affects all aspects of human society— from the cultural sphere to the religious, political, and economic spheres. The infected and affected are many in number, diverse in nature, and widely dispersed throughout the world. HIV/AIDS programs typically address such issues as poverty, economic development, gender inequality, stigma, and discrimination. To be effective, such programs require not only community involvement and dedicated personnel, but also detailed planning at all levels, close coordination of program implementation efforts, careful training and supervision of personnel, and continuous evaluation of program development and effects. “Operations research is a critically important way to support and inform these essential planning, coordinating, and evaluation functions,” write Fisher and Foreit.

Types of operations research
There are four basic types of operations research: exploratory/diagnostic, field intervention, evaluation, and cost-effectiveness. Exploratory/diagnostic studies seek to determine the factors responsible for a problem before a program begins. For example, if a discrepancy in rates of HIV infection were noted between villages in a small geographic area, an exploratory/diagnostic study would shed light on the factors responsible for this variation. With this knowledge, appropriate programs can be designed.

Field intervention studies test new approaches or solutions to problems in existing programs. In the example given above, researchers might have found that in the villages with low HIV prevalence, influential local leaders supported sexual behavior change, such as reducing the number of sexual partners or delaying the initiation of sexual relations, and condom distribution programs. Field intervention studies would test different ways of replicating that situation in the villages with higher HIV prevalence in order to determine the most effective strategy.

Once the most appropriate strategy was implemented, evaluation studies would confirm the success of the program. These studies can also be used to assess the achievements of interventions that have not been examined previously. In the effort to respond quickly to the devastating epidemic, HIV/AIDS programs sometimes are hastily planned and rapidly implemented. Evaluation is an ongoing process that should occur over the life of a program and could help to improve existing programs.

Finally, although the overall results of a program--in terms of increasing knowledge about HIV, changing unsafe sex practices, or reducing HIV transmission--may be known, its cost and particularly its cost-effectiveness often are not known. For program managers who have to make difficult decisions about allocating scarce resources, cost-effectiveness studies can be valuable management tools, and cost-effectiveness analyses are frequently part of intervention and evaluation studies.

The HIV/AIDS Operations Research Handbook guides program managers and researchers through each step in the design, implementation, and assessment of HIV/AIDS programs, giving them crucial tools and information in a straightforward format. To order the handbook, e-mail horizons@popcouncil.org or call 1 202 237 9400. The handbook can be downloaded at: http://www.popcouncil.org/horizons/orhivaidshndbk.html

Source
Fisher, Andrew A. and James R. Foreit with John Laing, John Stoeckel, and John Townsend. 2002. Designing HIV/AIDS Intervention Studies: An Operations Research Handbook. Washington, DC: Population Council. (PDF)

Outside funding
United States Agency for International Development

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