HORIZONS: Global Leadership, Research & Development

This 94-page report explores and evaluates the Horizons programme, which grew out of a cooperative agreement awarded in July 1997 by the United States Agency for International Development (USAID) to Population Council and its partners (International Center for Research on Women, PATH, The International HIV/AIDS Alliance, Tulane University, Family Health International, Johns Hopkins University, University of Alabama at Birmingham [1997-2001 only]). Horizons was designed to contribute to the goals of USAID and the President's Emergency Plan for AIDS Relief (PEPFAR) by developing and conducting operations research activities in concert with in-country institutions in numerous countries around the world. The main purpose of this operations research was to strengthen HIV prevention and treatment programmes to provide information for making needed changes and/or to replicate and expand successful programme activities.

Covering 11 years of activity, from July 1997 through July 2008, this final narrative report - with its hyperlinks to information on specific studies - is one part of the final reporting package. That package includes an updated "Findings from the Field" compact disk containing all Horizons study results, the Horizons Operations Research on HIV/AIDS Toolkit, and final reports from each study (See Annex A for the list by country and/or Annex B for the list by topic).

As explained here, Horizons' overall objectives were to:

• Identify important and timely HIV/AIDS operations research issues.
• Recommend refinements for existing service and/or care activities.
• Propose and test innovative approaches.
• Provide evidence to enable programmes to be scaled up.
• Build capacity of local collaborators to conduct operations research.

With emphasis on practical, field-driven research, Horizons tested different approaches to determine the most effective ways to prevent HIV infection as well as to provide treatment and counseling services for those already affected. With input from a diverse group of institutional partners, as well as 400+ in-country institutions (see Annex C for a list of the organisations), Horizons used operations research methods to assess and document the impact as well as the cost of HIV programmes. Study findings were widely disseminated with the overarching goal of increasing the efficiency, effectiveness, and quality of HIV/AIDS services while making those services more available and acceptable to those in need.

During its 11 years of operation, Horizons conducted 150 research-related activities addressing operational, programme, and policy-relevant issues related to HIV/AIDS that affect large geographic areas. These activities include consultative meetings to set the agenda; formative research to understand the problem; studies of the feasibility and acceptability of a programme strategy or a component; and complex, multi-year, multi-country impact assessments of approaches. Horizons also built research capacity and interest in research findings, and promoted utilisation of operations research results to expand and improve programme implementation. The majority of research activities were conducted in Africa, followed by Asia and Latin America. Horizons also conducted 20 global and 7 regional projects.

Topics were wide-ranging and that evolved over time, along with the epidemic. After the creation of PEPFAR, Horizons' research results fed directly into the original PEPFAR goals: to treat 2 million people with antiretroviral therapy (ARV); to prevent 7 million new infections; and to provide care and support to 10 million people affected by HIV/AIDS. Horizons documented progress toward those goals through its evidence-based work in several areas, including:

• Improving coverage, quality, and effectiveness of HIV/AIDS treatment (37% of the research portfolio);
• Identifying, testing, and disseminating best approaches to comprehensive HIV/AIDS prevention (38% of the research portfolio); and
• Expanding efforts to provide quality, effective care and support to those infected and affected by HIV/AIDS (25% of the research portfolio).
  

Findings from 11 years of operations research studies and research tools developed by Horizons have been used to develop policy, guide programme strategies, strengthen voluntary counseling and testing (VCT), and improve service delivery.

As reported here, dissemination was a vital component of Horizons. The goal was to reach the widest possible audience via various media, to encourage the use of Horizons research results and practical tools, and to impact prevention, treatment, care, and support activities on the ground. Print media, including peer-reviewed articles, final reports, research summaries, and research updates, proved to be an important means of wide distribution of Horizons results. Conferences and meetings were another important means of dissemination. Other formats used to share Horizons research included articles in international and regional e-newsletters, the Horizons section of the Population Council website, and a news capsule titled "On the Horizons" sent periodically via email to an ever-expanding list of service providers, policymakers, and colleagues. Several of the research and programmatic tools that were produced are described in the report.

A key objective of Horizons was to ensure that study findings, whether positive or negative, were utilised. Several pages (beginning on page 18 of the report) highlight a very small portion of the many examples of Horizons' impact in various areas.

An excerpt from the Director's Preface follows:

"There are three fundamental cornerstones of Horizons work. First, we have tried to address ignorance, bias, fear, and stigma by generating high-quality scientifically-driven data. These data have fundamentally increased our knowledge base about the opportunities and challenges to effective HIV programming...

Second, our mandate was not only to develop data about the nature and existence of problems, but also what to do about it. With the data in hand, we developed and tested solutions to the most pressing problems-producing the evidence-based strategies that are a key output of operations research.

[Third,] [i]n every case, Horizons worked with the appropriate change agents - government officials who want better lives for their people, hospital administrators who are open to new approaches, nurses in clinics who work hard to protect the health and safety of their patients, community leaders who want to see their neighbors prosper, and donors who provide critical resources to bring about change in systems, programs, procedures, and practices to improve the lives of the people they serve.

This process that I have just described is 'Operations Research.' We have hundreds of reports, fact papers, updates, summaries, and other publications on individual studies; and we have created a CD with a compilation of Horizons publications. Moreover, we have synthesized our methodology into an operations research toolkit, which contains all of the necessary elements for designing a successful HIV-related operations study, from developing the research protocol to collecting and analyzing data to turning research into practice. This toolkit is intended to allow other researchers to build upon the Horizons legacy, and to utilize the field-tested approaches developed and used by Horizons researchers. This, too, is available on a CD.

...The Horizons Program has ended, but I feel its impact will continue for some time to come. In the course of Horizons, we have trained hundreds of local researchers. Maybe even more significantly, the Horizons Program has helped to develop local institutions that are self-sustaining....In addition to our perhaps unique contribution of building capacity for operations research, we confer many practical, data-driven, and field-tested tools for PMTCT [prevention of mother-to-child transmission] training, adherence support, teaching life skills, and providing HIV prevention by faith-based organizations, among others. This capacity building will be one of the most enduring parts of the Horizons legacy, and one of which I am particularly proud.

Our outputs have been immense; we have generated new knowledge for the field; and we have focused on making sure the results were used and made a difference. UNAIDS [The Joint United Nations Programme on HIV/AIDS] has incorporated interventions designed and evaluated by Horizons into its best practices collection; USAID has cited examples of utilization of Horizons research results in its Success Stories; and our colleagues cited Horizons' impact in their call for greater attention and resources for operations research in the PEPFAR authorization."