Here is a view of outreach. Please let me know your thoughts.

My concern about outreach is not with the outreach workers themselves. It is with their managers. The managers have outreach workers meet the same people over and over. They don't reach enough people who have never been reached before. And the same people are tested and retested and retested. People who test negative annually several times are probably not going to test positive unless they undergo a major change of behaviour. And outreach is not going to change that.

Jamie

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HIV Outreach as Applied Science
Scott Berry
Feb 8, 2016

A conversation with a colleague reminded me that we must better emphasize the ways that HIV prevention outreach is an applied science. It sounds a little grandiose to say it this way, doesn’t it? But right now the opposite is true: we don’t value outreach fieldwork almost at all. We see it as the least skilled of all the practices that collectively aim to reduce HIV transmission.  Don’t believe me? Here’s the evidence:

Outreach workers, even in the poorest of settings, are usually volunteers who receive no compensation for practice.
Those lucky enough to be paid for outreach are never paid a living wage in almost any place in Asia. In fact, the in-country agreements between organizations ensure that outreach workers are paid very little for their practice – even as the required knowledge and skill-base they must cover is growing.
No one actively manages outreach workers in most community-based settings. In some places, months go by without any contact between managers and outreach workers. When managers do engage with them it’s usually for written data to punch in to reports for government and the Global Fund.

But if we’re going to have any sort of public health outcomes through HIV prevention outreach we need to fundamentally change our approach to it. The challenge is to understand how knowledge is applied in outreach practice and how to sustain motivation for best practice in outreach over time. These are the ways that we approach other kinds of applied practices like counselling and psychotherapy, nursing, management and teaching: theoretical knowledge is provided and then the ways it is utilized in practice are monitored and supervised. The lessons from practice are shared and incorporated in to the pedagogy of applied learning systems. Professional membership organizations set standards, provide systems for accreditation of practitioners and add value to knowledge and practice in multiple ways (I can feel you role your eyes now. You’re thinking: “as if anyone is going set up a professional membership organization for HIV outreach”).

It’s easy to assume that advances in HIV treatment-as-prevention will soon obviate the need for outreach prevention at all. But the opposite of that is likely to be true: HIV outreach prevention will have to get much more sophisticated if it is to meaningfully contribute to the UNAIDS first ‘90’ (i.e. 90 percent of all people with HIV know their status). It’s going to have to be much better managed if it is to cross the HIV Treatment Cascade and link people to clinical services. Supporting sexual and reproductive health for women and girls and transgender people will have to become a part of everyday fieldwork. And treatment-as-prevention poses rights risks for people who use drugs that outreach workers will have to deal with every day.

From my work supporting governments and community-based agencies responding to HIV among key populations in Asia, I think that these changes are essential if outreach practice is to genuinely add any value at all to the future HIV response:

Outreach workers should be full-time workers, paid a living wage, their fieldwork linked to results that can be measured, discussed and analyzed.
Training for outreach workers should no longer be ‘one-off’ events. Training should be ongoing. External technical assistance should prioritize engaging and training community managers in practice management and coaching. By doing this, training and learning become integrated in to organizational cultures.
It seems like a long-shot but here goes… a professional membership organization for outreach workers across international development domains could assist us to set accreditation standards and engage in multiple interventions that can dramatically improve the applied science of 'outreach prevention' across multiple development issues. This role could be played by regional networks or even UNAIDS in some places.

https://www.linkedin.com/pulse/hiv-outreach-applied-science-scott-berry