Evaluation questions: 1) How effectively is HIV React making the transition from general HIV prevention to HIV case identification, linkage to antiretroviral (ARV) treatment and achieving adherence and retention in care in both prisons and the community, post-release? 2) What are the project’s strengths, weaknesses and gaps? and 3) What are the constraints to successful implementation of this project?
Methods: Collection of qualitative data from interviews and focus groups with project implementers, clients and stakeholders; analysis of project indicator data; secondary data analysis; and document review.
Key findings and conclusions: The redesign and implementation of HIV React Phase II has appropriately made the transition from general HIV prevention to HIV case detection and linking HIV-positive prisoners and ex-prisoners to HIV treatment, with adherence and retention support. ART uptake rates among eligible prisoners are generally high. There is qualitative evidence that post-release support has increased adherence rates. However, due to the recent transition in programming, there was insufficient data to determine the effectiveness of this transition. The project is also not collecting a sufficient range of data to measure its progress in achieving the 90-90-90 objectives. New indicators are needed along with a revised monitoring plan for the project. HIV React has facilitated improved collaboration between penal medical departments and AIDS Centers which improved the quality of care within prisons and reduced loss to follow-up on release. The peer model for education and support is operating effectively. There is a need for advocacy to governments on replication of the HIV React model in nonproject sites. Key constraints include weak prison health systems which impact negatively on the quality of care; restrictions on the work of NGO implementing partners access to prisons; and the inability of the project to provide post-release treatment support to ex-prisoners who return to regions where the project is not working.