Envision: The newest tool in adolescent health and data

For several years, much of my time has been devoted to dissecting and analyzing the alarming statistics regarding new HIV infections among adolescent girls and young women. How is it that an adolescent girl is newly infected with HIV every three minutes in 2017? And why is it that among the quarter of a million new HIV infections that occurred among 10­–19-year-olds in 2017, two thirds were girls?

Of course, I am not the only one asking these questions — a coalition of concerned entities, through the prevention-focused group Start Free Stay Free AIDS Free tracks these efforts at the highest level. Ambitious targets have galvanized commitment to reverse this trend, namely: the Super-Fast Track prevention targets, which call for a 75 per cent reduction in new infections among adolescent girls and young women by 2020. In response, the international community has rallied together, National AIDS Control Councils have taken note and countless initiatives have poured resources and experiences into the perceived obstacles and challenges.

As confirmed by the DREAMS Initiative, an ambitious fifteen-country public-private partnership led by the US President’s Emergency Plan for AIDS Relief (PEPFAR), the holistic wellbeing of adolescent girls and young women is critical for HIV prevention. We know that effective prevention for girls and young women must be comprehensive, tailored to specific needs, and layered to deliver interventions that address the multiple deprivations experienced by the most vulnerable girls. Yet, 2020 is around the corner and alarmingly, new infections and death rates are projected to increase after years of modest decline. We need to urgently scale up all that we know works for women and girls.

A table labeled Intervention Packages plotting interventions against a number of countries
© UNICEF/2019Envision provides snapshots of country-wide interventions in HIV and interventions that address other related vulnerabilities.

Luckily, we are getting better equipped to rapidly assess what is working, and where more can be done.

I am elated to announce Envision for Girls: a data hub that maps programmes, and highlights opportunities for realizing the well-being of adolescent girls and young women. Knowing where the investments are, and where the gaps exist is now simply a few clicks away for HIV prevention advocates, ministries of health, national programme managers and donor agencies. This dashboard was created with the belief that to reach ambitious goals, current programme investments must be better aligned, and should target localities where new infections are highest.

While disparate datasets may be available online, no one data hub illustrates multiple intersecting vulnerabilities, tracks global investments, nor provides an update on programmatic actions at country level. Until now. Through data visualization, this dashboard illustrates the various investments made by key stakeholders down to the subnational level, and the extent to which effective combination prevention is being scaled up for impact.

This data visualization project will provide updated data points on funding sources as well as more granular subnational data

The dashboard currently features 18 priority countries in sub-Saharan Africa which represent more than 90 per cent of the burden of new HIV infections amongst adolescent girls and young women, namely: Botswana, Cameroon, Cote D’Ivoire, DRC, Ethiopia, Eswatini, Kenya, Lesotho, Malawi, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Uganda, Tanzania, Zambia and Zimbabwe.

This site tracks changes in the HIV epidemic trajectory since 2010, demographic changes and early warning indicators and documents the status of programmatic responses as of 2017, the year with the most complete data.

The good news is that there is significant funding available through external assistance sources to support a girl-centered response to the risks and vulnerabilities of adolescent girls and young women. The dashboard demonstrates, now, that these funds are largely aligned with the localities at the epicenter of the epidemic. Furthermore, at the subnational level, duplication across major external funders has been successfully minimized.

A map of Africa overlaid with buttons and labels like Indicator Description & Adolescent Gils
© UNICEF/2019 A screengrab from the Envision dashboard visualizing numbers of new HIV infections by region.

Combination prevention is largely prioritized, but attention needs to be called to efficiency and effectiveness for these components. The impressive scale up of PrEP (pre-exposure prophylaxis), the newest biomedical prevention tool, is an exciting story in the global response. School-based HIV prevention and social protection interventions have not been prioritized by the major funders, presumably because public sector delivery platforms already support their implementation at scale. Careful attention is needed to ensure that existing domestic investments and programmes are carefully leveraged and integrated with the externally supported programme components, to achieve a robust and ‘layered’ effect. We may need more investments in these interventions to secure enhanced life-course opportunities for the most vulnerable girls.

As funding approaches desired levels, and is sustained, prevention programmes for adolescent girls and young women remain in a scale-up phase. This data visualization project will avail updated data points on funding sources (including at the national level) and will incorporate more granular subnational data as available. These annual updates will improve the specificity of this dashboard over time, with the goal of supporting global reviews by 2021 — the commitment date for the existing HIV prevention targets.

Our vision is that programme managers, policy makers and young advocates in high-burden countries will engage with the data this dashboard avails and mount spirited campaigns to ensure all at-risk adolescent girls benefit from the investments they deserve. Our future depends on it.

 

A pediatrician and epidemiologist by training, Chewe Luo is Associate Director of Programmes, and HIV Section Chief for UNICEF, New York.

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