Strengthening Social and Behavior Change Programming Through Application of an Adaptive Management Framework: A Case Study in Tanzania.

Integrated social and behavior change (SBC) programs seek to achieve changes in behaviors and norms across a range of health areas. Realizing changes across multiple behaviors is inherently complex and requires programs to be designed and implemented nimbly in ways that are responsive to feedback, new learning, and contextual shifts. Responsive feedback (RF) promotes just this kind of data analysis, use, and programmatic adaptation. Under the U.S. Agency for International Development (USAID)'s flagship SBC program in Tanzania, USAID Tulonge Afya, we applied FHI 360's SBC Adaptive Management Framework, which shares many similarities with RF. It includes meaningful engagement with an array of stakeholders throughout project design, implementation, monitoring, and evaluation (M&E); requires close collaboration between M&E and programmatic staff to ensure data collection and use are informed by and contribute to refinement of the project's theory of change; and incorporates purposeful, routine opportunities for learning and course correction. Accompanying the framework is a suite of tools and activities to facilitate systematic collection, analysis, and application of data for project design, improvement, and evaluation. Use of the framework within a complex, integrated SBC program improved our ability to address emerging priorities and achieve greater scale, saturation, and quality execution of activities. It also facilitated significant input from local communities and stakeholders-through shared data analysis and feedback loops-ensuring project activities reflected their strengths, needs, and preferences rather than the perspectives and biases of program implementers. In this article, we discuss the key components of the SBC Adaptive Management Framework and its commonalities with RF, how use of the framework and the underlying principles and elements of the RF approach contributed to the project's success, and share lessons that may strengthen and expand the application of RF and similar approaches within future SBC programs.

Development, Implementation, and Scale Up of the National Furaha Yangu Campaign to Promote HIV Test and Treat Services Uptake Among Men in Tanzania.

Evidence has demonstrated that immediate HIV treatment initiation upon a positive HIV test, referred to as Test and Treat, can help people living with HIV live longer, healthier lives and prevent HIV transmission. Although Tanzania adopted the evidence-based Test and Treat strategy since 2016, men were not being adequately reached for HIV services. A national campaign was launched to promote the new HIV services with a focus on men. To inform the development and implementation of the campaign, we conducted formative audience insights-gathering (AIG) sessions to assess facilitators and barriers to accessing HIV Test and Treat services and inform the concepts and materials for the campaign. Qualitative AIG interviews and focus group discussions were conducted with 54 people who were unaware or aware of their HIV status and currently or not currently on treatment, as well as health workers. Facilitators and barriers included a fear of testing positive, the desire to belong, control their narratives, and reinvent themselves to achieve their dreams and live a happy life. The campaign played off a My Happiness! creative concept to position antiretroviral therapy (ART) as a solution to fears around what life would be like after a positive HIV diagnosis. The development and implementation of the campaign were informed by the AIG sessions and national stakeholders, leading to strong partners' buy-in that supported the scale-up of the ongoing campaign from 12 to 26 regions via the collaborative efforts of government, donors, and implementing partners.