Scaling up, coverage, and targeting

In this chapter, we examine the current state of knowledge and practice concerned with scaling up and achieving universal coverage of HIV and sexually transmitted diseases (STD) health services, and targeting interventions to specific populations. Recognizing that routes of disease transmission and the consequences of disease cross international borders, the processes of scaling up HIV and STD prevention programs are inherently global issues. Nonetheless, understanding specific local and national contexts is essential to effectively scale up health programs. As illustrated by the emerging research initiatives and resources for program implementation, there is also a push in the USA to build the theory and evidence to improve program performance and scale up programs that contribute to HIV and STD prevention, both nationally and globally. These issues are of importance not only for HIV and STD prevention programs, but they also raise significant political, economic, social, and technical concerns beyond these programs, for many stakeholders at local and national levels. These issues have a prominent place on the global health agenda, and particularly for low and middle-income countries and under-served populations, where HIV and STD prevention have the greatest potential to address the largest burden of disease.