the Elizabeth Glaser Pediatric AIDS Foundation, there is a clear, logical pathway between access to services, counseling and testing, test results, prophylaxis by women and infants, and aversion of infections. Assumptions and conversion factors to be determined for PMTCT can include questions like the following: What regimens are taken and how effective are they? Are they actually consumed and when? What is the rate of transmission during labor and delivery? What is the rate of prevention of infections in HIV-negative women who come in for counseling? What is the level of infection transmitted through breast milk? Speaker Carl Latkin of the Johns Hopkins School of Public Health cautioned that although models of change are needed to guide interventions, sometimes they don’t explain findings. Models are practical heuristics but should not be blinders, he noted; we should not let models narrow the way we look at change.

Impact evaluations also require the use of methodological approaches. These can include quantitative, qualitative, and participatory methods and theory-based program logic. Examples of impact evaluation methods, provided by speaker Mary Lyn Field-Nguer of John Snow, Inc., include client satisfaction interviews and surveys, exit interviews, mystery clients, targeted intervention research, focus groups, and key informant interviews.

The following case studies describe the experiences from evaluations of five HIV/AIDS assistance programs run by the World Bank, Poverty Action Lab, DFID, CARE, and The Global Fund. Conceptual models and different evaluation methodologies are described in the context of each study.

World Bank Evaluation of HIV/AIDS Assistance Programs

Workshop speaker Martha Ainsworth, lead economist and coordinator of the Health and Education Evaluation Independent Evaluation Group at the World Bank, described the approach and methodologies used in an independent evaluation of the World Bank’s HIV/AIDS assistance programs. The evaluation assessed $2.5 billion of World Bank investments in HIV/ AIDS prevention, care, and mitigation programs between 1988 and 2004 in 62 developing countries. Two objectives of the evaluation were defined: (1) to evaluate the development effectiveness—or relevance, efficiency, and efficacy—of HIV/AIDS assistance in terms of lending, policy dialogue, and analytic work at the country level relative to the counterfactual, or absence of a Bank program and (2) to identify lessons to guide future activities.

Ainsworth shared the World Bank’s experience in prioritizing what to measure in evaluation. Although the World Bank has a large portfolio of complementary programs in education and agriculture, indicators were narrowed down to only those with direct HIV/AIDS outcomes and impacts. In addition, identifying how lessons from completed assistance were still relevant to new approaches posed a challenge, given that three-quarters of

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