The lack of sanitation facilitates the spread of diarrheal diseases-a leading cause of child deaths worldwide. As of 2012, an estimated 1 billion people still practiced open defecation (OD). To address this issue, one behavioral change approach used is community-led total sanitation (CLTS). It is now applied in an estimated 66 countries worldwide, and many countries have adopted this approach as their main strategy for scaling up rural sanitation coverage. While it appears that many of the activities used in CLTS-that target community-level changes in sanitation behaviors instead of household-level changes-have evolved out of existing behavior change frameworks and techniques, it is less clear how these activities are adapted by different organizations and applied in different country contexts. The aims of this study are to (i) show which behavior change frameworks and techniques are the most common in CLTS interventions; (ii) describe how activities are implemented in CLTS interventions by region and context; and (3) determine which activities program implementers considered the most valuable in achieving open defecation free (ODF) status and sustaining it. The results indicate that a wide range of activities are conducted across the different programs and often go beyond standard CLTS activities. CLTS practitioners ranked follow-up and monitoring activities as the most important activities for achieving an ODF community, yet only 1 of 10 organizations conducted monitoring and follow-up throughout their project. Empirical studies are needed to determine which specific behavioral change activities are most effective at ending OD and sustaining it.

Water, sanitation and hygiene (WASH) interventions have been associated with improving the health of people living with HIV/AIDS (PLHIV). WASH is increasingly integrated into the HIV sector and is now considered a key component of the transition from an emergency response to a better incorporated and coordinated AIDS response. However, limited research exists on integration efforts. This qualitative research study aims to address the limited body of research on WASH integration into HIV programmes through examining the US President's Emergency Plan for AIDS Relief (PEPFAR). PEPFAR is the US government's initiative to combat AIDS in the most afflicted countries. This study analyses the perceptions of people who have worked or are working on WASH integration into PEPFAR, highlighting their views on accomplishments, challenges and areas for improvement. It concludes with recommendations for moving forward.