Lecture at EPISEA 2010 conference gaps in stragegic information on MARPs 24…

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  • Lecture for SLMA 28/2/2006

Transcript

  • 1. Gaps in strategic information on MARPs, Sri Lanka Dr Ajith Karawita MBBS, PGD Ven, MD Venereology
  • 2. Overview of the presentation
    • Country profile
    • Background
      • Background on current HIV/AIDS Control in Sri Lanka.
      • Three Ones principal
      • Basics on High Risk Activity and High Risk Group
      • Basics on project monitoring and evaluation
    • Gaps in strategic information on MARPs in Sri Lanka
  • 3. Category Sri Lanka Land area (sq km) 62,705 Provinces 9 Districts 25 Grama Niladari Divisions (GND) 14,013 Estimated mid year population (2005) 20 million Population density (Person per sq km) 313.7 Average annual growth rate (1981-2001) 1.1
  • 4. HIV Epidemic in Sri Lanka Prepared by SIM Unit, National STD/AIDS Control Programme, Sri Lanka, 2010.
  • 5. Estimates
  • 6. Reported Numbers
  • 7. Number of new HIV cases reported to National STD/AIDS Control Programme, Sri Lanka as of end 2009. National STD/AIDS Control Programme, Sri Lanka, 2009.
  • 8. Prepared by SIM Unit, National STD/AIDS Control Programme, Sri Lanka, 2010. Cumulative HIV Cases by Province as of end 2009 (N=1196)
  • 9. Cumulative HIV cases by mode of transmission as of end December 2009 (N=802) National STD/AIDS Control Programme, Sri Lanka, 2009.
  • 10. Background on Current HIV/AIDS Control in Sri Lanka
  • 11.  
  • 12. National STD/AIDS Control Programme, Sri Lanka National STD/AIDS Control Programme and the Central Clinic Strategic Information Management Unit of the National STD/AIDS Control Programme
  • 13. Partners in the STD/AIDS Control
    • Government
      • National STD/AIDS Control Programme , NBTS, NDDCB, Epid unit, FHB, HEB
    • Private sector partners (Business coalition)
    • Civil society organizations (NGOs, CBOs, FBOs)
      • E.g. Sarvodaya, CSDF, COJ, Alliance Lanka, MMM
      • Family planning association
    • Development partners (UN agencies, Other INGOs)
  • 14. Countries wanted to work towards one system
  • 15. The “Three Ones” principles
    • The "Three Ones" are a set of principles for the coordination of national AIDS responses
    • These principles were endorsed at a high-level meeting held on 25 April 2004 and co-hosted by UNAIDS, the United Kingdom and the United States.
    • The “Three Ones” principles are:
    • One agreed HIV/AIDS Action Framework that provides the basis for coordinating the work of all partners.
    • One National AIDS Coordinating Authority, with a broad-based multisectoral mandate.
    • One agreed country-level Monitoring and Evaluation System.
  • 16. One agreed HIV/AIDS Action Framework that provides the basis for coordinating the work of all partners. National Strategic plan
  • 17. One National AIDS Coordinating Authority, with a broad-based multisectoral mandate.
  • 18. One agreed country-level Monitoring and Evaluation System.
  • 19. Basics on High Risk Activity (HRA) and High Risk Groups (HRG) Main concern here is HIV Transmission, Acquisition and
  • 20. Which populations are most-at-risk?
    • Populations where there is a high concentration of risk activities (HRA)
    • High Risk Activities (HRA) are
    • Behaviours that put people at greater risk of HIV transmission and acquisition such as
      • High rates of unprotected sexual partnerships
      • Unprotected anal sex with multiple partners, and
      • Injecting drugs with multi-user equipment and drug preparations.
  • 21. Which populations are most-at-risk? HRA HRA HRA HRA HRA HRA HRA HRA HRA HRA HRA HRA HRA HRA HRA HRA HRA HRA HRA Sub-population. A Sub-population. C Sub-population. B Sub-population. D
  • 22. High Risk Groups (HRGs)
    • High risk groups
    • Female sex workers (FSWs)
    • Men who have sex with men (MSM).
    • STD clinic attendees
    • Clients of FSWs
    • Injecting drug users (IDUs)
    • Additional populations
    • Heterosexual men and women with multiple sexual partners
    • Prisoners
    • Populations surrounded by armed conflict
    • Female domestic workers
    • Street children
    Be careful when naming a group according to the occupation Behaviour is the risk. NOT the occupation
  • 23. Methodologies to identify high risk sub population in your area or country
    • Key informant interviews
    • In-depth interviews
    • Participatory approach (Stakeholder analysis and meetings) Importance/Influence)
    • STD clinic data analysis
    • Literature survey for evidence
    • Planning a behaviour study or research
    • Biological surveillance (HIV sero-surveillance)
    Strength of evidence
  • 24. Some of survey or study questions to track risk behaviour patterns
    • Age at coitarche?
    • Condom use at first sexual IC?
    • Condom use at last sex?
    • Condom use during the last month?
    • Number of regular partners (female/male) during the last month/12 months etc?
    • Number of non-regular partners (female/male) during the last month?
    • Condom use with regular partner (female/male) at last sexual IC?
    • Condom use with non-regular partner (female/male) at last sexual IC?
    • Have you ever injected drugs?
  • 25. How frequent we need behaviour data in a population?
    • Behaviour pattern are not changed rapidly in general
    • Once in 2-5 year is practical
    • Behavioural surveillance (continuous)
      • BSS, IBBS
      • Integration of behaviour questions to DHS survey
  • 26. Priority populations for prevention interventions in low level and concentrated epidemics Intervention: Is a specific set of activities implemented by a project or providers and can be focused at various levels such as the individual, small or large group, community or societal levels.
  • 27. Monitoring and evaluation of intervention strategies for MARPs
  • 28. Framework for indicator selection Input-Activities-Output-Outcome-Impact
  • 29. INDICATORs for MARPS
    • Number of members of the most-at-risk-population who test positive for HIV (FSW, MSW, MSM, IDU)
    • Percentage of the most-at-risk-populations that have received an HIV test in the last 12 months and who know the results (FSW, MSW, MSM, IDU)
    • Percentage of female sex workers reporting the use of a condom with their most recent client
    • Percentage of men reporting the use of a condom the last time they had anal sex with a male partner
    • Percentage of female sex workers who are HIV infected
    • Percentage of MSM who are HIV infected
  • 30. “ M&E pipeline” (Rugg et al., 2004). Another main strategic point here is simple: not everybody needs to do everything.
  • 31. Problems in generation of strategic information
    • Inadequate attention to information needs of all stakeholders
    • M&E data are seen as obligation imposed from outside
    • Inadequate attention during project design
    • Inadequate budget allocation for M&E (usually 5-10% allocation is necessary)
    • Focus only on input /activities
    • Over-ambitious data collection with little analysis
    • In-sufficient relevant skills and attitudes
    • Individual memory and experiences rather than institutional memory (poor knowledge management)
    • Inadequate reflection and action
  • 32. Gaps in strategic information on MARPs
  • 33. Gaps in strategic information on MARPs
    • Inadequate attention on HRAs and population groups at local level.
    • Lack of population size estimates of MARPs at all districts
    • Lack of mapping of MARPs data for districts
    • Inadequate data on MARPs for the
      • Strengthening of HIV surveillance and
      • Generation of HIV estimates by modeling (EPP, Spectrum)
    • Difficulty in getting a probability sample for surveillance and studies (Sampling from the moving target population) – Mapping of HRGs can facilitate the sampling.
  • 34.
    • More attention is on inputs and activities rather than planning of total project design matrix (log frame) including M&E
    • Inadequate experience and expertise for MARP studies in a low level of epidemic status.
    • Difficulty in setting coverage for MARPs at local and National level
    • Inadequate knowledge on typologies of MARPs and methods of their operations
    • Difficulty in reaching high-class commercial sex workers
    Gaps in strategic information on MARPs
  • 35.  
  • 36. Thank you