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Gaps in strategic information on MARPs, Sri Lanka Dr Ajith Karawita MBBS, PGD Ven, MD Venereology
Overview of the presentation <ul><li>Country profile </li></ul><ul><li>Background </li></ul><ul><ul><li>Background on curr...
Category Sri  Lanka Land area (sq km) 62,705 Provinces 9 Districts 25 Grama Niladari Divisions (GND) 14,013 Estimated mid ...
HIV Epidemic in Sri Lanka Prepared by SIM  Unit, National STD/AIDS Control Programme, Sri Lanka, 2010.
Estimates
Reported Numbers
Number of new HIV cases reported to National STD/AIDS Control Programme, Sri Lanka as of end 2009.  National STD/AIDS Cont...
Prepared by SIM  Unit, National STD/AIDS Control Programme, Sri Lanka, 2010. Cumulative HIV Cases by Province  as of end 2...
Cumulative HIV cases by mode of transmission as of end December 2009 (N=802) National STD/AIDS Control Programme,  Sri Lan...
Background on Current HIV/AIDS Control in Sri Lanka
 
National STD/AIDS Control Programme, Sri Lanka National STD/AIDS Control Programme and the Central Clinic Strategic Inform...
Partners in the STD/AIDS Control <ul><li>Government </li></ul><ul><ul><li>National STD/AIDS Control Programme , NBTS, NDDC...
Countries wanted to work towards one system
The “Three Ones” principles <ul><li>The &quot;Three Ones&quot; are a set of principles for the coordination of national AI...
One  agreed HIV/AIDS Action Framework  that provides the basis for coordinating the work of all partners.  National Strate...
One  National AIDS Coordinating Authority,  with a broad-based multisectoral mandate.
One  agreed country-level Monitoring and Evaluation System.
Basics on  High Risk Activity (HRA)  and  High Risk Groups (HRG) Main concern here is HIV Transmission, Acquisition and
Which populations are most-at-risk? <ul><li>Populations where there is a high concentration of risk activities (HRA) </li>...
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-popula...
High Risk Groups (HRGs) <ul><li>High risk groups </li></ul><ul><li>Female sex workers (FSWs) </li></ul><ul><li>Men who hav...
Methodologies to identify  high risk sub population in your area or country <ul><li>Key informant interviews </li></ul><ul...
Some of survey or study questions to track risk behaviour patterns <ul><li>Age at coitarche? </li></ul><ul><li>Condom use ...
How frequent we need behaviour data in a population? <ul><li>Behaviour pattern are not changed rapidly in general </li></u...
Priority populations for prevention interventions in low level and concentrated epidemics Intervention:  Is a  specific se...
Monitoring and evaluation of intervention strategies for MARPs
Framework for indicator selection Input-Activities-Output-Outcome-Impact
INDICATORs for MARPS <ul><li>Number of members of the most-at-risk-population who test positive for HIV (FSW, MSW, MSM, ID...
“ M&E pipeline”  (Rugg et al., 2004). Another main strategic point here is simple:  not everybody needs to do everything.
Problems in generation of strategic information <ul><li>Inadequate attention to information needs of all stakeholders </li...
Gaps in strategic information  on MARPs
Gaps in strategic information on MARPs <ul><li>Inadequate attention on HRAs and population groups at local level.  </li></...
<ul><li>More attention is on inputs and activities rather than planning of total project design matrix (log frame) includi...
 
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Lecture at EPISEA 2010 conference gaps in stragegic information on MARPs 24…

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  • Lecture for SLMA 28/2/2006
  • Transcript of "Lecture at EPISEA 2010 conference gaps in stragegic information on MARPs 24…"

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