Dr M Bhattacharya

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Dr M Bhattacharya

  1. 1. Data Triangulation in HIV <br />Prof Madhulekha Bhattacharya<br />HOD ,Deptt of Community Health Administration<br />National Institute of Health & Family Welfare<br />Munirka,New Delhi--67 <br />
  2. 2. Data Triangulation<br />Is an analytical approach that integrates multiple data sources to improve understanding of a public health problem and to guide programmatic decision-making to address these problems<br />Involves the synthesis and integration of data from multiple sources through collection, examination, comparison and interpretation<br />By collecting and comparing multiple data sets with each other, triangulation helps to overcome biases inherent in each data source<br />bhattacrya-NIHFW<br />
  3. 3. Gather data from multiple sources<br />Refine hypothesis (corroborate, refute or modify)<br />Examine data<br />Planning Triangulation<br />Conducting Triangulation<br />Communicating Results (for Action)<br />A visual representation of the triangulation process<br />
  4. 4. Difference from --- <br />Meta Analysis<br />Data triangulation<br />Meta analysis combines rigourous scientific data of similar quality and design to conduct statistical analysis<br />Uses data from diverse sources<br />Lists judgements and limitations of each<br />To be used by programme managers policy makers , and also researchers <br />bhattacrya-NIHFW<br />
  5. 5. Steps in Data Triangulation<br />Specify the question<br />Identify data sources, organize the data and identify data gaps<br />Conduct data quality and validation checks<br />Decide on data outlier and/or missing data<br />Refine/revisit the questions chosen for data triangulation<br />Analyze data from different sources for each question<br />Data triangulation<br />Summarize findings and draw conclusions<br />Outline next steps based on findings<br />bhattacrya-NIHFW<br />
  6. 6. Questions<br />What are the levels, differentials and trends in HIV/STI in general population, high-risk groups, and the bridge population?<br />What are the drivers of the epidemic?<br />What are the gaps in HIV/AIDS response at district level?<br />What are the data gaps?<br />bhattacrya-NIHFW<br />
  7. 7. Identifying and refining key questions<br />Brainstorming questions<br />Refining brainstormed questions<br />Key question(s)<br /><ul><li>Data available
  8. 8. Important, answerable
  9. 9. Actionable, appropriate
  10. 10. Method appropriate
  11. 11. Feasible</li></ul>bhattacrya-NIHFW<br />
  12. 12. Data sources<br />1. Data from HIV Sentinel Surveillance for different population groups<br />2. ICTC/PPTCT data on HIV prevalence<br />3. Mapping of HRGs - urban (under TI program) & rural (under Link Worker Program) <br />4. ART registration data<br />5. Behavioural Sentinel Survey (BSS)<br />6. Integrated Biological & Behavioural Assessment (IBBA)<br />7. Blood Bank data, STD Clinic data<br />8. Census of India, NFHS-3, DLHS-3<br />9.Any special studies<br />bhattacrya-NIHFW<br />NATIONAL INSTITUTE OF HEALTH & FAMILY WELFARE MUNIRKA, NEW DELHI – 110067.<br />
  13. 13. Inputs to Evidence-Based Planning<br />Overall burden of HIV<br />Sub-population distribution of HIV<br />Basic HIV transmission dynamics<br />Assessing gaps in responses to HIV situation<br />bhattacrya-NIHFW<br /><ul><li>Evidence required at the lowest levels of planning such as Districts and Sub-districts
  14. 14. Integration and triangulation using data from different sources
  15. 15. To Use valid and standardized methods to ensure that evidence derived is credible and comparable across states and districts</li></li></ul><li>Levels, Differentials and Trends<br />What is the current level of HIV and other specific STIs in the general population, among FSWs, MSM-T, IDUs, and clients of FSWs in the district?<br />Does HIV/STI prevalence differ across different sub-groups? Does HIV/STI prevalence vary by:<br />Rural and urban areas, Taluka/Block/Mandal, Age, Literacy and education, Occupation<br />Duration in sex work, Sex work typology, Client volume,<br />Self identity, Volume of anal sex partners<br />Frequency of needle sharing <br />bhattacrya-NIHFW<br />
  16. 16. SURAT<br />PHC – 75, CHC – 17<br />ICTC – 50, DIC – 3<br />Blood Bank – 8<br />STD Clinics – 31<br />ART Centre – 2<br />CCC - 2<br />
  17. 17. <ul><li>No of PLHIV- 22083
  18. 18. On ART – 2603
  19. 19. MSM/1000 Adult Population -1.21
  20. 20. FSW/1000 Adult Population - 1.35</li></li></ul><li>HIV Positivity – Talukawise from PPTCT sites (2008-09) Gujarat<br />
  21. 21. HIV Positivity Talukawise – for General Clients (ICTC) (2008-09) Gujarat<br />HIV Positivity at ICTC – General (2008-09) Gujarat – 5.5 (14645/267840)<br />Mehsana – 11.9 (435/3656)<br />Rapar – 21.8 (12/55)<br />Vadodara -<br />10.8 (864/7992)<br />Bhachau – 11.7 (40/343)<br />Rajkot – 17.6 (1278/7261)<br />Rajula – 13.3 <br />(8/60)<br />Keshod – 10.1 (57/567)<br />To 5<br />Amreli –11.6 (113/972)<br />Surat City – 12.4 (2814/22609)<br />
  22. 22. HIV prevalence amongst General Clients from ICTC by various characteristics in Gujarat, 2008<br />
  23. 23. Differentials of HIV Tested & %Positivity in ICTC Attendees(CMIS), Jamnagar <br />
  24. 24. Trends<br />What has been the trend in HIV/STI prevalence in the general population, among FSWs, MSM-T, IDUs, and clients of FSWs in the district?<br />bhattacrya-NIHFW<br />
  25. 25. Comparative trend of HIV Infection among pregnant women from different sources in Gandhinagar<br />
  26. 26. Prevalence of HIV in Low Risk Group, SURAT (SAPCU)<br />
  27. 27. Prevalence of HIV among High Risk Group, SURAT(SAPCU)<br />
  28. 28. Trends among High Risk Group, SURAT(SAPCU)<br />
  29. 29. Drivers of the Epidemic<br />Size estimation<br />Size and distribution of HRGs and bridge population<br />Underlying vulnerabilities<br />Migration<br />Risk behaviours<br />Risk profile of HRGs and bridge population including condom use behaviour<br />Profile of PLHIV<br />Characteristics and geographic distribution<br />bhattacrya-NIHFW<br />
  30. 30. Map of HIV prevalence district wise of PPTCT and number of High Risk Groups at Gujarat. <br />
  31. 31. Dual Drivers of STD Epidemics: Populations and Pathogens<br />bhattacrya-NIHFW<br />Pathogen<br />Population<br />Demography<br />Sexual Structure<br />Infectiousness<br />Virulence<br />Duration<br />ß, efficiency of transmission<br />c, contact rate between infected and susceptible<br />D, duration of infectiousness<br />
  32. 32. HIV Positivity Talukawise – for General Clients (ICTC) (2008-09) Gujarat<br />HIV Positivity at ICTC – General (2008-09) Gujarat – 5.5 (14645/267840)<br />Mehsana – 11.9 (435/3656)<br />Rapar – 21.8 (12/55)<br />Vadodara -<br />10.8 (864/7992)<br />Bhachau – 11.7 (40/343)<br />Rajkot – 17.6 (1278/7261)<br />Rajula – 13.3 <br />(8/60)<br />Keshod – 10.1 (57/567)<br />To 5<br />Amreli –11.6 (113/972)<br />Surat City – 12.4 (2814/22609)<br />
  33. 33. HIV prevalence amongst General Clients from ICTC by various characteristics in Gujarat, 2008<br />
  34. 34. Drivers of the Epidemic<br />Size estimation<br />Size and distribution of HRGs and bridge population<br />Underlying vulnerabilities<br />Migration<br />Risk behaviours<br />Risk profile of HRGs and bridge population including condom use behaviour<br />Profile of PLHIV<br />Characteristics and geographic distribution<br />
  35. 35. HIV Prevalence amongst MSM in consistent sites of Gujarat, 2005-2007<br />
  36. 36. Occupation of MSM<br />
  37. 37. HIV Prevalence amongst FSW in consistent sites of Gujarat, 2005-2007<br />
  38. 38. Risk Profile Of High Risk Group(MSM),Surat-SAPCU<br />
  39. 39. Response Gaps<br />What are the gaps in HIV prevention programs<br />HRGs yet to be covered in each taluka of the district<br />HRGs currently being contacted on a regular basis<br />Condom supply against requirement among HRGs<br />HRG’s access to services<br />What are the gaps in HIV/AIDS care, support and treatment programs?<br />Size estimation of PLHA in the district<br />Detection of HIV against the estimate<br />ART registration against the diagnosed <br />Started on ART against the registered<br />Currently on ART against those ever started<br />Differences in the profile of the registered, currently on ART and those who have dropped out of ART<br />bhattacrya-NIHFW<br />
  40. 40. Question /Response Gaps<br />What are the gaps in HIV prevention programs<br />HRGs yet to be covered in each taluka of the district<br />HRGs currently being contacted on a regular basis<br />Condom supply against requirement among HRGs<br />HRG’s access to services<br />What are the gaps in HIV/AIDS care, support and treatment programs?<br />Size estimation of PLHA in the district<br />Detection of HIV against the estimate<br />ART registration against the diagnosed <br />Started on ART against the registered<br />Currently on ART against those ever started<br />Differences in the profile of the registered, currently on ART and those who have dropped out of ART<br />
  41. 41. Route of Transmission of HIV positive cases in VCTC (Direct walk-in) Gujarat, 2007<br />
  42. 42. PPTCT coverage in Gujarat <br />
  43. 43. Yearly Performance Trend for NVP Coverage of MBP (ICTC- PPTCT) <br />
  44. 44. Yearly Performance HIV-TB (2006-2010)<br />
  45. 45. Status of ART/Link ART & CCC Centre in Gujarat 2008<br />
  46. 46. District & Residence Wise Patients on ART per 1 Lac Population <br />
  47. 47. District wise PLHIV by sex in Gujarat, 2008<br />
  48. 48. IEC Programs Implemented (GUJARAT) <br />IEC Programs Implemented (GUJARAT) <br />I<br />J<br />R<br />C<br />D<br />D<br />C<br />J<br />I<br />R<br />C<br />J<br />D<br />C<br />J<br />C<br />J<br />Category of District<br />J<br />I<br />I<br />R<br />C<br />C<br />D<br />J<br />J<br />C<br />J<br />J<br />C<br />C<br />D<br />J<br />C<br />D<br />R<br />C<br />D<br />C<br />R<br />J<br />I<br />C<br />D<br />U<br />U<br />D<br />R<br />C<br />R<br />J<br />C<br />D<br />16 DIC -12<br />J<br />C<br />C<br />J<br />U<br />J<br />20 JEEVAN DEEP - 20<br />I<br />R<br />C<br />J<br />C<br />D<br />D<br />J<br />5 UJAAS - 5<br />U<br />U<br />J<br />U<br />I<br />IRHAP/LINK WORKER - 8<br />I<br />D<br />J<br />C<br />I<br />R<br />8 RED RIBBON CLUB - 8<br />IDC CAMPAIGN - 22<br />J<br />C<br />C<br />
  49. 49. SURAT<br />
  50. 50. Outline for presenting the triangulation process and findings…2<br />4. Discuss data interpretation findings (secondary findings).<br /> i. Summarize other secondary results identified through the triangulation analysis.<br />5. Note limitations (be honest).<br />6. Summarize findings.<br />7. Translate findings into:<br /> i. need for additional data;<br /> ii. programmatic recommendations;<br /> iii. policy recommendations.<br />bhattacrya-NIHFW<br />
  51. 51. Information flow in the monitoring and evaluation system within the context of strategic information: an overview<br />Health information systems HMIS,<br />vital statistics<br />Programme monitoring<br />Programme evaluation<br />Qualitative studies<br />Behavioural surveys<br />DLHS 1,2,3<br />Operations<br />research<br />HIV surveillance;<br />Pop based eg NFHS<br />Data management<br />Data analysis and synthesis<br />Use of data for action<br />Communication<br />to the media<br />Advocacy material<br />Estimates<br />(e.g. HIV, ART)<br />Resource allocation<br />Programme planning<br />Reports<br />Policy<br />Formulation<br />bhattacrya-NIHFW<br />
  52. 52. 4545<br />THANKS<br />

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