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Using the PLACE Method to Inform Decision Making

Led by Dr. Sharon Weir, MEASURE Evaluation, and Professor Peter Figueroa, University of the West Indies, Jamaica.

Presentation on the PLACE method and how it has been used for HIV/STI surveillance, behavioral surveillance, program monitoring, size estimation of most-at-risk populations, and program planning.

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Using the PLACE Method to Inform Decision Making

  1. 1. Using the PLACE Method to Inform Decision Making Sharon S Weir, University of North CarolinaJ Peter Figueroa, University of the West Indies, Jamaica
  2. 2. Troubleshooting If you lose connectivity  Re-enter the meeting room by clicking on the webinar link provided If you have trouble with audio  Run the Audio Setup Wizard (under “Meeting” at top of screen) to see if your speakers are working Send an email to
  3. 3. Tips for Participating in theDiscussion To comment, raise your hand by clicking on the icon.  Speak into your microphone (be sure it is enabled by clicking on the icon at the top of the screen).  Type questions in Q&A window located at the top of your screen.  A recording of the webinar will be made available at
  4. 4. Agenda• Welcome and introductions• The importance of data-informed decision making• Overview of the PLACE approach• PLACE in Jamaica• Questions and answers• Wrap up
  5. 5. Why data-informed decisionmaking? Pressing need to target health policies, strategies, & interventions to the populations that need them the most
  6. 6. “… without information, things are donearbitrarily and one becomes unsure ofwhether a policy or program will fail orsucceed. If we allow our policies to be guidedby empirical facts and data, there will be anoticeable change in the impact of what wedo.” National-level Policymaker, Nigeria
  7. 7. Using the PLACE Method to Inform Decision Making Sharon S Weir, University of North CarolinaJ Peter Figueroa, University of the West Indies, Jamaica
  8. 8. PLACE Countries: Past and Present Kazakhstan Karaganda Almaty Russia Kyrgyzstan Saratov-Engels Samara China Uzbekistan Osh Liuzhou St. Petersburg TashkentMexicoChetumalCiudad Hidalgo Burkina Faso India Banfora Bhubaneswar DR Congo Haiti TenkodogoJamaica Carrefour Burundi RwandaAll parishes All 12 provinces Guyana Uganda Kenya All 8 provinces St. Lucia Ghana Tanzania Castries All 10 regions Angola Magu Malawi Gros Islet Luanda Madagascar Anse la Raye Zimbabwe 7 cities Zambia Hwange District Mongu Kapiri Mposhi South Africa Lesotho 2 townships in Port Elizabeth Ficksburg, Maseru, Maputsoe, East London Ladybrand, Fouriesburg, Butha 1 Township in Cape Town Buthe
  9. 9. Global Recommendationfor PLACE “Use innovative methods (PLACE, key informant interviews) to estimate the size and location of relevant key populations by country.” Key Population Working Group Presentation to PEPFAR’s Scientific Advisory Board Washington, DC, October 2-3, 2012 Mead Over, Center for Global Development
  10. 10. Problem Addressed by PLACE:Preventing HIV transmission at thelocal level The PLACE method addresses the need for rapidly available information to target and monitor local AIDS prevention strategically.
  11. 11. PLACE Argument The HIV pandemic is worldwide but transmission occurs in local epidemics Prevention should focus in geographic areas where HIV incidence is highest No two local HIV epidemics are the same. Each local HIV epidemic reflects its unique underlying pattern of new and concurrent sexual and needle sharing partnerships. National and provincial data may hide local epidemics. In the absence of empiric data on the geographic distribution of HIV incidence and number of new infections, national stakeholders can thoughtfully interpret available information to identify where HIV incidence is high.
  12. 12. PLACE Argument Interrupting HIV transmission requires focusing on people with high rates of new sexual or needle sharing contacts. Effective prevention among these individuals must be multi- level, using tailored “combination prevention” to reduce their partnership rates, increase testing, treatment, referral and counseling for HIV/STI, and condom use. The PLACE method identifies venues and events where local intervention programs can reach the most important sexual and injecting drug use networks. Although outreach to these places can be expensive, outreach is cost-effective if chains of transmission are broken.
  13. 13. PLACE protocol overview: The 5 Steps1 Using available data, identify geographic areas likely to have high incidence of HIV infection2- 4 Conduct rapid assessment in each area 2 Identify venues where people meet new partners 3 Visit, characterize, map venues 4 Assess risk behavior & estimate prevalence though interviews/testing of venue patrons & workers5 Use results to improve programs
  14. 14. Step 2: Within High Incidence Areas,Ask Community Informants: Where do peoplemeet new partners?  Probe based on strata of interest for mixing  Young women and older men  Commercial sex workers  Mobile and resident populations  Military and civilian  Ask until no new venues are found  Output: List of venues with number times reported
  15. 15. Step 3: Visit, characterize and mapplaces  Reported places are visited and mapped. An interview is conducted with a knowledgeable person on-venue to obtain characteristics of the place  A place can be an establishment such as a bar, an outdoor site such as a park or street, an event such as a community festival, an internet site, or a phone number— such as for escort services.  Mapping can be done by hand, onto an aerial photo, or using GPS
  16. 16. Characteristics of places / venues Obtained from interviewing a knowledgeable person at the venueTo Gauge Prevention To describe patrons of venues Program Coverage and Potential at Venues  Male:female ratio Type of venue  Regular patrons Condom availability  Where patrons reside Evidence of AIDS  Whether patrons include prevention commercial sex workers, gay, Busy times military, mobile, youth, locals, Maximum occupancy unemployed Number of staff  Whether people meet new partners at venue Venue stability
  17. 17. Step 4: Interview and test people at places Opinion:  Socio-demographic & behavioral characteristics  Do other people come here to meet  Number of new and new partners? total partners in the past four weeks, year Behavior:  Condom use  Have YOU ever met  Exposure to a new partner at this intervention venue?  Have YOU ever  Test for HIV & other STI injected?
  18. 18. STEP 5Inform interventionsMaps can show wherecondoms are needed
  19. 19. Collaboration re PLACE in Jamaica 2002 PLACE Montego Bay 2003 PLACE roll out Kingston, Negril 2005-06 PLACE RCT Kingston 2006 PLACE roll out island wide Caribbean study tour Technical assistance to St Lucia 2008 PLACE Survey 2012 PLACE Survey
  20. 20. Impact of PLACE in Jamaica Improved Surveillance of MARPS  Identified staff and patrons at venues as high risk via PLACE  Showed the continued high prevalence of other STIs  Improved the tracking of HIV & risk factors among MARPs Improved interventions  Significantly increased access & outreach to MARPs  Developed the scope and expertise of our outreach staff  Spearheaded outreach HIV and STI testing/ youth Increased used of data to guide planning & interventions  Helped us to refine our outreach interventions  Convinced policy makers of need to retain field staff  Showed the importance of social vulnerability  Improved monitoring & evaluation Helped to reduce HIV prevalence among sex workers from 9% to 4.5%
  21. 21. Method Adapted to Jamaica’sNeeds Survey questions developed to meet program needs, to meet global reporting requirements, to parallel questions asked previously and questions asked in national KAPB survey, and to meet requests from stakeholders (to extent possible) HIV+ persons enrolled in national treatment and care program STI treated at no charge to participants
  22. 22. HIV and STI Infections Measured HIV (rapid tests) Syphilis Testing (multiple tests used) Gonorrhea Chlamydia Trichomoniasis Gen-Probe laboratory equipment Women: urine or vaginal swab (acceptability)
  23. 23. Data Use: PLACE provided prevention indicators for female sex workers Indicator 2011 Condom use at last sex with a 91% client Knowledge of how to prevent HIV 38% (5 questions) Knowledge of how to prevent HIV 52% omitting one faithful partner option Reached with prevention program 92% HIV tested in past 12 months and 75% know result24
  24. 24. Future Needs Complete Institutionalization of PLACE in the Ministry & Health Regions in Jamaica Consolidate the outreach intervention approaches Follow-up the cohorts of MSM and sex workers  Need to use anal swabs with MSM Develop & evaluate more effective interventions for MSM Additional analyses and publications Review the Modes of Transmission model & HIV treatment cascade Need to address other STIs especially among the youth Maintain STI testing capacity using GenProbe Gonorrhoea sensitivity testing Share these methods, approaches and lessons with other Caribbean countries
  25. 25. Questions and Answers
  26. 26. Join Data Use NetSend an email to Leave thesubject field blank and in the body of the messagetype ‘subscribe DataUseNet.’ For example:To: listserv@unc.eduFrom: youremail@youremail.comSubject:Subscribe Data Use Net
  27. 27. Presenter Contact Information Dr. Sharon Weir Prof. Figueroa
  28. 28. The research presented here has been supported by thePresident’s Emergency Plan for AIDS Relief (PEPFAR)through the United States Agency for InternationalDevelopment (USAID) under the terms of MEASUREEvaluation cooperative agreement GHA-A-00-08-00003-00. Views expressed are not necessarily those ofPEPFAR, USAID or the United States government.MEASURE Evaluation is implemented by the CarolinaPopulation Center at the University of North Carolina atChapel Hill in partnership with Futures Group, ICFInternational, John Snow, Inc., Management Sciences forHealth, and Tulane University.