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Using the PLACE Method to
      Inform Decision Making

      Sharon S Weir, University of North Carolina

J Peter Figueroa, University of the West Indies, Jamaica
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Agenda

• Welcome and introductions
• The importance of data-informed decision
  making
• Overview of the PLACE approach
• PLACE in Jamaica
• Questions and answers
• Wrap up
Why data-informed decision
making?
       Pressing need to target health
    policies, strategies, & interventions
     to the populations that need them
                   the most
“… without information, things are done
arbitrarily and one becomes unsure of
whether a policy or program will fail or
succeed. If we allow our policies to be guided
by empirical facts and data, there will be a
noticeable change in the impact of what we
do.”

                 National-level Policymaker, Nigeria
Using the PLACE Method to
      Inform Decision Making

      Sharon S Weir, University of North Carolina

J Peter Figueroa, University of the West Indies, Jamaica
PLACE Countries: Past and Present



                                                                            Kazakhstan
                                                                            Karaganda
                                                                            Almaty


                                                                                             Russia
                                                                       Kyrgyzstan            Saratov-Engels
                                                                                             Samara                              China
                                              Uzbekistan               Osh                                                       Liuzhou
                                                                                             St. Petersburg
                                              Tashkent
Mexico
Chetumal
Ciudad Hidalgo                                  Burkina Faso                                                              India
                                                Banfora                                                                   Bhubaneswar
                                                                   DR Congo
                              Haiti             Tenkodogo
Jamaica                       Carrefour                                 Burundi                               Rwanda
All 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
Global Recommendation
for 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
Problem Addressed by PLACE:
Preventing HIV transmission at the
local level

 The PLACE method addresses the need for
  rapidly available information to target and monitor
  local AIDS prevention strategically.
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.
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.
PLACE protocol overview: The 5
    Steps
1 Using available data, identify geographic areas likely
  to have high incidence of HIV infection
2- 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 & workers
5 Use results to improve programs
Step 2: Within High Incidence Areas,
Ask Community Informants: Where do people
meet 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
Step 3: Visit, characterize and map
places
  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
Characteristics of places / venues
   Obtained from interviewing a knowledgeable person at the venue

To 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
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?
STEP 5
Inform interventions
Maps can show where
condoms are needed
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
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%
Using the PLACE Method to Inform Decision Making
Method Adapted to Jamaica’s
Needs
 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
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)
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 result
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
Questions and Answers
Join Data Use Net
Send an email to listserv@unc.edu. Leave the
subject field blank and in the body of the message
type ‘subscribe DataUseNet.’ For example:
To: listserv@unc.edu
From: youremail@youremail.com
Subject:
Subscribe Data Use Net
Presenter Contact Information

 Dr. Sharon Weir sharon_weir@unc.edu
 Prof. Figueroa figueroa10@gmail.com
The research presented here has been supported by the
President’s Emergency Plan for AIDS Relief (PEPFAR)
through the United States Agency for International
Development (USAID) under the terms of MEASURE
Evaluation cooperative agreement GHA-A-00-08-00003-
00. Views expressed are not necessarily those of
PEPFAR, USAID or the United States government.
MEASURE Evaluation is implemented by the Carolina
Population Center at the University of North Carolina at
Chapel Hill in partnership with Futures Group, ICF
International, John Snow, Inc., Management Sciences for
Health, and Tulane University.

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Use of Qualitative Comparative Analysis in the Assessment of the Actionable D...
 
Sustaining the Impact: MEASURE Evaluation Conversation on Health Informatics
Sustaining the Impact: MEASURE Evaluation Conversation on Health InformaticsSustaining the Impact: MEASURE Evaluation Conversation on Health Informatics
Sustaining the Impact: MEASURE Evaluation Conversation on Health Informatics
 

Using the PLACE Method to Inform Decision Making

  • 1. Using the PLACE Method to Inform Decision Making Sharon S Weir, University of North Carolina J Peter Figueroa, University of the West Indies, Jamaica
  • 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 glbitar@unc.edu
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  • 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. Why data-informed decision making? Pressing need to target health policies, strategies, & interventions to the populations that need them the most
  • 6. “… without information, things are done arbitrarily and one becomes unsure of whether a policy or program will fail or succeed. If we allow our policies to be guided by empirical facts and data, there will be a noticeable change in the impact of what we do.” National-level Policymaker, Nigeria
  • 7. Using the PLACE Method to Inform Decision Making Sharon S Weir, University of North Carolina J Peter Figueroa, University of the West Indies, Jamaica
  • 8. PLACE Countries: Past and Present Kazakhstan Karaganda Almaty Russia Kyrgyzstan Saratov-Engels Samara China Uzbekistan Osh Liuzhou St. Petersburg Tashkent Mexico Chetumal Ciudad Hidalgo Burkina Faso India Banfora Bhubaneswar DR Congo Haiti Tenkodogo Jamaica Carrefour Burundi Rwanda All 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. Global Recommendation for 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. Problem Addressed by PLACE: Preventing HIV transmission at the local level  The PLACE method addresses the need for rapidly available information to target and monitor local AIDS prevention strategically.
  • 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. 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. PLACE protocol overview: The 5 Steps 1 Using available data, identify geographic areas likely to have high incidence of HIV infection 2- 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 & workers 5 Use results to improve programs
  • 14. Step 2: Within High Incidence Areas, Ask Community Informants: Where do people meet 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. Step 3: Visit, characterize and map places  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. Characteristics of places / venues Obtained from interviewing a knowledgeable person at the venue To 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. 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. STEP 5 Inform interventions Maps can show where condoms are needed
  • 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. 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%
  • 22. Method Adapted to Jamaica’s Needs  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
  • 23. 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)
  • 24. 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 result 24
  • 25. 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
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  • 28. Presenter Contact Information  Dr. Sharon Weir sharon_weir@unc.edu  Prof. Figueroa figueroa10@gmail.com
  • 29. The research presented here has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID) under the terms of MEASURE Evaluation cooperative agreement GHA-A-00-08-00003- 00. Views expressed are not necessarily those of PEPFAR, USAID or the United States government. MEASURE Evaluation is implemented by the Carolina Population Center at the University of North Carolina at Chapel Hill in partnership with Futures Group, ICF International, John Snow, Inc., Management Sciences for Health, and Tulane University.