Mapping, Size Estimation and Integrated Behavioral and Biological Assessment (IBBA) In High HIV Prevalence Setting In India
|Category / Nature:
|Collaboration / Participating Centers:
||Implementing ICMR institutes:
1.National AIDS Research Institute (NARI), Pune
2.National Institute of Epidemiology (NIE), Chennai
3. National Institute of Nutrition (NIN), Hyderabad
4. National Institute of Medical Statistics (NIMS), Delhi
5.Regional Medical Research Center (RMRC), Dibrugarh
6.Karnataka Health Promotion Trust (KHPT), Bangalore
|Funding Agency(ies) / Sponsors:
||Bill and Melinda Gates Foundation (BMGF)|
||1. To measure the major outcomes and impacts of the interventions funded by ‘Avahan’ under the “India AIDS Initiative”;
2.To make available data that will be used for estimating sizes of populations targeted by the Avahan project; and
3. To make information available to a partner organization under Avahan for modeling the impact of the intervention.
4. To measure the major outcomes and impacts of the interventions funded by ‘Avahan’ under the “India AIDS Initiative”;
Family Health International (FHI)
AVAHAN, The India AIDS Initiative, of the Bill and Melinda Gates Foundation was inaugurated in 2003 with the aim of slowing down the HIV epidemic in India, through focused, integrated, large-scale HIV prevention programs among ‘high-risk’ populations in AVAHAN districts of six high prevalent states (Andhra Pradesh, Karnataka, Maharashtra, Tamil Nadu, Manipur and Nagaland) in India along with ‘National Highways’. AVAHAN intends to reduce HIV incidence among ‘high-risk’ populations and stabilize infection rates among the general population in six high prevalent states. The Integrated Behavioral and Biological Assessment (IBBA) is a major component of the overall AVAHAN evaluation strategy; and designed to measure and understand the impact of the AVAHAN interventions among ‘high-risk’ and ‘bridge’ populations and to provide data for epidemic impact modeling.
The IBBA in the selected districts was initiated with mapping of the sub populations and it was followed by sampling frame development. Simultaneously Community Advisory Boards (CAB) and Community Monitoring Boards (CMB) were established as a part of harm minimization protocol for protecting participants’ rights.
Intensive community preparation activities:
? Probability sampling using appropriate methods for high-risk group populations
? Extensive ethical framework
? Strong Monitoring, QA & QC mechanism
? Comprehensive logistical preparations for collection/ transport/storage of specimens
? Strong partnership with multiple partners
Implementation of IBBA Survey:
This unique cross-sectional survey has been implemented by National AIDS Research Institute in collaboration with other ICMR institutes with technical support from Family Health International (FHI); and impeccable coordination from ICMR institutes, FHI, Professional Research Agencies, AVAHAN, State Lead Partners, State AIDS Control Societies and other state agencies.
The first round of this survey was completed during the period 2005 – 07 with the collection of data on approximately 180 behavioral and 7 biological variables from 27,095 participants from six states and national highways.
The second round of the survey was initiated on 15th March 2009 in ‘Vizag’ district of Andhra Pradesh for Female Sex Worker (FSW) group and ended on 23rd February 2010 with Injecting Drug Users (IDU) group in Mumbai-Thane district of Maharashtra.
Uniqueness of IBBA:
51,602 sample size (including both the rounds of survey)spread over six states, twenty nine districts, four highway sites, (Total 133Surveys), 180 behavioural and seven biological variables for each participant makes this study unique.
Highlights of data:
? The programme coverage has improved significantly across majority of the groups of FSW, MSM, IDU and truckers.
? However, Vizag, East Godavari, and Chittoor in Andhra Pradesh, Thane Brothel Based FSWs in Maharashtra among FSW groups, Wokha and Mumbai-Thane for IDUs and South East Route category of truckers showed decline in programme coverage.
? The proportion of respondents who had undergone HIV testing has also shown increase in majority of the groups surveyed, indicating greater coverage.
? HIV prevalence has shown decline across majority groups in all the states except few.
? The groups which have shown increase in HIV prevalence are for FSWs in Vizag and Warangal in Andhra Pradesh, Mumbai and Thane in Maharashtra; for MSM of Guntur, Hyderabad, Chennai and Coimbatore; for IDUs Churachanpur; andfor Clients of FSWs in Chennai
? However, the decline / increase in HIV prevalence needs further analysis.
? Increasing trendof FSWs having non-paid regular partners in conjunction with continuing low condom use (last time as well as consistent) with non-paid regular partners is a concern.
|Current Status :