Introduction to hIv, aIds and sexually transmitted ...

1 Introduction to hIv , aIds and sexually transmitted infection surveillance MODULE 2 surveillance of hiv risk behaviourswho-EM/STD/126/EIntroduction to hIv, aIds and sexually transmitted infection surveillanceMODULE 2 surveillance of hiv risk behaviourswho-EM/STD/126/EwhO Library Cataloguing in Publication DataWorld Health Organization. Regional Office for the Eastern MediterraneanIntroduction to HIV, AIDS and sexually transmitted infection surveillance : Module 2: surveillance of HIV risk behaviours / World Health Organization. Regional Office for the Eastern Mediterranean, Joint United Nations Programme on Acquired Immunodeficiency Syndrome epidemiology Middle East Africa, Northern 2. HIV infections epidemiology Middle East Africa, Northern 3. sexually transmitted Diseases epidemiology Middle East Africa, Northern 4. Population surveillance Middle East Africa, Northern 5. Risk Reduction Behaviour 6.

2 Information Seeking Behaviour I. Title II. Regional Office for the Eastern Mediterranean III. Joint United Nations Programme on HIV/AIDS(NLM Classification: WC ) World Health Organization 2010 All rights designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication.

3 However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Publications of the World Health Organization can be obtained from Distribution and Sales, World Health Organization, Regional Office for the Eastern Mediterranean, PO Box 7608, Nasr City, Cairo 11371, Egypt (tel: +20 2 2670 2535, fax: +20 2 2670 2492; email: Requests for permission to reproduce, in part or in whole, or to translate publications of WHO Regional Office for the Eastern Mediterranean whether for sale or for noncommercial distribution should be addressed to WHO, Regional Office for the Eastern Mediterranean, at the above address; email: Design by Permanent Design. Printed by the WHO Regional Office for the Eastern 7how to use this module 7additions, corrections.)

4 Suggestions 8acknowledgements 9 UNIT 1 Behavioural surveillance 11 Overview 13 What this unit is about 13 Warm-up questions 13 Introduction 15steps for conducting behavioural surveillance 22summary 26 Unit 1 exercises 27 UNIT 2 Measures and indicators for behavioural surveillance 29 Overview 31 What this unit is about 31 Warm-up questions 31 Introduction 33selecting indicators for behavioural surveillance 33standardized versus locally-adapted indicators 35summary 35 Unit 2 exercises 36 UNIT 3 Formative assessment 37 Overview 39 What this unit is about 39 Warm-up questions 39 Introduction 41 Formative assessment methods 43 Qualitative data collection methods 46 Rapid assessment tools 51 Building alliances 53 Specific ethical considerations for conducting formative assessment 54summary 55 Unit 3 exercises 554 surveillance of hIv risk behavioursUNIT 4 Survey methods 57 Overview 59 What this unit is about 59 Warm-up questions 59 Introduction 61data collection methods 61survey instruments 61 Measurement error 63 Fieldwork practicalities 67selecting appropriate interviewers and supervisors 69summary 69 Unit 4 exercises 70 UNIT 5 Sampling 71 Overview 73 What this unit is about 73 Warm-up questions 73 Introduction 75 Concepts.

5 Terms and definitions 75selecting a sample 76 Calculating sample size 78additional issues in calculating sample size 81 Probability sampling techniques 84sampling most-at-risk populations 85sampling options in the absence of a sampling frame 87 New sampling techniques 88determining sampling approach 90summary 92 Unit 5 exercises 92appendix summary of probability sampling techniques 94appendix Formula for sample size calculation to detect change in proportion 96appendix Random numbers table and instructions 98 UNIT 6 Data analysis and use 103 Overview 105 What this unit is about 105 Warm-up questions 105 Introduction 107data management issues and activities 107data analysis 108 Using behavioural surveillance data 110summary 113 Unit 6 exercises 114 UNIT 7 Ethical considerations 115 Overview 117 What this unit is about 117 Warm-up questions 117 Introduction 119 Ethical principles of conducting human subjects research 119 Informed consent 120 Confidentiality 121 Ethical considerations unique to behavioural surveillance 122summary 125 Unit 7 exercises 126appendix samples of verbal consent forms for participation in hIv biological and behavioural surveillance surveys 127appendix declaration of helsinki on Ethical Principles for Medical Research Involving human subjects 129 Final case studies 135 Final case study 1 Part 1 137 Part 2 138 Part 3 138 Final case study 2 Part 1 139 Part 2 139 Part 3 140 Part 4 140 Final case study 3 Part 1 141 Part 2 141 Part 3 142 Module summary 143 References 149 Annex 1 Glossary 153 Annex 2 Useful links 163 Annex 3 Answers to warm-up questions and case studies 169 Unit 1 answers 171 Unit 2 answers 173 Unit 3 answers 174 Unit 4 answers

6 176 Unit 5 answers 178 Unit 6 answers 181 Unit 7 answers 183 Final case study answers 184 Annex 4 Action plan for implementing hIv behavioural surveillance of most-at-risk populations in EMR/MENA countries 193 Introduction 195 What is an action plan? 195 National action plan worksheet 196 Contents 57 Introductionhow to use this module what you should know before the courseThe human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) epidemic continues to grow worldwide and to devastate individuals, communities and entire countries and regions. Behavioural surveillance measures trends in the behaviours that can lead to HIV infection. It has been shown to make an important and useful contribution to national responses to HIV. Conducting behavioural surveillance requires many skills, including coordination among various partners.

7 Although there are useful reference materials available for behavioural surveillance , there has not yet been a comprehensive effort to train surveillance teams. This training course aims to help address course is meant primarily for people involved in planning and using behavioural surveillance . You should already have a basic understanding of the epidemiology of HIV/AIDS and public health surveillance . This module is part of a set of four modules that have been designed with a focus on the World Health Organization s (WHO) Eastern Mediterranean Region. The modules were designed for use in training workshops. The other modules are: Module 1: Overview of the HIV/AIDS epidemic with an Introduction to public health surveillance Module 3: surveillance of most-at-risk and vulnerable populations Module 4: Introduction to respondent-driven sampling. Similar training modules have been developed for WHO s African, Americas, European and South-East Asia regions.

8 Although the overall framework of the modules is the same, each region has different patterns of HIV epidemics and distinct social and cultural contexts. Also, different countries may have different HIV surveillance capacities and different needs. Thus, these modules were developed taking into account the specific context of the HIV epidemic in the countries of the Eastern Mediterranean Region. The modules are also intended for use in the countries of the Joint United Nations Programme on HIV/AIDS (UNAIDS) Middle East and North Africa Region. For the purpose of this training course, all countries in the WHO Eastern Mediterranean Region plus Algeria are therefore the intended audience. We refer to these collectively as Eastern Mediterranean Region/Middle East and North Africa (EMR/MENA) countries. 8 surveillance of hIv risk behavioursModule structureThis module is divided into units.

9 The units are convenient blocks of material for a single study session. This module can also be used for you already know quite a bit about HIV/AIDS, we begin each unit with some warm-up questions. Some of the answers you may know. For other questions, your answer may be just a guess. Answer the questions as best you can. You will keep your answers to the warm-up questions in this module. No one will see your answers but you. We will study and discuss the unit, and then you will have time to go back and change your warm-up answers. At the end of the unit, the class will discuss the warm-up questions and you can check your work. As you study this module, you may come across terms and acronyms that are unfamiliar. In Annex 1, you will find a glossary that defines many of information is provided in the following annexes:Annex 1: GlossaryAnnex 2: Useful links Annex 3: Answers to warm-up questions and case studiesAnnex 4: Action plan for implementing HIV behavioural surveillance of most-at-risk populations in EMR/MENA countriesAdditions, corrections, suggestionsWe welcome feedback on this training module.

10 Please send your suggestions for any changes or additional information that might be included to the following address for possible inclusion in future editions. Mailing address:World Health OrganizationRegional Office for the Eastern MediterraneanDivision of Communicable DiseasesAIDS and sexually transmitted Diseases (ASD) Unit Abdul Razzak Al-Sanhouri Box 7608 Nasr CityCairo 11371, EgyptEmail: Introduction 9 AcknowledgementsThis manual was prepared by the University of California San Francisco, San Francisco, USA, in collaboration with: WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt; WHO headquarters, Geneva; Joint United Nations Programme on HIV/AIDS (UNAIDS), Regional Support Team, Cairo, Egypt; World Bank; and Centers for Disease Control and Prevention (CDC), Atlanta, USA. Special thanks are due to Family Health International (FHI), whose behavioural surveillance materials provided a basis for this training module.