1 / 31

Luh Putu Lila Wulandari Pande Putu Januraga

Maximising the use of VCT data for programs' planning and evaluation; experience from developing longitudinal studies of FSWs in Bali.

alanna
Télécharger la présentation

Luh Putu Lila Wulandari Pande Putu Januraga

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Maximising the use of VCT data for programs' planning and evaluation; experience from developing longitudinal studies of FSWs in Bali • Presented in Satellite Session, Local to Large: Utilising Locally Available Data to Evaluate Programs and Answer Research Questions. AIDS 2014 20th International AIDS Conference. 22 July 2014 Luh Putu Lila Wulandari Pande Putu Januraga School of Public Health, Udayana University, Bali, Indonesia

  2. HIV epidemic in Bali • Bali Province has been one of the more heavily affected • Epidemic is at concentrated level with HIV prevalence among general population 0.68% • FSWs is among the groups that highly affected • Epidemic among this group is not only a local problem • The majority of FSWs are migrant workers • The mobility nature of FSWs and their clients

  3. Surveillance of HIV in Bali, Indonesia • Effective and efficient surveillance system is crucial to supports prevention programs: • For monitoring the impact of epidemic • For predicting the future course of epidemic • For planning • For monitoring the impact of intervention program • Population based surveys among high risk groups have become the primary source of data for tracking trends in the HIV epidemic in Bali, and results have been made available on a regular basis in provincial and national

  4. Population based surveys to monitor HIV epidemics among FSWs in Bali • IBBS, MOH of Indonesia, 2007 and 2011, direct (brothel based) FSWs in Denpasar • Sero-surveys, Bali Health Office, 2000-2013, direct (brothel based) and indirect (non-brothel based) FSWs • Behavioral surveys, YayasanKertiPraja (YKP), direct FSWs, 2007, 2009, 2012 and 2013

  5. HIV prevalence among FSWs in Denpasar, Bali

  6. Population based surveys provide more representative point prevalence estimates • Howeverin Bali context • Expensive, logistically complex. • Methodological problems such as inconsistencies in the sampling technique, sample numbers and sites over time, and incomplete recording of individual information about survey participants • Lack of incorporation of additional information on behavioural factors to ensure that the surveillance system is in the best position to support prevention activities.

  7. Details of analysis of population based surveys of high risk groups in Bali could be found in an article of International journal of STD & AIDS 2013, 24:633-637.

  8. It is time now to also look at another potential source of surveillance data

  9. VCT data in Bali • Multiple VCT providers: • Hospitals based (12 centres) • Health centres/Puskesmas based (23 centres) • NGO clinics based (4 centres) • Different approaches: • Outreaches: health centres and NGO clinics • Referrals: hospitals • Growing databases

  10. Growing databasesNumber of FSWs underwent VCT at Amertha clinic 2000-2011

  11. Multi centres (VCT clinics with the majority of clients are FSWs) VCTs: 2 D FSWs: 150 Sero-surveys: no VCT: 1 DFSWs: 280 Sero-surveys: irregular VCTs: 2 D FSWs: 2,200 Sero-surveys: yes VCT: 1 D FSWs: 500 Sero-surveys: irregular

  12. Contribution to the surveillance data in Bali Up to now contributing very little to the surveillance of HIV Bali • Self selection bias, users will differ between sites and even over time within sites • Context-specific: data collected in a Puskesmas or NGO clinics VCT centre will be different from those collected in a testing centre attached to a hospital • Lack of VCT data sets with individual client data from all key VCT providers, poor overall reporting 'culture'. • Lack of multi-sites comparisons of VCT and survey data including trends from multiple surveys

  13. The potential of VCT data for surveillance purposes among high risk groups including FSWs • Since 2007, the majority of VCT clinics have followed National Guidelines on VCT data collection forms, analysis and reporting • The scale up of ARV treatment among FSWs in Bali has significant implications for surveillance of HIV-AIDS • Have the potential as sources for longitudinal community studies • Since the data is in a multi-site manner, the results may have far reaching implications for surveillance and estimates

  14. In Bali context and particularly to the HIV epidemic among FSWs … • Does VCT data have potential for supplemental HIV surveillance? • Does VCT data have potential for HIV prevalence trends? • Can prevalence trends among VCT centres be used to approximate HIV incidence trends, with the introduction of ART policy and program? • Can others data (behavioural) collected from VCT centres be used to inform planning and evaluation?

  15. Dr.Wulan…

  16. Context: • This project showcase the use of VCT data to supplement the other HIV surveillance • We used the VCT database available at private clinic in Bali mainly serve female sex workers (YKP) • This clinic has been providing VCT services for FSWs since 2000, however dataset were available since 2006 • Until 2013, there have been more than 14,000 VCT sessions conducted in this clinics, at least 9,000 of them were among FSWs

  17. Context : • VCT testing at the this clinic uses a combination of three rapid HIV tests, the same method used for the serosurveillance • Almost all of clients who came to this clinics were came from areas where the sample of serosurvey were selected. • The number of clients participated in the VCT testing far outnumber the number of sample of survey. • Large amount of data collected is consistently collected over time at the same site

  18. HIV proportion among FSW from VCT data in Bali

  19. HIV proportion among FSW from VCT data in Denpasar

  20. HIV proportion among FSW who came at the first time from VCT data

  21. HIV proportion among FSW who engaged in the sex work for less than 12 months

  22. HIV proportion among FSW who came to the VCT clinic without HIV symptoms

  23. HIV positivity among direct FSWs in Denpasar, Bali

  24. HIV positivity among indirect FSWs in Denpasar, Bali

  25. Our study demonstrates that routinely collected data from a large VCT clinic can provide a robust source of data over time on FSWs, to supplement serosurvey data • Although the point HIV prevalence estimates using VCT data as described in this study are lower than those estimated from serosurveillance data, this VCT data paralled the trend of HIV infection among sex workers • The VCT data also confirmed the lower rate of HIV infection among indirect sex workers compared with direct sex workers which is also found in serosurvey data

  26. VCT data is provides more comprehensive sociodemographic and behavioural data from the same individual seeking HIV testing which is useful when interpreting the time trend of HIV epidemic

  27. Acknowledgement • YKP Clinic • Bali Health Office • Kirby Institute • DFAT

More Related