Using Mapping for Sampling & Size Estimation The 2 nd Generation Surveillance System for HIV/AIDS in Pakistan

1. Using Mapping for Sampling & Size Estimation The 2nd Generation Surveillance System for HIV/AIDS in Pakistan Dr. Hasan A Zaheer Dr. Faran Emmanuel National Program Manager Chief Technical Officer National AIDS Control Program Canada Pakistan HIV/AIDS Surv. Project The 2nd Global HIV Surveillance Meeting 2-5 March, Bangkok Thailand

2. Surveillance ….. HASP • The HIV/AIDS Surveillance Project: Phase I – started in 2004 and funded for 5 yrs by CIDA • implemented by a consortium consisting of Agriteam Canada Consulting Ltd, University of Manitoba and Pro Action: Partners for Community Health. • Health Canada also plays a strong role in providing technical support • Pakistani partners consist of the Ministry of Health, National AIDS Control Program (NACP), and Provincial AIDS Control Programs (PACP) in Punjab, Sindh, North-West Frontier Province (NWFP) and Balochistan.

3. HASP – Key Objectives • Main objectives: • Support the development and use of HIV second generation surveillance data • Build capacity for implementing second generation surveillance at the national and state levels and involves working with the National AIDS Control Program (NACP), provincial AIDS Control Programs (PACPs) and other stakeholders including NGOs, Research Institutes and laboratories to develop a sustainable SGS system for HIV/AIDS.

4. SGS – Reviewing the Overall Purpose • Mapping and rapid assessments • To quickly identify the locations and size of key populations (e.g. sex workers, IDUs) • Distribution and typologies • Integrated behavioural and biological surveillance • To determine the risk and protective behaviours of key population members • To determine the distribution of HIV in key population groups • Track program delivery success

5. MAPPING – Steps The PRE-MAPPING Preparations Collecting LEVEL ONE information Data Collation Validating information in LEVEL 2 Triangulation of data Data analysis & Report Writing Using RESULTS Of Mapping

6. Some key points • IDUs, FSWs, TGs & MSWs • Develop sampling frames for IBBS • Geographical mapping approach • Dividing target area into zones & compiling information within each zone • An element of Network assessment developed for TGs & Home/kothikhana based FSWs. • Information collected from Secondary and Tertiary Key Informants and validated by HRGs themselves

7. 2 major Data collection Levels LEVEL ONE • Information on HRG collected within each zone • Secondary and Tertiary Key Informants interviewed • Extremely extensive activity • 12 cities in Surveillance R2 : approx 30,000 interviews • Information collected • High risk activity spots for each HRG • number of HRG at each spot • operational types e.g., FSWs (4 major types) • operational dynamics .. (risk taking/seeking, timings of operation, contacts of resource persons)

8. 2 major Data collection Levels LEVEL TWO • Level 2 involved VALIDATION of spots, identified in L1. • The information is obtained from Primary KI • No of spots validated In large cities atleast 50% In smaller cities ALL spots • Spot validation means visiting each spot and interviewing a HRG member to validate information collected at L1. • If spot is not validated, it is deleted from the list • New spots found at L2 are added in the list • Followed by Data analysis/integration and triangulation

9. The FINAL Information - Estimates City wise distribution of IDUs in 12 cities in Pakistan : SGS data R2

10. The FINAL Information - Typologies Operational types of FSWs in Pakistan : SGS data R2

11. The FINAL Information – Distribution HRA spots for IDUs in DG Khan, Pakistan : SGS data R3

12. Using this Information – SAMPLING For Example : Sampling of FSWs • The sample is aimed to be as representative as possible • Multistage sampling approach • Proportionate allocation of sample for each sub-type … (HBSW 40%, SBSW 30%, KKBSW 25%, BBSW 5%) • Proportionate allocation within each zone • Random selection of spots • Random recruitment of FSWs from each spot Other sampling approaches • RDS, Systematic Random, Network sampling

13. National Estimates • National estimates were created through extrapolation of available data from Mapping studies • Population parameters were taken from Federal Bureau of Statistics, Census division, GoP • Based on the size estimates available from 27 cities “No of HRG/1000 adult males/females” within each province. • Provincial Estimates were developed first, which were later added up to provide a National estimate • No of IDUs/ 1000 adult males Punjab = 4.21 Sind = 3.29 NWFP = 0.41 & Balochistan = 0.65 per 1000 • Numbers were based on urban and rural population

14. National Estimates Based on these calculations, we have a fairly resaonable know how of the estimated number of HRGs: • IDUs : 70,000 to 100,000 • FSWs : 110,000 to 135,000 • MSWs : 40,000 to 75,000 • TGs : 35,000 to 65,000 This information has been used to develop for used to develop new prevention plans (National Strategic Framework, PC-1s) and project proposals for various funding opportunities (GFATM, UNAIDS, World Bank)

15. ACKNOWLEDGMENTS • National AIDS Control Program • Provincial AIDS Control Programs • All field teams involved in the study • High risk groups & stakeholders • CIDA • HASP team • Organizers of the 2nd Global HIV Surveillance Meeting for presenting our work THANKS