AIDS Indicator Survey and Malaria Indicator Survey

1. AIDS Indicator Survey and Malaria Indicator Survey Second Global HIV/AIDS Surveillance Meeting Bangkok, March 2009 Steven Yoon, ScD, MPH CDC President’s Malaria Initiative

2. President’s Malaria Initiative • 30 June 2005, President Bush announced a new 5-year, $1.2 billion initiative to rapidly scale up malaria control interventions in high burden countries in Africa • Challenged other donors to increase their funding

3. Funding Levels and Coverage

4. PMI Goal and Targets • Goal: To reduce malaria-related mortality by 50% in 15 selected countries • Targets: To achieve 85% coverage of vulnerable groups with four key interventions

5. PMI Interventions • Artemisinin-based combination therapy (ACTs) • Insecticide-treated bed nets (ITNs) • Intermittent preventive treatment in pregnancy (IPTp) • Indoor residual spraying (IRS) (where appropriate)

6. Countries Selected First Year (FY06): Angola, Tanzania, Uganda Third Year (FY08): Benin, Ethiopia, Ghana, Kenya, Liberia, Madagascar, Mali, Zambia Second Year (FY07): Malawi, Mozambique, Rwanda, Senegal

7. Malaria At A Glance • Each year, an estimated 300 million to 500 million people become ill with malaria, and more than 1 million die. • More than 80 percent of the world’s malaria deaths occur in sub-Saharan Africa. • Every 30 seconds, an African child dies of malaria. • Malaria is a leading cause of death of young children in Africa. • Malaria causes an annual loss of $12 billion, or 1.3 percent, of Africa’s gross domestic product. • Malaria accounts for approximately 40 percent of public health expenditures in Africa. • Malaria is a preventable and treatable disease.

8. Malaria Epidemiology and Control Efforts • Malaria transmission is often seasonal • A country could have multiple zones of transmission • Control efforts are targeted at vulnerable population (children under 5 years and pregnant women) • Safe and effective interventions available • Prevention • Treatment

9. Malaria Indicator Survey

11. Background • Roll Back Malaria Partnership (RBM) launched in 1998 • RBM Monitoring and Evaluation Reference Group (MERG) established in 2002 • RBM MERG Household Survey Task Force developed MIS • Designed to assess core household indicators

12. Purpose of MIS • To provide reliable information on malaria at the national and subnational level and for population subgroups • To allow calculation of standard Roll Back Malaria indicators (see Core Indicators Guidelines) • To meet country-specific needs for monitoring and evaluation of malaria programs

13. Combining AIS and MIS Tanzania Uganda

14. Tanzania • Seasonality • AIS – avoid rainy season • MIS – high malaria transmission season • Testing • RDT for malaria – simple, but not MERG standard • Questionnaire • Overall, positive experience

15. Uganda • Originally planned for Sept 2008, now maybe late summer 2009 • MoH interest in combining surveys

16. Uganda AIS/MIS 2009 (1)

17. Uganda AIS/MIS 2009 (2)

18. Advantages • Desire from MoH • Sample design • Generating and using same EAs • Survey cost • Transportation • Personnel • Scientific • Funding organization perception

19. Disadvantages (1) • Seasonality of malaria transmission • Different age groups of interest • Biological specimen – amount required for parasitemia and anemia is relatively small compared to CD4, etc. • Sample size – MIS tends to be smaller (based on national level estimates)  • Uganda – MIS about 1/3 of AIS

20. Disadvantages (2) • Survey fatigue [household level] • Length of combined questionnaire • [Possible delay in] Availability of final data • Protocol clearance • Cost and complexity of coordinating two surveys  • Funding complexities

21. Future • Continue to explore ways to combine surveys – understand country context • Clear expectations from both sides – timeline, IRB, etc. • Willingness to compromise • Document and share experiences from Tanzania and Uganda • Address capacity/resource discrepancy between HIV/AIDS and malaria communities

22. Thank you.