HIV Surveillance in Hard to Reach Populations
Description
Hard to reach populations such as injecting drug users (IDUs), men who have sex with men (MSM), and commercial sex workers (CSWs) are at the highest risk of HIV infection due to their specific social and behavioural characteristics. In the countries with low-level and concentrated HIV epidemic, these populations account for most HIV infections and are also called “core groups” for HIV transmission. The most demanding task in surveillance of these groups is in reaching them. Because of stigma, discrimination and often illicit nature of their behaviours, they are difficult to reach and standard probabilistic sampling methods such as cluster-based sampling cannot be used. That is why another, recently used sampling methods such as respondent-driven sampling and time-location sampling are recommended to be used. Achieving a high quality sample allows us to monitor trends of the epidemic over time, and compare results across different geographical areas of the country. Surveillance of HIV in high-risk groups is challenging but immensely important, and it is the main component of HIV/AIDS surveillance in low-level and concentrated epidemics. High-quality surveillance in these groups and its links with the system of monitoring and evaluation enables programmatic responses to be cost-effective and well-targeted.
Learning objectives
The aim of this course is to provide skills in designing and implementing surveillance surveys in hard to reach populations, with an emphasis on men who have sex with men, injecting drug users, and commercial sex workers. Focus of the course is on gaining practical skills which is achieved through interactive sessions on protocol development. Participants will be presented with the main methodological tasks and challenges related to surveying hard to reach populations, ranging from issues on how to choose an adequate sampling method to interpreting and disseminating data collected.
Key topics
The course will cover selected topics that are the cornerstone of any project of HIV/AIDS surveillance in hard to reach populations, including both biological and behavioural aspects:
- Pre-surveillance assessment and mapping of high risk groups
- Qualitative data collection used in presurveillance assessment
- Size estimates of target populations
- Selecting the sampling method:
- cluster-based stratified sampling
- time-location sampling
- respondent-driven sampling
- Calculations of sample size and data weighting
- Field work organisation and quality control
- Indicators and questionnaire development
- Ethical issues in surveillance in hard to reach populations,
- Data management, analysis and dissemination,
- Establishing a surveillance system for high-risk groups
The course also presents participants with experiences from a number of studies conducted among high risk groups in different parts of the world, various sampling strategies used, and advantages and disadvantages of these different approaches and lessons learned.
Key references:
Behavioral Surveillance Surveys: guidelines for repeated behavioral surveys in populations at risk of HIV. Arlington: Family Health International, 2000.
Link
Resources on Most-at-Risk Populations: Sampling strategies and design tool for most at risk groups: http://www.theagencyfordesign.com/clients/cdc/index.htm
Estimating the size of populations at risk for HIV: issues and methods. Arlington: Family Health International, 2003.
Link
Magnani R, Sabin K, Saidel T, Heckathorn DD. Review of sampling. hard-to-reach and hidden populations for HIV surveillance. AIDS. 2005;19(Suppl 2):S67-72.
Mills S, Saidel T, Mangani R, Brown T. Surveillance and modelling of HIV, STI and risk behaviors in concentrated HIV epidemics. Sex Transm Infect 2004; 80:ii57-ii62.
Muhib FB, Lin LS, Stueve A. A venue-based method for sampling hard-to-reach populations. Public Health Rep. 2001;116(suppl 1):216-222
Heckathorn DD. Respondent driven sampling: a new approach to the study of hidden populations. Soc Probl. 1997;44:174–199
Teaching Methods
The course consists of lectures, exercises and presentations. Participants will be working in small groups to develop protocols for implementing a surveillance survey in a chosen high-risk group. They can use this protocol for an actual study that they will be designing and implementing in their own country. At the end of the course, participants have the opportunity to present an outline of the protocol of their proposed study. Participants also receive key literature on a CD with all the lectures and exercises.
Target Audience
Epidemiologists, social scientists, public health professionals.
Duration:
The course takes place in five days.
Partners:
Health Protection Agency, UK
United Nations Development Programme
Faculty of Arts and Humanities, Zagreb
Downloads:
Programme: Training course in Surveillance in Hard to Reach Populations
