
b8d9365dc75c340a9a6b7aad018ebb1b.ppt
- Количество слайдов: 18
Monitoring the effects of ARV treatment programmes on prevention Gabriel Mwaluko 1, Mark Urassa, 2, John Changalucha, 2, Ties Boerma 3 1 TANESA Project, Mwanza, Tanzania 2 National Institute for Medical Research, Mwanza, Tanzania 3 University of North Carolina at Chapel Hill
The effect of treatment on prevention / HIV transmission Positive – more HIV testing & counselling, – stigma reduction, – behavioural change, – reduction in infectiousness of people on treatment Negative: – behavioural disinhibition, – more STIs, – resources diverted from prevention – longer period of infectiousness because of longer life
Monitoring of prevention interaction: levels and methods • At the individual level - among those who are on treatment – in the context of treatment visits – information from partners • At the population / community level - among those living in communities with access to treatment – through local studies – through national surveys – qualitative and quantitative data
Sources of data on knowledge, attitude, risk behaviour • General population surveys: reproductive ages (1549, 15 -59) • Youth / adolescents surveys (12 -19, 15 -24, 10 -17) • Target group surveys: sex workers, clients of sex workers, MSM, IDU • Qualitative data; participatory research, qualitative data
Monitoring at the community / population level: indicators • HIV Testing and Counselling uptake – Routine data from centres - include reason for testing – Population survey: ever had a test, wants a test, knows where to get a test etc. • Stigma /discrimination – Survey: Willingness to care for household member with AIDS; buy food from shopkeeper with HIV/AIDS; female teacher with HIV/AIDS not sick allowed to continue teaching; member of family infected, want it to remain a secret – Qualitative data • Risk perception
Indicators of Stigma, Kisesa 1996 -2000 (both sexes combined)
Trends in Sexual Behaviour • Abstinence/ first sex • Multiple partnerships • Condom use
Trends in median age at first sex (years) among young people, Kisesa, Tanzania* *Based on current status data among 15 -19 year olds
Indicators Sexual behaviour: general q Proportion reporting a non-marital non-cohabiting partner in the last 12 months - cohabitation is considered lower risk q Proportion who used a condom during the last sex with a noncohabiting partner Condom use at last sex is good measure of consistency of use at the population level
Condoms: Used a condom at last sex with non-regular partner, men, Tanzania, 1994 -1999
Multiple partnerships, Lusaka, Zambia, 1990 -98
Trends in number of partners in the last year among sexually active MEN, Kisesa
Trends in condom use among MEN 15 -44, Kisesa, Tanzania
ABC and more. . studies How accurate is self reported sexual behaviour? • Extensive comparison of levels and trends in Uganda, Thailand, Zambia and Kenya, Cameroon and Zimbabwe • Four city study UNAIDS • Rural Kisesa - Manicaland comparison • Difficult to assess validity but certainly multiple issues
Trends in HIV/STI Transmission • HIV prevalence by sex and age • HIV incidence • STI as a proxy
Trends in sexual behaviour and STIs in industrialized countries • STIs: Infection rates of early syphilis, rectal gonorrhoea • Sexual behaviour: unprotected anal intercourse among HIV negative men, number of partners • HIV incidence? • Caution - role HIV optimism
HIV prevalence among MEN and WOMEN 15 -44 in three sero-surveys, Kisesa, Tanzania* *All prevalence rates are age-standardized
Concluding thoughts • Monitoring of effect of treatment programmes on prevention is a necessity - regular monitoring or research or both? • Individual behaviours - condom use? STD incidence probably best bet (HIV incidence in partners? ) • Measurement of trends over time in behaviour is difficult and one needs to look for opportunities at both national and local levels, supplemented by qualitative research • Need for better STI surveillance • HIV surveillance - multiple methods will have to be employed