BSS

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• BSS
• What is it?
• Berapa harganya?

Dr Margaret MacDonald
National Centre in HIVEpidemiology Clinical
ResearchUniversity of New South Wales, Sydney,
Australia joumlah
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NCHECR

• National Centre in HIV
• Epidemiology and Clinical Research, UNSW

• Established by the Australian Government by a
  grant to the Faculty of Medicine, UNSW 1985
• Epidemiology Unit provides surveillance data and
  research relevant to the National Strategies
  HIV, viral hepatitis, and other STIs -
  prevalence, incidence and related behaviours
  National Drug Strategy.
• annual surveillance report www.med.unsw.edu.au/n
  checr

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Behavioural Surveillance Surveys
BBS

• Component of second generation HIV surveillance
  in Asia FHI, UNAIDS, WHO et al
• Repeated cross-sectional surveys in key
  populationsto monitor trends in behaviour (key
  variables)important to HIV transmission ongoing
  and systematic
• collection, analysis, and interpretation
• of behavioural data related to HIV infection
• and other threats to public health
• Informative picture of changes in behaviour and
  use of HIV prevention services and education

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Behavioural HIV surveillance
Goals of BBS

• Develop a clear picture of the extent of and
  potential for HIV transmission
• Understand the behaviours driving the epidemic in
  a country or region
• Understand trends over time - key indicators
• Focus on sub-populations at greatest risk
• Flexible to move with the epidemic
• Used to plan prevention and care
• Integrated with other surveillance and public
  health information systems

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Transmission of HIV
Cultural Economic Legal Policy Social
BEHAVIOUR Mixing ofBlood / body fluid HIV
present
New infection
PREVALENCE IN POPULATION of INTEREST

• Amount of inoculum
• Viral load

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Transmission of HIV

• Risk of transmission

1. Likelihood of transmission per contact
Probability of source having
infection Amount viral load of fluid 2.
Frequency of contact ? Reduce contact ?
Unprotected sex drug injection Prevention
programs - adopt safer behaviour ? Track these
behaviours over time
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Transmission of HIV

• HIV prevalence

• ? HIV Failure of prevention programs
• Stable or ? HIV no new infections
• OR ? deaths
• Continued low prevalence
• successful prevention programs
• OR HIV not reached critical mass
• Asymptomatic infection
• Prevalence old new infections
• doesnt track recent changes in new infections

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HIV infection
HIV Epidemics

• Diverse - defy standardization effects different
  geographical areas and different population
  subgroups in different ways at different times
• Necessitates customized surveillance systems
• Varying sexual and drug-using behaviours
• Illegal / Antisocial / Personal
• Migration patterns
• War and conflict
• Economic and social trends
• Surveillance systems must remain dynamic and
  change over time to capture new epidemic trends
  and hot-spots

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Epidemiology

• Basic principles

• the distribution and determinants of diseasesor
  outcome of interest eg behaviour
• Frequency of and types of behaviours in groups of
  peopleand factors that influence the
  distribution of behaviours in those groups
• Behaviours that lead to disease are not randomly
  distributed throughout a population, but rather,
  sub-groups differ in the frequency and
  circumstances of different behaviours
• Always consider person, place, time

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Approaches to monitoring

• Monitoring the extent, spread and moderators of
  HIV

• Population based surveys
• Case reporting - HIV
• - AIDS
• Routine voluntary / mandatory testing
• Special surveys - cohort
• - repeat cross-sectional

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Approaches to monitoring

• Other forms of behavioural data collection

• KABB surveys
• Formative research
• Rapid assessments
• Ad hoc surveys
• Mapping
• Qualitative studies
• Focus groups / indepth methods / key informants /
  ethnographic field work
• Local community understanding and involvement

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Approaches to monitoring

• Assessment

• Choosing the right groups Ethnographic,
  epidemiological, political
• Accessing the right groups Focusing on key
  risks Not harming already marginalised groups
• Establishing feasibility
• Staying with the epidemic

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Approaches to monitoring

• BBS cannot do it all

• BSS is surveillance, not evaluation
• Tracks trends over time in key behaviours
• Should meet national information needs
• Hijacking for evaluation sacrifices rigour
• Rarely provides necessary rigour
• Investment needed in program evaluation
• Tools, systems, people

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Meeting objectives

• Behavioural surveillance Malaysia

• Identify clear strategies to meet the most
  important needs
• Assess current capacity to support behavioural
  surveillance and associated training needs
• Increase usefulness of data generated that is
  appropriate to the epidemic state of the country
• Inform changes in behaviour and use of HIV
  prevention services and knowledge
• Efficient and effective monitoring - best use of
  scarce resources

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Meeting objectives

• Behavioural surveillance Malaysia

• Construct partnerships
• Who is doing what?
• What capacity exists in the country / region?
• How do we move ahead?
• Concrete strategy for developing necessary
  guidelines, and materials and trainings to build
  capacity

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Meeting objectives

• Surveillance partnerships

• Formalise
• Preparatory phase
• Time and resources
• Technical working groups
• Members of communities at risk of HIV and those
  that interact with them
• Illegal activities - police
• Sexual activity - moral / religious

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Meeting objectives

• Agreement

• Which sub-populations will be included in the
  surveys?
• What information will be collected from these
  groups?
• Who will do the data collection and analysis?
• What mechanisms will ensure that information
  gathered will be used to benefit the communities
  involved?

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Meeting objectives

• Program

• Background information on BSS and the state of
  the epidemic
• Sample Which groups? Where, how and when
• Data Key indicators and how to measure
• Process Stakeholders, steps and timeline