National%20Family%20Health%20Survey%20(NFHS-3),%202005-06

1
National Family Health Survey (NFHS-3),
2005-06

• HIV Measurement Process and Prevalence

2
Contents

• HIV measurement process
• Coverage of HIV testing in NFHS-3
• HIV prevalence

3
Goals for HIV Prevalence Estimates

• GOALS
• To Estimate HIV prevalence
• At all India level by rural urban residence
  and by background characteristics of the
  respondents and
• Separately at state level by sex for six high
  prevalence states (Andhra Pradesh, Karnataka,
  Maharashtra, Manipur, Nagaland, and Tamil Nadu),
  and Uttar Pradesh
• However, in Nagaland blood could not be
  collected because of the strong local opposition

4
Ethical Considerations and HIV/AIDS Sample

• All national and International guidelines and
  protocols required for blood collection and
  testing were followed
• An informed consent statement was read to each
  respondent for voluntary HIV testing
• Complete anonymity and confidentiality is
  maintained

5
Collection of Samples in the field for HIV Testing

• Blood spots from a finger prick were collected on
  a special filter paper card
• No names or personal identifiers were placed on
  the filter paper sample
• Self-adhesive barcode labels bearing same numbers
  were affixed to filter paper card and
  questionnaire for each individual respondent

6
Storage and shipment of samples

• Samples collected were allowed to dry overnight
  in a drying box with desiccants and a humidity
  indicator card
• By morning, the blood spot samples were
  completely dry and were called Dried Blood Spots
  (DBS)
• Appropriately packaged DBS samples were
  transported to the Ranbaxy sample collec-tion
  centres

7
Transportation

• Transported from SRL Ranbaxy Collection Centres
  to SRL-Mumbai as ambient shipment in SRL packing
  materials along with transmittal sheets
• Blood samples were tested for sero-positivity at
  Ranbaxy
• A subsample of more than 5,000 samples, including
  all positive samples were sent to NARI by Ranbaxy
  for external quality control

8
Contents

• HIV measurement process
• Coverage of HIV testing in NFHS-3
• HIV prevalence

9
Coverage of HIV Testing

• Percent of eligible women age 15-49 and men age
  15-54 whose blood was tested for HIV
• Women 85 percent
• Men 78 percent
• Response rates are comparable to HIV test
  response rates on national household surveys
  worldwide

10
Non-Response Rates by Reason
Reason Women () Men ()
Not interviewed Refused to give blood Absent at time of blood collection Other 6 6 1 1 14 5 2 2
Persons who were not interviewed were not
eligible for blood collection
11
Response Rates in 6 States
State Women () Men ()
Tamil Nadu Manipur Andhra Pradesh Uttar Pradesh Karnataka Maharashtra 93 91 85 83 82 78 90 82 81 79 72 68
Response rates are higher than the national
average in Tamil Nadu and Manipur, about the same
as the national average in UP and Andhra Pradesh,
and lower than the national average in
Maharashtra and Karnataka
12
Contents

• HIV measurement process
• Coverage of HIV testing in NFHS-3
• HIV prevalence

13
HIV Prevalence

• HIV prevalence estimates are based on HIV
  tests of 102,946 blood samples
• 52,853 from de facto women age 15-49
• 50,093 from de facto men age 15-54

14
HIV Prevalence by Residence and Sex, India
Sex Women () Men () Total ()
Urban Rural 0.29 0.18 0.41 0.32 0.35 0.25
India 0.22 0.36 0.28
15
HIV Prevalence by State
State Total () Women () Men ()
Manipur Andhra Pradesh Karnataka Maharashtra Tamil Nadu Uttar Pradesh Non-high prevalence states 1.13 0.97 0.69 0.62 0.34 0.07 0.12 0.76 0.76 0.54 0.48 0.40 0.05 0.08 1.59 1.22 0.86 0.78 0.27 0.10 0.16
India 0.28 0.22 0.36
16
Confidence Intervals
State HIV Prevalence () Confidence Interval
Manipur Andhra Pradesh Karnataka Maharashtra Tamil Nadu Uttar Pradesh Non-high prevalence states 1.13 0.97 0.69 0.62 0.34 0.07 0.12 0.82-1.44 0.70-1.25 0.44-0.93 0.43-0.81 0.18-0.50 0.03-0.11 0.07-0.19
India 0.28 0.23-0.33
17
Ratios of HIV Prevalence Rates by Residence and
Sex
State FemaleMale RuralUrban
Manipur Andhra Pradesh Karnataka Maharashtra Tamil Nadu Uttar Pradesh Non-high prevalence states 12.1 11.6 11.6 11.6 10.7 12.1 12.1 NA NA NA NA NA NA NA
India 11.6 11.4
18
HIV Prevalence in India by Age
Age Total () Women () Men ()
15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 0.04 0.18 0.35 0.54 0.37 0.30 0.33 NA 0.07 0.17 0.28 0.45 0.23 0.19 0.17 NA 0.01 0.19 0.43 0.64 0.53 0.41 0.48 0.34
19
HIV Prevalence by Prior HIV Testing
NFHS-3, 2005-06
20
HIV Prevalence by Background Characteristics

• HIV Prevalence rates are low for all groups so
  the differentials in HIV prevalence by socio-
  economic and background characteristics and
  individuals sexual behaviour are generally small
• And these results need to be interpreted with
  caution because of the small number of the cases
  by many of these characteristics

21
HIV Status among Married Couples

• NFHS-3 data on women and men can be linked to
  identify married couples
• Married couples in which both the wife and the
  husband were tested for HIV in NFHS-3 can be
  studied to examine HIV discordance
• The study of HIV discordance is important for
  designing effective HIV/AIDS interventions

22
HIV Discordance among Couples

• Among the 27,771 married couples who were tested
  for HIV in NFHS-3, there were 138 couples in
  which the wife or the husband or both were HIV
  positive
• Among these 138 couples
• For 22, both the husband and wife were HIV
  positive
• For 64, only the husband was HIV positive
• For 14, only the wife was HIV positive

23
HIV Prevalence Summary

• HIV prevalence among the household population in
  the 15-49 age group in India is low (0.28)
• HIV prevalence exceeds 0.5 in Manipur, Andhra
  Pradesh, Karnataka, and Maharashtra
• Tamil Nadu does not appear to be a high HIV
  prevalence state

24
HIV Prevalence Summary

• HIV prevalence is 64 higher among males than
  among females
• 48 higher in high HIV prevalence states and 106
  higher in other states
• HIV prevalence is 40 higher in urban areas than
  in rural areas

25
HIV Prevalence Summary cont

• NFHS-3 provides an accurate and robust estimate
  of HIV prevalence in the general household
  population age 15-49 (0.28)
• Analysis of non-response and missed populations
  provides evidence that HIV prevalence in the
  general population age 15-49 is approximately
  0.3, and could not be higher than 0.4 under any
  reasonable assumptions

26
Summary

• Based on the NFHS-3 estimate of HIV and other
  data, the Government of India has reduced its
  official HIV estimate for the adult population.
  However, strong programmes are still required to
  prevent the further spread of HIV.

27
Summary and Highlights (contd.)

• HIV prevalence among the NFHS-3 household
  population of men and women age 15-49 is 0.28
  percent. Based on this estimate and other data,
  the Government of India has reduced its official
  HIV estimate for the adult population. However,
  strong programmes are still required to prevent
  the further spread of HIV.