APRIL 2009 REPROGRAMMING:

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

Recent surveys carried out by the University of Texas Health Sciences Center and the Muhimbili University,

College of Health Sciences, University of Dar es Salaam uncovered newly introduced high-risk behaviors

among sex workers and injection drug users (IDUs), which are overlapping populations. The increase in

heroin use among sex workers has led to an increased HIV prevalence in this population (McCurdy 2006).

This core group of potential HIV transmitters could lead to a wave of new infections in the broader

population through their casual and steady partners. These developments warrant increased attention to

sentinel surveillance of these most at-risk populations (MARPs).

In FY 2009, UCSF will provide technical assistance to the National AIDS Control Program (NACP) to

conduct a behavioral surveillance survey with biological markers (BSS+) using respondent-driven sampling

(RDS) among commercial sex workers in Dar es Salaam. Other activities will include holding a series of

meetings to ensure use of results, initiating formative work to design intervention components and planning

of future BSS among additional MARPs populations in Mainland Tanzania.

Activities will include a) training of trainers in behavioral surveillance methods including respondent-driven

sampling methods, b) training field data collectors on the survey methods, c) data collection and

management, d) training in data analyses and report preparation, and e) dissemination of study results.

In FY 2009, UCSF will scale back technical assistance to the Zanzibar AIDS Control Program (ZACP). As

capacity building within ZACP was a significant component of the first round of MARPs BSS, UCSF will

provide only limited technical assistance to ZACP to conduct BSS of IDU on Pemba Island using

respondent-driven sampling (RDS). In FY 2009, Tulane will also provide scaled-back support during the

second round of BSS+ among CSW, MSM, and IDU on Unguja Island.

Note: The current agreement is ending in March 2009. The new partner will be determined once the new

agreement has been awarded.

TITLE: Behavioural and biological surveillance among most at-risk populations in Zanzibar

~~~~~~~~~~~~~~~~~~~~~~~~~~~~

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

With FY 2008 funds, UCSF supported a country-led data synthesis aimed at identifying the drivers of the

HIV epidemic and the impact of prevention responses. The process was pushed forward in-country by the

Data Synthesis Task Force led by TACAIDS. FY08 funds supported an external consultant and two major

stakeholder's workshops which identified research priorities, outlined the triangulation process, and

successfully built in-country capacity to carry-out data compilation and analysis.

In FY 2009, data synthesis will continue and will include a shift from a national to a regional focus. Dramatic

regional variance in prevalence rates and behaviors indicates that approaching data synthesis by region

might produce findings with direct programmatic applications and build capacity at a decentralized level.

While national-level activities will continue with TACAIDS leadership, in FY 2009, funds will focus on

supporting regional partners in one to two regions to undertake data synthesis activities to answer questions

relevant to their local epidemics.

Note: The current agreement is ending in March 2009. The new partner will be determined once the new

agreement has been awarded.

TITLE: Rapid multiple-source HIV/AIDS data synthesis for program planning (Triangulation) in Tanzania

NEED and COMPARATIVE ADVANTAGE: This activity is part of the overall SI strategy of Tanzania to build

capacity to assemble, analyze, and better utilize existing data to answer key program questions and inform

policy decisions and program planning and implementation.

As PEPFAR-funded country programs have expanded and matured, SI systems have also evolved and

data collection has become widespread. Countries collect individual and aggregate program monitoring

data through routine monitoring systems; HIV biological and behavioral data through surveillance systems;

additional knowledge, attitude, behavior, and biomarker data through population based surveys; service

availability and provision data through facility surveys; and program evaluation and research information

through special studies.

Although countries expend a lot of effort to collect these data, they are seldom synthesized, disseminated or

used effectively to inform program planning and implementation or to make policy decisions. Fostering

evidence-based decision-making is one of the most important uses of HIV/AIDS data. When stakeholders

use this information to make decisions, they help to improve overall health care by increasing the health

system's ability to respond to the needs of those affected at all levels. Better use of this information also

promotes accountability and transparency in the decision-making process. In order to do this effectively, it is

essential to know the users, as well as their required and desired uses of the data. It is critical to identify

underutilized data sources and address the reasons why data are not being better used to meet the needs

of stakeholders.

Triangulation is synthesis and integrated analysis of data from multiple sources for program

decisionmaking,

and a powerful tool that is used to demonstrate program impact, identify areas for improvement,

direct new programs and enhance existing programs, and help direct policy changes. It strengthens the

Activity Narrative: understanding of complex health issues, and provides support for making evidence-based public health

decisions.

ACCOMPLISHMENTS: Using FY 2007 funds (central & in-country), Tanzania will begin data synthesis

activities with assistance from UCSF and CDC HQ. Accomplishments to date include advocacy meetings

with Ministry of health (NACP and HMIS), TACAIDS and NIMR, all of which are very enthusiastic about this

project. Next steps include initial stakeholders meeting in the fall of 2007 to be facilitated by UCSF, and

formation of a task force to begin activities including the identification key questions.

ACTIVITIES: The three goals of this activity are a) to analyze single source data from routinely collected

data from HIV/AIDS intervention programs such as PMTCT or counseling and testing programs, b) to

conduct the country-driven data triangulation process to answer key questions prioritized by the country

team, and c) to build in-country capacity (individual and institutional) to synthesize, interpret, disseminate,

and use data for program improvement including evidence-based policy-change decisions. This

countrydriven

approach will enhance ownership and promote sustainability.

This activity will synthesize data from many sources including: a) routinely collected data from HIV/AIDS

intervention programs such as PMTCT, CT, TB/HIV, and blood donor services; b) surveillance data,

including. ANC surveys (with valid data available from 2001) and AIDS case surveillance; c)

populationbased

surveys such as the THIS (2003/4 and 2007) and Demographic Health Survey; and d) special

surveys and impact assessments.

This activity will be done in three phases: a) For each data source, there will be assessment, through

stakeholder meetings and discussions to determine the users of the data, and what information they need in

order to fully utilize data to inform program planning, implementation and policy modification as necessary.

The content and packaging of the synthesized information will be tailored to suit the target audience for

each data source. This may include packaging the reports into several levels and formats, e.g. reports to

National policy makers versus reports intended for service providers at facility, district or regional level. b)

For each data source, the national task force will determine what data have already been collected, the

quality of that data, and what additional data need to be collected to meet users' needs. The task force will

also develop mechanisms for accessing data from all sources. c) Once the data have been assembled,

CDC, in collaboration with UCSF and the task force, will develop an approach to analyses which will include

determining which data sources will be analyzed and disseminated individually to target groups, versus

those that will be part of the triangulation process to answer key questions. Due to varying/multiple user

needs, some data sources will be in both.

Planned funds will be used to continue activities started in FY 2007 to build in-country capacity to regularly

conduct triangulation as new data becomes available. Specifically, funds will cover external consultant

salary and travel, a local in-country coordinator/analyst to keep the process moving forward and to provide

technical assistance, materials adaptation and preparation (including workshop materials, reports, and

presentations), and any costs associated with conducting the in-country workshops funds may also be used

to conduct follow-up analytic and capacity-building activities upon request of the country team.

There will be five major activities as follows: a) formation of a country task force to guide the identification of

existing data sources and to formulate key questions that can be answered by synthesizing these data; b)

conduct stakeholder meetings to link program and policy experts with strategic information experts in order

to bridge the disconnect between the SI personnel who are charged with collecting and managing the data

and the program managers who need the information to make evidence-based decisions and plan

programs; c) conduct data compilation, analyses and report packaging workshops facilitated by UCSF data

analysts and attended by in-country data analysts from NIMR, NACP, MoHSW, TACAIDS and other USG

partners. These workshops will ensure sustainability by building long term capacity for regular data

synthesis; d) conduct task force meeting(s) to review findings and organize the report(s) for presentation at

the stakeholder meeting; e) conduct stakeholder meetings to disseminate findings, develop strategies for

further dissemination, develop recommendations for data use and identify gaps in knowledge that could be

filled by future data synthesis work.

LINKAGES: This activity will bridge the gap that often exists between the SI personnel who are charged

with collecting and managing the data and the program managers who need the information to make

evidence-based decisions and plan programs. Stakeholder meetings will see the two groups working

closely together with the program managers identifying key program questions that they see as useful in

informing their decisions, and SI personnel formulating data analyses to answer these questions. Program

managers incorporated into the task force will review the findings, reports and presentations, and provide

feedback as to whether data are presented in a format that answers the key questions. Additionally,

triangulation of data from different HIV/AIDS program areas and evidence of the inter-relationships between

these interventions will provide an opportunity for personnel to share ideas on how to strengthen referral

and other linkages between programs.

CHECK BOXES: This is an SI activity which will build capacity.

SUSTAINAIBLITY: The approaches used in this activity ensure ownership and promotes sustainability.

These include a country-driven data synthesis that brings together SI personnel with program managers

and policy makers to: a) jointly understand the functions and needs of data users; b) determine the

information that each group needs to perform functions appropriately; c) understand what data have already

been collected, the quality of that data, and what additional data need to be collected to meet users needs;

d) develop content and packaging information in a format and language suitable for the intended audience;

e) make the information available through appropriate channels and as rapidly as possible; and f) build

individual and institutional capacity to interpret, disseminate and use information.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13660

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

13660 9578.08 HHS/Centers for University of 8548 8548.08 UTAP $300,000

Disease Control & California at San

Prevention Francisco

9578 9578.07 HHS/Centers for US Centers for 4950 4950.07 $30,525

Disease Control & Disease Control

Prevention and Prevention

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $50,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.17: