Pakistan, Canada-Pakistan HIV/AIDS Surveillance Project (HASP): October 2003–October 2011
Sector: Health and Population
Region: South Asia
Funded by:
Canadian International Development Agency (CIDA)
Total Value: C$9 million
Partners and Counterparts:
In Canada: University of Manitoba; ProAction: Partners for Community Health; Public Health Agency of Canada
In Pakistan: Ministry of Health, National AIDS Control Program (NACP), Provincial AIDS Control Programs (PACPs), National and Provincial Steering Committees and the National and Provincial Technical Committees
Purpose
To enhance the capacity of the Government of Pakistan to implement an effective second generation surveillance system for HIV/AIDS.
Challenge
In 2001, the Government of Pakistan finalized the National HIV/AIDS Strategic Framework, and two rounds of serological surveillance established Pakistan as a low-prevalence country. However, it was not clear to what extent HIV had penetrated higher risk groups (HRGs) such as commercial sex workers (CSWs) and intravenous drug users (IDUs). Further, NACP and PACPs needed additional capacity in developing methodologies, ethical and gender guidelines, supervision and monitoring protocols, integration of data from diverse sources, data analysis skills and improved dissemination and use of data.
Approach
Agriteam adopted a second generation surveillance (SGS) approach, which combines both biological data (e.g., blood) and behavioural data (e.g., reporting of sexual and injecting practices through in-depth interviews). Annual surveillance rounds are conducted among CSWs (female/male/trans-gendered) and IDUs where a dried blood specimen is provided and an in-depth behavioural questionnaire answered. This approach attempts to link data on behaviour to HIV sero-prevalence data and provide a picture of the direction of the epidemic and the effectiveness of prevention programming.
Project Description
Since 2004, HASP has run a pilot and two full rounds of surveillance in a total of 13 cities. In 2008, HASP is running a third and final round, and will include a 14th city. Each round involves mapping and integrated behavioural and biological surveillance. The purpose of mapping is to estimate the size, distribution and basic operational typology of specific HRGs (in this case, CSWs and IDUs) in each city. Cities are geographically distributed into zones, and key informants within each zone are interviewed to obtain information about the location and size of HRGs. Once this first-level information is obtained, a second level of data collection is undertaken with HRGs themselves at the main sites mentioned to verify and expand on the information provided by the key informants, and to identify critical locations or spots that were not obtained at the first level. The integrated surveillance subsequently consists of face-to-face interviews and the collection of a dried blood sample for HIV testing. The data from mapping is used to draw up a sample of HRGs that is representative with respect to geographic location and typology. In each city, sample quotas for each geographic area and typology are based on mapping estimates.
Results
- Establishment of the Central Data Coordinating Unit
- Standardization of HASP mapping methodology as the official government-approved methodology
- Appointment of a National Field Epidemiologist at NACP
- Designation of surveillance positions at the provincial level
- Completion of one pilot and two rounds of surveillance
- Completion of testing and evaluation of data collection methodologies
- Release of data through two National Surveillance Reports
- Development of functional service delivery programs allowing comparison of data and improved programming
- Revision of provincial government program planning documents using HASP surveillance round data as supporting evidence
- Massive scale-up of mapping and service delivery planned in all provinces based on results from surveillance rounds
- Indication of evidence-based policy development, planning and programming at national and provincial levels
Canadian investments in HIV/AIDS programming are achieving results worldwide:
www.acdi-cida.gc.ca/CIDAWEB/acdicida.nsf/En/NAD-112611374-MH8?OpenDocument
www.acdi-cida.gc.ca/INET/IMAGES.NSF/vLUImages/HIV-AIDS/$file/Results.pdf
Project Director
Merydth Holte-McKenzie
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