1. Where do we focus our HIV responses in Asia? Amala Reddy UNAIDS Regional Support Team – Asia Pacific Manila, November 27 th, 2009

2. Modes of Transmission in Asia Project Overview

3. Objectives of project To apply existing data in models to estimate the distribution of new infections by mode of exposure –Modes of Transmission worksheet and –Asian Epidemic Model To review prevention responses and relationship to new infections To improve national prevention responses by aligning them with sources of new infections in a country –Part of “Know your epidemic, Know your response” process

4. Scope of project To conduct study during 2009 and 2010 –MOT: Philippines, Pakistan, Nepal –MOT and AEM: Myanmar, Indonesia, Cambodia, Vietnam To be conducted by country teams, supported by UNAIDS country offices, national consultants and team of international consultants Collaborating partners: –World Bank GAMET and New Delhi –WHO

5. An evidence-based collaborative process 1.Critically review & document existing epidemiological, behavioral and size data 2.Apply MOT and/or AEM model using this data 3.Identify important data gaps and fill them 4.Revise and document models and inputs 5.Prepare in-country recommendations report for national prevention planning 6.Disseminate findings widely 7.Develop regional report of lessons learned

6. Potential data sources for building the models Sentinel surveillance Behavioural surveillance Special studies –Sex workers and clients –MSM –Overseas Filipino workers National surveys Scientific literature

7. Data sources are reviewed for Quality of data collection Representativeness of key populations Geographic coverage Consistency with other available data

8. 2007 en Modes of Transmission Model The spreadsheet uses the current prevalence of HIV infection numbers of individuals with particular exposures to HIV, and the rates of these exposures to calculate the expected incidence of HIV infection over the coming year

9. 2007 en Major modes of transmission of HIV in adults considered: Sexual contact –Commercial sex –Casual sex –Marital sex –Men who have sex with men Injecting drug use Blood transfusions Medical injections

10. Modes of Transmission Model Spreadsheet

11. Model output

12. Outcomes for national policy Comprehensive review of –Alignment of current prevention efforts with new infections –Limitations of available epi, behavioral and size estimation data Recommendations on –Improving data systems to fill knowledge gaps –Adjusting future prevention efforts to more effectively address the epidemic situation

13. Who’s involved in the process?

14. National Consultants To work with country teams to collect and review epidemiological data –Bai Bagasao & Mosende Zimmbodilion (UNAIDS Philippines) Country Coordination and Technical Support Provide comprehensive documentation of data inputs for model Report on quality of data Work with international consultants to complete the Modes of Transmission or AEM model Work with international consultants to produce country specific reports on distribution of new infections by mode of transmission

15. International consultants –Tim Brown (EWC) East-West Center –Amala Reddy (UNAIDS RST-AP) UNAIDS Regional Office –Nalyn Siripong (EWC) MOT consultant –Wiwat Peerapatanapokin (EWC) AEM Consultant Provide technical support on applying Modes of Transmission and AEM models Work with national consultants to produce in-country reports with recommendations for national prevention planning Produce regional report of lessons learned

16. Just completed training workshop To introduce and familiarize country teams with Modes of Transmission model To work through and discuss epidemiological, size estimation, and behavioral data sources To make preliminary application of the model To lay out a work plan in concert with other ongoing efforts for improving model and exploring policy and program implications

17. Thank you!