PLACE Method Priorities for Local AIDS Control Efforts 1 1 MEASURE Evaluation, A Manual for implementing the PLACE Method

Learning Objectives & Overview  Objectives  Summarize PLACE Method 1  Recognize fit of this approach within the context of special survey methods  Overview  Summarize PLACE rationale & objectives  Discuss method within Asian context 1 For more detailed information on the method, refer to MEASURE Evaluation, A Manual for implementing the PLACE Method

PLACE Objectives  Provide rapid information used to target and monitor local AIDS prevention efforts  Monitor and improve AIDS prevention program coverage in areas where HIV transmission is most likely to occur

 Target programmatic efforts where they are needed  Epidemiological data show geographic clustering of HIV transmission risk  Prevention efforts should focus on these areas  Team can use epidemiologic and contextual data to identify areas where transmission is likely to be high PLACE Rationale

PLACE Focus: New Partnerships (Sexual or IDU) LOW No Sex or 1 Non-new Partner in Past Year MODERATE HIGH Any New/Multiple Partners Past 12 Months Past 4 Weeks Any New/ Multiple Partners

PLACE Method Overview 1.Prepare a PLACE Strategy Select priority prevention area (PPA) based on available data 2-4. Conduct rapid assessment in each area 2.Identify venues where people meet new partners 3.Visit, characterize, & map all venues 4.Confirm high partnership formation rates at venues 5.Use Results to improve programs

Prepare a PLACE Strategy  PLACE steering committee uses available data to identify areas with high incidence  Consider geographic convergence of risk  High unemployment, rapid urbanization, poor housing, crime, congested pop, alcohol/drug use, limited STI care, migrant labor, border stations  Output  PPAs identified

Conduct rapid assessment in each area: ID venues where people meet new partners  Ask 250-1,200 community informants  Where do people meet new partners?  Probe based on strata of interest for mixing  Young women and older men  Commercial sex workers and injecting drug users  Mobile and resident populations  Military and civilian  Ask until no new sites  Output  List of sites with number of times reported

Conduct rapid assessment in each area: Visit, characterize and map all venues  Reported venues are visited, mapped and an interview is conducted with a knowledgeable person to obtain characteristics of the venue  Mapping can be done by hand, onto an air photo, or using GPS

Conduct rapid assessment in each area: Example characteristics of sites  Prevention  Type of site  Condom availability  Evidence of AIDS prevention  Busy times  Maximum occupancy  Number of staff  Site stability  Patrons  Male:Female ratio  Regular patrons  Where patrons reside  Whether patrons include commercial sex workers, gay, IDUs, military, mobile, youth, locals, unemployed  Whether people meet new partners at site

Conduct rapid assessment in each area: Interview site patrons  Opinion:  Do other people come here to meet new partners?  Behavior and socio-demographic characteristics: -Have you ever met a new partner at this venue? -Have you ever injected drugs? -Number of new & total partners in past 4 weeks/year -Where else do people meet new partners? -Condom use & exposure to intervention  Output  Cross-sectional, self-reported data from non-representative sample that defies risk group labels

Use Results to improve programs & inform interventions  Mapping leads to targeted interventions  Condom distribution when people meet new partners  Needle exchange programs targeted to places IDUs will gather  Now: PLACE cane be used to estimate the size of hard to reach populations (coming)

Limitations of PLACE  Could miss important sites  Could miss very clandestine networks – both sexual and IDU  Transitory sights  Site-based interventions need site stability  No biomedical validation of method (yet)  May not be appropriate for all contexts

MEASURE Evaluation is a MEASURE project funded by the U.S. Agency for International Development and implemented by the Carolina Population Center at the University of North Carolina at Chapel Hill in partnership with Futures Group International, ICF Macro, John Snow, Inc., Management Sciences for Health, and Tulane University. Views expressed in this presentation do not necessarily reflect the views of USAID or the U.S. Government. MEASURE Evaluation is the USAID Global Health Bureau's primary vehicle for supporting improvements in monitoring and evaluation in population, health and nutrition worldwide.