1. Strengthening Impact Evaluation for FSW Interventions through Surveillance-linked Triangulated Evaluation in Bangladesh Bangladesh AIDS Program USAID / FHI 2005 – 2009

2. Authors* Robert Kelly 1 Diane Lindsey 1 Tanvir Ahmed 1 Nadira Yasmin 1 Ashish Datta 1 Dimitri Prybylski 2 1 Family Health International Bangladesh Country Office 2 Family Health International, Asia Pacific Regional Office, Thailand * At the time this abstract was submitted

3. Bangladesh is a low HIV prevalence (<.01) country in South Asia

4. USAID Bangladesh AIDS Program (BAP) and Behavioral Surveillance Survey (BSS) area Triangulation in 1 district BAP in 20 districtsBSS in 7 districts

5. What is surveillance-linked triangulation? Evaluation methodology that: –Uses and analyze data from multiple sources including: Population based data: potentially generalizable to the entire target population Program-based data: measures program effort and outputs –Uses various methods of analysis Triangulation aims to: –Increase the validity an reliability of program evaluation –Assess the plausibility of interventions effectiveness

6. Triangulation Example Study population: Street based female sex worker from Chittagong Input-output program data from a NGO targeting FSW in this area (YPSA): –Condom distribution Behavioral surveillance data: –Condom use with client (last sex / past week) –Received condoms from outreach worker

7. Source: Bangladesh behavioral surveys 2002 to 2007 Trends in consistent condom use with clients past week among FSWs, by area

8. Percent of FSWs carrying a condom at time of interview, by survey area Source: Bangladesh behavioral surveys 2007

9. Percent of FSWs who have received condoms from NGO workers past month, by survey area Source: Bangladesh behavioral surveys 2007

10. Triangulation of: condom use at last sex with clients and NGO condom distribution in Chittagong Source: Bangladesh behavioral surveys 2007 and program data from YPSA

11. Condom use at last sex and symptoms of STI in the past year among SBFSW, by survey area Source: Bangladesh behavioral surveys 2007

12. Conclusions Data triangulation strongly supports that both provision of condom and condom promotion to FSWs have contributed to increased condom use with clients High level of condom use with clients associated with access to sexual health services has dramatically reduced the prevalence of STI among FSW, thus reducing FSWs’ risk to HIV Data triangulation is a valuable tool to assess national survey results and program data Using a combination of multiple resources of data can help validate changes in indicators

13. Thank You