PLACE METHOD

SESSION OBJECTIVES

Define PLACE1

Decide when to use it Identify its relationship with other data sources Identify the objectives of PLACE How to use it The five steps of PLACE implementation Determine whether it is Quantitative or

Qualitative method

1For more detailed information on the method, refer to MEASURE Evaluation, A Manual for implementing the PLACE Method

DEFINITION

P = Priorities L = Local A = AIDS C = Control E = Efforts

DATA COLLECTION TOOL

It is a rapid assessment tool used to monitor and increase the coverage of the HIV/AIDS prevention in the areas most likely to have higher rate of transmission.

KEY ELEMENTS OF THIS DEFINITION

Rapid assessment tool To monitor and To increase coverage Areas with higher/highest transmission

rate

OBJECTIVES OF PLACE To assist local managers to allocate

resources to any preventive programs that reduce/prevent transmission

To identify gaps in current prevention programs

To improve program delivery To track program coverage over time

PLACE Rationale 1:

The concept of geographic targeting Epidemiological data show geographic clustering of HIV transmission risk.

Prevention should focus in geographic areas where HIV incidence is high.

In the absence of HIV incidence data--which are rarely available– a national team of knowledgeable people can review and interpret epidemiologic and contextual data to identify areas in a country where incidence is likely to be high.

PLACE calls these areas Priority Prevention Areas (PPAs), High Transmission Areas (HTAs) or Zones d’ Intervention Prioritaires (ZIPs)

PLACE Rationale 2: New sexual and needle sharing partnerships have a

critical role in the spread of HIV infection

HIV transmission models reveal the importance of the rate and pattern of new sexual partnerships. Within Priority Prevention Areas, prevention programs should focus on preventing transmission among new sexual and needle-sharing partnerships.

Healthoutcome

Demographicoutcome

Biological determinants

Proximate determinants

Underlyingdeterminants

Rate of Contact of susceptible to infected persons

Efficiency of transmission per contact

Duration ofinfectivity

HIVincidence

STIincidence

Mortality

New Partner acquisitionMixing patternsConcurrencyAbstinence

Condom useConcurrent STIRisky sexual practicesChemotherapy

Treatment

ContextSocio-economicSocio-cultural

InterventionprogrammesVCTSTD controlCondom promotion

Acute Infection

PLACE Protocol Overview

1 Prepare a PLACE Strategy

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

Step 1: PLACE Strategy

A PLACE Steering Committee reviews and interprets available epidemiologic and contextual data to identify areas with high incidence

Consider geographic convergence of risk Unemployment, urbanization, poor housing, crime

congested population, alcohol abuse, limited STI care, migrant labor, border stations, others?

Steering Committee selects Priority Prevention Areas, selects key populations and programs, and adapts protocol

04/19/23

Some Decisions That Need to Be Made Should PLACE identify “hot spots,” or venues where

vulnerable groups such as gays, CSWs, youth, or IDUs socialize?

Will PLACE assess changes in program coverage over time?

Will PLACE assess effectiveness of venue-based prevention programs?

Will PLACE obtain indicators that can be compared with other HIV/AIDS indicators?

Ethical Review and Data Confidentiality

Steering committee is responsible for local ethical review and approval of the protocol

Research ethics and regulations protect human subjects by ensuring:∆ meaningful informed consent∆ social/scientific value of research ∆ proper risk benefit ratio of research

Steering Committee

Chair: Principal Investigator

PLACE Coordinator

Field Coordinator PPA #1

Field Coordinator PPA #2

Data Entry Personnel Data Analysts

Mapping Specialist

Interviewers Interviewers

Staffing

Step 2: Ask 300-500 community informants where people meet new partners?

Probe based on strata of interest for mixing Young women and older men Commercial sex workers Mobile and resident populations Military and civilian

Ask until no new venues Output: List of venues with number times

reported

Use epidemiologic context to guide selection of community informants

Type of informants available: Officials, taxi drivers, bar workers, shebeen

owners, STI patients, youth, hostel residents, teachers, sex workers, police, health care providers, hairdresser, mobile populations, street sellers

Step 3: Visit, Characterize, Map Venues

Reported venues are visited, mapped and an interview is conducted with a knowledgeable person on-venue to obtain characteristics of the venue

Mapping can be done by hand, onto an air photo, or using GPS

Characteristics of venues Obtained from interviewing a knowledgeable person at the venue

To Gauge Prevention Program Coverage and Potential at Venues Type of venueCondom availabilityEvidence of AIDS prevention Busy timesMaximum occupancyNumber of staffVenue stability

To describe patrons of venues Male: Female ratio Busiest times Regular patrons Where patrons reside Whether patrons include

commercial sex workers, gay, military, mobile, youth, locals, unemployed

Whether people meet new partners at venue

Sites in PAA inside City or District

X

X

X X

X

X

X

X PPA X

X

X

X

X

X

X

X

X

X

Venues

PPA

#2

City or District

OUTPUT after step 3: Venues in PPAs located

Venue Based Indicators from Step 3Eastern Cape, South Africa

Venues where new partners are met 234% with condoms always available 5%% with condoms never available 80%% willing to have AIDS program 92%% with alcohol consumption at venue 88%% with student patrons 27%

Percentage of Venues that Never had Condoms in the Past Year

0102030405060708090

100

CT Twp EL Twp PE CBD Area inKampala

Banfora,Burkina

Faso3 PPAs in South Africa

Percentage of Venues with Commercial SexSix urban areas in Africa

0

5

10

15

20

25

30

35

CT Twp EL Twp PE Twp PE CBD Area inKampala

Banfora,Burkina

Faso-- 4 PPAs in RSA----------

Percentage of Venues with AlcoholSix urban areas in Africa

0102030405060708090

100

CT Twp PE Twp Area inKampala

Step 4: Interview Venue Patrons Interviews at busy times at venues

Interval sampling strategy with probability of selection proportional to size is used to select venues where interviews with patrons will occur

Opinion: Do other people come here to meet new partners?

Socio-demographic & behavioral characteristics Have you ever met a new partner at this venue? Have you ever injected drugs? Number of new and total partners in the past four 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

Percentage of Patrons Who Have Ever Met a New Sexual Partner at the Venue

0

10

20

30

40

50

60

70

CT Twp EL Twp PE Twp PE CBD Area inKampala

Banfora,Burkina

FasoMen Women

Mean Number of New Sexual Partners in the Past 4 Weeks in South Africa Townships and Business District

0

0.5

1

1.5

2

2.5

3

CT Twp PE Twp EL Twp PE CBD

Men

Women

Patrons: East London, South Africa Township

Male unemployment 48% Attend venue weekly or more 77% Mean number venues visited / day 2.5 Never used condom (men) 64% Of sexually active men, (88%):

% with new partner in past 4 weeks 40% % paid for sex <1%

04/19/23

STEP 5

Inform Interventions

Maps can show where condoms are needed

PLACE can help… Provide understanding of the size and

shape of the sexual networks and mixing patterns in a community

Identify intervention venues Provide indicators for monitoring

prevention--- particularly exposure to programs

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

How is PLACE different than other methods?

DHS DHS is large-scale, expensive household survey that obtains

information on a range of health topics including HIV. PLACE focuses on HIV and is implemented within PPA at a fraction of the cost of the DHS.

DHS provides national-level health indicators using population-based data. PLACE data are not representative of the general population, but monitor behavior & prevention programs among persons most likely to acquire and transmit HIV in key target areas.

Since it is a household survey, DHS may miss mobile populations, under-represent young men, and be conducted in a setting where people are less likely to report extra-marital partnerships. PLACE interviews persons who are socializing at venues identified as places where people meet new sexual partners and thus often includes a large number of sexually active youth and mobile populations. PLACE can miss persons who do not visit public venues.

How is PLACE different than other methods?Targeted Risk Group Surveys Targeted risk group surveys require operational definitions of target groups

to develop the sampling frame. PLACE avoids having to define “men who have sex with men” or “sex workers” during data collection because it samples from all venues where any persons meet sexual partners. Indicators for particular groups can be obtained during the analysis phase.

Results from targeted risk group surveys are usually specific to the defined target group. PLACE data allows generalization to the population that visits venues where people meet new sexual partners and allows examination of the overlap between groups.

PLACE results serve local programs immediately by providing maps of program coverage and identify priority venues where AIDS prevention programs are needed. A package of venue based prevention programs is being developed to increase the effectiveness of PLACE based outreach efforts.

WHEN ARE YOU LIKELY TO USE PLACE?

1. Anytime?

2. After a HIV/AIDS prevalence survey?

3. After an intervention?

4. Other?

PLACE

Is likely to take place after 2 & 3 activities

because It needs the findings of these activities to

1. identify areas with higher prevalence

2. identify determinants of higher rate in

these areas.

IS PLACE QUANTITATIVE/QUALITATIVE TOOL?

Quantitative? =

Qualitative? =

MORE LIKELY QUANTITATIVE WITH QUALITATIVE ASPECTS

1. It uses descriptive epidemiology to initiate its

investigations 2. It does not have a denominator 3. It attempts to capture some of the subtlety of

human experience 4. It captures more of the ‘truth’ about the world,

and is less likely to allow comparisons.