HIV Integrated Biological-Behavioural Surveillance

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HIV Integrated Biological-Behavioural Surveillance

IBBS Launching - Speech by National AIDS Council Chairman Sir Peter barter

Minister for Health, HIV and AIDS, Honourable Maxtone-Graham, His Excellency, Mr. Teddy Taylor, the US Ambassador to PNG; Director of National Research Institute, Dr. Thomas Webster, The acting Director of NACS, Mr. Philip Tapo, Ms. Laura Bailey, Country Manager - Word Bank, Anne Malcolm Director for PNG – Australia HIV AIDS program, Development partner representatives, representatives from the National Department of Health and National Aids Council Secretariat, IBBS Managing contractor representatives from FHI 360 and Burnett Institute; Ladies and Gentlemen.
It is my pleasure to make a few remarks in my capacity as Chair of NAC at the launching of the Integrated Bio Behavioural Survey
During the brief time I was Minister for Health and now Chair of the NAC I have always been concerned over the data collected and the manner in which it is used to establish the prevalence rate of HIV in PNG. With a population of around 6 million and testing a mere 150 the result can only be described as very vague particularly when you take into consideration the sectors being tested are primarily taken from urban or higher risk areas.
Because we in PNG access to remote regions is difficult and cultures so diversified I fear the message about HIV maybe being received but not fully understood by the majority of our population. Certainly, access for testing is not available unless those at risk seek help which again throws up distorted data.
For almost 25 years I have had a long association with what is known as the ‘Hagahai’ people on the border of WHP, ENGA, East Sepik but in the Madang Province. The late Dr Carol Jenkins passed the banner to me when she left PNG and since then our Foundation has continued to fund education and health services at Mamuse which includes the construction of the Carol Jenkins Memorial Health Centre under the direction of Benjamin Nanngai who has returned as a Nurse to serve his own people. I know this was always a dream Carol had and it now realised. Benjamin qualified to undertake testing in this remote part of PNG, an area one would think would not have people effected by HIV. I am not sure on just how many people were tested but I would guess less than 10,000 – the result was 10 positive with 2 who have since died. This was a great shock to me and a further investigation is now underway to confirm this result.
The reason for bringing up this today is to illustrate the need for NACS and all the stakeholders the need to obtain more information that can help us understand the need to step up our research which is indeed the reason we are here today to launch the IBBS, in particular in rural areas.
The official Prevalence figure for 2009 was announced at .093%, it is expected that the 2010 figure will be less, it for this reason again we need to apply a lot more research to establish how we can reduce the spread of HIV and to warn all the stakeholders involved not to become complacent.
The need to have a nationwide survey of this nature in PNG has been discussed for a number of years. I am pleased that at last the long awaited IBBS would be launched.
Last year we launched the National HIV and AIDS strategy 2011-2015 (NHS) and the results from the IBBS will also help us roll out our response at sub national level in a way that is appropriate for each region and population group.
Information from the IBBS will help our partners at all levels understand the distribution of HIV infection by geographic location & region, age, gender and economic status.
We will be using evidence from the survey to make our interventions more targeted and localised.
Knowing the more precise prevalence of HIV in our country will help the government will help the government and development plan and allocate financial resources accordingly.
Understanding the drivers of the epidemic and HIV transmission will inform design, implementation and evaluation of more effective national response.
The information is therefore important to those implementing HIV & AIDS intervention programs in the country.
Information from this population based biological and behavioural survey will provide representative trend data on HIV prevalence, HIV behaviour, knowledge and attitudes and the effect that exposure to programs are having in the general population.
It will help us make predictions about those likely to be affected in the future
We all know the importance of the data that will be generated from the conduct of this survey
The effectiveness of the national response depends on the data from this nationwide survey.
T
he council looks forward to the results from this survey which not only gives us an accurate picture of the epidemic but will also help our partner organizations in providing an evidence based response to the HIV epidemic in the country.
As all of you are aware, much research has already been done. A week barely goes by when I do not receive a paper on HIV not only in PNG but from other parts of the world. Although PNG should not duplicate what is done in other parts of the world, we can learn from experiences and apply them to the context of PNG. The IBBS is home grown, it is about PNG and it is about reducing and ultimately eliminating HIV in PNG it is therefore the beginning of the end providing the results achieved by the survey are put into practice.
NAC has recently conducted two independent studies into the future of how best we can improve the functions of NAC and NACS. It is premature to say much more, but we have drafted recommendations to the Minister in the hope that the GoPNG take the recommendations seriously to achive our common objectivity.
On behalf of the council let me thank these organizations that will be involved in supporting and conducting the IBBS – AusAID, World bank, UNAIDS, ADB, NZAID, NDoH and NACS.
I wish you success in this important endeavour.

IBBS Launching - Speech by Anne Malcolm Director for PNG – Australia HIV AIDS program

Minister for Health, HIV and AIDS, Honourable Maxton-Graham, His Excellency, Mr. Paddy Taylor, the US Ambassador to PNG, ....Ms Laura Bailey, PNG Country Manager for World Bank, Development partner representatives, representatives from the National Department of Health and National Aids Council Secretariat, IBBS Implementing Management organisation representatives from FHI 360 and Burnett Institute, Ladies and Gentlemen.

The Australian government welcomes this first national population-based survey on HIV.

As others have said, trying to stem the tide of HIV infections across a country the size of PNG is especially difficult when you don’t know who or what to target.

Without reliable and accurate information and estimates in this area, it is very hard to design activities to prevent the spread of HIV or to plan for the level of care and treatment needed for the future.

In 2007 a group of us travelled to Jayapura in Papua soon after the IBBS had been completed there. From the presentations that Indonesian government made to our group, it was clear that this had been a very valuable exercise in helping the government and their partners understand in the extent of the epidemic in Papua and which the kinds of behaviour that are placing people at risk. It was following that meeting that PNG began to discuss a similar exercise in this country.

In getting a similar exercise underway in PNG required several years of planning and mobilising funds. As you all know undertaking national surveys is expensive in PNG and this one is complicated by the additional element of HIV testing. The other concern was the need to get surveillance systems established and functioning in PNG through National Department of Health, because PNG needs to be able to maintain systems for routine data collection.

The use of surveillance and research is critical to our programming.

Australia also applies the findings of research and reviews to improve the effectiveness of our aid program in PNG and elsewhere.

As a result of global research on aid effectiveness the Australian aid program is now targeting a smaller number of sectors, Health - including HIV, Education, Law and Justice, and Transport, with a focus on improving service delivery at sub–national level.

Australia has also sought to improve PNG government capacity to commission and apply research. Our HIV and AIDS program supports both improved disease surveillance and social and behavioural research.

More specifically over the last three years, Australia has funded the Research Coordination Unit of the National AIDS Council Secretariat to support the NAC research program Since 2009 a number of major social and clinical research studies on HIV have been funded through Australian and international universities and partner institutions in PNG. We also have supported an analysis of research undertaken in PNG since 2007. This literature review gives us some good information on how culture and beliefs, sexuality and gender play out in influencing behaviour. It also highlights how sexual health, HIV care, treatment and prevention initiatives have been used to influence behaviour change.

Getting good data relies on good data collection and monitoring processes. We have seen an improvement in data collection by civil society partners including the Catholics and other faith based organisations since 2007. Now we can confidently say that in 2010, 60 per cent of partner-run HIV testing facilities reported regularly on national indicators disaggregated by sex and age, up from 25 per cent of sites in 2007.

As we move forward to target sub-national levels with our aid program in PNG we are aware that government and service providers at provincial level have a particular need for strategic information about their local area. There are systems being established to support this in provinces through PROMEST but these have some way to go to be fully functional. However through the Department of Health there is a stronger surveillance system now operating and the reporting from provincial and district ANC clinics and sentinel surveillance sites have been much stronger over the last 2 years. This has resulted in a better understanding of the epidemic. Similarly with the behavioural surveillance program through NRI we now have a much more comprehensive picture of behaviour and risks for HIV transmission.

AusAID’s HIV Program is firmly committed to providing this support, especially in those provinces most impacted and affected by HIV and AIDS along with our partners in Government, Civil Society and our AusAID health sector programs. Despite the challenges that lie ahead – like conducting a survey of such magnitude in an election year - the IBBS has the potential to contribute enormously to this effort.

IBBS Launching - Speech by Minister for Health and HIV & AIDS Hon. Maxton Graham

His Excellency, Mr. Teddy Taylor, the US Ambassador to PNG; Sir Peter, Chairperson of National Aids Council; Director of National Research Institute, Dr. Thomas Webster, The acting Director of NACS, Mr. Philip Tapo, Ms. Laura Bailey, Country Manager - Word Bank, Anne Malcolm Director for PNG – Australia HIV AIDS program, Development partner representatives, representatives from the National Department of Health and National Aids Council Secretariat, IBBS Managing contractor representatives from FHI 360 and Burnett Institute; Ladies and Gentlemen.

It is my pleasure to address you on the occasion of the launching of the Integrated Bio Behavioural Survey (IBBS).

This is the first time a nationwide survey on HIV & AIDS will be conducted in PNG

I understand that it is called “Integrated Bio Behavioural Survey” because, apart from asking questions about risky behaviour, blood samples will be collected from study participants to determine their HIV status.

This is no easy task when you have a sample size of approximately 12,000 people in urban as well as remote rural areas of PNG.

But it is a necessary task because the Data collected will give reliable estimates that tell us how many people have HIV, the prevalence of HIV and what behaviours people are engaging in that puts them at risk of being infected.

IBBS will also provide us with reliable information to determine what intervention programs we could use to prevent the spread of HIV in this country.

Current estimates of People living with HIV in PNG are based on statistics obtained from antenatal clinics. Information collection from antenatal clinics has improved but the problem with getting information from only one source is that it doesn’t give us an overall picture of the epidemic in different settings.

For example, currently it is mainly women from urban areas who have access to antenatal clinics. The IBBS will provide the evidence we need about what percentage of the community is living with HIV in each province, region and the country, and how HIV affects both men and women in rural and urban areas.

If we are going to make a real difference, we need to put our resources where they will have the most impact. Information from the IBBS will allow us to do that.

I Congratulate the Team from FHI 360 and Burnett Institute for winning the bid to carry out this important task

I have confidence in the team’s ability to carry out this enormous but necessary task.

I note also that there are plans to involve national research institutions as partners in the IBBS. Their involvement is important for research capacity building for national researchers in the country.

Let me on behalf of the government of PNG thank the organizations that will be funding the IBBS – AusAID, World Bank, NACS, ADB and NZAID.

Ladies and Gentlemen, It gives me great pleasure to declare that the Integrated Bio Behavioural Survey is now officially launched.

IBBS Launching - Speech by NACS Acting Director Mr. Philip Tapo

Talking points for the Integrated Bio Behavioural Survey Launching (Holiday INN – 2^ND September 2011) welcome remarks by Acting Director Philip Tapo.

Minister for Health, HIV/AIDS, Honourable Maxton Graham, Chairman of National AIDS Council Sir Peter Barter, His Excellency Mr Paddy Taylor the US Ambassador to PNG, Ms Laura BAILEY country manager -World Bank Representative, Development Partner representatives, Dr Thomas Webster from NRI, representatives from the NDoH and National AIDS Council Secretariat, IBBS managing Contractor from FHI and Burnett Institute, Ladies and Gentlemen.
On behalf of the Director Mr. Kanawi who is out of the country and will be arriving this afternoon, it gives great pleasure to welcome all of you who have accepted our invitation to attend the launching of the IBBS.
The IBBS is a priority in our National HIV/AIDS Strategy 2011-2015, the National HIV/AIDS Research Agenda 2009-2013 and the NDoH Surveillance plan.
We’ve have talked about this country level survey for a number of years and finally we are here to witness’ its launch’s.
NACS at that time during the design stage couldn’t do much when it depended so much on donor funding. Today the Government of PNG has come good in its budgetary support to combat HIV. Its support to NACS budget and also support coming from sub national level provinces; ENBP financial support going down to the LLG level. This is a break through in the national response in PNG.
We have a NEW NACS. NACS current restructure down seizing its total man power from 80 plus personals to 43. We have a new professional staffing, before the end of September all access staff will be paid off which sets a record in this country. We have a competent finance team in place able to response prudently. Our thanks to the Deilotte team who left us on the 31/08/11. Improved M&E system and reporting at the PAC
We are ready and committed to work with you to make sure this survey becomes a success.
We or NACS is also wiling to work with all the other Donor Partners as well with all stake holder partners.
Once again it’s my pleasure to welcome you all to this launching program.

IBBS Launching - Remarks by World Bank Country Manager Laura E. Bailey

Remarks by World Bank Country Manager Laura E. Bailey on the occasion of the Announcement of the Winning Firm to serve as International Management Organization for the Integrated Biological and Behavioral Surveillance (IBBS) Survey in Papua New Guinea

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Honorable Jamie Maxtone-Graham, Minister for Health and HIV-AIDS; Sir Peter Barter, Chair of the National AIDS Council; Dr. Thomas Webster, Director of the National Research Institute; Ambassador Teddy Taylor of the USA and other heads of agencies and diplomatic missions; valued representatives of Development Partners in the IBBS Consortium; Distinguished guests, Ladies and Gentlemen;

It is my happy duty today to officially announce the international management organization that will carry out the Integrated Biological and Behavioral Surveillance (IBBS) Survey here in Papua New Guinea.

Sir Peter Barter has eloquently reminded us why the IBBS is so important. [I would like to reflect a bit on why this effort is being made. Since the first case of HIV/AIDS was registered in PNG, there has been no national population- based survey to define and characterize the scale of the epidemic. Although some efforts have been undertaken in epidemiological and behavioral studies, the scope has been limited to certain sub-regions or sub-groups. This means that our current characterization of the HIV epidemic in PNG is based on proxies, not national population-based estimates.

In addition, the drivers and determinants of the epidemic have not been empirically identified and as a result, the national response over the years has been designed to address a generalized epidemic. These data limitations have reduced the possibility of fully understanding the epidemic, and fully informing developing effective responses.

What makes the IBBS so important is that it will help remove these limitations.]

As Philip Tapo from NACS reminded us, the road we have taken to get to this point has been long, and winding, and at times very difficult. There have obstacles and challenges in our path; storm clouds and thundery rain have obscured our view, reflecting difficulty in communication and in institutional relationships. There have been moments when the path at our feet has opened up, and a large financial hole has appeared to threaten our progress. But we have persevered, and now we are here, at a point where the path forward is clear, and the sun in shining: but NOW the real work begins.

It gives me great pleasure to formally announce that the international management organizations selected to carry out the IBBS survey in PNG, is Family Health International, known by its nickname “FHI 360”.

As agreed by Government and the financing partners, FHI 360 was recruited through a fully competitive process in compliance with the World Bank’s procurement rules.

FHI 360 is a US-based health, development, and research institution, which has provided global technical leadership in public health for 40 years. FHI 360 has managed more than 1,000 HIV surveillance, prevention, care, and treatment projects in more than 70 countries. FHI 360’s multi-disciplinary teams have a long history of success leading the design, sampling, conduct, and data analysis for large-scale surveys, having conducted more than 100 HIV IBBS and Behavioral Surveillance Surveys spanning 40 countries.

In carrying out the survey, FHI 360 will partner with and build the capacity of national institutions and researchers. NGOs, faith-based organizations and Government health facilities will also play an important role in implementation of the survey.

I would like to express our deep gratitude for the continuous commitment and support of Government of PNG, DPs and other relevant stakeholders not only in addressing HIV/AIDS in PNG over the last 20 years, but also in technically and financially supporting the IBBS process from the beginning.

We are grateful to PNG National Department of Health, the National AIDS Council Secretariat, the National Research Institute and the PNG Institute of Medical Research for working hard to see this become a reality. We are also thankful to UNAIDS and the World Health Organization (WHO) for their insightful contribution and technical inputs.

For financial support to the IBBS, special thanks to:

National AIDS Council Secretariat (NACS): for US$200,000

Australian Agency for International Development (AusAID): for making available additional resources to the value of US$2,625,000 without which the IBBS would not be possible.

New Zealand Aid Program (NZAID): for contributing US$940,000

The World Bank: for US$500,000

Asian Development Bank (ADB): for US$300,000

A special word of thanks to the US Embassy and USAID, who offered at the critical late moments to help fill any financial gaps that might be appearing; in the end, the financing was adequate, but we value their generosity.

In closing, I would also like to briefly mention the governance structure and the institutional arrangements for the IBBS Survey.

The NDoH has primary responsibility, on behalf of the Government, for the IBBS survey, jointly with the NACS. NDoH and NACS are the ‘Executive Sponsors’ of IBBS, with sovereign responsibility for defining the goals and objectives. They are the ultimate decision-makers for IBBS.

Given the cross-sectoral nature of the work and the presence of numerous national stakeholders and development partners, NDOH and NACS have established a framework for oversight of the IBBS which includes the IBBS Management Group, which will provide general management and oversight of the survey, and the Surveillance Technical Working Group advises on technical and ethical aspects of the survey. The Management Group acts collectively to resolve issues, make decisions, and provide direction and guidance, and it has been instrumental in securing the required funding.

The World Bank has been delegated by the management group to manage the contract with FHI during survey implementation, which means that FHI 360 will report directly to the World Bank for all aspects of the contract. In turn, the World Bank will report to the IBBS MG through weekly/monthly written updates and will work closely with NDOH and NACS to ensure the smooth implementation of the survey.

The sun is indeed shining upon us, and the path is clear – but we now face the challenge maintaining our momentum, working side-by-side, to complete the IBBS Survey and ensure that the information and analysis is used to the best possible effect in helping the men and women, boys and girls of Papua New Guinea.

Once again I would like to thank the Government of PNG for their commitment to the survey and all development partners for the constant support; and we wish FHI success in carrying out the IBBS Survey.

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