Category: News

Press Release

Ministry of Health Launches National Survey to Measure the Reach and Impact of Rwanda’s HIV Programs

Rwanda Population-based HIV Impact Assessment (RPHIA) will survey 10,800 households across Rwanda.

Kigali, October 10, 2018

The Ministry of Health announced today the launch of the Rwanda Population-based HIV Impact Assessment (RPHIA). The national household-based survey will measure the reach and impact of Rwanda’s HIV prevention, care, and treatment services across the country. RPHIA is led by the Ministry of Health through the Rwanda Biomedical Centre and the Ministry of Economic Planning and Finance through the National Institute of Statistics of Rwanda in coordination with ICAP at Columbia University and the U.S. Centers for Disease Control and Prevention and support from the U.S. President’s Emergency Plan for AIDS Relief.

“Data collected from RPHIA will provide critical insights on the successes and challenges Rwanda faces in confronting the HIV epidemic. RPHIA participants will benefit from free and confidential HIV testing, counseling, and treatment referrals.”

RPHIA will begin collecting household data on October 12^th, 2018 in the Northern Province. The survey is anticipated to last through February 2019. Over the course of five months, trained survey personnel will visit approximately 10,800 randomly selected households and collect demographic, clinical, and behavioral information from consenting participants. Staff will also perform HIV and hepatitis B and C testing.

Results from HIV and hepatitis B virus tests will be returned to participants on the same day, and RPHIA will provide viral load testing for those who test HIV positive. Viral load suppression is a count of how much HIV virus is in the blood and can show if treatment is being used effectively. Participants who test positive for HIV and those selected for hepatitis B and C testing will be referred to health facilities of their choice for further follow up: to receive further counseling and HIV treatment, to receive the vaccine or treatment for hepatitis B, and to receive hepatitis C test results.

The Ministry of Health has led a systematic and sustained response to the HIV epidemic, which includes education on preventing HIV infection as well as universal access to effective HIV medications. Rwanda has intensified HIV testing and treatment strategies and prioritized evidence-based interventions with the goal of achieving epidemic control by 2020.

RPHIA aims to estimate new HIV infections (incidence), number of people living with HIV (prevalence), and viral load suppression among adults and adolescent children. Data collection, laboratory services, and data management will be provided by the Rwanda Biomedical Center in collaboration of the National Institute of Statistics of Rwanda and Westat, Inc. RPHIA includes technical assistance at the national level to strengthen data collection systems, enhance laboratory infrastructure, and strengthen local human resource capacity.

RPHIA will help health authorities and policymakers better understand the impact of HIV on everyone in the population, not only people living with HIV but also their family, friends, and the community at large. The success of the survey and the accuracy of the findings depend on the voluntary participation of all selected households and individuals. The Ministry of Health encourages local leaders, religious leaders, and the press to encourage people, congregations, and followers to consider participating in RPHIA if selected; and to portray a positive and accurate picture of the RPHIA survey to the public.

“RPHIA survey personnel have been extensively trained and are ready to implement a successful survey. It is the mission of all researchers to treat participants with respect, keep their personal information confidential, and ensure they have a positive experience with this important endeavor.”

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ICAP at Columbia University
ICAP was founded in 2003 at Columbia University’s Mailman School of Public Health. A global leader in HIV, tuberculosis, other health threats, and health systems strengthening, ICAP provides technical assistance and implementation support to governments and non-governmental organizations. More than 2.2 million people have received HIV care through ICAP-supported programs, and over 1.3 million have received antiretroviral therapy through such support.

In a Perspective published in this week’s New England Journal of Medicine, Jessica Justman, Owen Mugurungi, and Wafaa El-Sadr show how Population-based HIV Impact Assessment (PHIA) data provide a robust picture of country-level HIV epidemics, including the gaps in the response, and help guide future actions with precision.

The article explains how PHIA surveys provide direct estimates of critically important measures, such as HIV incidence, population-level viral load suppression (defined as HIV RNA <1000 copies per milliliter), and other essential biomarkers countries and donors need to measure progress. Survey findings have revealed exceptional successes, such as a remarkably high prevalence of viral load suppression among adults living with HIV in three contiguous southern African countries (Malawi, Zambia, and Zimbabwe).

See two new maps: HIV Prevalence and Prevalence of Viral Load Suppression in the NEJM article for a new revealing look at the data (Data in the article, from First Reports and preliminary Summary Sheets, are publically available at phia.icap.columbia.edu).

The article also details the value of repeated surveys, which can reveal trends over time, as demonstrated by comparing results from the Swaziland HIV Incidence Measurement Survey 2 (SHIMS2, 2017) with SHIMS (2011). SHIMS2 data showed a dramatic reduction in HIV incidence (44%) and doubling of population viral load suppression (from 35% to 71% among HIV-positive people aged 18 to 49 years).

The article concludes with an overview of the efforts required to plan and implement population surveys, and a call for more accurate and current population-level data in order to measure progress and guide future policy, programs, and funding decisions with precision. Read the article here.

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Jessica Justman is the Senior Technical Director and PHIA Project Principal Investigator at ICAP at Columbia University; Owen Mugurungi is the Aids and TB Unit director in the Ministry of Health and Child Care, Zimbabwe; Wafaa El-Sadr is the Global Director of ICAP at Columbia University.

From New England Journal of Medicine, Jessica Justman, Owen Mugurungi, Wafaa El-Sadr, HIV Population Surveys – Bringing Precision to the Global Response, 378;20, 1859 Copyright © (2018) Massachusetts Medical Society. Reprinted with permission.

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About the Population-based HIV Impact Assessment Project

The PHIA Project was launched in 2014 to address the need for detailed population HIV measures. Initial findings are already available from seven countries in sub-Saharan Africa (Zimbabwe, Malawi, Zambia, Swaziland, Lesotho, Tanzania, and Uganda), where approximately 200,000 individuals from more than 85,000 households have been surveyed. PHIA surveys are funded by PEPFAR and conducted by ICAP at Columbia University in partnership with ministries of health and the US Centers for Disease Control and Prevention.

See below for PHIA Project presentations at the annual Conference on Retroviruses and Opportunistic Infections (CROI) held in Boston, Massachusetts from March 4-7, 2018.

Sunday, March 4, 2018

Clinical Trial Design and Analysis Workshop

Measuring Population-Level Impact of Interventions

Jessica Justman, PHIA Project principal investigator and senior technical director at ICAP

Tuesday, March 6, 2018

Oral Presentation

High HIV Burden among Children in Lesotho: Findings from a Population-Based Survey

Kyaw Thin, Ministry of Health, Lesotho

Poster Presentation

High HIV Burden among Children in Lesotho: Findings from a Population-Based Survey

Abstract

Progress Toward 90-90-90: 2016 Lesotho Population-based HIV Impact Assessment Results 

On World AIDS Day 2017, the PHIA Project at ICAP at Columbia University, conducted in collaboration with the Centers for Disease Control and Prevention (CDC), announced the release of new data from five survey countries, including preliminary results from Lesotho and Tanzania. With this release, data are now available for seven countries where the population-based HIV impact assessments (PHIAs) were conducted. The release also marks one year since the PHIA Project announced preliminary results from the first three survey countries— Malawi, Zambia, and Zimbabwe—that showed exceptional progress against the HIV epidemic.

PHIA surveys are conducted in collaboration with ministries of health. As part of these surveys, household-based HIV counseling and testing is offered to all household members from selected households by trained survey staff, with return of results. The surveys also ask questions about access to preventive care and treatment services for adults and children. The results measure national and regional progress toward UNAIDS’ 90-90-90 goals and guide policy and funding priorities. Data from the PHIA Project are prepared and disseminated in stages in order to allow the release of preliminary data as soon as possible.

Additionally, today, the PHIA Project posted new First Reports for Malawi, Zambia, and Zimbabwe that present in-depth results on the state of national HIV epidemics by socio-demographics, clinical characteristics, and regions. These 70-page reports also describe design, methods, and response rates and include data on topics such as HIV incidence, prevalence, immune status, achievement of the 90-90-90 targets, prevention of mother-to-child transmission (PMTCT), and sexual behavior.

“The First Reports released today further inform our understanding of the progress made in confronting the HIV epidemic in these three countries,” said Wafaa El-Sadr, M.D., M.P.H., M.P.A., global director of ICAP. “These findings will be crucial in guiding policymakers, researchers, and health officials as they consider the way forward.”

The PHIA Project also released new Summary Sheets detailing preliminary results from two more countries, Lesotho and Tanzania, and updated the Swaziland (SHIMS2) Summary Sheet.

In Lesotho, results show that HIV viral load suppression among all HIV-positive adults —a key marker of the body successfully controlling the virus—has reached over 67 percent among 15- to 59-year olds. This finding suggests that Lesotho is on track to achieve epidemic control by 2020, through reaching the UNAIDS 90-90-90 targets and expanding HIV prevention. Full achievement of the 90-90-90 targets implies achieving a viral load suppression of 73 percent among all people living with HIV.

In Tanzania, HIV viral load suppression among all HIV-positive adults has reached 52%, and researchers noted Tanzania’s progress in reaching people diagnosed with HIV with antiretroviral treatment, care, and support. Data from the survey further indicate Tanzania’s HIV epidemic is stabilizing.

“The collaboration with ministries of health has been fundamental to the success of the PHIA surveys,” said Dr. Jessica Justman, PHIA Project principal investigator and senior technical director at ICAP. “The PHIA findings are eagerly anticipated by the countries as they examine their HIV response to date and their future plans to meet the needs of their citizens.”

ICAP also announced the first publication for the PHIA Project in a supplement issue of the Journal of the International AIDS Society (JIAS). The article describes how the vast majority of viral load results from the first three PHIA surveys were returned to each HIV-positive participant’s preferred health facility within the eight-week target, a significant achievement possible through contributions from partners including ministries of health, CDC, and Westat.

As of December 2017, the PHIA Project has announced preliminary results from seven countries, including Swaziland and Uganda earlier this year. In July, the PHIA Project announced Swaziland’s impressive progress in confronting its HIV epidemic — including nearly halving the rate of new HIV infections — at the International Aids Society 2017 Conference in Paris, France, and spotlighted the stabilization of Uganda’s epidemic during an event hosted by UNAIDS at the UN General Assembly in September 2017.

In the coming months, ongoing surveys in Cameroon, Cote d’Ivoire, Ethiopia, and Namibia will be completed, and surveys will commence in Haiti, Kenya, and Rwanda. The PHIA Project will post additional data in the form of Summary Sheets, Final Reports, and public-access datasets as they become available.

About the Population-based HIV Impact Assessment (PHIA) Project

The PHIA Project, led by ICAP at Columbia University in partnership with the US Centers for Disease Control and Prevention (CDC), and funded by the President’s Emergency Plan for AIDS Relief (PEPFAR) measures the reach and impact of HIV programs in PEPFAR-supported countries through national surveys.

The Population-based HIV Impact Assessment (PHIA) Project announced major findings from the Swaziland survey at the 9^th IAS Conference on HIV Science (July 23-26). Key findings from the second Swaziland HIV Incidence Measurement Survey, SHIMS2, the Swaziland PHIA, revealed impressive progress in confronting the HIV epidemic. Previously released survey results showed similar progress in three high-burden countries: Malawi, Zambia, and Zimbabwe.

The Kingdom of Swaziland has long had a severe HIV epidemic with the world’s highest national HIV prevalence and incidence (rate of new infections). The country has demonstrated a commitment to turning the tide of the epidemic by dramatically scaling up HIV testing and treatment as well as other prevention efforts. Between 2011, when SHIMS1 was conducted, and SHIMS2 in 2016, HIV incidence among adults fell by nearly half (2.5% to 1.4%) and the percentage of HIV-positive adults with viral load suppression (VLS), as a measure of control of the virus, doubled (35% to 71%). HIV prevalence among adults was stable at 30%, similar to the 2011 HIV prevalence of 32%.

“Because of the severe HIV epidemic in Swaziland, it was critical for us to implement a combination HIV prevention package, scale up HIV care and treatment services, and engage in ongoing measurement of HIV incidence in order to assess the impact of these efforts,” said Senator Sibongile Ndlela-Simelane, the honorable Minister of Health, Swaziland. “The results of the SHIMS2 survey reveal a dramatic improvement in the state of the epidemic in Swaziland and we are very encouraged by this progress. We understand that the battle is not over, and therefore we must maintain the momentum.”

Leaders from across global health field expressed enthusiasm over the data. Wafaa El-Sadr, Director of ICAP at Columbia University, called the findings a “cause for celebration,” and Michele Sidibé, Executive Director of UNAIDS, said, “The best news of this conference will be the Swaziland results… The result should drive all our efforts.”

The Swaziland findings echo other PHIA results – released in December 2016 and expanded on through oral abstracts and posters presented at the IAS Conference.

Despite this substantial progress, significant work remains in order to further reach and engage men and young women, particularly around raising awareness of individual’s HIV-positive status and ensuring their access to effective treatment with high adherence.

The nationally representative PHIA surveys, implemented by ICAP in partnership with the US Centers for Disease Control and Prevention (CDC) and the ministries of health with funding from the President’s Emergency Plan for AIDS Relief (PEPFAR), provide valuable information on the state of HIV epidemics across Africa and help demonstrate measurable progress toward the UNAIDS 90-90-90 targets. In addition, the results provide further proof of how treatment works for prevention of HIV transmission.

“The partnership with the Swazi Ministry of Health was fundamental to the success of the survey,” said Shannon Hader, MD, MPH, director of the CDC’s Division of Global HIV & TB. “As we’ve seen in other countries, the PHIA findings will help the Ministry of Health and its partners to focus resources on urgent program priorities to achieve epidemic control.”

“We now have clear evidence that four African countries are approaching control of their HIV epidemics,” said Ambassador Deborah L. Birx, M.D., U.S. Global AIDS Coordinator and Special Representative for Global Health Diplomacy. “These unprecedented findings demonstrate the remarkable impact of the U.S. government’s efforts, through PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria, in partnership with African countries. We now have a historic opportunity to change the very course of the HIV pandemic.”

Swaziland HIV Incidence Measurement Survey 2: A Population-Based HIV Impact Assessment

The Swaziland HIV Incidence Measurement Survey 2 (SHIMS2) was a household-based national survey conducted between August 2016 and March 2017 to measure the impact of Swaziland’s national HIV response on HIV incidence and viral load suppression. SHIMS2 offered household-based HIV counseling and testing with return of results and collected information about uptake of HIV care and treatment services. This is the second survey to estimate national HIV incidence and viral load suppression. Previous measurements were conducted in SHIMS1 in 2011.

Click the link below to view the results summary sheet.

SHIMS2 Summary Sheet: Preliminary Findings (Updated in November 2017)

PRESS RELEASE

CONTACTS:
Stephanie Berger
Columbia University Mailman School of Public Health
212-305-4372
sb2247@columbia.edu

Hugh Siegel
ICAP at Columbia University
212-305-6533
hs3000@columbia.edu

PARIS, July 24, 2017                                 

Key findings from the second Swaziland HIV Incidence Measurement Survey, SHIMS2, reveal impressive progress in confronting the HIV epidemic in the country. Results show a doubling in population viral load suppression since 2011 and a decrease by nearly half in the rate of new HIV infections. The findings were released today at a press conference held by the Prime Minister’s office in Mbabane, Swaziland and at the International Aids Society (IAS) 2017 Conference in Paris, France.

“Because of the severe HIV epidemic in Swaziland, it was critical for us to implement a combination HIV prevention package, scale up HIV care and treatment services, and engage in ongoing measurement of HIV incidence in order to assess the impact of these efforts,” said Senator Sibongile Ndlela-Simelane, the honorable Minister of Health, Swaziland. “The results of the SHIMS2 survey reveal a dramatic improvement in the state of the epidemic in Swaziland and we are very encouraged by this progress. We understand that the battle is not over, and therefore we must maintain the momentum.”

The data come from one of the population-based HIV impact assessment (PHIA) surveys led by the Government of the Kingdom of Swaziland (GKoS) through the Ministry of Health (MOH) and Central Statistical Office (CSO). The survey (SHIMS2) was implemented by ICAP at Columbia University and the US Centers for Disease Control and Prevention (CDC), with funding from the President’s Emergency Plan for AIDS Relief (PEPFAR).

SHIMS2 is the second national incidence survey to be conducted in Swaziland, following the 2011 survey (SHIMS1) among adults 18-49 years of age.

In SHIMS2, over 14,000 children and adults participated in this nationally representative survey by agreeing to be interviewed and providing a blood sample for HIV testing.

Key SHIMS2 survey results include:

• The annual rate of new HIV infections (“HIV incidence”) among adults ages 15 years and older was 1.36 percent: 1.70 percent among females and 1.02 percent among males. Among adults 18-49 years, HIV incidence was 1.39 percent, nearly half of the prior HIV incidence rate in 2011 2.48 percent.
• The percentage of the adult population living with HIV (“HIV prevalence”) was 27.0 percent: 32.5 percent among females and 20.4 percent among males. The HIV prevalence among adults 18-49 years was 30.5 percent, similar to the 2011 HIV prevalence of 32.1 percent.
• The percentage of all HIV-positive adults with viral load suppression (VLS), an indication that the infection is under control, was 73.1 percent: 76.0 percent among females and 67.6 percent among males. VLS was estimated using all people living with HIV (PLHIV) as a denominator, regardless of knowing their HIV status or use of antiretroviral drugs. Among all HIV+ adults aged 18-49 years, twice as many had VLS in SHIMS2 as compared to SHIMS1 (71.3 percent compared to 34.8 percent in 2011).
• The percentage of all HIV-positive adults who knew their HIV status was 84.7%; of these individuals, 87.4% reported current use of antiretroviral treatment and, among those reporting treatment, 91.9 percent had VLS. These results indicate Swaziland has made substantial progress toward achieving all three of the “90-90-90’ targets set by UNAIDS to help end the HIV epidemic.

The progress represented by the findings is attributed to the expansion of HIV testing in the country as well as a substantial increase in the number of HIV-positive individuals on antiretroviral drugs from 2011 to 2016. This is combined with other HIV control interventions expanded in the country.

“These remarkable findings from Swaziland add to the evidence base that we are beginning to control the HIV epidemic in several high-burden countries,” said Ambassador Deborah L. Birx, M.D., U.S. Global AIDS Coordinator and Special Representative for Global Health Diplomacy. “They both demonstrate our extraordinary progress in ensuring that older HIV-positive adults are on life-saving treatment and virally suppressed as well as reveal key gaps that remain in reaching younger men and women with HIV services.”

“An amazing array of partnerships lasting over a decade – from collaboration within and between governments to coordination across international organizations and implementers – have brought us to an incredible level of success in the work on HIV and AIDS in Swaziland,” said Lisa J. Peterson, US Ambassador to Swaziland. “These partnerships are about people bringing their time and talents together to effect change. Thanks to these joint efforts, the SHIMS 2 data show that many more people will have the opportunity to share their own time and talents with their families and communities. It is especially important that we sustain and strengthen our collective engagement with Swaziland’s youth to ensure that we achieve an AIDS-free generation.”

“The partnership with the Swazi Ministry of Health was fundamental to the success of the survey,” said Shannon Hader, MD, MPH, director of the CDC’s Division of Global HIV & TB. “As we’ve seen in other countries, the PHIA findings will help the Ministry of Health and its partners to focus resources on urgent program priorities to achieve epidemic control.”

“The findings from SHIMS2 are a testimony to the remarkable commitment by the Government of Swaziland in confronting the HIV epidemic,” said Wafaa El-Sadr, MD, MPH, MPA, director of ICAP. “It is a demonstration that all the efforts put into the scale-up of HIV prevention, care and treatment services have borne fruit. ICAP is honored to have played a role in helping to support this successful scale-up.”

“Each Population-based HIV Impact Assessment – PHIA – survey provides a ‘report card’ on how each country is doing in responding to its epidemic as well as a blueprint for future response,” said Jessica Justman, MD, ICAP’s senior technical director and principal investigator of all of ICAP’s PHIA projects, including SHIMS1 and SHIMS2. “Swaziland has made notable progress and is poised to continue making great strides forward with the implementation of test and start and ongoing scale-up of routine viral load monitoring. The SHIMS2 results will help focus efforts and prioritize specific populations in need of urgent attention and innovative approaches.”

Other collaborating governmental entities in Swaziland included the Health Research Unit, Swaziland Health Laboratory Services (SHLS), Swaziland National AIDS Program (SNAP), Health Promotion Unit, Health Management Information System, Environmental Health Department, and National Emergency Response Council on HIV/AIDS (NERCHA).

Additional details on SHIMS2 are available in the summary sheet released by the Swaziland Ministry of Health and the websites for the Ministry of Health www.gov.sz , CDC/PEPFAR www.cdc.gov and www.pepfar.gov, and ICAPs PHIA Project: phia.icap.columbia.edu.

About ICAP at Columbia University

ICAP was founded in 2003 at Columbia University’s Mailman School of Public Health. A global leader in HIV, tuberculosis, other health threats and health systems strengthening, ICAP provides technical assistance and implementation support to governments and non-governmental organizations. More than 2.2 million people have received HIV care through ICAP-supported programs and over 1.3 million have received antiretroviral therapy through such support.

Join us to learn what the Population-based HIV Impact Assessment (PHIA) surveys data are telling us about the evolving HIV epidemic. (Full details can be found here)

Featured satellite session speakers:

• Ambassador-at-Large Deborah Birx, U.S. global AIDS coordinator
• Shannon Hader, CDC  director of the Division of Global HIV and TB
• Jessica Justman, ICAP technical director
• Peter Ghys, UNAIDS director of strategic information and evaluation
• Harriet Nuwagaba-Biribinwoha, Research director, ICAP in Swaziland

Additional PHIA activities at IAS 2017:

Monday, July 24

Oral abstracts
11:00 a.m.–12:30 p.m.
Late Breaker Oral Abstract Session (Blue Amphitheater)

• Substantial Progress in Confronting the HIV Epidemic in Swaziland: First Evidence of National Impact. R. Nkambule (# MOAX0204LB)

Tuesday, July 25 

Oral abstracts
11:00 a.m.–12:30 p.m.
Hitting the First 90 Target: Lessons from Population-based Surveys –
Oral Abstract Session Track C, Prevention Science (Maillot Room)

• Findings from the 2016 Zambia Population-based HIV Impact Assessment (ZAMPHIA): HIV prevalence, incidence and progress towards the 90-90-90 goals. D.T. Barradas (# TUAC0301)

• Correlates of being outside the 90-90-90 cascade among adults ages 15-64 years in Zimbabwe. A. Hakim (# TUAC0302)

• 90-90-90 targets in HIV-positive women using results from MPHIA: a Malawi success story. N. Wadonda-Kabondo (# TUAC0303)

• Children living with HIV in Malawi: first survey-based measurement of national pediatric HIV prevalence and viral suppression. S. Jonnalagadda (# TUAC0304)

Poster Exhibition
12:30–14:30 p.m. (Level 3)

• Estimation of HIV incidence and the profile of incident cases in Zimbabwe Population Based Impact Assessment (ZIMPHIA) 2015- 2016 (# TUPEC0832)

• Evidence from the Zimbabwe population HIV impact assessment on 90-90-90: a national and provincial call to action for the first 90 (# TUPEC0743)

• Undiagnosed HIV is higher among urban residents, young adults and men: first findings from Malawi Population-based HIV Impact Assessment (MPHIA) (# TUPEC0841)

• Is MPHIA survey a validation method for HIV spectrum estimates in Malawi? (# TUPEC0741) Closing the 90-90-90 Gap: ZAMPHIA, 2016 (# TUPEC0875)

• Geographical distribution of HIV burden in Malawi: where is the gap in achieving the 3rd 90? (# TUPEC0877)

• Unmet 90-90-90 targets among adolescent girls and young women living with HIV in Malawi (# TUPEC0876)

The PHIA Project is led by ICAP at Columbia University in partnership with the U.S. Centers for Disease Control and Prevention (CDC) and the Ministry of Health in each country. The project is funded through the U.S. President’s Emergency Plan for AIDS Relief (PEFPAR).

Today, survey teams for the PHIA Project are at work in three countries and have tested more than 53,000 people for HIV. Funded by PEPFAR through the CDC, this multi-year project to conduct population-based HIV-impact assessments (PHIAs) will provide critical information on the state of the HIV epidemic in these countries and help shape policies and programs to confront the epidemic.

Currently, PHIA survey teams are conducting thousands of interviews and HIV tests as they travel throughout Zimbabwe, Malawi, and Zambia in 4×4 trucks loaded with supplies. Every single item the teams use, from butterfly needles and vacutainer tubes to clipboards and pens, has arrived in their hands through months of meticulously planned procurement, transport, and inventory management. As the project prepares to start new surveys in Uganda, Tanzania, Swaziland, and Lesotho, logistics are a central focus of activities. “The project requires a unique combination of team talent, as well as supplies, and that must be available for consumption at remote locations,” says Charles Wentzel, ICAP’s PHIA regional procurement and logistics advisor.

Nearly every aspect of the survey fieldwork, including transportation of teams, laboratory testing, and training, relies on well-functioning equipment and adequate supplies to meet the survey targets. Given the scale of the project, which will survey between 20,000 and 30,000 people in each country, precise coordination is essential to delivering everything when and where it is needed. “There is a lot of information needed well ahead of time,” says Wentzel. Since most items are procured internationally, orders must be placed far in advance. The team factors in three months for shipping by sea, as well as customs clearances.

For each PHIA country, the ministry of health, the CDC, and ICAP work together to complete a planning worksheet. The team enters information onto the worksheet such as the number of households, expected HIV prevalence, specific lab tests, survey team composition, number of satellite labs, number of vehicles, and other parameters, and the worksheet then calculates the quantity needed for each item. David Hoos, PHIA project director, recalls that “ICAP first implemented a complex procurement tool during the implementation of the MTCT-Plus Initiative in 2002, for antiretroviral medication quantification.”

In some cases, mobile laboratories must be procured. This is necessary when blood samples will be collected from participants who are too far from any existing lab to meet the cold-chain or “arm-to-freezer” time requirements. In Zambia ICAP is using mobile laboratories which can process specimens and are equipped with refrigerators to ensure the samples and supplies are kept cold.

A customized logistics plan is necessary for each country and it reflects geography, weather, cultural, and political factors. Each factor may affect the specific equipment and supplies needed, the timing of the survey and transport of samples back to the lab, and time needed for customs clearance of imported supplies. Wentzel adds that, “addressing urgent or unforeseen challenges like delays, really comes down to the capacity of our team and the capacity of our system. Our team is experienced and can handle emergencies because they know what needs to be done.”

At the country level, the local logisticians are often lab technicians who understand the unique properties of PHIA supplies, particularly cold-chain items that may spoil. These technicians are trained in logistics functions and warehouse procedures. Some products have long production lead times, yet short expiry dates, further complicating the efforts to avoid ruptures in stock. Distribution of supplies is planned at multiple levels, with the warehouse providing stock to labs, and labs ensuring the field teams are fully equipped.

Tracking inventory is an essential function for the logisticians. The tracking mechanism itself is a user-friendly online system through which the in-country warehouse officer makes updates. Multiple people can access this in real time, so it allows simultaneous updating and tracking. The real-time aspect of the system is crucial for ensuring the field teams can work and move efficiently.

As the PHIA Project expands operations further, with four more countries starting data collection in 2016, the logistics teams are constantly implementing lessons learned. “We’re strengthening systems and enhancing ease of use for the upcoming surveys,” says Wentzel. “The system is changeable and we can make adjustments according to need.”

The PHIA Project is a multi-country initiative to measure the reach and impact of HIV programs in PEPFAR-supported countries and guide policy and funding priorities.