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Monitoring HIV/AIDS using Sample Vital Registration with Verbal Autopsy. Gregory Kabadi on behalf of SAVVY partners. Outline. SAVVY Overview Technical aspects for SAVVY Implementation plan SAVVY’s facilitation with RITA. SAVVY Overview.

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monitoring hiv aids using sample vital registration with verbal autopsy

Monitoring HIV/AIDS using Sample Vital Registration with Verbal Autopsy

Gregory Kabadi

on behalf of SAVVY partners

outline
Outline
  • SAVVY Overview
  • Technical aspects for SAVVY
  • Implementation plan
  • SAVVY’s facilitation with RITA
savvy overview
SAVVY Overview

‘SAVVY’=Sample Vital Registration with Verbal Autopsy

  • A sample demographic surveillance system built around vital events monitoring
  • Purpose is to provide improved monitoring and measurement of vital events
    • Not available from vital registration systems, household surveys, etc.
    • SAVVY will include cause of death ascertainment
    • Supplemental information from periodic surveys “nested” within system
  • SAVVY will consolidate and adapt “best practice” in
    • Sample and demographic surveillance techniques
    • Survey sampling methods
    • Validated ‘verbal autopsy’ methods
savvy s organisational structure
SAVVY’s ORGANISATIONAL STRUCTURE
  • National Level:
    • Technical Staff at MOHSW, Other Gov Depts, Development Partners. SAVVY’s Implementing Partners: IHI & NIMR Mza
  • District Level:
    • DMO and CHMT, SAVVY’s District Coordinator
  • Community Level
    • Census Supervisors, Enumerators and Key Informants
sentinel panel of districts spd
Sentinel Panel of Districts (SPD)

SPD central

District Medical Officer

SAVVY District Coordinator

FBIS District Coordinator

KIs & Census Enumerators

Facility I/C

FBIS = Facility-Based Info System

why savvy
Why SAVVY?
  • Several millennial commitments to ‘do better’ with investments in population health and development
  • Few reliable sources of information on mortality rates and causes of death- especially HIV/AIDS
  • Strengthen the capacity of the Ministry of Health & Social Welfare to collect and use surveillance data to manage programs
savvy sample selection nbs
SAVVY Sample Selection - NBS
  • Probability Proportional to Size
  • Enumeration area and households from Tanzania Mainland
  • National estimates
  • Stratified by rural-urban & gender
  • Target population is adults 18-59
what are the technical aspects
What are the technical aspects?

Censuses

  • Conduct baseline census followed by periodic updates
  • Deaths and births reported

Mortality Surveillance System

    • Deaths followed-up with ‘verbal autopsy’
    • Substantial and growing literature on the reliability and validity of this technique
    • Provides accurate cause of death data at community level by age and sex

Nested studies

  • Behavioral, service satisfaction, health equity, SES
implementation plan
Implementation plan
  • Sensitization and Govt buy-in
    • Signing of MOU with NIMR
    • Signing of MOU with NBS
  • List of names of the sample districts including EAs from NBS Statistical Master Sample
  • Plan/set up Financial & A/C reporting
  • SAVVY staff recruitment
    • So far, 2 hired at IHI, 3 at NIMR Mwanza
    • Pending, 4 – 6 at IHI & NIMR Mwanza (all, fulltime)
    • Pending 23 District Coordinators (District-based, fulltime)
    • District-based, KIs + Census enumerators (abt 270, temp)
  • Office set up, procurement of utilities + cars
implementation plan cont d
Implementation Plan… cont’d
  • Phased-in implementation of SAVVY
    • 4 Pilot districts – 2010: Kinondoni, Bagamoyo, Geita & Kahama
      • 12 districts by 2011; ALL by – 2012
    • Identification of key members in selected districts to organize district work and VA interviews
  • Preparation of SAVVY field manuals, guidelines and SoPs
  • Develop and pilot test data for census and VA both on Tablet PCs
  • Training of field teams on data collection using Tablet PCs
  • Write and submit Feasibility Study
implementation plan cont d1
Implementation Plan…..cont’d
  • Establish vital events reporting system in pilot districts
  • Train community Key Informants on recording & reporting of vital events
  • Conduct baseline census in the first 4 SAVVY districts & Conduct verbal autopsy interviews
  • Conduct supervision and quality assurance of baseline census
  • Data management and analysis of baseline census, write report of baseline census
  • Identification and training of physicians for coding of Verbal Autopsy data
  • Set up of Steering Group (high level) & TWG
registration of births deaths rita i
REGISTRATION OF BIRTHS & DEATHS, RITA - I

RITA = Registration, Insolvency & Trusteeship Agency

(Ministry of Justice and Constitutional Affairs)

  • To register a birth or death event (birth within 90 days, death within 30 days):
    • Birth or Death notification:
      • B1 or D1 for a birth or death at a health facility resp
      • B2 or D2 for a birth or death in communities resp
      • Certificate, TShs. 3,500/= (about US $ 3)
  • A birth/death event after the period recommended, more evidence will be needed, fee + penalty!
  • A birth certificate: Given a name, Citizenship, know own parents and to be cared for, Retirement, Higher education
  • A death certificate: Inheritance, Evidence to being an orphan, Sponsorship by Gov
registration of births deaths rita ii
REGISTRATION OF BIRTHS & DEATHS, RITA - II
  • SAVVY will monitor and register all live births and deaths in its communities (SAVVY districts)
  • RITA promised to issue SAVVY its notification registers (B1/B2 and D1/D2) that it will be distribute to Village Executive Officers (VEO)
  • SAVVY’s KIs inform the SAVVY District Coordinator of vital events in their communities
  • SAVVY Coordinator verifies events and collects data, registers them at the VEO (RITA’s registers)
  • SAVVY Coordinator / VEO send the notification registers to the RITA’s District Officer for issuance of certificates
savvy s key informants attributes
SAVVY’s Key Informants, Attributes
  • A SAVVY’s KI should be appointed by community leadership (Ward or Village) for having the following attributes/qualifications to be able to report on vital events:

- Be a resident of the community

- Approved of by the community

- Confidentiality

- Of good rapport

- Be able to read and write

working tools
WORKING TOOLS
  • Key Informant
      • A Bicycle
      • A Simple phone (within network coverage)
      • Incentive: for each birth or death reported
  • Census Enumerators/Supervisors
      • A Tablet PC
      • Transport during census
  • SAVVY District Coordinator
      • A Tablet PC
      • Transport
conclusion
Conclusion
  • Very powerful information platform to generate population-based demographic, health & mortality data
  • NBS-endorsed, national sample; results stratified by residence & zone
  • Provides economical, quality platform for detailed programme Monitoring & Evaluation
  • Provides opportunity for fundamental & operational research
  • Comparability over time: trend analysis
  • Included in the MOHSW’s HMIS project for sustainability in the near future
ad