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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 Verbal Autopsy

  • SAVVY Overview

  • Technical aspects for SAVVY

  • Implementation plan

  • SAVVY’s facilitation with RITA

Savvy overview
SAVVY Overview Verbal Autopsy

‘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

  • 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) Verbal Autopsy

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? Verbal Autopsy

  • 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 Verbal Autopsy

  • Probability Proportional to Size

  • Enumeration area and households from Tanzania Mainland

  • National estimates

  • Stratified by rural-urban & gender

  • Target population is adults 18-59

Savvy sampled districts
SAVVY Sampled Districts Verbal Autopsy

What are the technical aspects
What are the technical aspects? Verbal Autopsy


  • 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 Verbal Autopsy

  • 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 Verbal Autopsy

  • 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 Verbal Autopsy

  • 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

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

  • 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 Verbal Autopsy

  • 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 Verbal Autopsy

  • 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 Verbal Autopsy

    • 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

    ASANTENI Verbal Autopsy