PLACE supports focus on local HIV drivers, answers

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Sharon Weir

The following is a guest post By Sharon Weir, Ph.D. of MEASURE Evaluation

The Priorities for Local AIDS Control Efforts  — PLACE –method aims to improve our understanding of the drivers of local HIV epidemics, identify gaps in services available to those most likely to acquire and transmit HIV, and provide evidence that can support tailored interventions to reduce transmission. Achieving this goal is a challenge because many people don’t know they have the virus, making the local pattern of new infections almost impossible to detect.

PLACE was developed by MEASURE Evaluation—a project funded by USAID and the United States President’s Emergency Plan for AIDS Relief —to meet that challenge. The first implementation manual was published in 2005. Since then, the scope of the PLACE method has been broadened. A 2019 update—expanding PLACE from a single manual to a suite of five guidance documents, templates, training slide decks, and other tools—is now available to guide today’s implementation in response to new opportunities.

The PLACE Tool Kit incorporates best practices for using new tools in testing for HIV; new capabilities for geospatial analysis and electronic data collection; and an increased urgency to find people who are unaware that they have the virus and to get them on treatment—particularly to find people at risk of transmitting HIV to others if they are not successfully engaged in treatment.

The PLACE approach is a place-based strategy that can be carried out at the national level or in local high-risk areas by public health officials without outside expertise. The strategy is to identify venues where people who are the most likely to acquire and transmit HIV can be reached. In addition to providing programs with maps of places to reach people who are at risk of acquiring and transmitting HIV, a probability sample of people at high-risk venues is interviewed to obtain bio-behavioral surveillance data for estimating HIV prevention and treatment cascades, for estimating the size of key populations, and for determining the highest-priority locations for HIV prevention efforts. The data collection instruments are short, easy to use, and designed to provide data that can be analyzed in a straightforward way using commonly available software.

The PLACE method encourages engagement with local HIV testing, counseling, and treatment services so that those who have a positive HIV test in the course of participating in a PLACE study are linked to care. It also has an evidence-informed strategy for ethical implementation of the protocol, including a preliminary readiness assessment that gauges protocol safety, particularly regarding any possible unintended negative impacts on key populations, and provides guidance on the conditions under which the study should not be implemented. The new tool kit includes an overview of the rationale for the method, a sample protocol template that can be adapted for use, a guidance regarding key protocol decisions, a detailed field implementation and training guide, and a guide for conducting a PLACE study of internet sites and social media applications.

The tenet of PLACE remains the same. Controlling the HIV pandemic requires more than global effort; it requires local action in the thousands of communities and districts where HIV transmission is most likely to occur. The lack of local information stymies national efforts to scale up effective programs. PLACE can be a vital part of engaging local stakeholders to address the epidemic in their communities.

PLACE has been implemented in 33 countries, including hundreds of districts, provinces, wards, states, and parishes, with funding from USAID, PEPFAR, the United States Centers for Disease Control and Prevention, UNAIDS, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the World Bank, and other donors. The method was conceived in 1999 with funding from the National Institutes of Health under the Center for AIDS Research at the University of North Carolina at Chapel Hill, and further developed over the years since by MEASURE Evaluation.

For more information: The revised PLACE tool kit is available online at www.measureevaluation.org/place. For more information on MEASURE Evaluation’s work on HIV and key populations, see https://www.measureevaluation.org/our-work/key-populations

Sharon Weir is senior technical advisor for key populations, MEASURE Evaluation, and assistant professor, Department of Epidemiology, University of North Carolina at Chapel Hill.

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