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SIERRA LEONE MOT Final SSIIEERRRRAA LLEEOONNEE HHIIVV MMOODDEESS OOFF TTRRAANNSSMMIISSSSIIOONN SSTTUUDDYY KKNNOOWW YYOOUURR EEPPIIDDEEMMIICC,, KKNNOOWW YYOOUURR RREESSPPOONNSSEE 2010 Correspondence Details : National HIV and AIDS Secretariat, 15 A Kingharman Road Brookfields, Freetown Sierra Leone. Tel: +232-22-242202/235804 Email : [email protected] Website : http://www .nas.gov.sl i SIERRA LEONE HIV MODES OF TRANSMISSION AND PREVENTION RESPONSE ANALYSIS Draft Report August 2010 Study Team Patrick R. Kenya, Prince-Albert Roberts, Joseph Kobba, Noah Conteh, Dilys Thompson, Victor Kamara, Chibwe Lwamba ii CLOSING THE GATES By Modelling the expected distribution of new HIV infections by exposure groups and Understanding the sources of new HIV infections for programme planning and Supporting the work of programme pillars: Know your Epidemic, Know your Response : For guiding the development of: Final Joint Programme Review: To undertake comprehensive consultative Review in respect of the NSP 2006-2010; Provide recommendations that will guide the development of a new National Strategic Plan 2011-2015, the new National M&E Plan 2011-2015 and an Operational Plan. National Strategic Plan on HIV/AIDS 2011-2015 For guiding the development of a new National Strategic Plan for HIV/AIDS (2011 – 2015) National M&E Plan on HIV/AIDS 2011-2015 For the development of the new National M&E Plan for HIV/AIDS (2011 – 2015) Two-Year (2011-2012) Budgeted Operational Plan 2011-2012 For the development of a national Budgeted Operational Plan for the period 2011-2012 ©2010 – Sierra Leone National HIV and AIDS Secretariat All rights reserved. iii Sierra Leone HIV Modes of Transmission and Prevention Response Analysis Study Team Prof. Patrick R. Kenya, a Dr. Prince-Albert Roberts, b Mr. Joseph Kobba, c Dr. Noah Conteh d Mrs. Dilys Thompson e Mr. Victor Kamara f Mr. Chibwe Lwamba g a Lead Consultant, Epidemiologist and Incidence Modeller, b Consultant, Prevention Expert (Programmes), c Consultant, Prevention Expert (Policy), d Consultant, Epidemiologist and Incidence Modeller, e Consultant, Literature Review and Data Analyst, f Senior M&E Officer, NAS, g M&E Advisor, UNAIDS, Sierra Leone and UNAIDS MOT Study Coordinator This study is the outcome of close collaboration between UNAIDS and UNICEF, Sierra Leone Country Offices to support the Government of Sierra Leone to combat the scourge of HIV epidemic in the country through NAS by initiating the UNAIDS Modes of Transmission model for Sierra Leone. The purpose of the model is to understand the sources of new HIV infections for better programme planning and support of programme pillars. The model results, together with existing epidemiological data and the conclusions of recently completed studies on the factors driving Sierra Leone’s HIV epidemic are compared with data on HIV funding allocations, to derive recommendations for strengthening Sierra Leone’s HIV prevention response and also for improving HIV prevention based on evidence on what works to prevent new infections. Keywords : Sierra Leone, HIV , AIDS, epidemiology, epidemic, modes of transmission , incidence, prevalence, prevention, Know Your Epidemic , Know Your Response , expenditures, synthesis , Sierra Leone National HIV and AIDS Secretariat (NAS), UNAIDS Correspondence Details : National HIV and AIDS Secretariat, 15 A Kingharman Road Brookfields, Freetown Sierra Leone. Tel: +232-22-242202/235804 Email : [email protected] Website : http://www .nas.gov.sl iv Table of Contents Table of Figures ...................................................................................................................................................... x ACKNOWLEDGEMENTS ...................................................................................................................................... xii ACRONYMS ........................................................................................................................................................... xiii GLOSSARY OF TERMS ......................................................................................................................................... xv EXECUTIVE SUMMARY .................................................................................................................................... xvii CHAPTER 1. INTRODUCTION, METHODOLOGY and HYPOTHESIS ...................................................... 1 1.1. The Analysis of HIV Prevention and Modes of Transmission (MoT) Study Concept ............. 1 1.1.1 .... Relevance of the MoT Study to the concept of universal access to HIV prevention: ............................................................................................................................................................................. 3 1.2. Modes of Transmission Study in Sierra Leone: Rationale, purpose, and objectives ............. 4 1.2.1 ...................................................................... Use of MOT Study results in Sierra Leone: ............................................................................................................................................................................. 5 1.2.2 ......................................................................................................... Key Pillar Activities: ............................................................................................................................................................................. 5 1.3. Modes of Transmission (MOT) Report Structure ........................................................................... 5 CHAPTER 2: MODES OF TRANSMISSION STUDY METHODOLOGY ....................................................... 7 2.1. Overall oversight and approval of MoT Study deliverables ........................................................... 7 2.2. Methods for the KYE synthesis ....................................................................................................... 7 2.2.1 ......................................................................... Methodology – Epidemiological Review: ............................................................................................................................................................................. 7 2.2.2 .................................................................................. Literature search and cataloguing: ............................................................................................................................................................................. 7 2.2.3 ........................................................................................................... Types of data used: ............................................................................................................................................................................. 8 2.2.4 ............................................................................... Epidemiological Model for Analysis: ............................................................................................................................................................................. 8 2.2.5 ................................................................................ Methodology – Incidence Modeling: ............................................................................................................................................................................. 8 2.3. Methodology for the Know Your Response Synthesis ................................................................... 9 2.3.1 .............................................................................................................. Sampling method ............................................................................................................................................................................. 9 2.3.2 ............................................................................. Classification of prevention activities ............................................................................................................................................................................. 9 v 2.3.3 ............................................................................ Methodology – HIV prevention review ...........................................................................................................................................................................10 2.3.4 .......................................................... Methodology – HIV prevention resources review ...........................................................................................................................................................................10 2.4. Methods for the Know Your Epidemic-Know Your Response Synthesis ...................................... 11 2.5. Modes of Transmission (MoT) Study Limitations ......................................................................... 11 CHAPTER 3: THE CURRENT STATUS OF THE EPIDEMIC ....................................................................... 13 3.1 Introduction and Background ....................................................................................................... 13 3.2 National Trends in HIV prevalence ................................................................................................ 13 3.2 Heterogeneity of HIV Prevalence ................................................................................................. 22 3.2.1 ...........................................................................................
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