The PLACE Method for M&E of HIV Prevention Programs
Although the HIV epidemic is global, new infections occur within local sexual and injecting drug user networks that vary considerably between continents, cultures, and contexts. Prevention strategies should be tailored to local transmission networks. The Priorities for Local AIDS Control Efforts (PLACE) protocol is designed to provide strategic information to prevention programs based on the unique features of local HIV transmission networks.
The specific objectives of the PLACE method are:
- To identify geographic areas most likely to contain key HIV transmission networks;
- To assess HIV prevention program coverage among groups most likely to acquire and transmit HIV; and
- To provide specific actionable recommendations to address critical gaps in prevention programming.
The PLACE method was developed in 1999 and piloted tested in South Africa. Since then, the protocol has been implemented in Tanzania, Uganda, Zambia, Burkina Faso, Ghana, Madagascar, Malawi, Zimbabwe, India, Mexico, Jamaica, Russia, St Lucia, Haiti, Kazakhstan, Kyrgyzstan and Uzbekistan.
The Five Steps of the method are:
Step 1) A national PLACE Steering Committee reviews the HIV epidemic and identifies Priority Prevention Areas (PPAs) where HIV prevention needs are most acute.
Step 2) Local PLACE committees within each PPA take charge of local PLACE implementation. Interviewers conduct short surveys of 300-500 community informants to identify all local public venues (such as hotels, hostels, parks and bars) where people meet new sexual partners and where IDUs socialize. The focus is on venues where people meet new sexual partners and IDUs socialize because reaching persons with a high rate of new sexual or needle-sharing partnerships who have a disproportionate role in local HIV epidemics is critical for prevention programs.
Step 3) Trained interviewers visit all venues identified in Step 2 and characterize each in terms of the type of venue, the type and number of people who visit the venue (including youth, IDUs, MSM, sexworkers, and clients), the existence of any current HIV/AIDS prevention programs at the venue, and the feasibility of future on-site prevention efforts.
Step 4) A representative sample of 960 patrons is interviewed regarding their sociodemographic characteristics, their sexual and injecting drug use behaviors, and their exposure to HIV prevention programs, including HIV testing and condom promotion.
Step 5) The findings are locally analyzed and interpreted in an action plan to address prevention gaps.
Example: Samara, Russia
The Steering Committee selected Samara, Russia. 400 community informants named 320 venues where people meet new sexual partners or injecting drug users socialize. Of these, 248 were successfully located-- 48% were patronized by injecting drug users and 92% by people seeking new sexual partners. Researchers found syringes on the ground at approximately forty percent of the venues and condoms onsite only at 11%. Interviews conducted with a probability sample of 960 patrons confirmed HIV risk behaviors. Approximately 74% of the men and 68% of the women reported a new sexual partner in the past year; more than one-third reported two or more partners in the past four weeks; and about 10% of young people admitted occasional use of intravenous drugs. Based on these findings, the Steering Committee recommended that prevention efforts be broadened to include venues where youth and other individuals at risk of acquiring and transmitting HIV socialize.
The PLACE manual, including training materials, PowerPoint presentations, questionnaires, data entry templates, and Epi_info programs, can be ordered from the MEASURE Evaluation publications database.