Finding HIV/AIDS iNformation and dEMOgraphic data: Numerators and Denominators Timothy Fowler Peter Johnson Loraine West Population Division Presentation for the Global Health Mini-University, USAID October 8,

U.S. Census Bureau Tools HIV/AIDS Surveillance Data Base Sample Vital Registration with Verbal Autopsy (SAVVY) International Data Base (IDB) 2

Population: 22.1 million* 11 Provinces 128 Districts Urban areas concentrated in the south 2007 (Dec. 31) Adult HIV prevalence: 12.5 %** Background *Source: * U.S. Census Bureau, International Data Base, 2010 ** UNAIDS, 2008

HIV/AIDS Surveillance Data Base Health Studies Branch Population Division 4

5 What Is the HIV/AIDS Surveillance Data Base? Developed in 1987 Cumulative compilation of data from developing countries HIV prevalence HIV incidence Updated yearly Most complete HIV seroprevalence database Supported by USAID Current size 129,698 data records over 10,300 sources

6 Sources of Data Regional and international HIV/AIDS conferences Country sentinel surveillance reports Population-based surveys with HIV testing Journal articles Newspaper articles Unpublished manuscripts

7 Specific Applications Regional/country workshops USAID Issue-related reports Program managers UNAIDS/WHO Collaborate with UNAIDS and WHO in production of global and country HIV prevalence and incidence estimates and projections Provide data for WHO Country Epidemiological Fact Sheets

8 Dissemination of Data Base Currently on CD-ROM (December 2009) 850 subscribers 1,000 CD-ROMs distributed at the XVIII th International AIDS Conference in Vienna, Austria, July 2010 Interactive version available online at

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15 Eurasia Branch Population Division SAVVY Sample Vital Registration with Verbal Autopsy

16 SAVVY is a collaboration of MEASURE Evaluation U.S. Census Bureau

17 SAVVY A sample demographic and mortality surveillance system built around vital events monitoring Purpose is to provide improved monitoring and measurement of vital events Components of SAVVY may be used in conjunction with censuses and surveys to ascertain mortality rates and cause of death

18 Demographic Surveillance Complete and continuous enumeration of vital events and migrations within a geographically defined population –Baseline census followed by periodic update rounds –Provides accurate denominators for rates and sampling frames for nested surveys

19 Mortality Surveillance Deaths reported and followed-up with a verbal autopsy interview Purpose of verbal autopsy is to describe the cause structure of mortality at the community or population level, not intended to diagnose cause of death at the individual level

20 Verbal Autopsy Structured interview of caregiver soliciting information on signs and symptoms during the final illness, medical history, and history of injury or accident Verbal autopsy questionnaire based on new WHO international standard Verbal autopsy forms are reviewed by trained doctors, who code cause of death to ICD-10

21 SAVVY Toolkit Prototype questionnaires – baseline census, census update, and verbal autopsy (<28 days, 28 days – 14 years, 15 years and older) Manuals covering all aspects of system CSPro coded data processing evaluation-systems/savvy/

Mozambique Post-Census Mortality Survey Implementing a mortality survey linked to the 2007 population census was viewed as a way to obtain critical information to better guide planning and priority setting for health services at the national and provincial levels. 22

Overview of Mozambique Post- Census Mortality Survey To our knowledge, first time a mortality survey has been linked to a national census Implemented and led by the National Institute of Statistics and Ministry of Health Designed to identify causes of death at the national and provincial levels by using SAVVY tools in conjunction with the 2007 census 23

Funding of Post-Census Mortality Survey PEPFAR (USAID)……...…$2.5 million UNICEF…………..…......…$0.35 million Technical assistance provided by MEASURE Evaluation, U.S. Census Bureau, and the Centers for Disease Control (Mozambique) 24

25 95% Confidence Intervals Represented

26 Source: Mozambique Post-Census Mortality Survey

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What was Gained from the Post- Census Mortality Survey? Detailed mortality data set based on more than 10,000 deaths –Representative at the national, urban/rural, and provincial levels Mortality rates by age and sex Leading causes of death by age and sex Utilization of health services and place of death Sample is a building block for an ongoing mortality surveillance system 28

Policy Relevance of Survey Results Provide national mortality estimates for Ministry of Health budgeting and planning –Serve as a baseline for measuring the impact of scaled-up initiatives that aim to reduce mortality –Identify target populations and/or areas Provide indicators for national initiatives ( e.g., The President’s Malaria Initiative; PEPFAR) and international initiatives (e.g., Millenium Development Goal Indicators; and Poverty Reduction Strategies Indicators) 29

International Data Base (IDB) International Programs Center for Demographic and Economic Studies Population Division 30

What is the IDB? Demographic data from the estimates and projections developed by the Census Bureau Started in the early 1980s on a mainframe Moved to PCs in the early 1990s Started on the web in 1996 One of the most popular sites on the Census Bureau website at 31

Features of the IDB Demographic data for countries or regions Tables on the internet or downloadable to Excel (XLS) or other programs (CSV) Population pyramids on the web Reflects impact of sudden events (e.g., deaths due to earthquakes, typhoons, or wars, and refugee or other mass migrations). HIV/AIDS mortality for 50 countries 32

Data Available on the IDB Every year, 1950 to 2050 –Total midyear population for 227 countries or areas Every year, base year to 2050 –Midyear population by 5-year age group –Crude birth and death rates, net migration and growth rates –Life expectancy and infant mortality rates –Age-specific fertility rates, total fertility rates, and sex ratio at birth 33

34 Sources of Data Our estimates and projections are based on: –Census and survey data from each country –Vital registration data –Other administrative records –Data from international organizations such as the United Nations High Commissioner for Refugees (UNHCR) –Other sources of information regarding the country (e.g., wars, famines, epidemics)

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46 For More Information HIV/AIDS Surveillance Data Base SAVVY (toolkit) evaluation-systems/savvy/ International Data Base (IDB)

Thank You Timothy Fowler Loraine West Peter D. Johnson 47