Bio-Behavioral studies

CAI's Research, Monitoring and Evaluation Department develops and implements innovative, outcomes focused Bio-Behavioral Studies (BBS) with the purpose of assessing prevalence and trends in an epidemic that are specific to a geographic area and/or
population. BBS are designed to promote advocacy, increase awareness and support program goals.

Goal Setting and Strategic Planning

The majority of CAI's BBS work has focused on obtaining information on HIV and STI prevalence and the associated risk factors. The most important step in achieving a successful BBS is creating a strategic plan with clear goals, measurable objectives and ensuring the study's outcomes will support the project team's current efforts. Preparing for a BBS is complex, involving detailed protocol planning and development, and lengthy ethics review. CAI provides training to the study team, and works with the local PI to ensure a rigorous sampling approach prior to the study's commencement that includes establishing core indicators to measure outcomes, designing the questionnaire and submitting the core protocol to an ethics committee for review, identifying and pilot-testing the study population and methodology, and preparing a communication and data analysis plan detailing the advanced statistical methods that will be employed.

Methodology Design & Survey Piloting

CAI works with the PI and study team to identify study participants for both serological and behavioral testing. The design process begins with the team identifying the target population and tailoring the sampling strategy based on the project's feasibility, using systematic random sampling, respondent driven sampling, or convenience sampling techniques. CAI then pilot-tests the survey in the selected environment to assure questions are relevant for the specific population.

Implementation & Data Collection

During the implementation phase, CAI study teams travel to each site to assist with and manage data collection. All surveys are administered using Audio Computer Assisted Self Interview (ACASI) devises. Survey data is combined with serological results that have been collected by skilled clinicians who obtain HIV/STI serological samples from study participants. Results are validated with testing algorithms. We utilize best practices to ensure anonymity, obtain consent and provide immediate test results. Through CAI's BBS implementation process, local entities are able to develop study- specific protocols to notify HIV positive subjects of their status in the most private, confidential, and maximally sensitive manner possible. CAI ensures protocol adherence by keeping a log during implementation to track participants, flow, HIV testing, equipment and any issues that arise.

Data Analysis & Application

Following study implementation, CAI performs comprehensive statistical analyses on the serological and behavioral datasets and develops a study report. The analyses inform key study indicators (e.g. condom use among sex workers), and allows program managers to identify geographical or population hot spots, as well as gaps in awareness or access to services. Results can also help to inform programmatic strategies around questions assessed through the BBS like stigmatizing attitudes and behaviors, and aid in policy and funding decisions. Conducting BBS at midline and endline time periods, in addition to baseline, is also a useful way to track changes across indicators and measure a program's success over time.