HSH705 Needs Assessment and Health Program Planning

1. 1. Discuss the various needs assessment tools that you will use to gather information on you target population and health issue.
   2. Specify who exactly you will speak to, the types of tools you will use, the sample number you need for each.
   3. Provide an summary for each tool of what kinds of questions you will ask or information that you want to gather
   4. Create a simple table to capture this, in addition to writing up the information in paragraphs.
2. Draft and test one needs assessment tool (either a short 10 question quantitative survey or 6 question individual interview guide)
   1. Specify who you are gathering information on
   2. Specify what it is that you are trying to find out exactly
   3. Draft the questions
   4. Test the questions on a colleague or friend to see how they work (the person will have to role play!)
   5. Make revisions to the questionnaire.

AIDS or acquired immunodeficiency syndrome is a series of devastating infections that are caused by the HIV or the human immunodeficiency virus. It is a retrovirus, which attacks and kills the white blood cells, which are essential to the body's immune system. In the 21^st century, still no cure has been formulated for this devastating and frightening disease present in the world. AIDS and HIV continue to affect million lives around the world. The principal modes of transmission are through perinatal transmission, sexual contact or blood transfusion. The brutal circle of drug abuse has engulfed India. The number of addicts is increasing every day. Drug abuse started off among the high-income group youth. Presently, it has crossed social boundaries and permeated to every section of the society (Hser et al. 2016). The target population selected for this study is drug abusers from North India.

According to the World Health Organization, HIV has claimed more than 35 million lives till date. Globally, 1.0 million people died from HIV and its related factors in 2016. At the end of last year, there were 36.7 million HIV patients and 1.8 million newly infected patients. 43% children and 54% adult with HIV currently receive antiretroviral therapy (ART). Statistics state that the WHO African Region is most affected, with 25.6 million AIDS patients (Shisana et al. 2014). It accounts for two thirds of new global HIV infections. Around 25.5 million people living with HIV live in sub-Saharan African regions. Majority of them (an estimated 19 million) live in south and east Africa. 40% of all HIV patients are not aware of being infected.

Between 2000 and 2016, the rates of HIV infections reduced by 39%. HIV related deaths lowered by one third of the population and 13.1 million people were saved due to ART. The different HIV programs formulated by health organizations and governments helped in this achievement. According to the UNAIDS gap report 2016, the prevalence of HIV epidemic is third largest in India (Naco.gov.in, 2017). When compared to other middle-income countries, this value looks small. However, owing to India's large population, the value amounts to 2.1 million HIV patients. Recently, there has been a 32% decline in new HIV cases (86,000 in 2015), and a 54% decline in AIDS-related deaths between 2007 and 2015. As per the India HIV Estimation 2015 report, HIV prevalence in adults (15–49 years) was approximately 0.26% in 2015 (Naco.gov.in, 2017)). There was 0.22% prevalence among females and 0.30% among males.

India has recently witnessed a massive increase in drug hauls over the past five years according to data released by various reports. India acts like a prime target for illegal drug consumption according to the World Drug Report. Recent data suggest that more than 10.7 million people are drug users in the country. The demographics are represented by the WHO reports (as shown in Figure 3). Drug menace is a matter of concern in North India. The 2015 Punjab Opioid Dependence Survey found 230,000 drug users in the state (Pal et al. 2015). It was conducted between February and April. This amount equates to around 836 drug addicts per 100,000 people. Key populations who are at an increased risk of HIV include homosexual men, drug addicts, prisoners, sex workers and their consumers, and transgender people. These statistics show that there is a need of HIV assessment in the northern part of the country.

Review of two need assessment plans

Tools used- Needs assessment is the procedure of identification, analysis and prioritization of the needs of a target population. These plans help in determining the capacity of the target population in addressing the health issues. This part of the report will describe different aspects of two such plans (Warren et al. 2014). The first is capacity building needs assessment, in the context of IDU interventions in India. The second plan is the need assessment report: integrated HIV prevention in Forth Valley.

The IDU survey in India tried to understand capacity building needs and gaps of health service providers like managers, monitors and implementers related to IDU HIV prevention needs, throughout the country. This survey explored and documented the capacity of existing systems and tools related to IDU. It focused on a thorough analysis or review of the capacity tools, which already existed like training modules. The data was collected and analyzed by conducting an email survey among IDU staff, officers and monitoring staff. Semi structured questionnaires were developed and drafted for specific category during primary data collection. Peer review analysis was followed for these questionnaires and they were finalized after thorough discussion with stakeholders.

This survey encompassed questions built on series of essential themes that are associated with proper functioning of IDU. It included questions on basic drug addiction knowledge and HIV, reduction in harm, conducting management strategies, exchange of syringe, distribution of condoms and providing primary healthcare facilities. This survey did not collect data from individuals but questioned a representative of organization who was well acquainted with the functioning of IDU. All states were represented in the survey by sending questionnaires to the health organizations in all geographical regions of the country. 106 IDU targeted interventions were sent these surveys and the basis of selection was based purely on the prevalence of HIV in the different regions. The collected data was analyzed qualitatively and statistically to formulate recommendations for prevention of HIV.

The second assessment plan was conducted by to collect information from healthcare providers and service clients (patients) from different parts of the country, compare them and to implement the results in a model that will lead to efficient HIV prevention in the area. The epidemiology of HIV was studied from previous reports and research articles, professionals were consulted locally and in other areas. These professionals comprised of staff in government organizations, local authorities and healthcare service providers of voluntary organizations. Discussion with patients or client groups was carried out to identify their needs. The patients primarily represented the African community and homosexual (owing to the prevalence of HIV in them). A questionnaire was designed for the client groups which required information on the sexuality, gender, age, ethnicity, presence of steady sex partner, homosexuality, venue of meeting their partners and history of previous HIV tests. New findings were discussed with professionals and the findings were circulated. This was done to ensure successful implementation of the interventions.

Some of the key findings from the Forth Valley need assessment plan are mentioned The findings from the two reports led to the development of several recommendations. It was summarized that capacity building assessments need to be strengthened for better response from clients. Several management issues like resource allocation, provision of more staff, expertise and training experience in staff needed immediate attention. There should be regular update of the training materials and the staff should be attracted towards training programs by designing innovative mechanisms. Proper technical assistance must be provided to effectively deliver and implement the services. Certain thematic areas like management of drug overdose, female IDU, abscess management and availability of training and resource material in local languages needed more attention.

Need assessment tools for target population

• Short questionnaires- It will reach large number of participants in a short time with minimum cost incurred and minimum staff. It will mainly focus on substance abuse respondents from the northern states of India. Participants from the age group of 20-45 will be mainly spoken to (Bhana et al. 2015). These surveys will collect information on the different drugs used by them, the predominance of use, effects of these drugs on sexual acts and whether they use disposable needles or share them with peers.
• Face to face interviews- Though, this tool is time consuming and tedious, it will allow the interviewer to build a rapport with the participant. These interviews will be carried out in rehabilitation or healthcare centers where drug addicts have come for HIV diagnosis (Adebajo et al. 2014).
• Telephonic interview- These will provide better results compared to the previous two tools. Respondents will not feel embarrassed to talk about their sexual orientation, partners, prevalence of STDs and use of protection during such acts (Béhanzin et al. 2013).
• Multistep surveys- The respondents will be presented with questionnaires on more than one occasion. The data collected in first instance will be analyzed and they will be further subjected to specific questions based on their responses to the first survey until a consensus is reached. Questions will be based on their ethnicity, religious views, first exposure to drugs, reason for addiction, knowledge on HIV and AIDS (Hagan et al. 2015). This tool can be analyzed in community forums where people from the priority population of drug addicts can be invited. The primary goal of these tools is to construct a health program, which if implemented properly can prevent the prevalence of HIV among the drug addicts in North India.

Drafting of survey

A 6 question interview was drafted to study the behavior, associated risk factors and response of drug addicts, diagnosed HIV positive from North India owing to the prevalence of drug addiction in the region. This interview was pretested on a friend who role played. After pretesting, certain questions were added to the survey with the aim of utilizing better responses to improve HIV prevention services. The questions which had been added later on have been highlighted.

A major component of the study involved creating HIV services inventory. It intends to gather specific information about the staff and services at HIV centers. Community workers can play an important role in providing these services, which can prevent HIV in drug addicts in the target population.

Conclusion

This need assessment study on HIV infection among two different populations provides direct evidence on the services that need to be focused on while implementing the services in North Indian population of drug addicts. The report elaborates the different tools that are utilized in assessing the prevalence of HIV in a population. It can be concluded from the report that, HIV has been inextricably linked to drug addiction since the beginning. Several key services need to be followed for preventing the incidence of the disease among drug users in the target population.

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