Cote d'Ivoire's HIV prevalence rate continues to be reported as the highest in the West African region, at an estimated 7% among adults. To date, information on the epidemic has been limited to data collected on pregnant women and high-risk groups. Since September 2002, Cote d'Ivoire has experienced a profound political-military and economic crisis with an uncertain but anticipated exacerbating impact on HIV transmission. In order to better understand the current epidemiology of HIV/AIDS in this crisis environment, the Ivorian national authorities prioritized the implementation of a nationwide population-based AIDS Indicator Survey (AIS). As a result of Emergency Plan financial support and technical assistance, the data-collection phase of the nationwide AIS was successfully completed, despite the difficult conditions that prevailed in 2005.
Sporadic military hostilities gave way to a tense, unpredictable standoff when the AIS was launched in September 2004. Implementation of the survey required overcoming serious obstacles presented by the political-military crisis, which had divided the country into three zones, only one of which was fully controlled by government forces. The challenge of coordinating the implementation of a nationally representative high quality survey in such an environment was assured by an AIS Steering Committee, comprised of host country entities and international partners, with technical leadership provided by a PEPFAR implementing partner. Mapping for sampling and training in data and blood sample collection were completed in the first quarter of 2005, despite large-scale political demonstrations and violence. PEPFAR provided support for in all technical aspects of the survey, including preparation of questionnaires and manuals, training, data processing, and tabulation and analysis plans, even in the northern region where security agents had to be deployed with the technical experts to ensure safe passage.
Data and dry blood spot collection were successfully carried out nationwide between August 4 and October 20, 2005. Analysis of data from the field implementation of the survey is continuing. Despite ongoing tensions and the lack of unified leadership in the country, the response rate of the population in all three zones (government-controlled, rebel-controlled and buffer) was very high. All data were compiled and entered in the database in Abidjan, completing part of the AIS, for which the crisis conditions increased both the price tag and payoff in experience and knowledge gained.
Little is known about the dynamics of HIV/AIDS in crisis conditions, and yet such conditions are fairly common among those countries and populations most affected. The Cote d'Ivoire AIS, which could not have been implemented without Emergency Plan support, will provide high-quality information from such a setting. These data will be invaluable, informing USG HIV/AIDS programming and ensuring cost-effective use of Emergency Plan funding to mitigate the impact of the disease on highly vulnerable populations.
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