Public health triangulation: approach and application to synthesizing data to understand national and local HIV epidemics

<p>Abstract</p> <p>Background</p> <p>Public health triangulation is a process for reviewing, synthesising and interpreting secondary data from multiple sources that bear on the same question to make public health decisions. It can be used to understand the dynamics of HIV transmission and to measure the impact of public health programs. While traditional intervention research and metaanalysis would be ideal sources of information for public health decision making, they are infrequently available, and often decisions can be based only on surveillance and survey data.</p> <p>Methods</p> <p>The process involves examination of a wide variety of data sources and both biological, behavioral and program data and seeks input from stakeholders to formulate meaningful public health questions. Finally and most importantly, it uses the results to inform public health decision-making. There are 12 discrete steps in the triangulation process, which included identification and assessment of key questions, identification of data sources, refining questions, gathering data and reports, assessing the quality of those data and reports, formulating hypotheses to explain trends in the data, corroborating or refining working hypotheses, drawing conclusions, communicating results and recommendations and taking public health action.</p> <p>Results</p> <p>Triangulation can be limited by the quality of the original data, the potentials for ecological fallacy and "data dredging" and reproducibility of results.</p> <p>Conclusions</p> <p>Nonetheless, we believe that public health triangulation allows for the interpretation of data sets that cannot be analyzed using meta-analysis and can be a helpful adjunct to surveillance, to formal public health intervention research and to monitoring and evaluation, which in turn lead to improved national strategic planning and resource allocation.</p

Monozygotic Twins Discordant for the Acquired Immunodeficiency Syndrome

• Monozygotic twin girls discordant for acquired immunodeficiency syndrome were born to parents with antibodies to human T-cell lymphotropic virus type III. One twin had clinical evidence of the syndrome with tests positive for antibody, whereas the other at the age of 3 years was clinically, serologically, and virologically normal.(AJDC 1986;140:678-679

Outcomes and Impact of HIV Prevention, ART and TB Programs in Swaziland - Early Evidence from Public Health Triangulation

<p>Introduction: Swaziland's severe HIV epidemic inspired an early national response since the late 1980s, and regular reporting of program outcomes since the onset of a national antiretroviral treatment (ART) program in 2004. We assessed effectiveness outcomes and mortality trends in relation to ART, HIV testing and counseling (HTC), tuberculosis (TB) and prevention of mother to child transmission (PMTCT).</p><p>Methods: Data triangulated include intervention coverage and outcomes according to program registries (2001-2010), hospital admissions and deaths disaggregated by age and sex (2001-2010) and population mortality estimates from the 1997 and 2007 censuses and the 2007 demographic and health survey.</p><p>Results: By 2010, ART reached 70% of the estimated number of people living with HIV/AIDS with CD4</p><p>Conclusion: Against a background of high, but stable HIV prevalence and decreasing HIV incidence, we documented early evidence of a mortality decline associated with the expanded national HIV response since 2004. Attribution of impact to specific interventions (versus natural epidemic dynamics) will require additional data from future household surveys, and improved routine (program, surveillance, and hospital) data at district level.</p>

TB and HIV co-infection rates, coverage of TB/HIV interventions, according to NTCP registry (A) and TB notifications (B).

<p>TB and HIV co-infection rates, coverage of TB/HIV interventions, according to NTCP registry (A) and TB notifications (B).</p

HIV prevalence and incidence over time.

<p>HIV prevalence and incidence over time.</p

Case fatality rates among in-patients according to hospital cause-of-death coding registered in the health management information system, in relation to Spectrum-estimated AIDS deaths, for (A) adults (aged 15+) and (B) children (aged 0-14) [32].

<p>Case fatality rates among in-patients according to hospital cause-of-death coding registered in the health management information system, in relation to Spectrum-estimated AIDS deaths, for (A) adults (aged 15+) and (B) children (aged 0-14) [32].</p

Population standardized number of hospital admissions for (A) females and (B) males aged 15-49 and population standardized number of hospital deaths for (C) females and (D) males aged 15-49.

<p>Population standardized number of hospital admissions for (A) females and (B) males aged 15-49 and population standardized number of hospital deaths for (C) females and (D) males aged 15-49.</p

Uptake of HIV testing and counseling (A) and (B) estimated numbers of PLWH [32], according to ART eligibility/need of actual enrolment on ART, at the end of every year.

<p>Uptake of HIV testing and counseling (A) and (B) estimated numbers of PLWH [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0069437#B32" target="_blank">32</a>], according to ART eligibility/need of actual enrolment on ART, at the end of every year.</p