More about PHIA

What is a Population-based HIV Impact Assessment (PHIA) survey?


PHIA are national surveys that provide a direct measurement of progress toward global targets to control the HIV epidemic in several countries. These surveys are implemented under the leadership of each country’s Ministry of Health and supported with funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).


Why are PHIA surveys being conducted?


Global targets for HIV epidemic control call for finding and diagnosing more people living with HIV, and ensuring that these individuals receive sustained treatment to become virally suppressed – which reduces HIV transmission and saves lives. These surveys are a critical part of PEPFAR’s priority to make evidence-based decisions and evaluate program impact.


What is CDC’s role in PHIA?


As a key partner in PEPFAR, CDC supports countries to effectively respond to their HIV epidemics and other global health threats, ultimately protecting Americans at home. Working with Ministries of Health, other U.S. government agencies, CDC is lending its expertise in epidemiology, laboratory science, and data analysis to help partners design and implement PHIA surveys and rapidly harness the results for program improvement. CDC developed the LAg-Avidity EIA – a simple, rapid laboratory test that can simultaneously diagnose HIV and identify if an infection is recent – that was used in the PHIA surveys to directly measure population incidence.


What are the selected PHIA countries?


Fourteen PEPFAR-supported countries, mostly in sub-Saharan Africa – the region that is most severely affected by HIV were selected for PHIA. These countries include: Cameroon, Cote d’Ivoire, Ethiopia, Haiti, Kenya, Lesotho, Malawi, Namibia, Rwanda, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe.


How are people selected to participate in the PHIA surveys?


Households visited by PHIA survey teams are randomly selected. Consenting participants are asked questions about their knowledge of HIV, testing history, awareness of their HIV status, use of HIV care and treatment services, including voluntary medical male circumcision and behavior risk factors. They also receive home-based HIV counseling and testing, including return of results. Participants have the option not to answer questions about their use of HIV care and treatment services. They can also choose to decline participation in the home-based testing and counseling. Participants can withdraw at any time after starting the survey or participating in testing and counseling.


What happens to the HIV test results once the survey is completed?


Only participants who opt to get tested and receive their results are included in the estimates of HIV prevalence, incidence, and viral suppression. Their HIV and CD4 test results are returned to them through home-based testing and counseling programs. Some countries have included non-HIV tests, such as syphilis and Hepatitis B. Viral load testing is conducted in a central laboratory, and these results are sent to the clinic specified by the participant.


How are HIV-positive participants linked to treatment?


All HIV-positive participants are provided a referral form which they could use to seek care at a health facility of their choice. Viral load test results are returned to their chosen health facility within approximately 6 to 8 weeks. When viral load results are available to be sent to clinics, the participants receive a reminder text message or phone call. HIV infected children and newly diagnosed adolescent and adult participants may receive enhanced or active referral. In some PHIA surveys, participants are contacted by a PHIA team member who helps them enroll in care at their chosen health facility, unless they prefer not to be contacted.


How will PHIA results improve our understanding of HIV epidemics?


While the PHIA results demonstrate tremendous progress against HIV epidemics by achieving high coverage particularly among women and older people, we can only truly control these epidemics by achieving higher results among men and youth as well. In all six surveys, HIV positive men under age 35 and younger women were less likely to know their status, be on HIV treatment, or be virally suppressed than older adults. These PHIA results will help inform future programs to confront the global HIV epidemic, and focus country efforts and resources for maximal impact and efficiency. The methods developed for the PHIA surveys can be a model for other countries that are conducting their own HIV-focused household surveys.


How will PHIA affect HIV programs on the ground?


Survey data measure access to and the impact of HIV prevention and treatment services, and provide data for global health and development indicators. Because the PHIA surveys include HIV data by age, gender, and location, program planners and donors will be able to maximize impact by making smarter investments to reach the right people in the right places. Additional laboratory testing will help assess transmitted and acquired drug resistance. This information is very important as we further expand treatment of HIV-positive persons in affected countries.