Optimizing the implementation of integrated biological and behavioural surveillance surveys of HIV in resource limited settings-lessons from Nepal

ObjectiveTo discuss the basic standards for HIV related integrated biological and behavioural surveillance (IBBS) survey implementation, specific challenges of survey management, and to propose brief practical guidelines for management of IBBS surveys in resource limited setting.MethodsTwo methods were used to address our study objectives: (a) a narrative review of the literature and (b) our experience as participant observer when working on IBBS survey management between July 2012 and January 2013 in Nepal.ResultsIn Nepal, IBBS surveys are conducted among key populations at higher risk of HIV such as people who inject drugs, men who have sex with men, female sex workers, seasonal male labour migrants and truckers (proxy for clients of female sex workers). The involvement of different institutions, people, and procedures makes IBBS survey management-including planning, implementation, sharing of findings and possible uses of survey findings-complicated to perform. In addition, basic survey methods and techniques including respondent driven sampling and two stage cluster sampling, are sometimes not properly performed in practice.ConclusionsThis study showed that field implementation of some standards methods such as respondent driven sampling and cluster sampling for HIV related estimate or trends used for IBBS survey could be improved. This paper described lessons learnt and may be used as a guiding reference to improve and evaluate IBBS surveys in resource-poor settings also outside of Nepal.