Implementing bio-behavioral surveillance HIV/AIDS studies among the latin American uniformed services: Lessons learned from the field

Issues: Members of the armed forces, at elevated risk for inconsistent access to condoms and sexual health services, are at greater risk for HIV/STI infection. As part of a regional Latin American HIV prevention effort, bio-behavioral surveillance studies (BBSS) are implemented to assess HIV prevalence and identify risk factors for HIV/STI to aid countries in programmatic and policy planning. Description: To date, a BBSS has been conducted in eight countries; 6,891 participants from both military and police forces were sampled on 103 bases; 90% were male; the average age was 28. Serological data was acquired through rapid HIV tests; behavioral data was obtained using audio computer-assisted self-interview (ACASI). Daily logs were maintained documenting observations. Lessons Learned: Facilitators to study implementation included: 1) involving high-ranked retired members within the target population to assist with study implementation and address potential political challenges, 2) conducting preliminary meetings to clarify study details and responsibilities, 3) relying on country-based experts for issues on customs, travel and accommodation to navigate local policies, and 4 ) collaborating with local project staff in disseminating results, thus bolstering their sense of contribution and study ownership. Challenges to implementation included: 1) managing the dynamics of a complex team composed of military hierarchy, local and external stakeholders, and 2) motivating voluntary troop participation in countries where knowledge and awareness of HIV is relatively low. Recommendations: While impossible to predict all obstacles that arise during international surveillance studies, using these lessons learned will assist future research endeavors in reducing implementation barriers.