2005 Behavioral and Biological Surveillance Study – Albania
This report presents the results of the 2005 Behavioral and Biological Surveillance Study (Bio-BSS) conducted in Tirana, the first such study conducted in Albania. The survey collected data from three groups: injecting drug users (IDUs), men who have sex with men (MSM), and the Roma. Survey data were also collected from the general Albanian population (hereafter termed general population) to compare with data from the Roma sample.
The Bio-BSS was implemented with financial support from the Albania mission of the US Agency for International Development (USAID/Albania). A survey working group, consisting of members of the Institute of Public Health (IPH), Institute of Public Opinion Studies, USAID, The Synergy Project, and Family Health International (FHI), was formed to design and manage surveillance activities. FHI and The Synergy Project provided technical assistance for the design, implementation, and analysis of the Bio-BSS and for this report. The overall goal of the Bio-BSS was to establish a second-generation national behavioral and biological surveillance system for HIV.
The general objectives of the Bio-BSS were to
• provide baseline measurements of key behavioral and biological indicators for
high-risk and vulnerable groups in Albania, including correlations between risk
behaviors and exposure to specific sexually transmitted infections
• enhance national capacity to maintain surveillance as part of the national AIDS
• conduct analyses to inform national HIV-prevention program planning in Albania
Before starting the Bio-BSS, approval was obtained from the Albanian Medical Ethics Committee and from FHI’s Protection of Human Subjects Committee. Respondent-driven sampling (RDS) was used to recruit IDU and MSM participants. RDS is a modified form of snowball sampling that allows researchers to recruit highly stigmatized groups who do not congregate in known locations. RDS not only provides a probability method for achieving a desired sample size, but also allows the study team to identify networks and the characteristics of people within these networks. Thus, the data from the RDS samples allow inferences to be made about the characteristics of larger networks of IDUs and MSM in Tirana.
Standard household-cluster sampling techniques were used for the Roma and the general population. First, the Bio-BSS team updated and verified existing IPH maps of Roma neighborhoods. Then three Roma settlements (each representing a cluster) were randomly selected from 11 mapped settlements and a random sampling method was used to select specific households within these settlements. One male and one female between the ages of 18 and 49 were randomly selected from each household to participate in the study. Table ES-1 presents the projected (desired) and achieved sample size for each of the study populations.
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