Integrated behavioral and biological assessment: methodological issues in social and behavioral research

The IBBA round 1 was the first large-scale probability sample survey in India that included both behavioral and biological indicators among populations most at risk of HIV transmission. The survey was conducted in six endemic states: Andhra Pradesh, Karnataka, Maharashtra, Tamil Nadu, Manipur and Nagaland and among four segments of the National Highways. The IBBA collected data on prevalence of HIV and sexually transmitted infections, HIV risk behaviour and exposure to intervention programs, in a total of more than 25,000 respondents, over a 19 month period between November 2005 and June 2007, across 29 districts in India where Avahan program for these high risk groups were implemented. The survey was implemented by the respective state Indian Council of Medical Research institutes except in Karnataka where Karnataka Health Promotion Trust was responsible for IBBA. Methodological challenges related to social and behavioral areas faced during the implementation of IBBA in various areas like co-ordination of activities and proposed time line, identification and sampling of the target groups, establishment and feed back from the community board members, proper selection and setting up of temporary clinics, maintenance of quality control for both biological and behavioral data and how these challenges were handled are discussed in this paper.