The PLACE Method for Local Response to HIV Epidemics

Local epidemics are driven by unique local contexts, including sexual and injecting drug use networks. To be effective, local responses should be tailored to the local context and drivers of transmission. The PLACE method addresses the challenge of identifying and tailoring prevention programs to local epidemics. This method increases understanding of the local HIV epidemic among service delivery providers, community leaders, and other stakeholders, enabling a response tailored to the epidemic. The heart of the strategy is to identify where to reach those most likely to acquire and transmit infection, measure gaps in services to these people, and develop action plans to address the gaps. The PLACE method involves eight key steps: collecting local evidence, understanding the local epidemic, and responding with tailored prevention programs. Specifically, the method identifies areas with high HIV and sexually transmitted infections (STI) incidence using available data and epidemiologic theory. It then consults with local stakeholders to systematically identify and map venues and events where people meet new sexual or needle-sharing partners. The method assesses prevention outreach within these venues, creates coverage maps showing gaps in prevention programs, and obtains key program indicators from surveys of venue patrons and workers. The PLACE method also estimates risk behaviors and HIV and STI prevalence of persons in risk venues using new testing technologies. It builds capacity at the local level to analyze and interpret data, applies the findings to local action plans to address gaps in prevention programs, and repeats assessments to evaluate programs over time. The method has been implemented in 29 countries in over 100 target areas, with cost-sharing in almost all implementations. The PLACE method benefits people in resource-poor settings most at risk of acquiring and transmitting HIV, as well as local service delivery providers, HIV testing and treatment providers, HIV surveillance and monitoring and evaluation teams, and strategic planners at the national level. The method has been evaluated through concurrent implementation with respondent-driven sampling, repeat implementations, and comparison with the general population. The validity and reliability of the PLACE method have been confirmed through these evaluations. Information about the PLACE method is shared through webinars, peer-reviewed publications, a dedicated website, feedback sessions, and recommendations by UNAIDS and Global Fund guidelines. The method is well aligned with USAID and Global Fund priorities, and it has won a USAID Pioneer Prize for innovation in 2013. The PLACE approach reflects PEPFAR's strategy of evidence-based, mutually reinforcing biomedical, behavioral, and structural interventions.