title: Public health triangulation: approach and application to synthesizing data to understand national and local HIV epidemics.
abstract: BACKGROUND
  Public health triangulation is a process for reviewing, synthesising and interpreting secondary data from multiple sources that bear on the same question to make public health decisions. It can be used to understand the dynamics of HIV transmission and to measure the impact of public health programs. While traditional intervention research and meta-analysis would be ideal sources of information for public health decision making, they are infrequently available, and often decisions can be based only on surveillance and survey data.
  
  
  METHODS
  The process involves examination of a wide variety of data sources and both biological, behavioral and program data and seeks input from stakeholders to formulate meaningful public health questions. Finally and most importantly, it uses the results to inform public health decision-making. There are 12 discrete steps in the triangulation process, which included identification and assessment of key questions, identification of data sources, refining questions, gathering data and reports, assessing the quality of those data and reports, formulating hypotheses to explain trends in the data, corroborating or refining working hypotheses, drawing conclusions, communicating results and recommendations and taking public health action.
  
  
  RESULTS
  Triangulation can be limited by the quality of the original data, the potentials for ecological fallacy and "data dredging" and reproducibility of results.
  
  
  CONCLUSIONS
  Nonetheless, we believe that public health triangulation allows for the interpretation of data sets that cannot be analyzed using meta-analysis and can be a helpful adjunct to surveillance, to formal public health intervention research and to monitoring and evaluation, which in turn lead to improved national strategic planning and resource allocation.
authors.affiliation: Global Health Sciences, University of California, San Francisco, California, USA. grutherford@psg.ucsf.edu
authors.forename: George W
authors.initials: GW
authors.lastname: Rutherford
authors.forename: William
authors.initials: W
authors.lastname: McFarland
authors.forename: Hilary
authors.initials: H
authors.lastname: Spindler
authors.forename: Karen
authors.initials: K
authors.lastname: White
authors.forename: Sadhna V
authors.initials: SV
authors.lastname: Patel
authors.forename: John
authors.initials: J
authors.lastname: Aberle-Grasse
authors.forename: Keith
authors.initials: K
authors.lastname: Sabin
authors.forename: Nathan
authors.initials: N
authors.lastname: Smith
authors.forename: Stephanie
authors.initials: S
authors.lastname: Taché
authors.forename: Jesus M
authors.initials: JM
authors.lastname: Calleja-Garcia
authors.forename: Rand L
authors.initials: RL
authors.lastname: Stoneburner
mesh_terms: D004196:Disease Outbreaks; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D011159:Population Surveillance / Q000379:methods*; D011634:Public Health; D013223:Statistics as Topic / Q000379:methods*