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Components of STI Surveillance Systems – in detail



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Components of STI Surveillance Systems – in detail


Universal STI Reporting

Types of

reports used

In universal reporting, minimal data elements about STIs are collected from all health facilities in the country. The minimum data include information such as STI syndrome or aetiology by age group and gender.


Advantages and

disadvantages

The advantages and disadvantages of universal reporting for STIs are outlined in Table 6.5

Table 6.5. Advantages and disadvantages of universal STI reporting.




Advantages

Disadvantages


  • It is the most readily available source of STI surveillance data.

  • It provides data that are easy to collect from health facilities.

  • It provides data on the burden of STIs at the health facility level, important for planning health services.

  • When consistent, it can be used to track population-level STIs trends.

  • It is based on recognition of symptoms and thus provides a poor assessment of the true disease burden among women (compared with men, STIs are more often asymptomatic in women).

  • It does not provide a direct estimate of the population burden of STIs because people with asymptomatic infection do not realise they are infected, so they do not seek care.

  • It is affected by fluctuations in health-seeking behaviours of the population not related to the burden of disease (for example, availability of drugs or introduction of user fees at clinics).

Discussing

the table

Look at Table 6.5 and answer the following questions:




  1. Why does universal reporting provide poor assessment of disease burden among women?



  1. Does universal reporting provide a direct estimate of the population burden of STIs? Why or why not?


Prevalence Assessment and Monitoring

Definition

and terms

Here are some of the terms used in prevalence assessment and monitoring:




  • Prevalence of a disease or infection—the proportion of people in a population who have the disease or infection at a specified time.




  • Prevalence monitoring—following prevalence trends over time to see if they are increasing or decreasing.




  • STI prevalence assessment and monitoring—using surveys to determine what percentage or how many people have STIs when compared to the total population.


Prevalence assessment is a major component of STI surveillance. This core surveillance function is similar to HIV sero-prevalence surveys, and includes collecting blood or urine for identification of STIs as well as basic demographic information about the person tested.
Information obtained through prevalence assessments can be used to understand which groups are at greater risk for infection or resistance. Assessments determine demographic information about populations at risk. This information is used to describe a population. When prevalence and trends are identified, appropriate treatment can be planned.
Prevalence assessments are usually planned at the national level as one of the following:

The STIs that can be included in surveys are:




  • syphilis

  • gonorrhoea

  • chlamydia

  • Herpes simplex virus

  • hepatitis B



Objectives of

assessment and

monitoring

The main purposes of STI prevalence assessment and monitoring are to:




  • identify population sub-groups with high prevalence of STIs

  • monitor trends in STI prevalence among defined populations.

Prevalence assessments are used in various situations:




  • In prevalence assessment and monitoring, interventions (such as screening and treatment) are part of the surveillance activity.

  • Prevalence assessment may also be performed as part of a study. These studies are designed to obtain data for programme planning.

  • Often, STI prevalence is monitored in routinely screened, defined populations. For example, women are routinely screened for syphilis during antenatal care or delivery. The main purpose of screening at antenatal clinics is detection and treatment of STIs. Determination of prevalence is not the main goal.

Programme

planning

STI prevalence data are of great use in HIV and STI programme planning, management and evaluation. They are used to:




  • develop national estimates of STIs

  • identify population sub-groups at high risk for HIV infection (as evidenced by high rates of STIs)

  • guide funding and resource allocation for STI and HIV prevention programmes

  • monitor effectiveness of STIs and HIV prevention programmes

  • intervene in the transmission of STIs through screening and treatment.

Prevalence trends may be altered by changes in the population being screened for several reasons:




  • different types of clinics; for example, an STI clinic may get different results than a clinic serving the general population

  • change in the population's health-seeking behaviour

  • change in criteria used to select persons for screening

  • change in diagnostic tests, especially for chlamydia, which often vary in sensitivity and specificity.

Any changes should be recorded and taken into account in the interpretation of trend data.





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