What is Third Generation Surveillance?
Third generation surveillance seeks to answer the following questions:
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Who has the conditions?
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When did they get them?
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Where do they live?
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How have they put themselves at risk of contracting HIV and STIs?
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How many reported cases need treatment?
HIV/STI surveillance systems should be based on scientifically sound and well-known case definitions and well-established indicators for monitoring the epidemic and evaluating impact of interventions. They should also include orderly consolidation and evaluation (Quality Assurance) of data, and prompt dissemination to those who need to know.
Purpose of a
comprehensive
surveillance
system
A comprehensive HIV/STI surveillance system is one that:
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collects, analyses and publishes accurate and timely epidemiological, behavioural and care information
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monitors the spread (incidence, prevalence and underlying behaviours and factors) and the impact (health and social) of these conditions
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contributes to a better understanding of the magnitude of diseases, risk behaviours, and the care and treatment coverage for individuals suffering from these conditions
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contributes to a better understanding of the disease trends in different vulnerable groups and in different socio-economic strata and geographic areas
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provides timely and accurate data for public health planning
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supports health planners and decision-makers to plan and evaluate the impact of interventions and programmes (such as safer sex practises, reduction in incidence or prevalence of diseases, quality of care)
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enhances interventions to treat and decrease spread of infection.
The surveillance strategy should address core epidemiological, behavioural and care information systems. These systems should be responsive to the country’s data needs for priority conditions such as HIV and other STIs.
The overall aim of HIV/STI surveillance is to provide health planners and decision-makers with appropriate information to reduce spread, morbidity and mortality from HIV-infection and other STIs. This will also reduce costs associated with treatment of advanced disease, human suffering and death.
Levels of
surveillance
systems
Along with the differences between countries of the Caribbean—in population sizes, economic circumstance, geography, etc.—capacities in terms of HIV/STI surveillance differ greatly. In an effort to provide guidance and to standardise systems across member countries, CAREC has described three levels of surveillance systems—basic, intermediate and advanced. These are described in Table 4.1.
Table 4.1 Components of basic, intermediate and advanced surveillance systems.
Basic Surveillance System
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Surveillance component
|
Data source
|
HIV case surveillance
(all WHO clinical stages and deaths)
| -
Laboratories (public & private)
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Public health facilities (hospitals, health centres)
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PMTCT sites
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VCT (public, private, mobile sites)
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private physicians
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major private institutions
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hospices
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vital registration
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TB clinics, hospitals, control programmes
|
HIV sero-prevalence surveillance
| -
HIV sero-prevalence data amongst pregnant women
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Intermediate Surveillance System All the above, plus:
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Surveillance component
|
Data source
|
HIV sero-prevalence surveillance
|
High-risk groups
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Behaviour surveillance surveys/BSS
(*depending on the epidemic state and the risk groups)
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General population*
Youth*
High-risk groups
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Other
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Surveys amongst PLWHA re: quality of care, stigma and discrimination
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Advanced Surveillance System All of the above, plus:
|
Surveillance component
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Data source
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Special surveys
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HIV resistance monitoring and surveillance
Viral genotyping
Other special studies
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Section 4.1: HIV Case Surveillance
What this section
is about
This section provides an overview of the history, purpose and importance of HIV case surveillance. It explains:
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the natural history of HIV disease and the points in the course of disease that are important to monitor for surveillance purposes
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the history of case reporting and how changes in HIV testing methods and HIV treatments have affected reporting recommendations and practises
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the purpose of HIV case surveillance
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how other types of HIV programmes can provide data for surveillance purposes.
Warm-up
questions
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What are the key differences between HIV sero-surveillance and HIV case surveillance?
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True or false? Reporting of all HIV tests performed on women coming in for antenatal care is a component of AIDS case reporting.
True False
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Which of the following is NOT a purpose of advanced HIV disease/AIDS case reporting?
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Determining the burden of disease attributable to advanced HIV disease/AIDS in the region
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Assessing trends in advanced HIV disease/AIDS cases
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Providing information on the opportunistic infections associated with AIDS cases
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Measuring HIV incidence
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List four stages in the natural history of HIV disease that are target points for HIV case surveillance.
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List three reasons for conducting HIV case surveillance.
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Which stage in the life cycle of HIV requires use of special (not routine) laboratory tests?
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