AcknowledgementsIntroduction to an HIV Case Surveillance System
Defining Reportable Events HIV case definitions Countries should standardise HIV case definitions for surveillance purposes. All persons meeting the case definition should be reported to the national surveillance programme. See Tables 4.6 and 4.7 for the surveillance case definitions.
condition or reportable events
Once HIV case definitions are finalised, work with appropriate staff to incorporate the elements of the case definitions in to the country’s notifiable disease list. There is also a need to train healthcare staff on the reportable sentinel events for the notifiable disease. For example, all HIV-related tests could be reportable to the surveillance unit. This would include positive HIV EIA, western blots, viral load or CD4 tests. Case FindingIdentifying reporting sources
Surveillance programmes should identify reporting sources where HIV diagnosis, care and treatment occur. Reporting sources should include public and private clinics, healthcare programs, and hospitals. The following are some examples of reporting sources:
Educating providers Providers of case information should be educated regarding reporting requirements, including laws and regulations, case definitions, specific data elements, case surveillance forms, laboratory reports, and timeliness of reporting. Educating providers, continued Report sources must identify liaison(s) or contact person(s) who will be responsible for case surveillance and explain to him/her/them how the data will be used for programme planning. Disseminating surveillance data back to the providers will also assist with timely case reports. It is important to pay special attention to training providers on reportable events, how to report (case surveillance form) and what to report (the variables on the case surveillance form). It is important that providers understand all the variables on the case report form. Obtaining risk information is always challenging; developing display charts/posters can assist providers to accurately collect this critical piece of information. Ways to identify cases New cases of HIV infection are found by both passive and active surveillance. The definitions of active and passive surveillance are:
Comprehensive case (surveillance) information may be contained in documents obtained by both active and passive surveillance. For example, the surveillance office may receive an electronic laboratory report through passive reporting. However, for complete case information, surveillance office staff may contact or travel to the diagnostic or treatment facilities to obtain the additional data items not provided on laboratory reports. Laboratory- initiated reporting Identify all laboratories in your geographic area. If positive HIV EIA/WB or CD4 or viral load tests are reportable, work with the labs to develop a system where they can report cases to the surveillance unit in a confidential and timely manner. Special efforts should be made to automate systems as much as possible, so as not to cause unnecessary burden to the staff members. This will be critical to ensuring timely reporting of cases. Laboratory initiated reporting, continued There is a minimum set of information the lab should provide for each case. This set of information allows the surveillance unit to follow up with the provider to complete the case report form. These are: Following up with provider Once a positive HIV test has been reported to the surveillance unit, the surveillance officer can follow up with the provider to obtain the remaining information on the case surveillance form. Updating case information It is important to update case information through disease progression from asymptomatic infection through to advanced HIV infection, AIDS and death.
The surveillance system should be able to correctly distinguish newly reported persons from persons previously reported. Failing to properly link newly submitted case reports to previously reported cases leads to over-counting; incorrect linking of duplicate reports can result in under-counting and contamination of existing records with data from another case. Because doctors, hospitals, laboratories, and other sources may be required to report all HIV diagnoses whether or not they are newly identified, duplicate case reporting within a country may not be identified during routine case entry into the surveillance database (that is, duplicate case reports may not be readily identified as such). Eliminating duplicate reports on a regular basis is an important component of maintaining a reliable surveillance database and ensures accurate case counts at the national levels. Mandatory variables for counting a cases A minimum set of information must be available in order to count a patient as an HIV case. The mandatory variables required to count a case include:
As an HIV case may be reported from multiple sources or from the same source multiple times, having a minimum set of required information allows the national surveillance unit to accurately match an individual to his/her record and ensure that each HIV case is only counted once. This is of particular importance when a previously reported patient progresses through the stages to advanced HIV disease, AIDS and death. Identifying missed cases Missed cases can be identified from:
Reporting chain Each country must determine the reporting chain for HIV case reports. This may involve forwarding report forms from healthcare providers to a sub-national level, but ultimately HIV case reports should be sent to the national surveillance unit, where a complete database should be housed. This will allow de-duplication of cases reported from several sources, thereby giving a more accurate picture of the HIV situation for the country. At the national level, the office of the National Epidemiologist is responsible for the transmission of aggregate reports to CAREC.
responsibilities Roles and responsibilities of reporting sources:
Roles and responsibilities of the national HIV surveillance programme:
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