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Purpose of an

HIV case

surveillance form

The purpose of the case surveillance form is to standardise the information that is collected on all reported HIV cases.


An HIV case surveillance form is designed to:

  • collect information that promotes understanding of HIV infection, morbidity and mortality

  • facilitate reporting an HIV case (person diagnosed with HIV)

  • define minimum variables to be collected

  • standardise collecting of variables.

Timing of HIV

case surveillance
A patient should be reported when:


  • the person is diagnosed with HIV infection, regardless of clinical status

  • an HIV patient progresses to clinical stage 3 or CD4 less than 350 (advanced HIV disease)

  • an HIV patient progresses to clinical stage 4 or CD4 less then 200 (AIDS)

  • an HIV-infected person dies.

Elements of a case

surveillance form

The elements of a case surveillance form include the following:




  1. Information for tracking of reporting

    • Date form completed (with report date)

    • Date received by national surveillance unit

    • Type of report: new or update




  1. Information concerning the person reporting the case

    • Name of reporting source facility

    • Name of person reporting the case

    • Address of person reporting the case

    • Telephone number of person reporting the case

    • Email address of person reporting the case




  1. Information concerning the diagnosis facility

    • Name of diagnosing facility

    • Facility record number

    • Address of diagnosing facility

    • Diagnosis facility type

Elements of a case surveillance form, continued


  1. Information concerning the patient

    • Patient first name*

    • Patient’s last name*

    • Patient’s maiden name, if applicable *

    • Patient’s coded identifier (if used)*

    • Date of birth* (actual or estimated)

    • Sex*

    • Current city/town of residence

    • Current country of residence

    • Country of birth

    • Current pregnancy status (for females only)

    • Current (vital) status: Alive, dead, unknown

    • Date of death, if applicable

    • Cause of death: HIV related or other/unknown




  1. Risk factors/exposures

      • Sex with males(s)

      • Sex with female(s)

      • Sex with person(s) of known HIV-positive status

      • Sex with sex worker(s)

      • Injected non-prescription drugs

      • Perinatal exposure to HIV

      • Received transfusion(s) of blood, blood products or clotting factors

      • Received a transplant of tissue or organ or artificial insemination

      • Occupational exposure while working in a healthcare setting or laboratory, or provided safety or emergency services




  1. Laboratory results

    • Type(s) of confirmatory HIV-positive test

    • Date specimen was obtained from patient*

  • Test result dates*

  • Date healthcare provider received confirmed HIV result



  1. Clinical/immunological information

    • Date of first WHO HIV clinical stage 1 or 2 diagnosis

    • Date of first WHO HIV clinical stage 3 diagnosis

    • Date of first WHO HIV clinical stage 4 diagnosis

    • Date of specimen collection for first CD4 test

    • Date of specimen collection for first CD4 count <350

    • Date of specimen collection for first CD4 count <200

* These variables are required for a case to be counted.

Completing a

case surveillance

form

Anyone who provides services to an HIV-infected patient may complete an HIV case surveillance form. HIV infected persons access diagnostic, support, care and treatment from the following facilities/programmes:




  • programmes for prevention of mother-to-child HIV transmissions

  • voluntary counselling and testing facilities

  • tuberculosis clinics

  • general health clinic

  • antenatal clinics

  • clinics for Sexually Transmitted Infections (STI)

  • private healthcare provider

  • facilities that provide antiretroviral therapy

  • laboratories

Note: Laboratories may have a different mechanism of reporting HIV cases than other health providers, and may not have access to the minimum data elements to count a case. You should establish reporting procedures mechanism with your laboratories to ensure timely reporting of HIV cases.


Modifying and

piloting the

case surveillance

form


Generic HIV case surveillance forms are shown in Appendix H. This form should be modified and piloted for use in your country, using the CAREC guidelines that specify minimum variables that must be retained in order to ensure standardisation across countries.

You must ensure that the language used in your case surveillance form is relevant to your country and that the flow and layout of the document is understandable and user-friendly.


Providing education and instructions on how to complete the surveillance form is essential to achieve accurate and standardised case surveillance.

Protection of

confidentiality

To achieve acceptance of HIV case surveillance, national and sub-national surveillance programs must ensure the confidentiality of patient information and must have the public’s trust in that confidentiality. Confidentiality is essential, not only for effective surveillance, but also to protect patients’ rights to privacy and prevent any potential for disclosure or discrimination. In addition to the potential for adverse consequences for the individual, any breach of confidentiality from the HIV surveillance registry could impact the public’s confidence in public health systems and compromise the completeness of case surveillance (See Unit 7 on Confidentiality and Data Security).



Summary


  • HIV surveillance includes a variety of activities that provide information about:

    • the number and characteristics of persons with HIV, advanced HIV disease, and AIDS

    • the impact of antiretroviral therapy

    • the impact that treatment has on HIV/AIDS-related and mortality.




  • The WHO recently revised the surveillance case definition and clinical staging system to include the following components:

    • advanced HIV disease includes clinical stages 3 and 4

    • AIDS (clinical stage 4) can continue to be reported

    • countries should move toward reporting of all HIV cases, regardless of the clinical stage.




  • Focal persons for communicable disease surveillance must be identified at each level: health facility, sub-national (if applicable) and national.




  • A standardised reporting format must be developed for use at all levels: reporting health facilities, sub-national (if applicable) and national level. Sample forms and guidelines for modification are provided in Appendix H.




  • Data should be analysed, interpreted and used at the local level for public health action, as well as at national level.




  • With expanded efforts to provide antiretroviral therapy (ART) to persons with advanced HIV disease, HIV surveillance activities can include monitoring the number of persons receiving ART and the impact of ART on morbidity and mortality.




  • Improvements in the recording of vital events provide the opportunity to document deaths caused by HIV disease.


Unit 4 Case Study
You are the new HIV programme director in Cariba. Cariba has conducted antenatal sero-surveillance for many years, and the results from those surveys have been used to estimate the HIV prevalence in the country. The prevalence in young adults in Cariba is estimated to be 3% in urban areas. HIV case surveillance has been recommended, but only a few facilities have reported HIV cases. Because of the high HIV prevalence, it is assumed that the prevalence of AIDS is also very high.
Cariba has received additional resources that are to be used for providing HIV-infected patients with ART. Because of its high prevalence, Central Province, which has a large urban area, has been selected as a site that will offer ART. The provision of ART to HIV-infected patients is co-ordinated by your colleague (Dr. MB), the clinical care co-ordinator.
To begin planning for treating patients, you set up a meeting with Dr. MB. Together you decide that the initial focus should be on conducting surveillance for persons with advanced HIV disease. How would you go about doing this?
You and Dr. MB must make decisions regarding how ART should be provided in Central Province. You both agree to follow the WHO treatment guidelines. What are the WHO criteria for initiating ART?
You and Dr. MB decide to offer ART at three clinics in Central Province and at the medical college there. How will this affect your plans for advanced HIV disease case surveillance?
What are some initial steps that should be taken prior to offering ART?
Unit 4 Case Study, continued
What are the outcomes that you think should be monitored in order to evaluate the impact that ART is having on patients with HIV?
What methods can be used to measure the impact of ART on mortality?
Five years have passed. You meet with Dr. MB to discuss producing a surveillance report. Take the following data and develop a report. You should use the data to develop figures and tables and explanatory text for each figure or table.
Data from advanced HIV disease case reporting.


Year

Number of cases

2008

450

2009

623

2010

757

2011

650

2012

576

Data from advanced HIV disease case reporting are available for three years. Reporting was from three facilities and the data obtained had more detail.



Unit 4 Case Study, continued
Facility A, Year: 2005
Total reported: 142
Sex

Male

65

Female

77


Transmission category

Mother To Child

16

Injection Drug Use




Homosexual/Bisexual




Blood Or Blood Products




Heterosexual

122

Other (Please Specify)




DNK





Clinical features

Weight loss  10% / abnormally slow growth




Chronic diarrhoea  1 month

20

Prolonged fever  1 month(intermittent or constant)

73

Persistent cough  1 month




Generalised pruritic dermatitis

15

History of herpes zoster




Oropharyngeal candidiasis




Chronic progressive or disseminated herpes simplex virus




Generalised lymphadenopathy

36

Recurrent episodes of severe pneumonia

44

Kaposi’s sarcoma




Cryptococcal meningitis




Tuberculosis

60

Invasive cervical cancer




Disabling neurologic impairments





Treatment

Antiretroviral/HAART

47

Prophylaxis

98

Anti-TB prophylaxis or treatment

53

Treatment for opportunistic infections

68


Number of deaths: 60
Unit 4 Case Study, continued
Facility A, Year: 2006
Total reported: 257
Sex

Male

125

Female

132


Transmission category

Mother To Child

12

Injection Drug Use




Homosexual/Bisexual




Blood Or Blood Products




Heterosexual

198

Other (Please Specify)




DNK

28


Clinical features

Weight loss  10% / abnormally slow growth

25

Chronic diarrhoea  1 month

42

Prolonged fever  1 month (intermittent or constant)

29

Persistent cough  1 month

11

Generalised pruritic dermatitis




History of herpes zoster




Oropharyngeal candidiasis

24

Chronic progressive or disseminated herpes simplex virus




Generalised lymphadenopathy

32

Recurrent episodes of severe pneumonia

58

Kaposi’s sarcoma




Cryptococcal meningitis




Tuberculosis

93

Invasive cervical cancer




Disabling neurologic impairments

2


Treatment

Antiretroviral/HAART

156

Prophylaxis

230

Anti-TB prophylaxis or treatment

156

Treatment for opportunistic infections

204


Number of deaths: 77

Unit 4 Case Study, continued
Facility A, Year: 2007
Total reported: 289
Sex

Male

112

Female

173


Transmission category

Mother To Child

10

Injection Drug Use




Homosexual/Bisexual




Blood Or Blood Products




Heterosexual

228

Other (Please Specify)




DNK

38


Clinical features

Weight loss  10% / abnormally slow growth

38

Chronic diarrhoea  1 month

64

Prolonged fever  1 month (intermittent or constant)

38

Persistent cough  1 month

15

Generalised pruritic dermatitis




History of herpes zoster




Oropharyngeal candidiasis

44

Chronic progressive or disseminated herpes simplex virus




Generalised lymphadenopathy

35

Recurrent episodes of severe pneumonia

78

Kaposi’s sarcoma




Cryptococcal meningitis




Tuberculosis

89

Invasive cervical cancer




Disabling neurologic impairments





Treatment

Antiretroviral/HAART

202

Prophylaxis

253

Anti-TB prophylaxis or treatment

178

Treatment for opportunistic infections

256


Number of deaths: 75
Unit 4 Case Study, continued
Facility B, Year: 2005
Total reported: 138
Sex

Male

60

Female

76


Transmission category

Mother To Child

10

Injection Drug Use




Homosexual/Bisexual




Blood Or Blood Products




Heterosexual

112

Other (Please Specify)




DNK





Clinical features

Weight loss  10% / abnormally slow growth




Chronic diarrhoea  1 month

180

Prolonged fever  1 month (intermittent or constant)

70

Persistent cough  1 month




Generalised pruritic dermatitis

8

History of herpes zoster




Oropharyngeal candidiasis




Chronic progressive or disseminated herpes simplex virus




Generalised lymphadenopathy

39

Recurrent episodes of severe pneumonia

43

Kaposi’s sarcoma




Cryptococcal meningitis




Tuberculosis

65

Invasive cervical cancer




Disabling neurologic impairments





Treatment

Antiretroviral/HAART

42

Prophylaxis

102

Anti-TB prophylaxis or treatment

50

Treatment for opportunistic infections

72


Number of deaths: 65

Unit 4 Case Study, continued



Facility B, Year: 2006
Total reported: 243
Sex

Male

96

Female

144


Transmission category

Mother To Child

10

Injection Drug Use




Homosexual/Bisexual




Blood Or Blood Products




Heterosexual

206

Other (Please Specify)




DNK

13


Clinical features

Weight loss  10% / abnormally slow growth

45

Chronic diarrhoea  1 month

52

Prolonged fever  1 month (intermittent or constant)

13

Persistent cough  1 month

21

Generalised pruritic dermatitis




History of herpes zoster




Oropharyngeal candidiasis

29

Chronic progressive or disseminated herpes simplex virus




Generalised lymphadenopathy

38

Recurrent episodes of severe pneumonia

56

Kaposi’s sarcoma




Cryptococcal meningitis




Tuberculosis

98

Invasive cervical cancer




Disabling neurologic impairments





Treatment

Antiretroviral/HAART

166

Prophylaxis

225

Anti-TB prophylaxis or treatment

158

Treatment for opportunistic infections

208


Number of deaths: 68

Unit 4 Case Study, continued



Facility B, Year: 2007
Total reported: 274
Sex

Male

12

Female

144


Transmission category

Mother To Child

9

Injection Drug Use




Homosexual/Bisexual




Blood Or Blood Products




Heterosexual

239

Other (Please Specify)




DNK

48


Clinical features

Weight loss  10% / abnormally slow growth

28

Chronic diarrhoea  1 month

75

Prolonged fever  1 month (intermittent or constant)

34

Persistent cough  1 month

26

Generalised pruritic dermatitis




History of herpes zoster




Oropharyngeal candidiasis

49

Chronic progressive or disseminated herpes simplex virus




Generalised lymphadenopathy

46

Recurrent episodes of severe pneumonia

79

Kaposi’s sarcoma




Cryptococcal meningitis




Tuberculosis

78

Invasive cervical cancer




Disabling neurologic impairments





Treatment

Antiretroviral/HAART

205

Prophylaxis

238

Anti-TB prophylaxis or treatment

157

Treatment for opportunistic infections

246


Number of deaths: 65

Unit 4 Case Study, continued



Facility C, Year: 2005
Total reported: 89
Sex

Male

43

Female

51


Transmission category

Mother To Child

6

Injection Drug Use




Homosexual/Bisexual




Blood Or Blood Products




Heterosexual

80

Other (Please Specify)




DNK





Clinical features

Weight loss  10% / abnormally slow growth




Chronic diarrhoea  1 month

16

Prolonged fever  1 month (intermittent or constant)

33

Persistent cough  1 month




Generalised pruritic dermatitis

9

History of herpes zoster




Oropharyngeal candidiasis




Chronic progressive or disseminated herpes simplex virus




Generalised lymphadenopathy

31

Recurrent episodes of severe pneumonia

39

Kaposi’s sarcoma




Cryptococcal meningitis




Tuberculosis

52

Invasive cervical cancer




Disabling neurologic impairments





Treatment

Antiretroviral/HAART

27

Prophylaxis

68

Anti-TB prophylaxis or treatment

43

Treatment for opportunistic infections

48


Number of deaths: 48

Unit 4 Case Study, continued



Facility C, Year: 2006
Total reported: 178
Sex

Male

74

Female

91


Transmission category

Mother To Child

13

Injection Drug Use




Homosexual/Bisexual




Blood Or Blood Products




Heterosexual

154

Other (Please Specify)




DNK

11


Clinical features

Weight loss  10% / abnormally slow growth

23

Chronic diarrhoea  1 month

33

Prolonged fever  1 month (intermittent or constant)

21

Persistent cough  1 month




Generalised pruritic dermatitis




History of herpes zoster




Oropharyngeal candidiasis

13

Chronic progressive or disseminated herpes simplex virus




Generalised lymphadenopathy

38

Recurrent episodes of severe pneumonia

68

Kaposi’s sarcoma




Cryptococcal meningitis

1

Tuberculosis

63

Invasive cervical cancer




Disabling neurologic impairments





Treatment

Antiretroviral/HAART

147

Prophylaxis

166

Anti-TB prophylaxis or treatment

142

Treatment for opportunistic infections

154


Number of deaths: 59

Unit 4 Case Study, continued



Facility C, Year: 2007
Total reported: 238
Sex

Male

110

Female

128


Transmission category

Mother To Child

9

Injection Drug Use




Homosexual/Bisexual




Blood Or Blood Products




Heterosexual

212

Other (Please Specify)




DNK





Clinical features

Weight loss  10% / abnormally slow growth

27

Chronic diarrhoea  1 month

53

Prolonged fever  1 month (intermittent or constant)

31

Persistent cough  1 month

9

Generalised pruritic dermatitis

2

History of herpes zoster

9

Oropharyngeal candidiasis

40

Chronic progressive or disseminated herpes simplex virus




Generalised lymphadenopathy

55

Recurrent episodes of severe pneumonia

68

Kaposi’s sarcoma




Cryptococcal meningitis




Tuberculosis

86

Invasive cervical cancer




Disabling neurologic impairments





Treatment

Antiretroviral/HAART

197

Prophylaxis

233

Anti-TB prophylaxis or treatment

165

Treatment for opportunistic infections

213


Number of deaths: 62

Unit 4 Case Study, continued

Data from routine HIV testing of TB patients. Reporting was from five sites.



Year Number of TB patients Number tested for HIV Number HIV+

2004 569 547 270

2005 479 445 238

2006 510 503 214

2007 499 489 189



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