Annual HIV Epidemiologic Profile

Annual HIV Epidemiologic Profile

The Annual Epidemiologic Profile (Epi Profile) describes the HIV epidemic in various populations in a defined geographic area. It identifies characteristics of the general population, HIV-infected populations, and non-infected (and untested) persons whose behaviours place them at risk for HIV. It consists of information gathered to describe the HIV epidemic in terms of socio-demographic, geographic, behavioural, and clinical characteristics. Data sources for preparing the Epi Profile include vital registration; HIV case surveillance; sero-prevalence surveys; behavioural surveys; population-based surveys; health facility surveys; HIV programme data. The Epi Profile serves as a source of quantitative data from which HIV prevention, care and treatment needs are identified and priorities set for a given jurisdiction. An Epi Profile is designed to:

• 
  provide a thorough description of the HIV epidemic among the various populations (overall, and sub-populations) in a geographic area
  
• 
  identify characteristics of the general population and of populations who are living with, or are at high risk for, HIV in defined geographic areas, and who need prevention or care and treatment services
  
• 
  describe the current status of the HIV epidemic in the geographic area and provide some understanding of how the epidemic may look in the future
  
• 
  provide information required to conduct needs assessments and gap analyses.
  

• 
  age group and sex
  
• 
  race/ethnicity and sex (if applicable)
  
• 
  age group and sex for geographic subunits (for example, parish, province, region), if applicable.
  

HIV-infected

population

For the most recent available calendar year (analysis by HIV, advanced HIV disease and/or AIDS), important information includes:

• 
  the number of cases diagnosed in that year
  
• 
  the number, percentage, and rates of cases by sex and race/ethnicity (if applicable)
  
• 
  the number and percentage of cases by:
  
  • 
    age group and sex
    
  • 
    risk factor/behaviour and sex.
    

For geographic areas with large numbers of cases, you should determine:

• 
  the number and percentage of cases by:
  

• 
  age group and sex
  
• 
  risk factor/behaviour and sex
  

• 
  geographic sub-unit.
  

For mortality, determine:

• 
  the number and rates of death, by age group and sex
  

• 
  the number of deaths by underlying cause among persons age 25-44.
  

For most recent five-year period, determine:

• 
  the annual number of HIV diagnoses
  
• 
  the annual advanced HIV disease diagnoses
  
• 
  the annual number of AIDS diagnoses
  
• 
  the prevalence of HIV cases
  
• 
  the annual number of deaths among persons with HIV
  
• 
  the annual number of HIV cases among perinatally exposed children
  
• 
  annual number of HIV cases among perinatally infected children.
  

At-risk

Data sources for at-risk populations include:

• 
  Behavioural Surveillance Surveys (BSS)
  
• 
  Demographic Health Surveys (DHS)
  
• 
  AIDS Indicator Surveys (AIS)
  
• 
  Behavioural Risk Factor Surveillance Surveys (BRFSS) or Risk Factor Surveillance Surveys
  
• 
  Sexually Transmitted Infections (STI) control programme
  
• 
  Tuberculosis control programme
  
• 
  Data on persons diagnosed with hepatitis infections
  
• 
  Voluntary Counselling and Testing (VCT) programmes/sites
  
• 
  HIV patient monitoring systems
  
• 
  Maternal and Child Health Programmes.
  

Direct and indirect measures of risk behaviour include:

• 
  number and type of sex partners
  
• 
  frequency of condom use
  
• 
  pregnancies amongst young girls/women
  
• 
  STI data, including:
  

• 
  syndromic surveillance data for the most recent calendar year
  
• 
  aetiologic surveillance data for the most recent calendar and trends
  

• 
  TB data, including:
  

• 
  new diagnoses
  
• 
  concurrent HIV/TB diagnoses
  

• 
  hepatitis data, including:
  

• 
  new diagnoses
  

• 
  injection drug use and needle sharing
  
• 
  HIV counselling and testing data, including:
  

• 
  total number of tests
  
• 
  number/percent positive
  
• 
  behavioural data (reason for test, etc.).
  

prevention of

mother-to-child

transmission of HIV

(PMTCT)

This section should present the number of pregnant women found to be HIV-infected and the number of HIV transmissions in children born to HIV-infected mothers.

• 
  number of women offered HIV counselling and testing
  
• 
  number of women who accepted HIV testing
  
• 
  number of women who received their results
  
• 
  number of women who tested positive for HIV
  
• 
  number of women who were referred and put on treatment for HIV
  
• 
  number of women administered NVP/AZT before and during delivery.
  

HIV patient

monitoring data
Data collected by HIV patient monitoring systems should be included in reports. Analyses should include:

• 
  cumulative number of persons who ever received HIV-related care, by age group, sex, and care site, and geographic unit
  
• 
  annual trends in the number of persons who ever received HIV-related care, by age group, gender, and care site, district, or province
  
• 
  number currently receiving HIV-related care, by age group, sex, and care site, and geographic unit
  
• 
  cumulative number of persons ever started on ART, by age group, sex, and treatment site, and geographic unit
  
• 
  annual trends in the number of persons who began ART, by age group, gender, and treatment site, district, or province
  
• 
  number currently on ART, by age group, sex, and treatment site, and geographic unit.
  

ART treatment

cohort data
The value of cohort data is to measure changes over time. Consequently, data from these cohorts should focus on annual changes in:

• 
  functional status
  
• 
  median CD4 counts or proportion of patients who had CD4 testing whose counts were > 200 cells/mm³
  
• 
  survival or number of deaths
  
• 
  trends in the number of persons in the cohort living each year
  
• 
  trends in the incidence of selected opportunistic illnesses
  

Analyses should examine trends in these outcomes in aggregate and by selected demographic characteristics, such as age group, sex, and geographic unit.

receiving HIV

care and/or

treatment

Surveys
Health facility surveys (such as service provision assessment data) give information on the services provided by different health facilities, quality of service provided, and client perceptions of the quality of service received.

Agencies
Investigate whether confidential HIV reports can be collected from programmes that routinely test for HIV, such as the military, prisoners, insurance and visa applicants and drug rehabilitation programmes.

Include recent estimates of prevalence of HIV/AIDS in your country and the region developed by CAREC, and briefly describe how such estimates were derived.
Unit 8 Exercises
Warm-up

review

discussion

Get into small groups to discuss these questions.

1. 
   Who is responsible for data analysis and reporting at each level, and what kinds of reports are generated?
   

2. 
   What was the approximate AIDS incidence in your country in the last year? Is it increasing, decreasing or remaining stable? Are the trends the same among the various age groups?
   

3. 
   Describe the types of reports that are routinely produced using surveillance data in your country.
   

4. 
   What do you think will be the effect of HIV case surveillance on the existing trends for your country?
   

Apply what

you’ve learned/

case study

Work on this case study independently.
You work in the surveillance unit of Cariba and are responsible for developing the annual HIV surveillance report. You have data from AIDS case surveillance nationwide and from a single cohort of patients who received ART in a large urban clinic. Use this information to answer the following questions.

1. 
   What data will you include in your report? Describe some of the ways you might display the data according to the source of the data.
   

Apply what you’ve learned/case study, continued

2. 
   The following table shows the AIDS case incidence rates over seven years. The rates are per 1 000 population. Use this information to develop a figure that will represent what you think are the most important aspects of these data.
   

AIDS Incidence (per 1000), 1999-2005, Cariba.

	Age group (years)
Year	15-19	20-24	>=25
1999	60	150	103
2000	75	160	118
2001	20	29	18
2002	90	155	120
2003	60	162	125
2004	50	140	120
2005	30	88	100

3. 
   What would you write in your report about these data? (That is, what is your interpretation of these data)?
   

4. 
   The following table provides information from a clinic that has been providing ART to patients for a few years. Develop a figure that displays the data and provide explanatory text to accompany the figure.
   

	2003		2004		2005
% on ART	Men	Women	Men	Women	Men	Women
	25%	30%	35%	50%	35%	60%