Unit 6 Answers
Warm-up
questions
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True or false? Some elements of an STI surveillance system are more important for HIV surveillance activities. Others are more important for STI control programme activities.
True False
True. For example, combined STI/HIV behavioural surveillance surveys are important for HIV surveillance, while anti-microbial resistance monitoring is more important for STI control programmes.
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True or false? STI surveillance data can serve as an indicator of trends in HIV risk behaviours.
True False
True. Because STIs and sexually transmitted HIV are transmitted the same way, trends in STI data may reflect similar trends in HIV transmission.
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True or false? Aetiologic reporting of syphilis (by stage), gonorrhoea and chlamydia is considered a basic surveillance activity in the Caribbean.
True False
False. Aetiologic reporting is only possible where well-developed systems of laboratory diagnosis exist. In some countries of the Caribbean, the use of laboratory services for diagnosis is frequently not available for routine care.
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Which of the following is not a component of an STI surveillance system?
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STI universal case reporting
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STI sentinel surveillance systems
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STI testing and treatment
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STI prevalence assessment and monitoring
While important to controlling the spread of STIs and HIV, treatment of STIs is not a component of STI surveillance activities.
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True or false? In generalised HIV epidemics, surveillance activities should include monitoring gonorrhoea and chlamydia.
True False
True. These conditions suggest recent high-risk behaviours.
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True or false? An STI surveillance system includes conditions that are newly acquired, as well as those that represent past infections.
Warm-up questions , continued
True False
True. This will help to accurately calculate prevalence and incidence.
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In aetiologic reporting, STI cases are reported by the specific microbial organism that caused the STI, while in syndromic reporting, STI cases are reported by the clinical syndrome with which the patient presents.
Aetiologic testing involves a well-developed laboratory system. Therefore, it is less common in the Caribbean region.
Case study
You are the national STI surveillance officer for the Cariba. You rely primarily on syndromic surveillance using a universal reporting system. You have noticed an increase in the number of reported cases of male non-vesicular genital ulcer disease in St. James Parish, one of five parishes in the country.
Number of reported cases of male non-vesicular genital ulcer disease by parish and year, Cariba.
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Parish
|
Year
|
1998
|
1999
|
2000
|
2001
|
2002
|
2003
|
St. Mary
|
40
|
42
|
38
|
54
|
45
|
38
|
Kingstown
|
60
|
70
|
72
|
84
|
65
|
58
|
Arima
|
47
|
50
|
42
|
40
|
41
|
39
|
St. James
|
53
|
87
|
76
|
95
|
107
|
197
|
Yotown
|
49
|
49
|
36
|
72
|
65
|
48
|
a. What are some possible causes of this increase?
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improved surveillance
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artefact
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increase in health-seeking behaviour by local population
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increase in high-risk behaviour
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immigration
Arima and Yotown, the parishes that border with St. James, are primarily rural areas, whereas St. James has an urban centre with a recently refurbished and expanded health centre.
b. Could these differences between the parishes account for the increase in STI cases in St. James?
Yes. Because of the refurbished and expanded health centre in St. James, there could be increased health-seeking behaviour in St.
Case study, continued
James. Additionally, people from Arima and Yotown could be travelling to St. James to receive care.
c. How would you investigate this?
When analysing the data, stratify analysis by region or geographical area to show if there are significant differences between places.
You examine all syphilis tests done at the clinic for one month. Because this is a sentinel site for syphilis screening as well, demographic data, including parish of residence, are available. The table below shows your findings:
Results of sentinel syphilis screening by parish of residence, Cariba.
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Parish of residence
|
Positive syphilis tests
|
Total tested
|
Percentage positive
|
Arima
|
10
|
60
|
16.7
|
St. James
|
25
|
150
|
16.7
|
Yotown
|
3
|
80
|
3.8
|
d. Calculate the prevalence by parish of residence. How could these data be used for STI control? For HIV control?
Potential uses of these STI data include:
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estimating the quantity and types of drugs required for treatment of current and future STI cases
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advocating for resources for STI care
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developing focused interventions for STIs, including HIV
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