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HIV/STI Surveillance for CAREC Member Countries

Participant Manual

October 2007




Acknowledgements

This pilot manual was prepared by the Caribbean Epidemiology Centre (CAREC) in collaboration with:




  • the United State Department of Health and Human Services, Centers for Disease Control and Prevention (HHS-CDC), Global AIDS Program (GAP) Surveillance Team

  • the University of California at San Francisco (UCSF), Institute for Global Health, AIDS Research Institute through the University Technical Assistance Program (UTAP) with CDC/GAP.

This workshop is sponsored by the following partners of the CAREC Special Programme on Sexually Transmitted Infections:




  • the United State Department of Health and Human Services, Centers for Disease Control and Prevention (HHS-CDC)

  • PANCAP—Global Fund and World Bank Projects

CAREC thanks the workshop participants, national epidemiologists, surveillance officers and other public health professionals from the following countries: Trinidad & Tobago, Guyana, Turks & Caicos, Anguilla, Antigua & Barbuda, Barbados, British Virgin Islands, Dominica, Grenada, Montserrat, St. Lucia, St. Kitts & Nevis.


Funding for the initial creation of this manual was provided in part by the United States Agency for International Development and PANCAP.






Table of Contents




Unit 1, The Global HIV/AIDS Situation and the HIV/AIDS Epidemic in the Caribbean

8

Overview

8

Introduction

9

Trends (CAREC Surveillance data, 1982-2003)

14

Summary

17

Unit 1 Exercises

18

Unit 2, Biology, Transmission, Natural History, Prevention and Treatment of HIV Infection and AIDS

20

Overview

20

Introduction

22

Biology of HIV

22

HIV Transmission and Natural History

24

Spectrum of Disease Following HIV Infection

33

Prevention Transmission of HIV/AIDS

33

HIV/AIDS Treatment

36

Summary

38

Unit 2 Exercises

39

Unit 3, Overview of Public Health Surveillance

42

Overview

42

Introduction

43

Public Health Surveillance

43

Surveillance Terms

46

Past Approaches to Communicable Disease Surveillance

48

CAREC Regional Communicable Disease Surveillance System

49

Major Changes in the Regional Communicable Disease Surveillance System

50

Legal Basis

50

Strategic and Operational Plans

51

Reporting Chain

51

Data Transfer

53

Analysis and Interpretation

53

Dissemination of Information

54

Use of Data and Information

55

Monitoring and Evaluation

56

Summary

57

Annex 3.1. Syndromes and Communicable Diseases under Regional Surveillance

58

Unit 4, HIV Case Surveillance

60

Introduction

60

What is Third Generation Surveillance?

60

Section 4.1: HIV Case Surveillance

65

Table of Contents, continued








Introduction to HIV Case Surveillance

66

The Relationship Between the Natural History of HIV and Surveillance

66

History of HIV/AIDS Case Surveillance

69

Sources of HIV Case Surveillance Reports

73

Section 4.1 Exercises

74

Section 4.2: Clinical Staging and Surveillance Case Definitions for HIV Infection

76

Introduction to Clinical Staging and Surveillance Case Definitions for HIV infection

78

History of Clinical Staging and HIV/AIDS Case Surveillance Definitions

78

Linking HIV Clinical Staging, ART Use, and HIV Case Surveillance

83

Section 4.2 Exercises

85

Section 4.3: Components of an HIV Case Surveillance System

86

Introduction to an HIV Case Surveillance System

86

Defining Reportable Events

87

Case Finding

87

Case Report Form

92

Unit 4 Summary

96

Unit 4 Case Study

97

Annex 4.1. WHO clinical staging of HIV/AIDS for adults and adolescents with confirmed HIV infection

109

Annex 4.2. Revised WHO clinical staging of HIV/AIDS for infants and children with confirmed HIV Infection

110

Annex 4.3. Presumptive and definitive criteria for recognising HIV/AIDS-related clinical events in HIV-infected adults and adolescents (older than 15 years)

112

Annex 4.4. Presumptive and definitive criteria for recognising HIV/AIDS-related clinical events in HIV-infected children

122

Unit 5, Monitoring Surveillance System Quality

134

Overview

134

Introduction

135

What Surveillance Systems Describe

135

Evaluating Surveillance Systems

138

Evaluation Process

139

Data Flow in the Caribbean Region

143

Measuring Completeness

143

Measuring Timeliness

147

Measuring Validity

149

Planning for Future Evaluations

152

Summary

153

Table of Contents, continued








Unit 5 Exercises

154

Unit 6, Surveillance for Sexually Transmitted Infections (other than HIV)

156

Section 6.1: Overview of STI Surveillance

156

Introduction

158

STI Surveillance and HIV Epidemic State

159

STI Aetiologies versus STI Syndromes

160

Symptomatic and Asymptomatic STIs

161

Case Definitions

163

Components of STI Surveillance Systems

164

Levels of STI Surveillance - Basic, Intermediate and Advanced

164

Components of STI Surveillance Systems – In Detail

167

Universal STI Reporting

167

Prevalence Assessment and Monitoring

169

Assessing STI Syndrome Aetiologies

171

Behavioural and Biological Surveillance Surveys

174

Monitoring of Anti-Microbial Resistance of STI Pathogens

176

Section 6.2: Case Reporting, Data Management and Analysis

178

Planning Your Data Collection

179

Collecting Data

180

Entering and Analysing Data

182

Summary

185

Annex 6.1. Caribbean Epidemiology Centre Quarterly STI Reporting Form

189

Annex 6.2. CAREC Surveillance Case Definitions for Sexually Transmitted Infections (STIs)

190

Definition of STI, by Syndromes

190

Definitions of STI, by Aetiology

191

Unit 7, Confidentiality and Data Security

196

Overview

196

Introduction

198

Addressing Ethical Issues

198

Unique Identifiers—Name versus Codes: Balancing Risks and Benefits

199

Confidentiality

204

Guidelines for Confidentiality and Data Security

204

Guiding Principles

205

Policies

206

Responsibilities

211

Training

212

Physical Security

213

Table of Contents, continued








Data Security

216

Data Movement

217

Access Control

221

Summary

231

Unit 7 Exercises

232

Annex 7.1. Additional Laptop Security Considerations

234

Annex 7.2. Additional Security and Policy Considerations

238

Annex 7.3. Sample Employee Confidentiality Agreement/Oath

243

Annex 7.4. Attachment G: Using Surveillance Data to Document Need and Initiate Referrals

244

Unit 8, Analysis, Interpretation, and Dissemination of HIV Surveillance Data

256

Overview

258

Introduction

258

Communicating HIV Data

265

Formats for Disseminating HIV Data

266

Types of Analyses

267

HIV Surveillance Report

270

Annual HIV Epidemiologic Profile

272

Recommended Analyses

273

Programme Monitoring Data

275

Unit 8 Exercises

278

Appendix A, References

A-1

Appendix B, Abbreviations and Glossary

B-1

Appendix C, Useful Links

C-1

Appendix D, Answers to Warm-Up Questions and Case Studies

D-1

Appendix E, Action Plan for Strengthening Surveillance in Caribbean Countries

E-1

Appendix F, Regional Surveillance Indicators and Data

F-1

Appendix G, Regional Reporting Requirements HIV/AIDS and STI

G-1


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