Unit 1, The Global HIV/AIDS Situation and the HIV/AIDS Epidemic in the Caribbean
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8
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Overview
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8
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Introduction
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9
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Trends (CAREC Surveillance data, 1982-2003)
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14
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Summary
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17
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Unit 1 Exercises
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18
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Unit 2, Biology, Transmission, Natural History, Prevention and Treatment of HIV Infection and AIDS
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20
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Overview
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20
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Introduction
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22
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Biology of HIV
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22
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HIV Transmission and Natural History
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24
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Spectrum of Disease Following HIV Infection
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33
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Prevention Transmission of HIV/AIDS
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33
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HIV/AIDS Treatment
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36
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Summary
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38
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Unit 2 Exercises
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39
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Unit 3, Overview of Public Health Surveillance
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42
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Overview
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42
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Introduction
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43
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Public Health Surveillance
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43
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Surveillance Terms
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46
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Past Approaches to Communicable Disease Surveillance
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48
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CAREC Regional Communicable Disease Surveillance System
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49
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Major Changes in the Regional Communicable Disease Surveillance System
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50
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Legal Basis
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50
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Strategic and Operational Plans
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51
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Reporting Chain
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51
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Data Transfer
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53
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Analysis and Interpretation
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53
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Dissemination of Information
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54
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Use of Data and Information
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55
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Monitoring and Evaluation
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56
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Summary
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57
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Annex 3.1. Syndromes and Communicable Diseases under Regional Surveillance
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58
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Unit 4, HIV Case Surveillance
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60
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Introduction
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60
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What is Third Generation Surveillance?
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60
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Section 4.1: HIV Case Surveillance
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65
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Table of Contents, continued
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Introduction to HIV Case Surveillance
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66
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The Relationship Between the Natural History of HIV and Surveillance
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66
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History of HIV/AIDS Case Surveillance
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69
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Sources of HIV Case Surveillance Reports
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73
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Section 4.1 Exercises
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74
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Section 4.2: Clinical Staging and Surveillance Case Definitions for HIV Infection
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76
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Introduction to Clinical Staging and Surveillance Case Definitions for HIV infection
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78
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History of Clinical Staging and HIV/AIDS Case Surveillance Definitions
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78
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Linking HIV Clinical Staging, ART Use, and HIV Case Surveillance
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83
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Section 4.2 Exercises
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85
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Section 4.3: Components of an HIV Case Surveillance System
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86
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Introduction to an HIV Case Surveillance System
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86
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Defining Reportable Events
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87
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Case Finding
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87
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Case Report Form
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92
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Unit 4 Summary
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96
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Unit 4 Case Study
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97
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Annex 4.1. WHO clinical staging of HIV/AIDS for adults and adolescents with confirmed HIV infection
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109
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Annex 4.2. Revised WHO clinical staging of HIV/AIDS for infants and children with confirmed HIV Infection
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110
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Annex 4.3. Presumptive and definitive criteria for recognising HIV/AIDS-related clinical events in HIV-infected adults and adolescents (older than 15 years)
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112
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Annex 4.4. Presumptive and definitive criteria for recognising HIV/AIDS-related clinical events in HIV-infected children
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122
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Unit 5, Monitoring Surveillance System Quality
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134
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Overview
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134
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Introduction
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135
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What Surveillance Systems Describe
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135
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Evaluating Surveillance Systems
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138
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Evaluation Process
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139
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Data Flow in the Caribbean Region
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143
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Measuring Completeness
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143
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Measuring Timeliness
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147
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Measuring Validity
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149
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Planning for Future Evaluations
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152
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Summary
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153
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Table of Contents, continued
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Unit 5 Exercises
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154
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Unit 6, Surveillance for Sexually Transmitted Infections (other than HIV)
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156
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Section 6.1: Overview of STI Surveillance
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156
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Introduction
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158
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STI Surveillance and HIV Epidemic State
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159
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STI Aetiologies versus STI Syndromes
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160
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Symptomatic and Asymptomatic STIs
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161
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Case Definitions
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163
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Components of STI Surveillance Systems
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164
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Levels of STI Surveillance - Basic, Intermediate and Advanced
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164
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Components of STI Surveillance Systems – In Detail
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167
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Universal STI Reporting
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167
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Prevalence Assessment and Monitoring
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169
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Assessing STI Syndrome Aetiologies
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171
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Behavioural and Biological Surveillance Surveys
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174
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Monitoring of Anti-Microbial Resistance of STI Pathogens
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176
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Section 6.2: Case Reporting, Data Management and Analysis
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178
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Planning Your Data Collection
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179
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Collecting Data
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180
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Entering and Analysing Data
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182
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Summary
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185
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Annex 6.1. Caribbean Epidemiology Centre Quarterly STI Reporting Form
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189
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Annex 6.2. CAREC Surveillance Case Definitions for Sexually Transmitted Infections (STIs)
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190
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Definition of STI, by Syndromes
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190
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Definitions of STI, by Aetiology
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191
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Unit 7, Confidentiality and Data Security
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196
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Overview
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196
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Introduction
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198
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Addressing Ethical Issues
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198
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Unique Identifiers—Name versus Codes: Balancing Risks and Benefits
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199
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Confidentiality
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204
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Guidelines for Confidentiality and Data Security
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204
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Guiding Principles
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205
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Policies
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206
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Responsibilities
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211
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Training
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212
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Physical Security
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213
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Table of Contents, continued
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Data Security
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216
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Data Movement
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217
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Access Control
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221
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Summary
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231
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Unit 7 Exercises
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232
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Annex 7.1. Additional Laptop Security Considerations
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234
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Annex 7.2. Additional Security and Policy Considerations
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238
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Annex 7.3. Sample Employee Confidentiality Agreement/Oath
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243
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Annex 7.4. Attachment G: Using Surveillance Data to Document Need and Initiate Referrals
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244
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Unit 8, Analysis, Interpretation, and Dissemination of HIV Surveillance Data
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256
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Overview
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258
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Introduction
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258
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Communicating HIV Data
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265
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Formats for Disseminating HIV Data
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266
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Types of Analyses
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267
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HIV Surveillance Report
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270
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Annual HIV Epidemiologic Profile
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272
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Recommended Analyses
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273
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Programme Monitoring Data
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275
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Unit 8 Exercises
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278
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Appendix A, References
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A-1
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Appendix B, Abbreviations and Glossary
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B-1
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Appendix C, Useful Links
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C-1
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Appendix D, Answers to Warm-Up Questions and Case Studies
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D-1
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Appendix E, Action Plan for Strengthening Surveillance in Caribbean Countries
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E-1
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Appendix F, Regional Surveillance Indicators and Data
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F-1
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Appendix G, Regional Reporting Requirements HIV/AIDS and STI
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G-1
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