Warm-Up Questions: Instructions
Take five minutes now to try the Unit 1 warm-up questions in your manual.
Please do not compare answers with other participants.
Your answers will not be collected or graded.
We will review your answers at the end of the unit.
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What You Will Learn
By the end of this unit you should be able to:
describe the history of HIV and AIDS case surveillance and how changes in HIV treatments have affected surveillance recommendations and practises
describe the stages in the natural history of HIV disease that can be useful in surveillance
describe the primary purposes of conducting HIV case reporting
describe the differences between HIV case reporting and HIV sero-surveillance
list four types of HIV-related programmes that can provide data for HIV surveillance.
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HIV Case ReportingTerminology
WHO definitions:
HIV infection reporting = the reporting of all clinical stages of HIV
advanced HIV infection reporting = the reporting of advanced HIV (clinical stages 3 and 4 only) includes AIDS
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Key Stages In HIV Disease
HIV incidence
HIV prevalence
The incidence of advanced HIV disease (or AIDS)
The prevalence of advanced HIV disease (or AIDS)
Deaths from advanced HIV disease (or AIDS).
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Figure 1.1. Target points for HIV surveillance within the natural history of HIV without treatment
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HIV seroconversion
PrimaryHIV infection
Asymptomatic HIV infection
Advanced HIV disease
Death
HIV incidence
Incidence advanced HIV disease
Prevalence advanced HIV disease
HIV prevalence (all clinical stages)
Measurement of HIV Incidence
In order to know the direction of the HIV epidemic, it is important to have information on the HIV incidence:
The BED assay - a serologic test that uses a modified version of a standard HIV test
monitoring trends in HIV prevalence among the youngest age group (15-19 or 15-24 years) of women attending antenatal clinics
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Measurement Of HIV Prevalence
HIV prevalence is the number of persons living with HIV infection. includes persons with any stage of HIV disease
difficult to have a complete and accurate count of all persons infected with HIV
prevalence is often estimated
estimates can be done using a variety of data sources HIV/AIDS case reports results from surveys and special studies.
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Measurement Of Advanced HIV Disease
Obtaining an accurate and complete count of persons with advanced HIV disease/AIDS is important to:
anticipate need for medical care and other support services
obtain a measure of the success of treatment of HIV disease at earlier stages
You can count the number of persons with advanced HIV disease/AIDS through case reporting.
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Measurement Of
HIV/AIDS Mortality Deaths from AIDS have dropped dramatically in
countries where antiretroviral treatment has been widely used.
Tracking deaths from advanced HIV disease/AIDS is an important measure of the success of treatment programmes.
Understanding the proportion of deaths from HIV and the age groups most severely affected is an important measure of the magnitude of the problem.
In developing countries, reporting of AIDS deaths is highly incomplete due to the stigma associated with the disease.
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Purpose Of HIV Case Surveillance
determine the burden and impact of HIV on health services
provide information on the opportunistic infections associated with advanced HIV disease
determine the characteristics and risk factors of persons with HIV infection
determine the burden of disease attributable to HIV in the region
assess trends in HIV incidence and prevalence use data to advocate, mobilize resources, plan
programs, target prevention activities, and monitor and evaluate programs
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Table 1.1. Differences between HIV surveillance activities
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HIV sero-prevalence or HIV sero-surveillance (means the same thing)
measures the prevalence of HIV infection using serological survey methodsdoes not report on individual patients (as occurs with HIV case surveillance)
HIV infection reporting (all clinical stages)
reports all persons newly diagnosed with HIV, regardless of clinical stage or immunologic status
Advanced HIV infection (disease) reporting
reports the number of patients with clinical stages 3 and 4 or CD4 count <350
AIDS case reporting reports the number of patients with clinical stage 4 or CD4 count <200.
Replacing AIDS Case Reporting
ART has dramatically altered the natural history of HIV disease, delaying progression from early HIV disease to the advanced stages of HIV (including AIDS) and reducing HIV-related mortality.
AIDS case reporting alone can no longer provide a stable way of monitoring the HIV epidemic.
Including HIV-infected persons who have not yet developed late-stage HIV disease (advanced HIV disease/AIDS) may provide a more complete picture of the epidemic.
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Programmes With Information For Reporting
HIV care and antiretroviral treatment programmes
tuberculosis (TB) programmes programmes that provide ART to pregnant
women vital statistics registries
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How To Use Programme Data For Case Surveillance
supplement HIV case reporting data and data collected from HIV sentinel sero-surveillance
identify HIV-infected persons who should be reported to the surveillance programme
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How To Use Programme Data For Case Surveillance, Cont.
You can only use programme data for HIV case reporting if:
programmes collect and retain patient-level information methods are in place or developed to record cases that
have been reported programme staff are trained on how to report cases and
provided with case report forms surveillance officers provide guidance and technical
assistance in completing case report forms
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How To Use Programme Data For Case Surveillance, Cont.
In addition, case reporting is more likely to occur if surveillance officers:
meet with programme managers to discuss the importance of case surveillance, provide case report forms and training
adequately assure the security and confidentiality of case data
provide regular feedback to the healthcare workers/providers regarding the results from case surveillance
target programmes that serve the largest number of HIV-infected persons
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Warm-Up Review
Take a few minutes now to look back at your answers to the warm-up questions at the beginning of the unit.
Make any changes you want to.
We will discuss the questions and answers in a few minutes.
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Answers To Warm-Up Questions
1. What are the key differences between HIV sero-surveillance and HIV/AIDS case reporting?
• HIV sero-surveillance measures the prevalence of HIV infection using serological survey methods and does not report on individual patients.
• HIV/AIDS case reporting refers to reporting of individual patients with HIV disease, advanced HIV disease (clinical stages 3 and 4) and AIDS (clinical stage 4).
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Answers To Warm-Up Questions, Cont.
2. True or false? HIV testing of women coming in for antenatal care is a component of HIV case surveillance.
False. Sero-surveys are conducted in a blinded fashion and cases are not reported.
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Answers To Warm-Up Questions, Cont.
3. Which of the following is NOT a purpose of advanced HIV disease/AIDS case reporting?
• To determine the burden of disease attributable to advanced HIV disease in the region
• To assess trends in advanced HIV disease cases
• To provide information on the opportunistic infections associated with advanced HIV disease
• To measure HIV incidence
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Answers To Warm-Up Questions, Cont.
4. List five surveillance target points in the natural history of HIV disease.
• HIV incidence (that is, the number or rate of new HIV infections)
• HIV prevalence (that is, the number or rate of all persons living with HIV, regardless of how long they have been infected or whether or not they are aware of their infection)
• The incidence of advanced HIV disease (or AIDS)• The prevalence of advanced HIV disease (or
AIDS)• Deaths from advanced HIV disease (or AIDS)
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Answers To Warm-Up Questions, Cont.
5. List three reasons for conducting HIV case reporting.
• to capture the leading edge of the epidemic• to provide a complete count or estimate of the
number of persons with HIV infection, because AIDS case reporting does not include asymptomatic HIV-infected persons
• to measure the effectiveness of treatment programmes and other interventions
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Answers To Warm-Up Questions, Cont.
6. Which stage in the life cycle of HIV requires use of special (not routine) laboratory tests to measure?
Measuring recently acquired HIV infection—that is, HIV incidence.
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Case Study
1. You are the district surveillance officer for Yolo Republic in Afrcia. Yolo Republic has been estimated to have one of the highest prevalence levels of HIV in the region. The national AIDS control programme is interested in expanding and improving its surveillance programme and the national surveillance officer is conducting site visits to various districts to discuss ways of improving surveillance. During your meeting with the national surveillance officer, you are asked to suggest additional surveillance activities in your district that you believe could be implemented successfully. Describe what these activities would be.
Case Study, Cont.2. The national surveillance officer has indicated
that there is interest in using data collected from HIV and other care programmes for reporting of persons with advanced HIV disease. Review the worksheet you completed in your small group discussion and use this to determine the necessary steps to expand current surveillance activities. List these activities.
Unit 1 Summary
For a full understanding of the HIV epidemic, you should monitor five key stages in the course of HIV disease: HIV incidence, HIV prevalence, incidence of advanced HIV disease (and/or AIDS), prevalence of advanced HIV disease/AIDS, and deaths due to HIV disease.
HIV case reporting is conducted to obtain accurate and timely information on the burden of disease. This is necessary in order to provide and measure the impact of programmes for HIV prevention, care and treatment.
The 2006 WHO HIV surveillance recommendations call for replacing AIDS case reporting with reporting of persons with advanced HIV disease (clinical stages 3 and 4). Countries may opt to report all persons with HIV infection, regardless of their clinical stage.
Information collected as part of HIV-related programmes (tuberculosis control programmes, HIV care and antiretroviral treatment monitoring programmes, etc.) can be a source of identifying and reporting HIV-infected persons.
