1 / 29

A Comprehensive Evaluation of a HIV/AIDS Surveillance System Guangdong Province China, 2007

A Comprehensive Evaluation of a HIV/AIDS Surveillance System Guangdong Province China, 2007. Neha Shah, MD MPH Centers for Disease Control and Prevention Global AIDS Program March 4, 2009 2 nd HIV/AIDS Global Surveillance Conference Bangkok, Thailand. Background. Guangdong Province.

amie
Download Presentation

A Comprehensive Evaluation of a HIV/AIDS Surveillance System Guangdong Province China, 2007

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. A Comprehensive Evaluation of a HIV/AIDS Surveillance System Guangdong Province China, 2007 Neha Shah, MD MPH Centers for Disease Control and Prevention Global AIDS Program March 4, 2009 2nd HIV/AIDS Global Surveillance Conference Bangkok, Thailand

  2. Background

  3. Guangdong Province • Population: 75.6 million • As of 2006* • Cumulative number HIV/AIDS cases: 17,978 • 5,180 new HIV/AIDS case • 35% new cases in those between 15-29 * 2007 Evaluation of the Guangdong HIV/AIDS Surveillance System, China

  4. ObjectivesEvaluation Design

  5. Presentation Objectives • Review a surveillance evaluation the Guangdong province’s HIV surveillance system using the US CDC MMWR recommended guidelines • To provide lessons learned for conducting future surveillance evaluations

  6. Evaluation Design • Review of protocols and reports • Review of data • Direct observation • Visits to sentinel and case reporting sites • Visits to laboratories • Consultation with stakeholders • National Center for AIDS Prevention and Control • China CDC • GAP China office • Provincial, prefectural, county, and district CDCs

  7. Description of Surveillance System

  8. HIV Surveillance System Components • Sentinel surveillance • Behavioral surveillance • Special studies • Case-based reporting • Laboratory testing

  9. Sentinel Surveillance • 16 national and 49 provincial sites • Target population • Commercial sex worker • Drug user • Sexually transmitted infections • Antenatal clinics • Collected annually

  10. Comprehensive Behavioral Surveillance • 6 national sites • Target population • Same as sentinel surveillance • Includes young students • Collected annually except for student – every 2 years

  11. Special Studies • Conducted in 2003, 2005 and 2006 • Target populations • MSM, CSW, DU • Community-based sampling: snowball, convenience and RDS

  12. Case-Based Reporting • Initiated in 1986 • Web-based system initiated in 2004 • Allows real-time monitoring of HIV trends

  13. Laboratory Testing • 521 screening labs • 12 confirmatory sites

  14. Surveillance Evaluation

  15. Usefulness • Overall system somewhat useful • Aspects that are useful • Provides trends in new diagnosis of HIV cases • Provides geographic analysis of HIV positive cases • Aspect not useful: limited data on migrant population (22.6% of all HIV cases reported up until 2006)

  16. Simplicity • System somewhat simple • Aspects that are simple • Data entry and access to system • Simple data analysis • Aspects that are complex • Data collection and flow • Lab algorithm

  17. Data Flow for Case-Based Reporting System(per protocol) at site, informed consent and blood sample given by patient blood sent to screening lab + test sent to confirmatory lab results reported back to screening lab level case reported onto web- based system at screening lab local site contacted by CDC

  18. site where initial blood collected informed of + test demographic data collected by staff at initial site of blood collection data sent to local CDC data sent to preventive medicine department Data Flow for Case-Based Reporting System(en vivo) informed consent and blood sample given by patient blood sent to screening lab + test sent to confirmatory lab results reported back to screening lab level case reported onto web based system local site contacted by CDC

  19. [+] [-] Screening Lab or Center: Assay 2 & 3 (parallel) [+/+] [-/-] [+/-] Report as Negative Confirmatory Lab: Western Blot Indeterminate Follow-up Report as Positive [-] [+] HIV Testing Algorithm(per protocol) Screening Lab: Assay 1 (singlet) Source: 2004 National Guideline for Detection of HIV/AIDS, China CDC.

  20. HIV Testing Algorithm(en vivo) [+,+] [+,-] [-,-] Screening Center/Lab: Assay 3 &/or 4 (parallel) [+,- ] [+,+] [-,-] Confirmatory Lab: Assay 5 & 6 (parallel) [+,+] [+,- ] Confirmatory Lab: Western Blot Report as Negative Indeterminate Follow-up Report as Positive [+] [-] Screening Lab: Assay 1 & 2 (parallel)

  21. Flexibility • System is flexible • Other systems can be incorporated in web-based system • Addition more surveillance sites • Addition more screening labs • Data forms have been revised • However, sentinel sites and questionnaires too flexible decreasing ability to trend data

  22. Data Quality • Data quality is poor • Deletion of cases without documentation or notification • All data aggregated • No dual entry and limited checking of data • Little supervision or training • Data completeness varies by site • No algorithm for transmission category • 55.7% cases with unknown mode of transmission

  23. Acceptability • System acceptable • Ethical concerns • Informed consent may not be obtained • Names able to be viewed easily • Lab specimens have personal identifiers

  24. Representativeness • Poor representativeness • Potential misclassification of risk category • Institution-based sampling • Sample size concerns

  25. ConclusionsLessons Learned

  26. Conclusions • Highlighted gaps in data • Identified next steps for improving surveillance system • Review of national protocol for regional surveillance staff • Provided feedback to national level • Formally published results for funding allocation

  27. Lessons Learned • Engage stakeholders early • Review documents and data collection tools • Speak with study staff directly • Laboratory personnel key component • Visit as many surveillance sites as possible • If possible • Look at raw data • Watch surveillance being conducted • Include surveillance staff in evaluation and discuss findings as evaluation proceeds

  28. GAP Atlanta Dr Andrea Kim Dr Theresa Diaz Mi Chen, MS GAP China Dr. Jinkou Zhao Wang Bin, MS Liu Jie,MPH Guandong CDC Dr. Zhang Yurun Dr. Liu Yong Ying Wang Ye Wang Liyan Dr. Li Jie Dr. Yan Xingge Dr. Yu Guolong Dr. Peng Lin National Center for AIDS/STD Control and Prevention Dr. Xing Gao Dr. Qu Shuquan Dr. Wang Yanhe Guangzhou STI Clinic Dr. Zhang Dr. Ye Dr. Xu Huifang Ms. Chao Guangzhou CDC Ms. Xu Huifang Mr. Wu Fengming Mr. Xu Jianfeng Ms. Yu Huazhen Ms. Zhong Fei Mr. Qin Faju Mr. Li Zherong Mr.Zhao Yuteng Fushan CDC Chen Shuhua Liao Huadong Gong Yanhua Zhang Ming Dr. Muo Yingying Acknowledgements Shunde CDC Guangming Tan Chen Guoxiong Ma Jianqiang Chao Fupeng Zuo Fan Maternal and Infant Hospital of Guangzhou Ms. Gao Xiaoxing Ms. Yang Hongling Ms. Guo Caijiao Ms. Xie Qingshan Ms. Zhang ruifang Ms. Zhang Huiping Mr. Li Mingqing00

  29. Thanks!

More Related