Module 1: Final Case Study. #1-CS-1. Case Study: Instructions. Try this case study individually. We’ll discuss the answers in class. # 1-CS-2. Answers to final case study Question 1.
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Module 1: Final Case Study
Sero-prevalence of HIV among pregnant women attending ANCs in Inyo Province 1999- 2005.
Overall, HIV prevalence was highest in 2002 and decreased between 2002 and 2005. HIV prevalence was highest among pregnant women ages 25 to 34, while lowest among pregnant women ages 15 to 19 and 40 to 44. Among pregnant women 15 to 24 and 30 to 34 years old, HIV prevalence peaked in 2001 and decreased from 2001 through 2005. Among pregnant women ages 25 to 29 and 35 to 44 years, HIV prevalence was highest in 2003 and decreased between 2003 and 2005.
When possible, components of second generation surveillance that would strengthen the province’s surveillance system would include:
Biological measures could include: HIV prevalence, STI incidence and prevalence, TB prevalence, the number of adult AIDS cases and the number of pediatric AIDS cases. Behavioural indicators could include: sex with a non-regular partner in last 12 months, condom use at last sex with a non-regular partner, age at first sex, use of unclean injecting equipment reported by drug injectors and reported number of clients in the last week by sex workers. Sociodemographic indicators could include: age, gender, socio-economic and educational status, geographic residency (urban vs. rural) or migration status, marital status and parity (for antenatal sites).
Because ART is available in Inyo province, conducting HIV surveillance through anonymous unlinked sero-surveillance presents ethical issues. If anonymous unlinked surveillance surveys are used women must have access to voluntary HIV counselling and testing with referrals for care for HIV-infected women. Case reporting and surveys conducted in conjunction with voluntary counselling and testing would diagnose individuals with HIV infection and give them their results so that if needed, they could begin ART and must present the same ethical concerns as anonymous unlinked surveys.
Missing data during sero-surveillance by site, Inyo Province
20% of HIV serologic results are missing from site 4.
There are many possible explanations, including:
Additional training session might be needed. At a minimum, the sero-prevalence coordinator should meet first with the laboratory director and then with laboratory staff to review the protocol.
Get into small groups to discuss these questions.
1. You are the regional surveillance officer for Ethiopia. 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 region that you believe could be implemented successfully. Describe what these activities would be.
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.