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(Brief) Overview of the HIV Epidemic and the National HIV/AIDS surveillance. Pasakorn Akarasewi Director, Bureau of Epidemiology Thailand Ministry of Public Health. Acknowledgement. Bureau of Epidemiology Bureau of AIDS, TB and STI National Institute of Health,DMSc

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brief overview of the hiv epidemic and the national hiv aids surveillance

(Brief) Overview of the HIV Epidemic andthe National HIV/AIDS surveillance

Pasakorn Akarasewi

Director, Bureau of Epidemiology

Thailand Ministry of Public Health

acknowledgement
Acknowledgement
  • Bureau of Epidemiology
  • Bureau of AIDS, TB and STI
  • National Institute of Health,DMSc
  • Disease Control Regional Offices -12
  • BMA and 76 Provincial Health Offices
  • Armed Force Research Institute of Medical Science (AFRIMS)
  • Thailand MOPH-US CDC Collaboration
  • People living with HIV/AIDS and local communities.
thailand health statistics
Thailand Health Statistics

WHO Report on Health Statistics, 2006

slide5

The Next Big

Things ?

Pregnant Women

Male withMultiple Partners

CommercialSex Workers

IntravenousDrug Users

Homosexual

Children

Children

1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 -2004 2005-

first aids report in thailand
First AIDS Report in Thailand
  • 28 yeas old Thai male, studied in U.S. with history of homosexual exposure
  • In 1983, he was admitted at a hospital in USA with Pneumocystis Cariniipneumonia
  • In 1984, he was referred to Thailand for continuing treatment
thailand hiv aids epidemic

Interventions

 Care and ART

 Focus on prevention

AIDS in 2 men (homosexual contacts)

Rapid spreadingamong IDUs “0%”  “30%”

Massive campaign with100% condom

Report in blood transfusion

Rapid spreading among FSW (44%)

Generalized Epidemic:Children born to HIV+ women

Thailand HIV/AIDS Epidemic

First report  Explosive Epidemic

1984

1989

1991

1987

1988

2000

2007

Concentrated epidemic (MSM, SW and IDUs)

  • 2007 AEM Estimation:
  • 14,000 new infections
  • 1,100,000 cumulative HIV+
  • 550,000 Living with HIV
early surveillance aids case reporting system
Early Surveillance….AIDS case reporting system
  • Established in 1984
  • Voluntary reporting system
  • Confidential
  • Hospital-based system
  • Passive system
  • To follow the occurrence of AIDS cases
slide9

Surveillance tools

1. รง.506/1

slide10

Provincial Health Office 75 Sites

Bangkok Metropolitan

Administration

Regional

1 - 12

Bureau of Epidemiology

Office of PermanentSecretary,Ministry of Public Health

Other Department and Bureau

Epidemiological Surveillances Network

thailand national hiv surveillance
Thailand National HIV Surveillance

RDS

HSS = HIV sentinel sero-surveillance

BSS = Behavioral surveillance

IBBS = Integrated HIV+STI and BSS

PDA = Personal Digital Assisted

TLS = Time-Location-Sampling

ARV resistance

IBBS - FSW

IBBS using TLS - MSM

Perinatal HIV Infection Surveillance

BSS-SAQ

BSS-PDA / Audio-PDA

BED-CEIA Incidence

HSS

Passive AIDS reporting

2003

1984

1995

2001

1989

2004

2006

2005

2007

thai hiv sentinel serosurveillance
Thai HIV Sentinel Serosurveillance

Start : June 1989

Site : 14 cities - 31 - 76

Nature : Biannual crossectional

: Annually in June 1995

No. Until June 2007

are 25 th round

Target :

Direct and Indirect P.

Male CSWs Male at STD Clinic

Pregnant Woman IDUs.

Donated Blood

Seafarer, Foriegner worker

Conscript (Royal Thai Army Military)

hiv sero sentinel surveillance
HIV sero-sentinel surveillance
  • Bi-annual HIV sero-surveillance among sentinel population in all province of Thailand
  • First implemented since 1989
  • The system was designed to monitor the trend of HIV prevalence
hiv sentinel surveillance
HIV sentinel surveillance
  • 8 sentinel groups
    • Commercial sex worker: Direct & Indirect
    • Injection drug users
    • Male who attended STD clinic
    • Male in commercial sex worker
    • Military recruits (army)
    • Blood donor
    • Pregnant women who attended ANC
slide16

IDU

Direct SW

Indirect SW

Male military

ANC

Explosive HIV Epidemic in Thailand

%

40.1

37.5

28.3

3.5

7.6

2.9

2.1

1.4

0

year

the first national policy to fight with hiv aids oct 21st 1992
The First National Policy to Fight with HIV/AIDSOct 21st, 1992

Prevention of HIV/AIDS Policy was announced by the Prime Minister, Chuan Leekpai:

  • # 8.3.6: Every governmental sectors, private and civil societies play roles in AIDS prevention, including educational and behavioral change communication for Thai population, especially high risk population
  • # 8.3.7:Set up healthcare services and supportive counseling for HIV/AIDS patients
slide18

IDU

Direct SW

Indirect SW

Male military

ANC

Explosive HIV Epidemic and Rapid Response in Thailand

National AIDS policy

%

28.3

7.6

3.5

5.3

3.5

2.9

2.1

1.4

0.8

0

0.5

year

hiv prevalance among pregnant women by age groups 1995 2007
HIV Prevalance among pregnant women by age groups, 1995-2007

year

Source: Sentinel Sero-surveillance, Bureau of Epidemiology, Ministry of Public Health

hiv prevalance among pregnant women by gravida 1995 2007
HIV Prevalance among pregnant women by gravida, 1995-2007

%

Source: Sentinel Sero-surveillance, Bureau of Epidemiology, Ministry of Public Health

slide21

Percent of pregnant women infected with HIV urban & rural hospital ,1997-2007

%

Urban Hospital

Rural Hospital

Time

Source: Serosurveillance, Bureau of Epidemiology, Ministry of Public Health.

slide22

Reported AIDS Cases by year, Thailand 1984-2007

Number of cases

Source: Bureau of Epidemiology, MOPH,Thailand

data as of September 30 , 2007

slide23

Reported AIDS Cases by age, gender, Thailand 1984-2007

Number of cases

Source: Bureau of Epidemiology,MOPH,Thailand

data as of September 30, 2007

slide24

Risk Factor of AIDS Cases from 1984-2007, Thailand

Source: Bureau of Epidemiology,MOPH,Thailand

data as of September 30, 2007

slide25

Proportion of Opportunistic infection in AIDS Cases

Cases reported from 1984 – 2007

%

Source: Bureau of Epidemiology, MOPH,Thailand

data as of September 30, 2007

slide26

Number of AIDS and TB/AIDS, Thailand, 1993 - 2007(data up to September,2007)

Number of Patient

AIDS

AIDS/OITB

Year

Source: Bureau of Epidemiology, MOPH,Thailand

data as of September 30, 2007

slide27

Behavior Surveillance

Additional tool to

Better understand HIV Dynamism

Background

  • In 1989 HIV/AIDS Surveillance was established
  • The HIV prevalence continued worrisome
  • In 1995, a Behavioral Sentinel Surveillance system (BSS) was established and conducted annually
objectives
Objectives
  • To follow the trends of high risk sexual behavior among target populations in Thailand
12 population groups
12 Population groups
  • Male conscripts
  • Female commercial sex workers
  • Male and female general population aged 15-49
  • Male and female factory workers
  • Male and female students grade 8th
  • Male and female students grade 11th
  • Male and female 2nd year vocational school students
key information
Key Information
  • Demographic data
    • Gender
    • Age and year of birth
    • Marital status
    • Education
    • Income
key information cont
Key Information (cont.)
  • HIV/AIDS related behavior
    • First sexual experience
    • Sex experience and condom use within 12 months
  • STD and STD treatment
  • Drug use and alcohol consumption
  • HIV/AIDS knowledge
  • HIV testing
slide35

Reports of ever-had-sex among high school students, 1996-2006

%

Male

Female

SAQ

PASI

Source: Bureau of Epidemiology, Department of Disease Control, MOPH

Note SAQ = Self administered questionnaire

PASI = Personal digital assisted self interviewing

slide36

Fig. 5 Proportion of male conscripts, male factory workers and male students who used condoms consistently with commercial sex workers from 1995 – 2005

slide37
Fig. 11: Proportion of male conscripts, factory workers, and students who had STD symptoms in the past year
monitoring care and treatment for hiv aids

Monitoring Care and Treatmentfor HIV/AIDS

Along with the development

of Anti-retroviral Treatment policy

And TB/HIV

slide39

Fig.3 HIV testing and counseling in TB patients among 12 pilot provinces, Thailand, 2005 – 2006

Percent

Cohort

Year2006

Year 2004

Year2005

Source of data : Bureau of Epidemiology,MOPH Nonthaburi , Thailand

national hiv aids art treatment program
National HIV/AIDS ART Treatment Program

National Access to ARV Treatment for PLHA (NAPHA)

NationalHealthSecurityProgram

Global Fund

PMTCT national program

SocialSecurity

Civil servant fund

ARV mono and dual therapy under research settings

2002

2003

2004

2005

2006

2007

1997-1998

2000

2001

number of currently received arv thailand
Number of Currently Received ARV, Thailand

Up to 130,000 PLHA accumulatively received treatmentin 2007 by different schemes of health care services

thailand national hiv surveillance42
Thailand National HIV Surveillance

RDS

HSS = HIV sentinel sero-surveillance

BSS = Behavioral surveillance

IBBS = Integrated HIV+STI and BSS

PDA = Personal Digital Assisted

TLS = Time-Location-Sampling

ARV resistance

IBBS - FSW

IBBS using TLS - MSM

Perinatal HIV Infection Surveillance

BSS-SAQ

BSS-PDA / Audio-PDA

BED-CEIA Incidence

HSS

Passive AIDS reporting

2003

1984

1995

2001

1989

2004

2006

2005

2007

among successes there are failures

Among successes, there are failures.

The challenges

Can we build to last (long)….

hiv chlamydia and gonorrhoeae infection among street female sw in 2007 rds survey
HIV, Chlamydia, and Gonorrhoeae Infection among Street Female SW in 2007 RDS survey

Prevalence of infection (%)

Chlamydia trachomatis

Neisseria Gonorrhea

HIV

hiv prevalence among msm ibbs using time location sampling 2003 2007
HIV Prevalence among MSMIBBS using Time-Location Sampling, 2003-2007

%

Thailand MOPH-U.S. CDC Collaboration

Sentinel provinces

slide48

HIV incidence (% per year)

HIV prevalence (%)

0. 59 (0.35-0.84)

0.47 (0.23-0.71)

0.28 (0.15-0.40)

0.09 (0.04-0.15)

Year

Median HIV Prevalence and BED Estimated Incidence among Indirect Female SW in Sentinel Provinces

warning signs of rising hiv prevalence
Warning Signs of Rising HIV Prevalence
  • Non-access non-venue based (e.g., street, call girls) sex workers
    • High HIV prevalence as 18-30% were reported
  • Un-save sex behaviors, especially among youth
    • About 20-50% using condom with regular and casual sex partners
    • Multiple sexual partners
    • Exchange sex for money or gifts
  • Persistently high prevalence among IDU and MSM
  • Indirect evidence on rising trend of HIV incidence by BED-CEIA HIV seroincidence surveillance
current situation
Current Situation

2007 Estimation, 2008 Report on the global AIDS epidemic

conclusions
Conclusions
  • Evidences indicated that the HIV/AIDS problems remained huge problem in Thailand, and there are the new overlapping concentrated epidemics in certain group of population.
  • Effective surveillance is critical to determine HIV epidemic status, as well as monitoring of prevention efforts. New approach and technology must be workout to fit the new context of HIV/AIDS dynamism.
  • Risk of new wave of epidemic is high
  • Thailand (GOVT, civil society) needs to increase prevention efforts, especially among high-risk groups such as men who have sex with men, injecting drug users and PLHA who have HIV discordant couples etc.
hiv sentinel serosurveillance method
HIV Sentinel Serosurveillance Method

Sample size depend on last year prevalent in each group

hiv sentinel serosurveillance method54
HIV Sentinel Serosurveillance Method

Sample size 100-200 in each group or

Sample size depend on last year prevalent in some group

thailand hiv aids epidemic55

AIDS in 2 men (homosexual contacts)

Rapid spreadingamong IDUs “0%”  “30-40%”

Report in blood transfusion

Rapid spreading among FSW (44%)

Generalized Epidemic: men and pregnant women

Thailand HIV/AIDS Epidemic

First report  Explosive Epidemic

1984

1989

1991

1987

1988

2000

2007

national response to hiv epidemic
National Response to HIV Epidemic
  • the National AIDS Prevention and Control Committee was set up in 1993
    • Government funding for HIV/AIDS was stepped up, reaching to 89.85 million US dollar in 1996
    • a massive public information campaign on AIDS was launched under the leadership of cabinet member
    • Enforce 100% condom use in all commercial sex establishments with massive condom distribution and behavioral change communication and education
achievements to the national response
Achievements to the National Response

Significant increasing in condom use

Reduction in visits to sex workers

Dramatic reduction in HIV infection rates among sexually related risk population