developing a national hiv aids surveillance system in haiti
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Developing a National HIV/AIDS Surveillance System in Haiti . NASTAD Haïti Juillet 2012. Reportable HIV/AIDS Events in Haiti. HIV disease sentinel events. HIV exposure (exposed infants or sexual transmission ). HIV infection. 1 st positive HIV test. 1 st CD4 count.

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reportable hiv aids events in haiti
Reportable HIV/AIDS Events in Haiti

HIV disease sentinel events

HIV exposure

(exposed infants or sexual transmission)

HIV infection

1st positive

HIV test

1st CD4 count

1stCD4 count <350

1st viral load

1st CD4

<200

AIDS-related

Opportunistic

Infection

Death

monitor hiv disease
Monitor HIV Disease

HIV disease sentinel events

HIV exposure

(exposed infants or sexual transmission)

HIV infection

1st positive

HIV test

1st CD4 count

1stCD4 count <350

1st viral load

HIV Case Reporting

1st CD4

<200

AIDS-related

Opportunistic

Infection

Death

monitor aids disease
Monitor AIDS Disease

HIV disease sentinel events

HIV exposure

(exposed infants or sexual transmission)

HIV infection

1st positive

HIV test

1st CD4 count

1stCD4 count <350

1st viral load

AIDS Case Reporting

1st CD4

<200

AIDS-related

Opportunistic

Infection

Death

slide5
System Design of Haiti’s HIV/AIDS Surveillance System (HASS)

(MESI, Haiti, Daily/Weekly)-

“Surveillance”-Online

(MESI, Haiti, Daily/Weekly)-

“Surveillance”-Offline

MESI 1

HAITI

HIV SURV

MESI

ITECH

(I-TECH, WA,

Biweekly/Monthly)-EMR

De-duplication

(GHESKIO, Haiti, Biweekly/Monthly)-EMR

Surveillance Loop

(PIH, MA, Biweekly/Monthly)-EMR

MOH

slide6
System Design of Haiti’s HIV/AIDS Surveillance System (HASS)

MESI – flux hebdomadaire

“Surveillance”-Online

Feedback aux sites sur la qualite des donnees

MESI-offline – Flux hebdomadaire

“Surveillance”-Offline

Balisesautomatisees de saisie de donnees

MESI

HAITI

Base de donnees

Surveillance

HIV/SIDA epuree

MESI

ITECH

National EMR – Flux mensuel

Deduplicationautomatisee et manuelle intra/inter systemes

GHESKIO EMR – Flux mensuel

Feedback de duplication Intra-EMR

Surveillance Loop:

- Rapports de tendance

- Rapports de processus

- Rapports de qualite

PIH EMR – Flux mensuel

MoH

departmental distribution of hiv cases at diagnosis vs population distribution hass 1983 2011
Departmental Distribution of HIV Cases at Diagnosis, vs. Population Distribution (HASS 1983-2011)
departmental distribution of hiv cases at diagnosis vs population distribution
Departmental Distribution of HIV Cases at Diagnosis, vs. Population Distribution

Outer: Estimated departmental HIV prevalence

  • Center:
  • % Haiti population per department
hiv diagnoses rate in all age group population per department hass 2006 2011
HIV diagnoses rate in all age group population per department (HASS, 2006-2011)

Haiti 182 per 100,000

*Unique individuals, 2006-2011 (6 years), department of first report, 2009 population

unique hiv cases reported to hass 1983 2011 by system and total
Unique HIV cases reported to HASS (1983-2011), by System and Total

----- iSanté

----- GHESKIO

----- PIH/ZL

----- MESI

First HIV Diagnosis in Central Plateau (PIH)

Earthquake of 2010

  • Health facilities destroyed.
  • Health staff perished.
  • Millions displaced.

First HIV Diagnosis in Haiti (GHESKIO)

MESI launched (Solutions)

Foreign Assistance Programs increase in Haiti (PEPFAR, Global Fund)

Case Surveillance pilot begins (MSPP, NASTAD)

slide15
Patient Mobility Within and Between Networks

(% of patients in network EMR diagnosed in same network)

reported vs estimated vih sida deaths in hass 1983 2011
Reported vs. Estimated VIH, SIDA Deaths in HASS, (1983-2011)

Reported

Estimated

Of the 146,762 unique patients in HASS and according to information originally received from the report- 87% are diagnosed with HIV, 8% with AIDS, and 5% dead. Using estimated information (below), 68% are diagnosed with HIV, 19% with AIDS, and 13% are presumed dead.

People are presumed dead if they were diagnosed prior to 2000 and do not have another report in HASS or they are 65 years or older and reported prior to 2006.

People are presumed to have SIDA if they have a CD4 count <= 350 per ml blood.

Note:  These amounts may be subject to change as the methods for estimating death and out-migration are refined.

conclusion
Conclusion
  • Since 2009, an estimation of 95% of all HIV cases diagnosed in Haiti have been reported to the case surveillance system.
  • 252 sites (56%) are periodically reported HIV diagnosis cases.
  • By early 2012, all four major electronic data sources were providing data feeds on a monthly basis.
  • Crucial reporting variables are present in more than 99% of all case reports.
  • Though the end of 2011, a total of 193,065 HIV cases were reported to HASS. Of those cases, 23.4% were reports related to a person reported more than once in the system.
  • With the existing and use of the de-duplication algorithm 147,880 unique HIV cases are identified in the national HIV/AIDS case surveillance system
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