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An Introduction to HIV Case Surveillance. Irum Zaidi Epidemiologist Global AIDS Program Centers for Disease Control. Have you ever laid awake at night wondering…. How many people know their HIV status (diagnosed) in my country?. Have you ever laid awake at night wondering….

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an introduction to hiv case surveillance

An Introduction to HIV Case Surveillance

Irum Zaidi

Epidemiologist

Global AIDS Program

Centers for Disease Control

have you ever laid awake at night wondering
Have you ever laid awake at night wondering….

How many people know their HIV status (diagnosed) in my country?

have you ever laid awake at night wondering1
Have you ever laid awake at night wondering….

I wonder what their CD4 count was at time of diagnosis – are they eligible for HIV treatment?

How many people know their HIV status (diagnosed) in my country?

have you ever laid awake at night wondering2
Have you ever laid awake at night wondering….

How many of the ones diagnosed with HIV have died – was the death due to the an HIV-related illness?

I wonder what their CD4 count was at time of diagnosis – are they eligible for HIV treatment?

How many people know their HIV status (diagnosed) in my country?

have you ever laid awake at night wondering3
Have you ever laid awake at night wondering….

What are the behaviors associated with HIV infection…heterosexual, MSM, IDU, mobile populations?

How many of the ones diagnosed with HIV have died – was the death due to the an HIV-related illness?

I wonder what their CD4 count was at time of diagnosis – are they eligible for HIV treatment?

How many people know their HIV status (diagnosed) in my country?

evolution of data needs
Evolution of data needs
  • Need for epidemiologic data in countries has evolved over the past 5 years
  • 2004 - few national level HIV care and treatment programs
    • surveillance need at that time was to monitor HIV in general population.
  • 2009 – many national large scale prevention, care and treatment programs
    • people are living with HIV for many years, need epidemiologic information about people who are diagnosed with HIV.
background information
Background information
  • Countries had variable coverage of AIDS case surveillance
  • With the revised WHO HIV case definitions, recommendation is to transition from AIDS surveillance to HIV or advance HIV case surveillance
  • Monitoring only AIDS will not inform us on the direction of the HIV epidemic
components of a surveillance system are like pieces of a puzzle
Components of a surveillance system are like pieces of a puzzle

High-Risk Pop Surveillance

ARV drug resistance and subtyping

HIV Incidence Surveillance

STI

TB/HIV

General Pop Surveys

HIV Case Reporting

ANC Surveillance

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

1st CD4count <350

1st viral load

1st CD4 <200

AIDS-related

Opportunistic

Infection

Death

monitor hiv disease1
Monitor HIV disease

HIV disease sentinel events

HIV exposure

(exposed infants or sexual transmission)

HIV infection

1st positive

HIV test

1st CD4 count

1st CD4count <350

AIDS reporting

1st viral load

1st CD4 <200

AIDS-related

Opportunistic

Infection

Death

monitor hiv disease2
Monitor HIV disease

HIV disease sentinel events

HIV exposure

(exposed infants or sexual transmission)

HIV infection

1st positive

HIV test

1st CD4 count

1st CD4count <350

HIV case reporting

1st viral load

1st CD4 <200

AIDS-related

Opportunistic

Infection

Death

what type of data do we have
What type of data do we have?
  • Have aggregate information on the
    • Estimated # of PLWHA, among general population, sub-pops like high-risk groups
    • Behavioral data about different groups
    • Number of tests done for HCT (not unique individuals)
    • Number of HIV positive tests from HCT (not unique individuals)
    • Number of people in care and treatment (unique individuals)
data from hiv case reporting
Data from HIV case reporting
  • Provides in-depth information about people diagnosed with HIV
  • Individual level data on people diagnosed with HIV
    • Date of HIV diagnosis
    • HIV transmission risk
    • CD4 closest or at diagnosis
    • Date started care and treatment
    • Date of death
  • As HIV case reporting becomes complete then need for prevalence surveys decreases
reporting sources
Reporting sources
  • Counseling and testing
  • Care registers
  • ART registers/patient cards
  • TB registers
  • Hospitals
  • Labs
  • Vital registration
what will the data tell us
What will the data tell us?
  • Assist to monitor the incidence and prevalence of HIV infection including AIDS, and HIV-related morbidity and mortality in the population
  • Identify changes in trends of HIV transmission and identify populations at risk
  • Target prevention interventions and evaluate their effectiveness
  • Where there is a high-level of completeness of reporting, the BED assay can be applied to estimate incidence rates
  • More accurately determines need for care and treatment
  • Provide denominator data to evaluate reach of programs
country x example
Country X Example
  • Estimated 990,000 PLWHA 2007, (UNAIDS 2008)
  • Ever enrolled into care 209,790 (Country level PMS, December 2008)
  • Ever started on ART 122,243 (Country level PMS, December 2008)
  • Currently on treatment 90,212 (Country level PMS, December 2008)
slide19

990,000 estimated PLWHA

320,000 estimated # of people

need of ART

slide20

980,000 estimated PLWHA

310,000 estimated need of ART

90,212 currently on ART

slide21

Estimated number of people infected with HIV

How many people diagnosed with HIV?

number of people receiving ART

in closing
In closing
  • Data from case surveillance system will provide demographic, clinical and behavioral information on persons diagnosed with HIV
  • Data can focus areas needed for further research/surveillance such as behavioral surveillance
  • Case reporting system can also be used as a platform for drug resistance and incidence surveillance