1 / 10

“HIV surveillance as a dynamic component of strategic information in an evolving epidemic”

“HIV surveillance as a dynamic component of strategic information in an evolving epidemic”.

keagan
Download Presentation

“HIV surveillance as a dynamic component of strategic information in an evolving epidemic”

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. “HIV surveillance as a dynamic component of strategic information in an evolving epidemic” Authors: Laxmi Raj Pathak, National Centre for AIDS and STD Control, Ministry of Health and Population, Nepal; Isabel Tavitian-Exley, UNAIDS-Nepal, Laxmi Bilas Acharya, Family Health International, Nepal; Sharon Arscott-Mills, USAID-Nepal; Amaya Maw-Naing, WHO-Nepal Second Global Surveillance meeting, Bangkok, Thailand, 5th March 2009

  2. Nepal’s HIV epidemic • Evolved from low prevalence to concentrated epidemic (~ an estimated 70,000 HIV infections – as of Jan 2009: 12,933 cases identified) • HIV transmission: driven by injecting drug use and sexual transmission • During times of conflict and political unrest, incremental approaches and innovative partnerships are paramount for generating strategic information to manage the HIV epidemic. • At various stages of the epidemic appropriate surveillance strategies have been vital in providing adequate responses.

  3. Nepal National Surveillance timeline (1993-2007) • HSS/STI patients: 6 sites in Kathmandu, Pokhara, Birgunj, Nepalganj and Kanchanpur (regional government hospitals) and an NGO run hospital in Jhapa (Eastern region). • HSS/ANC: 6 sites in Kathmandu, Pokhara, Birgunj, Nepalganj, Kanchanpur and Jhapa. Source: National Centre for AIDS and STD Control, Strategic Information Technical Working Group

  4. Responding to a changing context • 1999, Sero-prevalence among TB patients increased from 0.6% in 1996 to 2.2% • HIV sero-prevalence among pregnant women remained at 0.2%, prevalence in STI patients rose from 1.3 % to 2.7% with higher infection rates observed in the Far-West. • After 2001, most facility-based surveillance activities were delayed or put on hold, due to conflict and instability. • Global guidance and re-thinking of HIV surveillance was rapidly applied in Nepal to complement facility-based HSS to population-based surveys among groups at highest risk of transmission

  5. Data management Data analysis and synthesis HIV estimates and projections Use of data for action Second Generation Surveillance systemin Nepal: evolution and components STI surveillance HIV surveillance HIV/AIDS/STI case reporting Behavioural surveillance HR popn. size estimation SGS elements prioritised & functioning SGS components in use – being strengthened Weak SGS components to be strengthened Monitoring and Evaluation Source: National Centre for AIDS and STD Control

  6. HIV prevalence measured by population based surveillance was significantly higher among groups most-at-risk of transmission • Facility-based surveillance showed low HIV prevalence compared to population based surveys. • Facility-based data would not have captured the magnitude of the problem. • It is recognized that facility-based surveillance targets different groups than does population-based surveillance; • the population data completes the picture

  7. HIV prevalence in HSS (STI patients) and IBBS (high-risk groups) IBSS survey in IDUs & FSW (larger sample) BSS in IDUs & FSW- community survey Source: National Centre for AIDS and STD Control, UNAIDS, WHO, USAID/FHI(2008)

  8. Use of surveillance data Distribution of HIV Infections by Risk Groups in Nepal, 2007 3 rounds of National estimations of HIV infections (2003, 2005 & 2007) Methods used: UNAIDS/WHO estimation methods and tools and national surveillance data Highlight emerging scenario: • The population group with the highest number of infected individuals was migrant labourers (& likely their spouses in Nepal) • They account for 42% of all HIV infections in Nepal in 2007. • Despite some variations, findings are consistent over time in 2003, 2005 and 2007 estimations) MSM FSW IDU Other Female Clients Trafficked Women Migrants Source: National Centre for AIDS and STD Control, UNAIDS, WHO, USAID/FHI(2008)

  9. Signs of declining HIV prevalence among IDUs(IBBS 2002-2007) Kathmandu Pokhara Eastern Terai Western Terai N = 303 N = 300 N = 345 N = 300 N = 300 N = 345 N= 300 Source: NCASC/USAID/FHI/New ERA/SACTS

  10. Conclusions • Appropriate sources of surveillance data prioritized and supported (eg. regular reviews,..) • A flexible and dynamic surveillance plan in place (allows adaptation and changes, eg. possible spacing..) • National leadership involved in the SGS development and coordination (eg. Surveillance–Technical Working Group > Strategic Information TWG chaired by NCASC (MoH)) • Innovative partnerships on Strategic Information developed (eg. SI-TWG brings together range of partners with different skills, competences and perspective, includes civil society) • Data used for action and programming decisions (eg. Nepal initiative, IDU prevention focus for GFATMRd II, UNODC established in country (2005), Border project India-Nepal developed (2007), focus on IDUs and migrants in GFATM RdVII (2007)) • Sustainability and continuity (technical, financial…)

More Related