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  1. Integrated Surveillance for HIV, Viral Hepatitis, and Sexually Transmitted Diseasesin Central Asia Region CDC Central Asia Program, DIH, EPO; Division of Viral Hepatitis, NCID;Centers for Diseases Control and Prevention, AtlantaIn Partnership with: USAID, USA Embassies,and Ministries of Health of Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, Uzbekistan

  2. Surveillance The process of systematic collection, collation and analysis of data with prompt dissemination to those who need to know, for relevant action to be taken. Protocol for the Assessment of National Communicable Disease Surveillance and Response Systems. Guidelines for Assessment Teams WHO/CDS/CSR/ISR/2001.2

  3. What is Integrated Surveillance ? Surveillance that identifies persons with conditions, infections, diseases that often have overlapping risk factors, to achieve better public health interventions ‘Provisional Definition’ H.S. Margolis, MD - ‘Provisional Definition’, 2001

  4. Reasons to Combine Viral Hepatitis, HIV/AIDS and STD Surveillance, Control, and Prevention • Major public health problems • Routes of transmission overlap • Effective prevention tools • Immunization, treatment, risk reduction • Lack of national programs for integrated prevention activities leads to transmission of viral hepatitis, HIV/AIDS and STD

  5. Major public health problems

  6. Routes of transmission overlap

  7. Effective prevention tools -Immunization

  8. Missed Opportunities for Prevention of Hepatitis B Virus Infection • Of persons with acute hepatitis B: • 36% previously treated for an STD • 25% previously incarcerated • 11% both incarcerated and treated for an STD

  9. Lack of national programs for integrated prevention activities leads to transmission of viral hepatitis, HIV/AIDS and STD

  10. Sites Diseases HIV (anti-HIV + EIA+IB) Acute syphilis (VDRL +; TPPA +) Chronic syphilis (VDRL -; TPPA +) Other STI (symptoms and sign) HCV (two + by consec. tests; Abbott) Temirtau City 222\899 25% 103\899 11.5% 50\899 5.6% 52\899 5.8% 576\646 89.2% Karaganda City 21\890 2.4% 116\890 13.0 57\890 6.4% 58\890 6.5% 442\605 73.1% HIV, STI, and HCV among IDUs in Karaganda Oblast, Kazakhstan, 2002

  11. Anti-HIVamong IDUs by lengths of drug use, Karaganda Oblast, Kazakhstan, 2002 N = 1799

  12. HIV, HCV, HBV, and Syphilis among IDUs by lengths of drug use, Kazakhstan, 2002 N = 1799

  13. Main principles for integrated sentinel surveillance building • Populations under surveillance: IDUs, SW, Prisoners, Pregnant, Clients of STD clinics, MSM, Donors, Police. • Comprehensive Integrated sentinel surveillance sites selection • Site specific samples size calculation • Unifiedoutreach(response driven sampling) • Standardize Laboratory Methods • Standard Reporting (Computerized) • Unified timelines

  14. HIV, VH, Syphilis integrated sentinel surveillance sites in Central Asia Kostanai Pavlodar Temirtau Almaty YangeYul Osh Functioning and proposed HIV surveillance sites

  15. HIV, HCV regional integrated sentinel surveillance data from IDUs, 2003-2004 Prevalence of: Anti-HCV Anti-HIV

  16. 20% 20% 12% 2% 30% 6% 8% Anti-HIV, anti-HCV among Sex Workers in Kazakhstan , sentinel surveillance data, 2004

  17. Antibody to Syphilis among IDUs in Kazakhstan, sentinel surveillance data, 2004

  18. Challenges • Funding and/or referral sources for: vaccines, lab tests, medical care • Funding of prevention services flows through separate programs (hepatitis, HIV/AIDS, STD, immunization, corrections) • Staff of other programs (HIV/AIDS, STD, drug treatment, corrections) may not see viral hepatitis and STI prevention as part of their job • Incorporation of viral hepatitis and STI prevention messages into “client-centered” counseling

  19. Integrating prevention services for viral hepatitis, HIV/AIDS,STDs and drug abuse is GOOD PUBLIC HEALTH

  20. Acknowledgement - Tatiana Kalashnikova MD, Ph.D., D.Sc., Gulzhan Muratbayeva MD, Ph.D., Umid Sharapov MD, Andrew Dadu MD, Baurzhan Zhussupov, Maureen Sinclair MHP, Ed Maes Ph.D.; Central Asia Program, Division of International Health, Epidemiology Program Office, Rachel Bronzan, MD, MPH, Shakarishvili, Anna, MD, MPH, Ryan, Caroline MD, MPH; International Activities Unit, Division of STD Prevention, National Center for HIV, STD and TB Prevention, Harold Margolis MD, Jan Drobeniuc MD, Ph.D.; Division of Viral Hepatitis, Centers for Disease Control and Prevention Atlanta, USA Nikolay Kuznetsov MD, Valeriya Kryukova MD, Zoya Tukhtina MD, Karaganda HIV Control and Prevention Center, Sholpan Baimursina MD, Temirtau HIV Control and Prevention Center, Isidora Erasilova MD, Nataliya Kovtunenko MD, Viktoriya Zeman MD; Kazakhstan Republic HIV Control and Prevention Center, Kanat Ermekbaev MD; Karaganda Oblast Health Commissioner, Anatoliy Belonog MD, Aigul Kairolapova; Ministry of Health, Svetlana Demenkova MD, Andrew Mikhailov, Ric Golubjatnikov Ph.D.,MPH, John Doyle MD, Ph.D.; Almaty Sexual Transmitted Infection Diagnostic Laboratory in affiliation with Wisconsin State Laboratory of Hygiene, Wisconsin, USA Nurali Amanzhelov, NGO “Shapagat” Almaz Sharman MD, Ph.D., D.Sc., Jennifer Adams Ph.D., Kerry Pelzman Central Asia Office, The United States Agency for International Development