Second-Generation HIV Surveillance: Better Data for Decision-Making

By Rehle, Thomas; Lazzari, Stefano et al. | Bulletin of the World Health Organization, February 2004 | Go to article overview

Second-Generation HIV Surveillance: Better Data for Decision-Making


Rehle, Thomas, Lazzari, Stefano, Dallabetta, Gina, Asamoah-Odei, Emil, Bulletin of the World Health Organization


Voir page 125 le resume en francais. En la pagina 125 figura un resumen en espanol.

Introduction

Information generated by effective surveillance systems is essential for health professionals, national governments, and international agencies to mounting an adequate national and international response to the HIV/AIDS epidemic. There are many uses of surveillance data in addition to estimating the magnitude of the epidemic and monitoring its trends. For example, the data can be used to strengthen commitment, mobilize communities, and to advocate for sufficient allocation of resources to national AIDS control programmes. Behavioural data are particularly useful for targeting interventions to individuals at higher risk or in geographical areas with a concentration of high-risk behaviour. Surveillance data are also essential for planning and evaluating prevention and care activities and for assessing their impact. Finally, estimating the number of current and expected HIV/ AIDS caseloads can be useful in planning and providing care services. This is particularly important at a time when substantial new resources are being allocated to greatly improve access to HIV treatment.

In response to these expanded needs for data collection, WHO and UNAIDS, the Joint United Nations Programme on HIV/AIDS, in collaboration with other international partners, are promoting the improvement of surveillance systems based on the "second-generation" approach. This approach considers biological surveillance--i.e. HIV sentinel surveillance, reporting of AIDS cases, and surveillance of sexually transmitted infections (STIs)--and behavioural surveillance to be integral and essential components of surveillance systems (1, 2). Second-generation systems focus on strengthening and improving existing surveillance methods and combine them in ways that have the greatest explanatory power. Surveillance efforts are targeted at segments of the population in which most new infections are concentrated, which might differ depending on the stage and type of the epidemic. Second-generation systems enable HIV serosurveillance and behavioural data to be used and compared concurrently, allowing national programme managers not only to better understand and explain the observed trends in the HIV epidemic but also to better assess the impact of national AIDS control programmes.

This paper describes the recommended data collection strategies, with emphasis on the key elements of the expanded surveillance efforts. It also provides the rationale for the development of technical direction and guidance in supporting countries with different types and at different stages of the epidemic to implement second-generation HIV surveillance systems. Although second-generation HIV surveillance is designed primarily for countries in the developing world, the concept of this surveillance is equally applicable to developed countries.

Improving and expanding existing surveillance methodologies

Different data collection systems deliver different products, and with varying degrees of cost and complexity. A national programme must make choices about what mix of methods to adopt, with what frequency, and on what scale, if its resources are to be used in the most efficient way. These choices will reflect at what stage the country's epidemic is, as well as the country's political and social environment, existing capacity for data collection, and available resources. The current guidelines for second-generation surveillance activities provide a useful framework for an evolving national surveillance system (1,2). However, increasing the quality of surveillance data will require considerable investment in human and financial resources. Although the move towards more integrated disease surveillance systems (3) may assist in the task of building national capacities and expertise for expanded surveillance activities, there is still the need for developing a consensus on specific guidelines and recommendations to improve the collection, analysis, interpretation, and dissemination of the different types of HIV-related data. …

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