Unit 6: Second-Generation HIV/AIDS Surveillance

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Warm Up Questions: Instructions

Take five minutes now to try the Unit 6 warm up questions in your manual.

Please do not compare answers with other participants.

Your answers will not be collected or graded.

We will review your answers at the end of the unit.

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What You Will Learn

By the end of this unit you should be able to:

describe the concept of second-generation surveillance

discuss the various elements of a second-generation HIV surveillance system

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Second-Generation HIV Surveillance

Developed by the WHO and UNAIDS as a response to the increasing complexity of the HIV epidemic

Outlines more sophisticated surveillance activities

Provides a more comprehensive understanding of epidemic trends

Improves effectiveness of control and prevention efforts

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Figure 6.1. The Components of Second-Generation Surveillance

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Figure 6.1. The components of second-generation surveillance*

*Monitoring and Evaluation is on-going

AIDS case reporting

HIV surveillance

STI surveillance

Behavioural surveillance

Data management

Data analysis and synthesis

HIV estimates and projections

Use of data for action

Goals of Second-GenerationHIV Surveillance

Better understanding of trends over time

Better understanding of behaviours driving the epidemic in a country

Increased focus on sub-populations at highest risk for infection

Flexible to change with the stage of epidemic

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Table 6.1. Biological Indicators

HIV prevalence

STI incidence and prevalence

TB prevalence

number of adult AIDS cases

number of pediatric AIDS cases

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Table 6.1. Behavioural Indicators

sex with a non-regular partner in last 12 months

condom use at last sex with non-regular partner

age at first sex for youth

use of unclean injection equipment by drug injectors

reported number of clients in the last week by sex workers

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Table 6.1. Socio-demographic Indicators

age, sex

socio-economic and educational status

residency or migration status

parity (for antenatal sites)

marital status

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Table 6.2. Basic Data Collection Methods

Sentinel surveillance in defined sub-populations (such as antenatal clinic attendees, STI clinic patients, sex workers)

Serial cross-sectional behavioural surveys in high-risk sub-populations

Regular HIV screening of donated blood

AIDS case surveillance

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Table 6.2. Additional Data Collection Methods

Regular screening of occupational cohorts or other sub-populations (such as factory workers, military recruits)

HIV screening of specimens taken in general population surveys

Serial cross-sectional behavioural surveys in the general population

HIV case surveillance

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Table 6.2. Additional Data Collection Methods, Cont.

Death registration and mortality surveillance

STI and TB surveillance

Data from VCT and treatment programmes

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Year

Figure 6.2. HIV Prevalence and Condom

Use Among Female Sex Workers, Abidjan, Côte d’Ivoire, 1992-98

Source: Ghys et al. AIDS 2001.

Stages of the HIV/AIDS Epidemic

low-level (Madagascar, Seychelles) confined to persons with high-risk behavior not above 5% in any sub-population

concentrated (Mauritania, Senegal) above 5% in one or more risk populations not above 1% in ANCs or pregnant women in

urban areas generalised (most of sub-Saharan Africa)

well established in general population consistently above 1% in ANCs or pregnant

women in urban areas

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Surveillance Needs for Low-Level Epidemics

Are there groups with risk behaviours?

What are the main risk behaviours?

How much HIV infection is there?

Who else might be affected and to what extent?

Note: this information corresponds to Table 6.3 in your participant manual

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Surveillance Needs for Concentrated Epidemics

How much HIV infection is there?

What are the main risk behaviours and how do they change over time?

Who else might be affected and to what extent?

Note: This information corresponds to Table 6.4 in your participant manual

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Surveillance Needs for Generalised Epidemics

What are the trends in HIV infection?

Is behaviour changing?

Do recorded changes help explain trends in HIV infection?

What is the impact of HIV?

Note: This information corresponds to Table 6.5 in your participant manual

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In Summary

The goal of second-generation HIV surveillance is to provide a more complete picture of the HIV/AIDS epidemic using surveillance methods that are flexible.

The components that may be used include behavioural surveillance, HIV/AIDS case reporting, death registration and STI surveillance.

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Warm Up Review

Take a few minutes now to look back at your answers to the warm up questions at the beginning of the unit.

Make any changes you want to.

We will discuss the questions and answers in a few minutes.

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Answers to Warm Up Questions

1. Which of the following is the goal of second-generation HIV surveillance?

a. better understanding of behaviors driving the epidemic

b. surveillance more focused on sub-populations at highest risk for infection

c. surveillance of the children of patients who acquired HIV in the first wave of infections

d. a and be. none of the above

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Answers to Warm Up Questions, Cont.

1. Which of the following is the goal of second-generation HIV surveillance?

a. better understanding of behaviors driving the epidemic

b. surveillance more focused on sub-populations at highest risk for infection

c. surveillance of the children of patients who acquired HIV in the first wave of infections

d. a and be. none of the above

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Answers to Warm Up Questions, Cont.

2. The types of elements included in second-generation surveillance vary according to the type of epidemic. List the three types of HIV/AIDS epidemics.

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Answers to Warm Up Questions, Cont.

2. The types of elements included in second-generation surveillance vary according to the type of epidemic. List the three types of HIV/AIDS epidemics. Low-level, concentrated, generalised

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Answers to Warm Up Questions, Cont.

3. True or false? Second-generation surveillance is flexible and can change with the needs and state of the epidemic in a particular country.

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Answers to Warm Up Questions, Cont.

3. True or false? Second-generation surveillance is flexible and can change with the needs and state of the epidemic in a particular country. True

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Answers to Warm Up Questions, Cont.

4. Which of the following is not yet a regular element of second-generation surveillance?

a. Screening of donated blood

b. Behavioural surveillance

c. Surveillance for coexisting opportunistic infections

d. AIDS surveillance

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Answers to Warm Up Questions, Cont.

4. Which of the following is not yet a regular element of second-generation surveillance?

a. Screening of donated blood

b. Behavioural surveillance

c. Surveillance for coexisting opportunistic infections

d. AIDS surveillance

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Small Group Discussion: Instructions

Get into small groups to discuss these questions.

Choose a speaker for your group who will report back to the class.

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Small Group Reports

Select one member from your group to present your answers.

Discuss with the rest of the class.

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Case Study: Instructions

Try this case study individually.

We’ll discuss the answers in class.

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Case Study Review

Follow along as we go over the case study in class.

Discuss your answers with the rest of the class.

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Questions, Process Check

Do you have any questions on the information we just covered?

Are you happy with how we worked on Unit 6?

Do you want to try something different that will help the group?

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