Guidelines for second generation HIV surveillance - World Health ...

Table 3.2. Surveillance activities for areas with concentrated epidemics
(the frequency is only indicative and not prescriptive)
Surveillance activity Scope of activity Frequency
Size estimation of key populations at
higher risk
• Initial assessment in all areas of the
country/region
• In-depth assessment where large
numbers are found
• Every 2–3 years
Biobehavioural surveys of key populations
at higher risk (for example, BSS, IBBS)
Facility- or community-based HIV and STI
sentinel surveillance for key populations at
higher risk
HIV or advanced HIV infection case
reporting
STI case reporting
ANC sentinel surveillance for HIV and
syphilis
• In areas where more than 500 persons
belonging to population groups with
high-risk behaviour in a city or town
• Prioritize areas where key populations
with risk behaviours are present
In areas with intervention sites serving
more than 500 beneficiaries among key
populations
All facilities conducting HIV testing and
counselling
All facilities diagnosing STIs by syndrome
or laboratory diagnosis
• In areas where HIV prevalence among
key populations at higher risk is high
(for example, more than 10%) and the
size of male key populations at higher
risk is large (for example, persons who
inject drugs comprise more than 1% of
the adult male population)
• Only sites where the ANC volume is
larger than 150 new attendees per
month
• Every 2 years for high-priority sites
• Every 3–5 years for lower-priority sites
Annually
Ongoing
Ongoing
Annually or biannually
Concentrated epidemic: brief explanatory notes
• HIV case reporting: Case reporting data are useful for triggering further investigation into an area when
sudden spikes or unusually large numbers of cases are reported. It is important to understand the
underlying pattern of testing, diagnostic capability and reporting by different facilities to interpret these
data appropriately.
• If in previous sentinel surveillance activities the HIV prevalence was more than 5% and there are large
enough key populations, then an integrated biological and behavioural surveillance or other sampling
methodologies such as time–location sampling or respondent-driven sampling can be used. The
threshold for when to conduct surveillance should be lowered to 500 people within the key populations.
• ANC sentinel surveillance: By definition, in a concentrated epidemic, transmission among the general
population occurs infrequently, except for regular partners of populations whose behaviour puts them
at high risk for HIV. ANC sentinel surveillance is a useful tool for assessing when the burden of HIV
becomes large in the general population. This will help you to forecast care and treatment service needs.
ANC sentinel surveillance should be conducted where:
• HIV prevalence among key populations at higher risk is high, that is, higher than 15%
• key populations at higher risk are large, comprising more than 1% of the population.
Antenatal clinic sentinel surveillance sites may also be important in source communities where a large
proportion of the males are migrants and there are well known places for sex work. ANC sites with low
regular attendance should not be included.
If most of the pregnant women are covered by PMTCT services, ANC surveillance may be not necessary.
Instead, regular reporting of data from PMTCT services can be use to replace data from ANC sentinel
surveillance. However, an extensive assessment of the PMTCT data is required before ANC surveillance can
be stopped completely. More concrete recommendations are in the process of being developed to address
the issues of quality of data, and the possible use of PMTCT data to replace that from ANC.
28