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

• If prevalence in the general population is very high, that is, higher than 15%, more frequent general
population surveys done at a subnational level may be more useful for tracking the epidemic than
focusing on surveys or sentinel surveillance among traditional key populations at higher risk (sex
workers, persons who inject drugs, men who have sex with men).
• Testing for STI in general population surveys allows for early identification of populations in need of
HIV prevention interventions.
In generalized epidemics, household surveys of the general population are an important surveillance tool.
The usefulness of these surveys is enhanced if they are designed to look at trends in HIV prevalence or
related risk behaviours in smaller geographical areas (15).
This is particularly true in countries where overall HIV prevalence in the general population is above 1% but
still in low single digits. These countries may have regions with diverse epidemic conditions. National-level
estimates are not informative when you seek:
• to understand the nature of your epidemic
• to decide how to use ANC sentinel surveillance as a proxy for your general population
• help to focus intervention programmes.
Get the most information from your surveillance resources:
• Be sure that the questions in existing household surveys such as the demographic and health survey
(DHS or AIS) include the information needed for surveillance.
• Include collection of biomarkers for HIV and STI often.
More recently, a number of countries have conducted multiple rounds of general population surveys. In
these cases, trends are examined in different regions of the country among various subgroups, such as men
and women aged 15–19 years or 20–24 years.
Do not use general population surveys in low-level epidemic areas
These types of surveys are expensive and resource-intensive to conduct so they are not recommended for
low-level epidemic areas. Instead, use probability surveys of key populations at higher risk if you have a
low-level epidemic.
• HIV case reporting: The use of HIV case reporting can have a different purpose in generalized epidemics.
Complete HIV case reporting remains useful for measuring the number of people infected and for
knowing their status. If people know their own HIV status, they may be likely to seek care and treatment
services.
• Characterization of key populations at higher risk for HIV: Mapping-based size estimates for traditional
key populations, such as sex workers, persons who inject drugs, men who have sex with men and clients
of sex workers remain important for generalized epidemics. In addition, identifying subpopulations with
large numbers of concurrent sexual partners in the general population also becomes critical. Some
forms of mapping of risk venues, such as the Priorities for Local AIDS Control Efforts (PLACE) method
(16), can be used for these groups. Other important methods include general population surveys that
capture patterns of risk behaviour.
• STI case reporting: Data from STI case reporting in generalized epidemics can assist in explaining
changing trends in HIV prevalence as well as indicate the effectiveness of prevention programmes.
• Biobehavioural surveys: Surveys for key populations at higher risk should include those designed to
sample subgroups of the general population with large numbers of, or concurrent, sexual partners. If
resources are limited, sites where the largest numbers are present and ANC prevalence appears highest
should be selected.
3.1.2. Collect data on a regular basis from a variety of sources
As your surveillance plan is put in place, you will continue to track data from the sources you have identified.
Some additional long-term sources are given below.
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