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

• Prepare annual reports of the epidemic situation in the country.
• Lead the review and planning process of the second generation surveillance system, including formal
evaluation of second generation surveillance systems as needed.
• Feed into the national planning process based on evidence.
Subnational surveillance units often take on more direct responsibility for implementation of surveillance
activities according to national minimum standards:
• Select final sites and population groups in their administrative area.
• Conduct pre-surveillance activities.
• Manage/supervise/provide quality control of data collection teams.
• Process documentation of activities.
• Enter, clean and manage data for routine surveillance activities.
• Analyse and synthesize data within their administrative area.
• Disseminate results to local stakeholders.
• Drive the process of evidence-based planning and management of programmes.
• Contribute local expertise for the development of national surveillance guidelines, protocols and system
reviews.
• Report data to the central level.
Evaluating a National Surveillance System
The staffing of each unit will depend on the number of sites and range of activities included in the second
generation surveillance system. Epidemiologists at both the national and subnational levels are useful for
ensuring methodological rigour in surveillance protocols, as well as in analysis and interpretation of the
data. Statistical support staff, data entry staff and statisticians are needed in units to manage, clean and
analyse data such as those on AIDS case reporting and sentinel surveillance. Data management resources
for surveys involving questionnaires are usually built into the operational costs of conducting the survey.
3.2.2. Strengthen laboratory systems
Due to the importance of biological data for understanding the epidemic, a strong public health laboratory
infrastructure is a critical component of high-quality second generation surveillance systems. Investment
in the public health laboratory system to support HIV surveillance activities can also be an opportunity to
contribute to overall health systems strengthening. Ensuring that qualified staff is given adequate training
and detailed protocols are key to strong second generation surveillance systems (19).
Testing conducted only for surveillance purposes may follow specific protocols and quality assurance
procedures that are different from those used for diagnostic testing purposes. Whenever test results of data
collected for surveillance purposes are returned to participants, the standards of confirmation and quality
assurance appropriate for diagnostic testing must be used. Similarly, only those test kits that have been
approved for diagnostic testing should be used for these types of surveillance activities. The diagnostic
testing process should also include high-quality counselling and referral to services, as with any testing
encounter (19).
In many countries, good experience with dried blood spot technology has been used to ease the logistic
issues of collecting and transporting specimens from multiple field sites for either centralized testing, quality
assurance or specimen banking. Use of dried blood spot specimens should be weighed against:
• the potential limitation of other types of testing that can be done (for example, syphilis testing or hepatitis
B/C) with dried blood spots compared to venous blood;
• the potential additional cost of human resources to prepare dried blood spot specimens for testing or
cost of test kits designed for use with dried blood spots.
The inclusion of other biological markers of acute STIs (i.e. active syphilis, gonorrhoea, chlamydial and
trichomonas infections) in biobehavioural surveys is feasible in some settings due to the wider availability
of rapid point-of-care tests and NAATs, which enable detection of multiple STI pathogens from urine or
self-collected genital swabs. The regional STI reference laboratory network also can assist with the
implementation of integrated STI, HIV and sexual behaviour surveillance systems in many countries.
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