Guidelines on surveillance among populations most at risk for HIV

When constructing a questionnaire, consider other major data collection efforts within the country. Avoidre-creating questions. Copy word-for-word questions that have been used in previous surveys: to allow comparison of results between surveys to reduce field-testing of questions.Make sure the survey questionnaires evolve as the epidemic evolves. Family Health International hasdeveloped questionnaires for use among populations most at risk. Consult those examples for ideas (52).(http://www.fhi.org/en/hivaids/pub/guide/bssguidelines.htm).Consider international reporting needs and indicators required for national commitments beforefinalizing the questionnaire. Also be sure to translate and back-translate the questionnaire to identify anymisunderstandings, and pretest the questionnaire in a community outside of the sample.3.1.3 Plan handling of specimens and HIV testingWHO and UNAIDS have developed guidelines for HIV using testing technologies for surveillance (53). Theseguidelines consider a country’s laboratory infrastructure and surveillance needs, and then suggest methodsfor selecting, evaluating and implementing HIV testing technologies and strategies. These guidelinesprovide recommendations for: specimen selection collection, storage and testing of specimens selection and evaluation of appropriate HIV testing strategies technologies that meet surveillance objectives quality assurance issues.<strong>Guidelines</strong> on surveillance among populations most at risk for HIVHIV testing among most-at-risk populations presents unique challenges as well as opportunities. Thedevelopment of rapid testing technologies allows testing to move from the laboratory to the field. Providingresults at the time of the test is very useful when working with populations that are hard to reach, asopportunities for these populations to learn their HIV status might not occur often. Depending on thesurveillance design, two strategies have been proposed for most-at-risk populations. See Table 3.2.Table 3.2. Testing strategies for most-at-risk populationsCountry/surveillance situationStrategy 1: For unlinked anonymous surveillance – whentest results and counselling are not provided torespondentsStrategy 2: For linked surveillance – when test results andcounselling are provided to respondents at the time ofthe surveyTesting algorithmUse a two-test strategy Both tests need high sensitivity and high negative predictive value. Specimens reactive to both tests are considered HIV-positive.Use a three-test strategy Confi rmatory results are needed according to the algorithms used fordiagnosis. Specimens reactive to three different assays are considered positive.3.2. Step 5: Data managementThe reward for careful planning and implementation of surveillance comes with the analysis.3.2.1 Plan the data management systemThe structure and content of the database should be specified before data collection begins. Databasedevelopment involves five steps.27