Guidelines on surveillance among populations most at risk for HIV

4.1.4 Use the results to improve programmesUse the results to inform prevention, care and treatment programmes. The information may have beendisseminated widely to a broad group of stakeholders. However, it is critical to take the data to the next stepfor use by decision-makers.Make an effort to ensure that programme managers have access to the results to plan appropriateinterventions based on the surveillance results. Surveillance results should help improve services for mostat-riskpopulations and reduce their risk of acquiring HIV infection. Involve the most-at-risk populations notonly in the research but also in the development of intervention programmes based on the results.Analyse data to generate strategic information. Use the information for decision-making and planning. Onlyin this way can resources devoted to surveillance be justified and used to curb the epidemic in populationsmost at risk for HIV.Try to report on a regular basis to communities at risk, partner organizations and national AIDS councils.Support these stakeholders to determine how the results best inform their services. Make this a part of theongoing activities of surveillance. Surveillance staff should have access to and proactively participate in theHIV response planning process.<strong>Guidelines</strong> on surveillance among populations most at risk for HIVExamples of how surveillance data have been used to improve programmes have been highlighted in recentconferences (85). In a number of countries in sub-Saharan Africa, surveillance data have been used in simple models (seeexample below) to estimate where new HIV infections are occurring. In Kazakhstan, surveillance data from prison populations have been used to develop an appropriateprevention response for the prison population. In Bangladesh, sophisticated subtyping of HIV strains has provided evidence of how HIV has spreadbetween populations and neighbourhoods.Example of use of surveillance dataSurveillance data on most-at-risk populations can be used to improve HIV programmes with “Modesof Transmission” models. Modes of Transmission is a simple spreadsheet model that allows countriesto predict where new infections will occur in their country. Using data on HIV prevalence amongdifferent subpopulations and most-at-risk populations, a team of epidemiologists from Kenya wasable to identify populations where estimates of new infections can be expected. These data wereused to help plan interventions in the national strategic plan. This exercise led to a recommendationto increase service provision for men who have sex with men, persons who inject drugs, other drugusers and sex workers.Figure 4.2: Distribution of new infections in KenyaHeterosexual sex within union/regular partnershipCasual heterosexual sexFemale sex workers and clientsMSM and prisonInjecting Drug Use (IDU)Health Facility RelatedMore information on the Modes of Transmission software can be found at www.unaids.org.Source: Kenya National AIDS Control Council. HIV prevention response and modes of transmission analysis. 2009. (http://www.unaidsrstesa.org/fi les/u1/Kenya_MoT_Country_Synthesis_Report_22Mar09.pdf).33