Epidemiological analysis of the quality of HIV sero-surveillance in the world: how well do we track the epidemic?
ABSTRACT The objective of this paper was to analyse the quality of HIV/AIDS sentinel surveillance systems in countries and the resulting quality of the data used to make estimates of HIV/AIDS prevalence and mortality.
Available data on sero-surveillance of HIV/AIDS in countries were compiled in the process of making the end of 1999 estimates of HIV/AIDS. These data came primarily from the HIV/AIDS Surveillance Database developed by the United States Census Bureau, from a database maintained by the European Centre for the Epidemiological Monitoring of AIDS and all country reports on sentinel surveillance that had been provided to World Health Organization or UNAIDS. Procedures were developed to score quality of surveillance systems based on four dimensions of quality: timeliness and frequency; appropriateness of groups; consistency of sites over time; and coverage provided by the system. In total, the surveillance systems from 167 countries were analysed.
Forty-seven of the 167 countries whose surveillance systems were rated were judged to have fully implemented sentinel surveillance systems; 51 were judged to have systems that had some or most aspects of a good HIV surveillance system in place and 69 were rated as having poorly functioning or non-existent surveillance systems.
This analysis suggests that the quality of HIV surveillance varies considerably. The majority of countries most affected by HIV/AIDS have systems that are providing sufficient sero-prevalence data for tracking the epidemic and making reasonable estimates of HIV prevalence. However, many countries have poor systems and strengthening these is an urgent priority.
SourceAvailable from: Pedro F. Saint-Maurice[Show abstract] [Hide abstract]
ABSTRACT: Background: There has been a great interest in tracking health-related fitness across the United States. The NFL PLAY 60 FITNESSGRAM Partnership Project (NFL P60FGPP) is a large participatory research network that involves the surveillance of fitness among more than 1000 schools spread throughout the country. Fitness data are collected by school staff and therefore these data can vary in quality and representativeness. Therefore, careful screening procedures are needed to ensure that the data can reflect actual patterns in the schools. This study examined the impact of different data screening procedures on outcomes of aerobic fitness (AF) collected from the NFL P60FGPP. Methods: Data were compiled from 149,101 youth from 504 schools and were processed using the established age-and gender-specific AF FITNESSGRAM health-related standards. Data were subjected to three different screening procedures (based on grade size and boy-to-girl ratio per grade). Linear models were computed to obtain unadjusted and adjusted (for age, BMI-Z, and socio-economic status) estimates of % youth in the Healthy Fitness Zone (HFZ) in order to determine if, 1) there were differences in % in the HFZ and 2) if differences could be explained by changes in the representativeness of the sample due to the different data screening procedures. Results: Depending on the screening procedure used, the final sample ranged from 96,999 (no screening) to 46,572 youth (most stringent criteria). The proportion of youth achieving appropriate levels of AF ranged from 56% to 61% with unscreened data resulting in consistently lower percentages of youth achieving the standard (P < 0.05). Overall, these differences were not explained by possible changes in demographic characteristics as the result of applying different screening criteria. Conclusions: The findings demonstrate the importance of establishing appropriate screening procedures that maximize sample size while also ensuring generalizability of the findings.Open Journal of Preventive Medicine 11/2014; 4(4):876-886. DOI:10.4236/ojpm.2014.411099
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ABSTRACT: Objective To study and analyze the surveillance activities in HIV prevention and control in India. Introduction Surveillance of risky behaviors of HIV infection and its manifest diseases has provided a better understanding of the complex nature of the HIV epidemic in India. However, little attempt is made to analyze progress of these surveillance activities. Methods A review & analysis of surveillance activities undertaken in India were done. Pub-med, cohrane library and peer-reviewed journals were referred for relevant literature. Results Initially, medical officers from multiple types of government hospitals in India were expected to report AIDS cases, including deaths. However, this reporting mechanism was inadequate, complicated by many disparate types of reporting units with incomplete and delayed reports. Therefore AIDS case reporting has been replaced by HIV case reporting from the 4532 Integrated Counseling and Testing Centers. Newer surveillance strategies like Behavior sentinel surveillance measure behaviors that affect risk for acquiring HIV. However, behavioral and biological data are resource-intensive and time-consuming. Facility-based sero-surveillance (also called HIV Sentinel Surveillance or HSS) has emerged as the key surveillance strategy for HIV/AIDS in India. Starting with 55 urban sentinel sites HIV Sentinel Surveillance expanded to 1215 in 1994. Most of these pre-selected sites were antenatal clinics but also included sexually transmitted infection clinics and special facilities. Subsequent expansion of high-risk group sites has improved the representation of all sub-populations in HSS. While stigma against most high-risk populations and HIV-positive people continues, it has lessened as shown by the behavioral surveys. Also, accessibility to testing sites has increased with increased availability of care and treatment options for infected individuals. Conclusions While acknowledging the vastness and diversity of India, the key limitations remain suboptimal coverage and lack of representativeness surveillance data. Moreover, due to selection bias, the populations selected for HSS at targeted intervention sites may not represent everyone in that community. There is lack of national information system to collect HIV testing information from the private sector. Further efforts are needed to improve HIV surveillance data and usage of this data to predict the epidemic.04/2013; 5(1). DOI:10.5210/ojphi.v5i1.4578
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ABSTRACT: One much needed tool to assist with the monitoring and evaluation of Human Immunodeficiency Virus (HIV) prevention programs is to provide a valid instrument to measure protective sexual behavior and related factors. The current study aimed to design a valid and reliable instrument to predict the protective sexual behaviors of women at risk of HIV in Iran. The current study was a sequential mixed cross-sectional and methodological research. Initially, via a qualitative research, constructs and factors associated with sexual protective behavior of women at risk were identified through 25 in-depth interviews. The questionnaire on predictors of protective sexual behaviors in women at risk of HIV (PSPB) was designed based on a qualitative study, and then its qualitative validity, content, and construct validity were evaluated. Exploratory factor analysis was performed and 200 women at risk participated. Seven concepts emerged after exploratory factor analysis of the 48 items. The content validity ratio (CVR) of the questionnaire constructs were 0.55 to 0.76, and content validity index (CVI) structure was 0.86 to 0.95. Cronbach's alpha coefficient for the entire questionnaire was 0.78, and correlation coefficient of the test-retest reliability for the constructs was from 0.73 to 0.89. The current study proved the capability of the predictors of sexual protective behavior in women at risk for HIV questionnaire as a valid and reliable instrument for the Iranian community.09/2014; 16(9). DOI:10.5812/ircmj.14682