HIV surveillance systems aim to monitor trends of HIV infection, the geographical distribution and its magnitude, and the impact of HIV. The quality of HIV surveillance is a key element in determining the uncertainty ranges around HIV estimates. This paper aims to assess the quality of HIV surveillance systems in low- and middle-income countries in 2009 compared with 2007.
Four dimensions related to the quality of surveillance systems are assessed: frequency and timeliness of data; appropriateness of populations; consistency of locations and groups; and representativeness of the groups. An algorithm for scoring the quality of surveillance systems was used separately for low and concentrated epidemics and for generalised epidemics.
The number of countries categorised as fully functioning in 2009 was 35, down from 40 in 2007. 47 countries were identified as partially functioning, while 56 were categorised as poorly functioning. When compared with 2007, the quality of HIV surveillance remains similar. The number of ANC sites in sub-Saharan Africa has increased over time. The number of countries with low and concentrated epidemics that do not have functioning HIV surveillance systems has increased from 53 to 56 between 2007 and 2009.
Overall, the quality of surveillance in low- and middle-income countries has remained stable. Still too many countries have poorly functioning surveillance systems. Several countries with generalised epidemics have conducted more than one population-based survey which can be used to confirm trends. In countries with concentrated or low-level epidemics, the lack of data on high-risk populations remains a challenge.
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[Show abstract][Hide abstract] ABSTRACT: There exists no consistent explanation for why some countries are successful in combating HIV/AIDS and others are not, and we need such an explanation in order to design effective policies and programmes. Research evaluating HIV interventions from a biomedical or public health perspective does not always take full account of the historical and organizational characteristics of countries likely to influence HIV outcomes. The analysis in this paper addresses this shortcoming by testing the impact of organizational and structural factors, particularly those resulting from population interventions, on HIV outcomes at the country level in sub-Saharan Africa.
The primary independent variables are factors that originated from efforts to slow population growth: whether a country has a long-time affiliate of the International Planned Parenthood Federation and whether a country has a population policy. Additional structural factors likely to impact HIV outcomes include the level of wealth, the level of cultural fractionalization, and the former colonial power. The present study uses multivariate regression techniques with countries in sub-Saharan Africa as the unit of analysis, and four measures of success in addressing HIV: the change in prevalence between 2001 and 2009; the change in incidence between 2001 and 2009; the level of overall antiretroviral coverage in 2009; and the level of antiretroviral coverage for prevention of vertical transmission in 2009.
Countries with the greatest declines in HIV prevalence and incidence had older International Planned Parenthood Federation affiliates and had adopted population policies, even after controlling for age of epidemic, level of antiretroviral coverage, and funding for HIV. Population policies are also important predictors of levels of overall antiretroviral coverage and of coverage of HIV-positive pregnant women to prevent vertical transmission. Structural factors with significant impacts include wealth, cultural fractionalization and former colonial power.
The organizational and structural context of African countries is strongly predictive of HIV outcomes. This finding implies that policy and programmatic efforts should be put towards strengthening existing organizations and perhaps even creating new ones. The fact that cultural fractionalization also influences HIV outcomes suggests that efforts must be put towards identifying ways to reach political consensus in diverse societies.
Journal of the International AIDS Society 09/2011; 14 Suppl 2(Suppl 2):S6. DOI:10.1186/1758-2652-14-S2-S6 · 5.09 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The paper tools used to monitor outreach work in all major cities in Viet Nam had substantial writing requirements for each contact with difficulty maintaining confidentiality.
This paper describes the development of a Unique Identifier Code (UIC), a field data collection notebook (databook) and a computer data entry system in Viet Nam. The databook can document 40 individual clients and has space for commodity distribution, group contacts and needles/syringe collection for each month.
Field implementation trials of the UIC and databook have been undertaken by more than 160 peer outreach workers to document their work with people who inject drugs (PWID) and sex workers (SW). Following an expanded trial in Hai Phong province, there have been requests for national circulation of the databook to be used by peer educators documenting outreach to PWID, SW and men who have sex with men. The standardized UIC and databook, in a variety of locally adapted formats, have now been introduced in more than 40 of the 63 provinces in Viet Nam.
This development in Viet Nam is, to our knowledge, the first example of the combination of a confidential UIC and an innovative, simple pocket-sized paper instrument with associated customized data-entry software for documenting outreach.