Surveillance and modelling of HIV, STI, and risk behaviours in concentrated HIV epidemics

Family Health International, Hanoi, Vietnam.
Sexually Transmitted Infections (Impact Factor: 3.4). 01/2005; 80 Suppl 2(Suppl 2):ii57-62. DOI: 10.1136/sti.2004.011916
Source: PubMed

ABSTRACT HIV epidemics in most countries are highly concentrated among population subgroups such as female sex workers, injecting drug users, men who have sex with men, mobile populations, and their sexual partners. The perception that they are important only when they cause epidemic expansion to general populations has obscured a critical lack of coverage of preventive interventions in these groups, as well as appropriate methods for monitoring epidemic and behavioural risk trends. The difficulties in accessing such groups have likewise often cast doubt on the representativeness of observed disease and behavioural risk estimates and their validity and reliability, particularly those related to sampling and the measurement of risk behaviours.
To review methodological obstacles in conducting surveillance with population subgroups in concentrated HIV epidemics, elaborate on recent advancements that partially overcome these obstacles, and illustrate the importance of modelling integrated HIV, STI, and behavioural surveillance data.
Review of published HIV, STI, and behavioural surveillance data, research on epidemic dynamics, and case studies from selected countries.
The population subgroups that merit regular and systematic surveillance in concentrated epidemics are best determined through extensive assessment and careful definition. Adherence to recently refined chain referral and time location sampling methods can help to ensure more representative samples. Finally, because of the inherent limitations of cross sectional surveys in understanding associations between complex sexual behaviours and HIV and STI transmission, mathematical models using multiple year data offer opportunities for integrated analysis of behavioural change and HIV/STI trends.

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Available from: Tobi Saidel, Jun 30, 2015
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    • "The advent of human immunodeficiency virus (HIV)/AIDS over the past 25 years has further deepened the scope of morbidity, mortality, and various forms of clinical presentations GUDs.[23] HIV/AIDS, which has no doubt created a fertile ground for sexually transmitted diseases (STDs) to thrive, and vice versa, presently poses a serious health threat to at least a billion people of the global community.[456] "
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    Indian Journal of Sexually Transmitted Diseases and AIDS 04/2014; 35(1):59-61. DOI:10.4103/0253-7184.132434
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    • "During the mid 2000s, around the time NACP III was being developed, there was substantial debate about the scale of the epidemic in India [14-17] with some analysts asserting that India was ‘on the brink of a significant epidemic’ [17]. Debates took place about whether the required response should be that typically associated with a generalized or concentrated epidemic [18,19]. "
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    Implementation Science 04/2013; 8(1):44. DOI:10.1186/1748-5908-8-44 · 4.12 Impact Factor
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    • "Even in generalized epidemics, in which prevalence is[1% in pregnant women attending antenatal clinics, there is recognition that risk is not uniformly distributed within populations and is driven, at least initially, by most-at-risk populations that bridge HIV to the lower-risk general population (Chopra et al. 2007; Doherty et al. 2006; Gregson et al. 2002; Halperin and Epstein 2004). Accurate HIV data on incidence and prevalence and associated behavioral data from most-at-risk populations are essential for designing targeted prevention programs to reduce the further spread of the epidemic (Mills et al. 2004; Pisani et al. 2003; Zaba et al. 2006). In most countries, however, HIV surveillance systems, the primary source of epidemiologic data, do not generate representative samples of most-at-risk populations. "
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