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

London School of Hygiene and Tropical Medicine, Londinium, England, United Kingdom
Sexually Transmitted Infections (Impact Factor: 3.4). 01/2005; 80 Suppl 2(Suppl 2):ii57-62. DOI: 10.1136/sti.2004.011916
Source: PubMed


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.

Download full-text


Available from: Tobi Saidel, Jun 30, 2015
    • "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] "
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Genital ulcerative diseases are a major public health problem. The advert of human immunodeficiency virus (HIV)/AIDS over the past 25 years has deepened the scope of morbidity, mortality, and various forms of clinical presentations of sexually transmitted diseases (STDs). Materials and Methods: A total of 50 cases having Genital ulcerative diseases and STD reporting to STD clinic during the period of the year from November 2005 to December 2006 were included and detailed history and clinical examination were carried out and provisional diagnosis is made. Laboratory confirmation of clinically diagnosed cases was done using laboratory tests such as S. HIV, venereal disease research laboratory, Tzanck smear, gram stain, and Giemsa stain. Result: In the present study, the incidence of herpes progenitalis was (38%) followed by primary syphilis (32%), chancroid (26%), lymphogranuloma venereum (02%), and genital scabies (02%). HIV sero-positivity was detected in 12% (n = 6) cases. Conclusion: HIV was found to be more common among genital ulcer disease patients, especially syphilis and genital herpes.
    No preview · Article · Apr 2014 · Indian Journal of Sexually Transmitted Diseases and AIDS
  • Source
    • "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]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Major investments by development partners in low- and middle-income countries (LMICs) often seek to develop a supportive policy environment. There is limited knowledge about the mechanisms that development partners use to influence government policy, or which mechanisms are effective. This study assessed the influence of Avahan, a large HIV/AIDS prevention program in India supported by the Bill and Melinda Gates Foundation, on the development of HIV/AIDS policies in India, particularly the National AIDS Control Program III (NACP III). Methods A retrospective assessment of the contributions of Avahan to the development of NACP III was conducted based upon document review and in-depth interviews with key informants, including Avahan staff and staff of implementing partners. This assessment was carried out within a framework centered on three domains: evidence considered by policy and decision-makers; the channel through which influence is exerted; and the target audience for influence. Results Respondents identified a number of respects in which Avahan influenced NACP III policy, notably, Avahan influenced perception of the feasibility of scaling up services (through a demonstration effect) and Avahan, along with others, helped ensure a strong focus on targeted interventions. Overall Avahan’s influence was greatest during policy implementation. While the extent to which research evidence generated by Avahan influenced NACP III was limited, best practice evidence generated by Avahan, including the lessons learned from routine implementation and management, contributed significantly to NACP III. This was largely due to the credibility Avahan had established and strategic ‘inside track’ communications. Conclusion While studies of knowledge translation typically focus primarily on scientific evidence, this study suggests that other forms of evidence, notably best practice evidence derived from program experience, and disseminated through personal communication, were particularly influential. The framework developed for the paper provides a useful tool to analyze how evidence-based influence is exerted.
    Full-text · Article · Apr 2013 · Implementation Science
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To determine operational and analytical characteristics of respondent-driven sampling (RDS) in international settings and to explore factors that may affect recruitment of most-at-risk populations using RDS, we reviewed HIV biological and behavioral surveillance studies that used this method outside of the United States. We identified 123 eligible studies, 59 from Europe, 40 from Asia and the Pacific, 14 from Latin America, seven from Africa and three from Oceania. Studies collectively recruited 32,298 participants between 2003 and 2007; 53% of studies were conducted among injecting drug users, which generally had faster recruitment compared with studies among sex workers. All but 13 studies reached > or = 90% of their intended sample size, and six studies failed to reach equilibrium for key variables. This review has shown that RDS is an effective technique, when designed and implemented appropriately, to sample most-at-risk populations for HIV biological and behavioral surveys.
    Full-text · Article · Jul 2008 · AIDS and Behavior
Show more