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“HIV surveillance as a dynamic component of strategic information in an evolving epidemic”

“HIV surveillance as a dynamic component of strategic information in an evolving epidemic”.

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“HIV surveillance as a dynamic component of strategic information in an evolving epidemic”

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  1. “HIV surveillance as a dynamic component of strategic information in an evolving epidemic” Authors: Laxmi Raj Pathak, National Centre for AIDS and STD Control, Ministry of Health and Population, Nepal; Isabel Tavitian-Exley, UNAIDS-Nepal, Laxmi Bilas Acharya, Family Health International, Nepal; Sharon Arscott-Mills, USAID-Nepal; Amaya Maw-Naing, WHO-Nepal Second Global Surveillance meeting, Bangkok, Thailand, 5th March 2009

  2. Nepal’s HIV epidemic • Evolved from low prevalence to concentrated epidemic (~ an estimated 70,000 HIV infections – as of Jan 2009: 12,933 cases identified) • HIV transmission: driven by injecting drug use and sexual transmission • During times of conflict and political unrest, incremental approaches and innovative partnerships are paramount for generating strategic information to manage the HIV epidemic. • At various stages of the epidemic appropriate surveillance strategies have been vital in providing adequate responses.

  3. Nepal National Surveillance timeline (1993-2007) • HSS/STI patients: 6 sites in Kathmandu, Pokhara, Birgunj, Nepalganj and Kanchanpur (regional government hospitals) and an NGO run hospital in Jhapa (Eastern region). • HSS/ANC: 6 sites in Kathmandu, Pokhara, Birgunj, Nepalganj, Kanchanpur and Jhapa. Source: National Centre for AIDS and STD Control, Strategic Information Technical Working Group

  4. Responding to a changing context • 1999, Sero-prevalence among TB patients increased from 0.6% in 1996 to 2.2% • HIV sero-prevalence among pregnant women remained at 0.2%, prevalence in STI patients rose from 1.3 % to 2.7% with higher infection rates observed in the Far-West. • After 2001, most facility-based surveillance activities were delayed or put on hold, due to conflict and instability. • Global guidance and re-thinking of HIV surveillance was rapidly applied in Nepal to complement facility-based HSS to population-based surveys among groups at highest risk of transmission

  5. Data management Data analysis and synthesis HIV estimates and projections Use of data for action Second Generation Surveillance systemin Nepal: evolution and components STI surveillance HIV surveillance HIV/AIDS/STI case reporting Behavioural surveillance HR popn. size estimation SGS elements prioritised & functioning SGS components in use – being strengthened Weak SGS components to be strengthened Monitoring and Evaluation Source: National Centre for AIDS and STD Control

  6. HIV prevalence measured by population based surveillance was significantly higher among groups most-at-risk of transmission • Facility-based surveillance showed low HIV prevalence compared to population based surveys. • Facility-based data would not have captured the magnitude of the problem. • It is recognized that facility-based surveillance targets different groups than does population-based surveillance; • the population data completes the picture

  7. HIV prevalence in HSS (STI patients) and IBBS (high-risk groups) IBSS survey in IDUs & FSW (larger sample) BSS in IDUs & FSW- community survey Source: National Centre for AIDS and STD Control, UNAIDS, WHO, USAID/FHI(2008)

  8. Use of surveillance data Distribution of HIV Infections by Risk Groups in Nepal, 2007 3 rounds of National estimations of HIV infections (2003, 2005 & 2007) Methods used: UNAIDS/WHO estimation methods and tools and national surveillance data Highlight emerging scenario: • The population group with the highest number of infected individuals was migrant labourers (& likely their spouses in Nepal) • They account for 42% of all HIV infections in Nepal in 2007. • Despite some variations, findings are consistent over time in 2003, 2005 and 2007 estimations) MSM FSW IDU Other Female Clients Trafficked Women Migrants Source: National Centre for AIDS and STD Control, UNAIDS, WHO, USAID/FHI(2008)

  9. Signs of declining HIV prevalence among IDUs(IBBS 2002-2007) Kathmandu Pokhara Eastern Terai Western Terai N = 303 N = 300 N = 345 N = 300 N = 300 N = 345 N= 300 Source: NCASC/USAID/FHI/New ERA/SACTS

  10. Conclusions • Appropriate sources of surveillance data prioritized and supported (eg. regular reviews,..) • A flexible and dynamic surveillance plan in place (allows adaptation and changes, eg. possible spacing..) • National leadership involved in the SGS development and coordination (eg. Surveillance–Technical Working Group > Strategic Information TWG chaired by NCASC (MoH)) • Innovative partnerships on Strategic Information developed (eg. SI-TWG brings together range of partners with different skills, competences and perspective, includes civil society) • Data used for action and programming decisions (eg. Nepal initiative, IDU prevention focus for GFATMRd II, UNODC established in country (2005), Border project India-Nepal developed (2007), focus on IDUs and migrants in GFATM RdVII (2007)) • Sustainability and continuity (technical, financial…)

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