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An alternative to Annual HIV surveillance among ANC

The Second Global HIV/AIDS Surveillance: the new strategies for HIV surveillance in resource constrain countries. Txema Calleja WHO March 2-5 , 2009 Bangkok. An alternative to Annual HIV surveillance among ANC. Outline. HIV sentinel surveillance in Antenatal Clinics (ANC)

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An alternative to Annual HIV surveillance among ANC

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  1. The Second Global HIV/AIDS Surveillance: the new strategies for HIV surveillance in resource constrain countries Txema Calleja WHO March 2-5 , 2009 Bangkok An alternative to Annual HIV surveillance among ANC

  2. Outline • HIV sentinel surveillance in Antenatal Clinics (ANC) • Data available with MTCT programs • Conclusions

  3. What’s the Problem? • 21st Century: Era of Antiretroviral therapy • Argument: all women, especially in high prevalence settings, should know their HIV status • Anonymous, unlinked surveillance in the absence of PMTCT program is increasingly viewed as unethical • Syphilis rapid test introduced in ANC l

  4. Benefits • Could save cost for annual ANC surveys, if PMTCT data can be used • Should improve PMTCT data collection if there is systematic review and data use • Could improve quality assurance of PMTCT program • Could contribute to evaluate impact of PMTCT programs

  5. The question : • Can PMTCT replace ANC surveillance systems in SS Africa ? • What are the conditions under which PMTCT program data can replace ANC sentinel surveys as the primary source of HIV prevalence data ?

  6. Fifth Meeting of the WHO/AFRO Technical Network on HIV/AIDS and STI SurveillanceHarare, Zimbabwe26-28 September 2006 

  7. HIV Testing in ANC: UAT vs. PMTCT (Example) Woman attends antenatal clinic At first visit, blood drawn for routine syphilis testing; routine demographic information (age, parity) obtained May accept HIV testing for PMTCT at any visit or may refuse testing Specimen aliquoted for HIV testing for surveillance Demographic data transcribed onto data sheet Personal identifiers removed Blood collected with personal identifiers at facility laboratory; Demographic data (age, gravidity) recorded in logbooks Specimen and demographic data sheet transported to central laboratory Specimen tested for HIV on site: Determine® and UniGold® in parallel EIA or InstantScreen ® as tie breaker Specimen tested for HIV: Determine® only Test result given to woman with counseling No test result given to woman

  8. UAT and PMTCT-based Median HIV Prevalence by Age Group for 6 Sites (Kenya 2004) Nicole Seguy Wolfgang Hladik CDC 2005

  9. Percentage HIV-Positive by Sentinel Site Among ANC and PMCTC Atendees, Zimbabwe, 2004 HIV %

  10. Uganda: Gulu District Comparison between UAS and PMTCT prevalenceOverall adjusted prevalence Fabiani et al AIDS 2006

  11. Uganda: Gulu District Comparison between UAS and PMTCT prevalenceAge-specific adjusted prevalence (2004) Fabiani et al AIDS 2006

  12. Afro Epinetwork Recommendations… • Improve PMTCT programmatically • Enhance accessibility and coverage • Prioritize historical ANC sites • The network recommends that all UAT surveillance sites should offer PMTCT services. • Improve PMTCT data collection systems • Currently, accessibility and quality of data is highly variable • Use ANC data to assess PMTCT outcomes and impact

  13. Challenges with PMTCT Data at ANC • Logbook / register may lack standardization • Number and order of variables in log book may vary by site and over time within same site • Lack of training/ supervision on completing register • Not all data available in one day e.g. HIV test result may not be available on the day of the test • Data may be recorded in 2 to 3 logbooks • Data is aggregated/ summarized monthly and reported to officials (no line list data reporting)

  14. Possible Criteria • Individual Information from PMTCT patients • Similar variables than ANC surveillance systems • High coverage for ANC • High coverage of PMTCT programs and uptake • HIV laboratory issues; algorithm and quality

  15. Conclusions • Need to continue UAT among PW to be able to interpret historical HIV sentinel trends • Limited use of PMTCT data for surveillance at present • Need clear criteria on how and when to use PMTCT data • Feasibility studies ongoing • Next afro epinetwork meeting June 2009 to review and evaluate criteria to replace ANC sentinel surveillance

  16. Thank you

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