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STI Surveillance in Latin America

STI Surveillance in Latin America

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STI Surveillance in Latin America

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  1. STI Surveillance in Latin America Edgar R. Monterroso, MD, MPH Freddy Tinajeros, MPH Sonia Morales, DVM, MPH Centers for Disease Control and Prevention (CDC) Global Program on AIDS (GAP)

  2. HIV prevalence (%) in adults (15–49) in Latin America, UNAIDS, 2007 2.18

  3. HIV Second Generation Surveillance Components HIV/AIDS Surveillance Laboratory Investment STI Surveillance Other Sources Tuberculosis ART Surveillance Mortality Data use/ management Monitor and evaluation Behavioral Surveillance 2nd. Generation surveillance

  4. HIV Second Generation Surveillance Components HIV/AIDS Surveillance Laboratory Investment STI Surveillance Other Sources Tuberculosis ART Surveillance Mortality Data use/ management Monitor and evaluation Behavioral Surveillance 2nd. Generation surveillance

  5. Surveillance Systems Evaluations in Central America, 2004-2007 Countries evaluated from 2004 - 2006 Country evaluated in 2007 STI surveillance only

  6. HIV and Syphilis Prevalence among high risk groups, MCS, 2000-2003

  7. Strengthening STI Surveillance in Central America • Using the Bolivia model • Focusing on Commercial Sex Worker regular screening • Established in Honduras and Guatemala • Based at MOH STI Clinics and in conjunction with MOH Staff

  8. Bolivia Model • Initiated by Dr. W. Levin, CDC, and others in 1992 • Focusing on strengthening of: • Etiologic diagnosis laboratory-based • Strengthening clinical management and training of staff • Intervention: outreach, condom usage, clinical management in a humane environment • Informatics: electronic data management and analysis

  9. HIV/AIDS Prevalence in adults in Latin América and the Caribbean Prevalencia por cada 100 personas de 15-49 años Bolivia is number 27 in Latin America and the Caribbean

  10. STI prevalence in CSW, La Paz 1993, 1999* and 2007** *Number of observations: 1992, 141; 1999, 130; 2007, 256 Missing observations excluded from some denominators **RPR titer >1:8, Chlamydia data from 2006

  11. STI prevalence in CSW, Santa Cruz 1993, 1999* y 2007** *Number of observations: 1993, 354; 1999, 832; 2007, 386 Missing observations excluded from some denominators **RPR titer >1:8 Chlamydia data from 2006

  12. Condom Use among CSW in Three Cities in Bolivia* 1992, 1999 and 2006 1993 1999 2006 1992 1999 2006 1997 1999 2006 *Condom use always or almost always during vaginal sex in the last month. 2006 Data, KAP Survey (Population Council)

  13. HIV prevalence (%) in adults (15–49) in Latin America, UNAIDS, 2007 2.18

  14. Selected findings from Guatemala and Honduras VICITS

  15. CSW Demographic Characteristic STI Sentinel Surveillance, VICITS Guatemala, June-August 2007

  16. Internal migrant CSW towns of originSTI Sentinel Surveillance, VICITS Guatemala June – August 2007

  17. Alcohol and drug consumption among CSW, STI Sentinel Surveillance - VICITS, Guatemala June-August, 2007 1 drug n = 55 2 drugs n = 8 n = 189 Percentage 3 o + drugs n = 2 No data n = 1 n = 66 Drugs** *Consumo durante el último mes **Consumo alguna vez en la vida

  18. Positive results for STI among CSW,STI Sentinel Surveillance, VICITSGuatemala, June-August 2007 Persons tested HIV: 217 VDRL: 217 Swabs: 193 Percentage

  19. Condom use among CSW in the last month by partners, STI Sentinel Surveillance, VICITS Guatemala, June-August, 2007 Percentage

  20. Honduras: STI Prevalence and condom use among CSW, VICITS, 2006 @ last sex encounter

  21. STI Prevalence and condom use VICITS vs. BSS Honduras, 2006 *Only those reported attended to health center (VICITS) @ last sex encounter

  22. STI Prevalence and condom use VICITS vs. BSS Honduras, 2006 *Only those reporting services at STI health center (VICITS)

  23. Conclusions and Recommendations • STI sentinel surveillance has a very important role to play in 2nd. Generation Surveillance among MARPs in LRC • STI surveillance systems are cost effective and have an impact in controlling the HIV epidemic • STI Surveillance and BSS play a complimentary role and both are necessary • STI surveillance systems should be developed or strengthened in order to monitor changes in MARPs • Political will needs to be changed in order to make available investment necessary to implement STI surveillance for the long term. • Lastly, STI surveillance systems can play a critical role in preventing HIV among MARPs (clinical management, condom distribution) given that it reduces the risk of HIV infection.

  24. The findings and conclusions of this presentation are those of the author and not necessarily those of CDC/ATSDR i Gracias !