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THE 2 nd GLOBAL HIV/AIDS SURVEILLANCE MEETING BANGKOK, MARCH 2009

Identification of a localized HIV epidemic in IDUs in one neighbourhood of Dhaka, Bangladesh –experience of triangulating data from different sources to strengthen the early warning system of surveillance .

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THE 2 nd GLOBAL HIV/AIDS SURVEILLANCE MEETING BANGKOK, MARCH 2009

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  1. Identification of a localized HIV epidemic in IDUs in one neighbourhood of Dhaka, Bangladesh –experience of triangulating data from different sources to strengthen the early warning system of surveillance Tasnim Azim1, Mahmudur Rahman2, M Shah Alam1, I A Chowdhury2, Masud Reza1, Ezazul Islam Chowdhury1, M. Hanif Uddin31ICDDR,B, 2IEDCR, 3National AIDS/STD Programme THE 2nd GLOBAL HIV/AIDS SURVEILLANCE MEETING BANGKOK, MARCH 2009

  2. BANGLADESH: THE SURVEILLANCE SYSTEM AND HIV PREVALENCE • 2nd Generation Surveillance since 1998 • Most at risk populations • Separate systems for HIV and behavioural surveillance surveys

  3. IDUs: Lending/borrowing needles/syringes in the last week BSS 2006-07 %

  4. Drug Users - Geographical Coverage in serological surveillance

  5. HIV PREVALENCE IN DRUG USERS, ROUND VIII (2007) 6508 drug users sampled from 28 cities HIV found in six cities only

  6. A cohort study on male IDU was initiated in two areas of Dhaka, Bangladesh in 2002 Area A Area B PREVALENCE OF HIV in 2003

  7. Infection prevalence rates in neighbourhoods of Dhaka: Surveillance data

  8. Incidence of HIV and HCV in neighbourhoods of Dhaka: Cohort data

  9. Potential spread of HIV from MARPs to the general population in Dhaka, Bangladesh 2% married 10% married MSW/HIJRA Rickshawpullers 73% married MSM 22%* 27% IDUs are rickshaw pullers 89% 10%* 72%* MSM 28% 11%* IDU 57%* 47% married 9.6%* 2-3%* FSW 18 - 23% of female SW mentioned their clients or non-commercial partners are IDU 1-3%* 76%* 54% married) Truckers 42% married 16% married *figures refer to last year

  10. Subtyping of HIV strains

  11. BD29/2003/IDU/C BD153/2004/IDU/C BD28/2003/IDU/C BD97/2003/IDU/C BD34/2002/IDU/C BD148/2004/IDU/C BD156/2004/IDU/C 94 BD43/2002/Hijra/C BD16/2001/FSW/C BD19/2001/STD/C 100 BD49/2002/FSW/BC BD30/2003/MSM/C BD15/2003/VCT/C 100 BD167/2005/FSW/C BD48/2002/FSW/C BD163/2005/FSW/BC BD76/201/TB/C BD53/2002/VCT/C BD42/2004/VCT/C BD42/Hijra/C ML170/1986/Kenya/A2 0.02 HIV strains from IDU are distinct from strains isolated from other population groups in Bangladesh

  12. SUMMARY AND CONCLUSIONS • BSS warned of an epidemic in IDU, HIV surveillance showed a slow rise • Research cohort study detected a localized HIV epidemic, confirmed by surveillance • Research also showed low incidence of HIV and declining incidence of HCV • BSS data has been warning of spread of HIV from MARPs to bridging populations • Molecular subtyping of strains showed that the overlap has not yet occurred Triangulation of data from surveillance and research studies provide a clearer picture of the HIV epidemic. It helps in identifying subtleties of the epidemic in low prevalence states

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