Unit 3: Universal Case Reporting and Sentinel Surveillance for STIs

1. Unit 3: Universal Case Reporting and Sentinel Surveillance for STIs #4-3-1

2. Warm Up Questions: Instructions • Take five minutes now to try the Unit 3 warm up questions in your manual. • Please do not compare answers with other participants. • Your answers will not be collected or graded. • We will review your answers at the end of the unit. #4-3-2

3. What You Will Learn • By the end of this unit, for STI universal case reporting and sentinel surveillance, you should be able to: • discuss the purpose of each system of surveillance • discuss the advantages and disadvantages of each • define when each should be implemented • define the population studied for each • discuss reporting under IDS #4-3-3

4. Two Case Reporting Approaches • This unit compares and contrasts two different approaches to STI case reporting: • In universal STI case reporting, all healthcare facilities report all STI cases to public health authorities. • In STI sentinel surveillance, selected sites collect more detailed data on STI cases. #4-3-4

5. Universal STI Case Reporting • Minimal data elements about STIs are collected from all health facilities. • Two types of reports may be used: • syndromic reports, which provide data on patients’ set of symptoms (syndromes) • aetiologic reports, which provide data on which micro-organism is causing symptoms. These determinations can only be made in a laboratory. • General lack of lab support in the African region means that syndromic reports will be the primary method used. #4-3-5

6. Advantages of Universal Case Reporting • Universal case reporting provides the most readily available source of STI surveillance data. • It provides data which is easy to collect from health facilities. • It provides data on the burden of STIs at the health facility level, important for planning health services. • When consistent, it can be used to track population-level STIs trends. (This information can be found in Table 3.1 in the text.) #4-3-6

7. Disadvantages of Universal Case Reporting • Universal case reporting is based on recognition of symptoms and thus provides a poor assessment of the true disease burden among women. • It does not provide a direct estimate of the population burden of STIs because people with asymptomatic infection do not realise they are infected so they do not seek care. • It is affected by fluctuations in health-seeking behaviours of the population not related to the burden of disease. (This information can be found in Table 3.1 in the text.) #4-3-7

8. Reporting Form for Universal Case Reporting • WHO recommends the IDS form for universal case reporting in the African region. • This form is used for all priority communicable diseases. • The STI syndromes reported in IDS are: • male urethral discharge • male genital ulcer disease • female genital ulcer disease #4-3-8

9. STI Sentinel Surveillance • A pre-arranged sample of health facilities and other sites agrees to report one or more notifiable conditions. • More demographic and risk data on STI cases are collected and reported. #4-3-9

10. STI Sentinel Surveillance, Cont. • Site trends in STI case reports are used to infer trends at other health facilities. • Take care in interpreting the results, since sentinel sites are not necessarily representative of the whole region. • Health facilities known to be diligent in reporting STI cases are selected as the sentinel sites. • Detailed high-quality data are collected from these sites. #4-3-10

11. Sentinel Site Case Reporting • STI cases are reported from a small number of sentinel sites using either the syndromic or aetiologic reporting. • Syndromic case reporting: • More common in African countries, where lab support is not usually available. • Same case definition at all sites, for easy comparison. • Aetiologic: • Lab support must be available. • Cases classified as confirmed or probable, depending on strength of laboratory evidence. #4-3-11

12. Advantages of Sentinel Site Case Reporting • Regular supervision, feedback and logistical support can be provided because sentinel sites are located in fewer facilities. • Higher quality data can be obtained from a few sites with intensive support of training, supervision and logistics. • Sentinel STI case reporting system is less expensive to run and maintain than a universal reporting system. • It is more flexible than universal case reporting. Additional studies can be added without changing the basic structure. (This information can be found in Table 3.2 in the text.) #4-3-12

13. Disadvantages of Sentinel Site Case Reporting • Sentinel STI surveillance cannot provide minimum population-based estimates of disease burden. • Sentinel sites are located in only a few health facilities and may not be representative of sites outside of their catchment areas. (This information can be found in Table 3.2 in the text.) #4-3-13

14. Selection of Sentinel Sites • Convenience sampling: the selection of sites based on their availability and accessibility • Probability sampling: the selection of sites that ensures that each site has an equal probability of being selected • Probability sampling gives more representative results, but it is more difficult and inconvenient. #4-3-14

15. Selection of Sentinel Sites, Cont. • Selection is influenced by: • the objectives of the system • the structure of the country’s health system • the extent to which STI case reporting is incorporated into primary healthcare • The sites should: • see a large number of STI cases and provide care • include both urban and rural areas • have qualified staff • include high-risk groups • integrate STI surveillance with other surveillance activities • include public and private sectors #4-3-15

16. Developing the Reporting Forms • The national AIDS/STI control programme should develop the forms. • The same form should be used at all sites. • Reporting forms should be simple. • To protect patients’ privacy, reporting forms should not have personally identifying information. #4-3-16

17. Table 3.3. Core and AdditionalData Elements #4-3-17

18. Implementing Surveillance • Site staff should be trained in data collection using the standard reporting forms. • There should be enough forms at sites. • There should be supervision from the national AIDS/STI control programme. • There should be a system of data transfer to the central office. • Sentinel sites should be monitored for data quality. #4-3-18

19. Combined Universal and Sentinel Surviellance Case Reporting • Universal case reporting through IDS provides basic estimates of incidence and prevalence. • Sentinel case reporting supplements universal reporting by providing epidemiological and clinical detail on a subset of cases. • Sentinel sites should report through both the universal and sentinel reporting systems. • Universal case reporting through IDS should be the priority. If this is not possible, sentinel surveillance can be conducted instead. #4-3-19

20. Syphilis Screening at Sentinel Sites • Distinct from sentinel STI case reporting • Data are collected from routine clinical syphilis screening programs. • Prevalence can be calculated for all tested patients, or by demographic or risk group. • Examples of sentinel sites include: • antenatal clinics • STI clinics #4-3-20

21. In Summary • STI surveillance can occur through universal case reporting, sentinel surveillance or a combination of the two. • Sentinel surveillance gives higher quality data than universal case reporting, at lower cost. • Sentinel surveillance data are not representative of the general population, while universal case reporting data can be. • Through IDS, priority is given to universal case reporting. #4-3-21

22. Warm Up Review • Take a few minutes now to look back at your answers to the warm up questions at the beginning of the unit. • Make any changes you want to. • We will discuss the questions and answers in a few minutes. #4-3-22

23. Answers to Warm Up Questions 1. Which of the following is an advantage of universal STI case reporting? a. It is the most readily available source of surveillance data and easy to collect from health facilities. b. It provides data on the burden of STIs at the health facility level, which is important for planning health services provisions. c. Under stable conditions and consistent reporting, data arising from STI case reporting can serve as a proxy for population dynamics of STIs. d. All of the above #4-3-23

24. Answers to Warm Up Questions 1. Which of the following is an advantage of universal STI case reporting? a. It is the most readily available source of surveillance data and easy to collect from health facilities. b. It provides data on the burden of STIs at the health facility level, which is important for planning health services provisions. c. Under stable conditions and consistent reporting, data arising from STI case reporting can serve as a proxy for population dynamics of STIs. d. All of the above #4-3-24

25. Answers to Warm Up Questions, Cont. 2. True or false? Data collected from sentinel sites can be easily generalised to a broader population. #4-3-25

26. Answers to Warm Up Questions, Cont. 2. True or false? Data collected from sentinel sites can be easily generalised to a broader population.False #4-3-26

27. Answers to Warm Up Questions, Cont. 3. In countries where information about STIs is obtained through a universal reporting system, sentinel STI surveillance a. is unnecessary b. should replace universal reporting as the primary method to study STIs c. should supplement information obtained from the universal reporting system #4-3-27

28. Answers to Warm Up Questions, Cont. 3. In countries where information about STIs is obtained through a universal reporting system, sentinel STI surveillance a. is unnecessary b. should replace universal reporting as the primary method to study STIs c. should supplement information obtained from the universal reporting system #4-3-28

29. Answers to Warm Up Questions, Cont. 4. True or false? Supervision and feedback are easier to provide for a sentinel surveillance system than for a universal system. #4-3-29

30. Answers to Warm Up Questions, Cont. 4. True or false? Supervision and feedback are easier to provide for a sentinel surveillance system than for a universal system. True #4-3-30

31. Answers to Warm Up Questions, Cont. 5. True or false? Universal case reporting provides a poor assessment of the true disease burden among women. #4-3-31

32. Answers to Warm Up Questions, Cont. 5. True or false? Universal case reporting provides a poor assessment of the true disease burden among women. True #4-3-32

33. Answers to Warm Up Questions, Cont. 6. What system of surveillance is recommended for reporting all priority communicable diseases? #4-3-33

34. Answers to Warm Up Questions, Cont. 6. What system of surveillance is recommended for reporting all priority communicable diseases? Integrated Disease Surveillance #4-3-34

35. Small Group Discussion: Instructions • Get into small groups to discuss these questions. • Choose a speaker for your group who will report back to the class. #4-3-35

36. Small Group Reports • Select one member from your group to present your answers. • Discuss with the rest of the class. #4-3-36

37. Case Study: Instructions • Try this case study individually. • We’ll discuss the answers in class. #4-3-37

38. Case Study Review • Follow along as we go over the case study in class. • Discuss your answers with the rest of the class. #4-3-38

39. Questions, Process Check • Do you have any questions on the information we just covered? • Are you happy with how we worked on Unit 3? • Do you want to try something different that will help the group? #4-3-39