1 / 17

Critical Review of HIV Surveillance System in India

Critical Review of HIV Surveillance System in India . D.C.S. Reddy NPO, WHO-India. Evolution. 1985: Sero diagnostic facilities established 1986: First case & expansion of Dx. facilities 1992: HIV Sentinel surveillance (HSS) in AN & STD clinics

stavros
Download Presentation

Critical Review of HIV Surveillance System in India

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Critical Review of HIV Surveillance System in India D.C.S. Reddy NPO, WHO-India

  2. Evolution • 1985: Sero diagnostic facilities established • 1986: First case & expansion of Dx. facilities • 1992: HIV Sentinel surveillance (HSS) in AN & STD clinics • 1998: Expansion of HSS and regular HIV estimation • 2001: Nation wide BSS and Mapping of MARPS • 2003: Expansion of HSS among MARPS

  3. Components of current HIV surveillance system in India • Surveillance among MARPS : (405 sites in 2007) • STD Clinic attendees (252 sites in 2007); FSW (83); MSM (18); IDU (30); Long Distance Truckers & Migrants (15 & 6) • General Population: • ANC attendees (628 sites) • National Behavioural Surveillance (2001 & 06) • AIDS Case & death Reporting • STI Surveillance

  4. Need for Review of Surveillance: Some concerns • Implementation of surveillance among MARPS through NGOs implementing TIs: • Conflict of interest & selection bias • Inadequate coverage • UAT sans consent in TI sites: An ethical dilemma • Relevance of HIV surveillance among STD patients (double counting?) • Sample size in ANC is 400: Is it sufficient? • Reporting of AIDS and STI cases: Clinic based, incomplete and delayed

  5. Need for Review of Surveillance: Some New Developments • Need to inform planning at district level under NACP-3 • Adequacy of data emerging from PMTCT, PITC & ART to supplement surveillance? • Suitability & Feasibility of new surveillance strategies (IBBS) & lab technologies (DBS & BED assay) to strengthen surveillance?

  6. Objecttives of review To recommend feasible and appropriate measures for improvement

  7. The Review: A Three Step Process • Step I: Small group meetings • Step II: Preparation of background documents • Step III: International consultation

  8. Step I: Small group meetings • To articulate key questions • Participants: Those who were closely associated with: • Implementation of surveillance • Surveillance data analysis • Separate meeting for each component

  9. Step II: Background Documents • Critical appraisal of current status • Prepared by experts associated with surveillance in India using – personal experiences • Literature review • Review of monitoring reports of prev. yrs. • Data from other relevant sources • Data analysis where needed and feasible (eg. Comparison of ANC surveillance & PMTCT data) • Circulated to proposed participants in the consultation

  10. Step III: International Consultation • Consensus based recommendations • In depth group discussions • Plenary • Participants: • NACO /WHO /UN partners (UNAIDS, UNICEF, UNFPA) /CDC /FHI /BMGF /National Institutes (ICMR & NIHFW)

  11. Group discussion during Consultation Five working groups deliberated on: • HIV surveillance among MARPS (STD pts., FSW, MSM, IDU, Migrants & L D Truckers) & BSS • HIV Surveillance in general population • STI surveillance • AIDS case surveillance • Laboratory issues related to surveillance

  12. Key questions about HIV surveillance among populations with high risk behaviors • Is UAT strategy in MARPS ethically acceptable? • How to ensure geographical coverage of HSS among MARPS? • What are the biases in MARP Surveillance? • What are the alternatives to overcome the issues of representation and bias & how to operationalize them? • Should surveillance be established among prisoners? • Does surveillance among STI patients add value in monitoring HIV trends in MARPS? • If not, is it time to phase out HIV surveillance in STI patients?

  13. Recommendations for HIV surveillance among MARPS • Concentrated epidemic in India: MARP Surveillance critical • Periodic MARP Mapping & size estimation • Replace BSS with scaled down IBBS (-lite) model with sufficient ext. validity every 2-3 years • Switch to UAT with consent • Switch to DBS for HIV testing after feasibility testing • Discontinue HIV surveillance in STI clinic sites in High Prev. states & phase out in Low Prev. states • Use subgroup analysis of ICTC data for HR behaviour popn. to identify emerging epidemics

  14. Significant outcomes accepted by NACO • Use of DBS and UAT with consent in MARP surveillance studied and being used • Fresh mapping completed & being validated • Accepted to phase out HSS among STD patients and to do subgroup analysis of VCTC data for MARPS to identify emerging infection • Protocol under preparation for IBBA (-lite) as recommended

  15. Significant outcomes accepted by NACO • protocol under preparation for piloting HIV case reporting using WHO case definitions • Agreed to strengthen STI surveillance – protocol to be prepared • BED Assay: Efforts to develop correction factor for subtype C and Avidity assay are underway at National AIDS Research Institute. Implementation depends on study outcomes

  16. Conclusions • Evaluation of HSS is possible by structured review and consultation • Helps in decisions in consensus with programme managers • Involvement of NACs leads to ownership of decisions and facilitates acceptance and implementation

  17. Thank You

More Related