A global analysis of trends in the quality of HIV sero-surveillance J M Garcia-Calleja, E Zaniewski, P D Ghys, K Stanecki, N Walker ............................................................................................................................... See end of article for authors’ affiliations ....................... Correspondence to: Dr P D Ghys, UNAIDS, 20 Avenue Appia, CH-1211 Geneva 27, Geneva, Switzerland; ghysp@ unaids.org ....................... Sex Transm Infect 2004;80(Suppl I):i25–i30. doi: 10.1136/sti.2004.010298 Objective: To examine the quality of HIV sero-surveillance systems in countries by 2002, as well as trends between 1995 and 2002. Methods: The quality of countries’ surveillance systems was scored for five years: 1995, 1997, 1999, 2001, and 2002. Sero-surveillance data were compiled from the US Census Bureau’s HIV/AIDS Surveillance Database, the EuroHIV database, and from countries’ national HIV surveillance reports that were available to WHO/UNAIDS. The quality of systems was scored according to the level of the countries’ epidemic. Results: There has been a large variation in the quality of HIV surveillance systems across the 132 countries by type of the epidemic and over time from 1995 to 2002. Over the 1995–2002 period the number of countries with a fully implemented system decreased from 57 (43%) in 1995 to 48 (36%) in 2002. The proportion of countries with a fully implemented system was 58%, 34%, and 10% in countries with a generalised, concentrated, and low level epidemic, respectively. In the 53 countries with generalised epidemics the number of countries with a fully implemented system increased from 24 (45%) in 2001 to 31 (58%) in 2002. Conclusion: Many countries still have poor functioning HIV surveillance systems and require urgent strengthening. Countries should monitor and evaluate their own HIV surveillance systems and examine whether the systems are appropriate and adequate. H IV surveillance constitutes a core function of national AIDS programmes worldwide. Surveillance data on HIV infection is important for numerous reasons, but most importantly to track the spread of HIV both within different populations in countries as well as across different geographic regions. 1 Since 2000, UNAIDS and WHO have promoted the second generation surveillance framework. 2 This more strategic approach to surveillance aims to improve understanding of the epidemic through the collection of information from different sources, including the spread of HIV infection and other STIs, risk behaviours, morbidity, and mortality. The second generation surveillance framework also aims to tailor surveillance systems to the countries’ type of epidemic. Ultimately, second generation surveillance aims to contribute to an improved response to the epidemic based on an improved analysis of surveillance data from a variety of sources. Information generated by second generation sur- veillance systems also allows better understanding of HIV dynamics and provides information to evaluate the impact of past and current HIV/AIDS programmes. Countries’ HIV/AIDS surveillance systems have evolved over time. Most countries have initiated a sentinel HIV sero-surveillance component to study the distribution of infection among different populations and geographically, and to monitor trends in levels of infection over time. The analysis of trends in HIV sero-prevalence data over time is key to understanding the dynamics of the epidemic, but depends on the availability of sero-prevalence data collected repeatedly from the same sites. An analysis of HIV sero- surveillance systems through 1999 suggested that the quality of HIV sero-surveillance varied considerably across coun- tries. 3 Although the majority of countries most affected by HIV/AIDS had systems that could provide sufficient data for tracking the epidemic and making reasonable estimates of HIV prevalence, many countries had poor functioning systems. In the past few years more resources have become available to countries, from a variety of sources including their own national budgets, the Global Fund for AIDS, Tuberculosis and Malaria (GFATM), the World Bank’s Multi-Country HIV/ AIDS Program project, and bilateral sources, for their response to the HIV/AIDS epidemic. This increase in resources will place increased demands on monitoring and evaluation systems, including information generated by surveillance systems. HIV sentinel sero-surveillance data are a major building block for deriving national estimates of prevalence of HIV infection. 45 The quality of the sero- surveillance data will determine the certainty of those estimates. This paper examines the quality of HIV sero-surveillance systems in 132 low and middle income countries in 2002, as well as trends between 1995 and 2002. METHODS Data sources An overall database of HIV surveillance data was developed by combining information from four sources. Data on HIV sero-surveillance were retrieved from the HIV/AIDS surveil- lance database developed by the United States Census Bureau. 6 Data for countries in Europe came from a database maintained by the European Centre for the Epidemiological Monitoring of AIDS. 7 These data were combined with national HIV surveillance reports that were available to WHO and UNAIDS. Finally, countries that had conducted a nationally representative population based survey including HIV prevalence had those data included in the overall surveillance database for review. We excluded high income countries from this analysis. Abbreviations: IDUs, injecting drug users; MSM, men who have sex with men i25 www.stijournal.com group.bmj.com on November 5, 2015 - Published by http://sti.bmj.com/ Downloaded from