6. h.i.v. sentinel surveillance - sap.pptx

8/19/2019 6. H.I.V. SENTINEL SURVEILLANCE - SAP.pptx

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H.I.V. SENTINELSURVEILLANCE

Dr. Rajesh Kamath

Assistant ProfessorDepartment of Public health

Manipal University


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Introduction According to the HIV Estimates for 202! the

estimated num"er of #eo#$e $i%ing &ithHIV'AI(S in India &as 20.)* $a+h in 20.

The adu$t ,-/* agegrou# HIV #re%a$ence

at nationa$ $e%e$ has continued its stead1dec$ine from an estimated $e%e$ of 0./ in200 to 0.23 in 20.

4ut sti$$! India is estimated to ha%e the thirdhighest num"er of estimated #eo#$e $i%ing

&ith HIV'AI(S! after South Africa and Nigeria,UNAI(S Re#ort on the 5$o"a$ AI(S e#idemic200.


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The to# 20 6 7eo#$e $i%ing &ithHIV ' AI(S

Ran+ Countr1 7eo#$e &ith HIV'AI(S South Africa -!800!000 2 Nigeria 9!900!000 9 India 2!/00!000

/ :en1a !-00!000 - ;o


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The to# 20 6 7eo#$e $i%ing &ithHIV ' AI(S

>am"ia *)0!000 2 ;a$a&i *20!000 9 China 3/0!000

/ Cameroon 80!000 - Thai$and -90!000 8 Cote d?I%oire /-0!000 3 U+raine 9-0!000

) 4ots&ana 920!000 * Indonesia 90!000 20 Lesotho 2*0!000


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The to# 20 6 HIV'AI(S adu$t #re%a$encerate Ran+ Countr1 HIV'AI(S adu$t #re%a$ence

rate S&aim"a"&e /.9 8 >am"ia 9.-

3 Nami"ia 9. ) ;o


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The to# 20 6 HIV'AI(S adu$t #re%a$encerate

:en1a 8.9 2 Tan


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Introduction . The annua$ nationa$ HIV Sentine$ Sur%ei$$ance

,HSS is one of the com#onents of secondgeneration HIV sur%ei$$ance in India.

2. India@s HSS s1stem is the $argest HSS s1stemin the &or$d.

9. The HSS s1stem he$#s in understanding thed1namics of the HIV e#idemic and monitoringthe trends among dierent #o#u$ation grou#sand geogra#hica$ areas and! thus!

/. #ro%ides in#uts to the #rogramme forstrengthening #re%ention and contro$ acti%ities.


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Introduction -. The sentine$ sites ha%e "een sca$ed u# in a

#hased manner from )0 in **) to 9-* in

200. 8. 8*8 ANC sites! )/ ST( sites and /3* sites

among high ris+ grou#s ,Bema$e Se Dor+ersBSD! ;en &ho ha%e Se &ith ;en;S;!

TransgendersT5 InFecting (rug UsersI(U and"ridge #o#u$ation,Sing$e ;a$e ;igrantsS;; Long (istance Truc+ersL(T.

3. A tota$ of /!23!--* sam#$es &ere co$$ected andtested during HIV Sentine$ Sur%ei$$ance 200.


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Introduction

). A$most e%er1 district in the countr1 is no&co%ered under sur%ei$$ance.

*. Under HSS! an antenata$ c$inic ingo%ernment or #ri%ate hos#ita$s is designatedas an ANC sentine$ site &here /00 #regnant&omen ,ANC attendees are recruited.

0. Simi$ar$1! the ST( c$inic and 51naeco$og1,G45 c$inic in the same ,or near"1go%ernment faci$it1 are together designated asan ST( sentine$ site &here -0 ST( #atientsattending the ST( c$inic and 00 fema$e ST(#atients attending the G45 c$inic! are inc$udedin sur%ei$$ance.


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Introduction

. Sur%ei$$ance is carried out o%er a#eriod of three months.

2. Three stamem"ers at each faci$it1are gi%en the res#onsi"i$it1 to im#$ement

the sur%ei$$ance acti%ities. 9. The1 inc$ude a doctor! &ho is

designated as the sentine$ site incharge! /. a nurse or counse$or &ho assists in

data co$$ection and a -. $a"orator1 technician res#onsi"$e for

co$$ection of the "$ood s#ecimens.


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IntroductionHIV #re%a$ence among dierent #o#u$ation

grou#s in 200 sho&s that HIV is

concentrated among High Ris+ 5rou#s 6Transgenders !.!"#$% &DU '.()#$% M*M).)+#$ and ,*- ".'#$ &hi$e HIV#re%a$ence among ANC c$inic attendees!considered #ro1 for genera$ #o#u$ation! is $o&at /.)/#.

4ridge #o#u$ation grou#s ha%e HIV #re%a$ence of/.00# among migrants and ".10# amongtruc+ers.


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Dhat is HIV Sentine$Sur%ei$$ance J

HIV Sentine$ Sur%ei$$ance is deKned as a s1stem of monitoring HIV e#idemics among s#eciKed #o#u$ation grou#s "1 co$$ecting information on HIV from

designated sites ,sentine$ sites o%er 1ears! through a uniform and consistent

methodo$og1 that a$$o&s com#arison ofKndings across #$ace and time!

to guide #rogramme res#onse.


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Dhat is HIV Sentine$Sur%ei$$ance J

Sentine$ Site is deKned as a designated ser%ice #oint'faci$it1!&here "$ood s#ecimens re$e%ant

information are co$$ected from a Kednum"er of e$igi"$e indi%idua$s!

from a s#eciKed #o#u$ation grou# o%er a

Ked #eriod of time! #eriodica$$1! for the#ur#ose of monitoring the HIVe#idemic.


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G"Fecti%es of HIV Sentine$Sur%ei$$ance ,HSS

. To monitor trends in #re%a$ence of HIVinfection o%er time.

2. To monitor the distri"ution and s#readof HIV #re%a$ence in dierent #o#u$ationsu"grou#s and in dierent geogra#hica$areas.

9. To identif1 emerging #oc+ets of HIVe#idemic in the countr1.


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5rou#s co%ered under HSS . High Ris+ 5rou#s BSD! ;S;! T5 I(U 2. 4ridge 7o#u$ation ;igrants Truc+ers 9. Lo& Ris+ 7o#u$ation 7regnant &omen attending ANC C$inics

BSD Bema$e Se Dor+er;S;;en &ho ha%e Se &ith ;en

T5 Trans5ender I(U InFection (rug Users


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E#idemio$ogica$ "asis of HIV Sur%ei$$ance

;ALES

;a$ec$ients

BSD

I(Us

;S;

BE;ALES

CHIL(REN

S#ouses'

7artners


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Dh1 sur%ei$$ance among ANCc$inic attendeesJ . 7regnant &omen re#resent the seua$$1

acti%e segment of genera$ #o#u$ation! and

hence ta+en as #ro1 for monitoring HIV amonggenera$ #o#u$ation 2. Un$in+ed Anon1mous Testing strateg1 is

#ossi"$e on$1 at those c$inics &here testing and"$ood s#ecimen co$$ection is done routine$1. At

ANC c$inics! routine "$ood s#ecimen co$$ection isdone for S1#hi$is and Hemog$o"in testing! a #artof &hich can "e used for HIV testing

9. 7regnant &omen re#resent a morehomogeneous grou# than #ersons attending an1other c$inic' G7(.


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Dh1 sur%ei$$ance among ANCc$inic attendeesJ

/. 7regnanc1! "eing #h1sio$ogica$! doesnot introduce an1 "ias in HIV #re%a$ence

&hich other i$$nesses' diseases ma1introduce due to under$1ing factorscommon to HIV

-. Baci$ities for antenata$ care are

a%ai$a"$e across the countr1 at dierent$e%e$s of hea$th care s1stem and henceare feasi"$e for im#$ementation


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;ethodo$og1 ofHIV Sentine$

Sur%ei$$ance atANC sites


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Inc$usion Criteria . Inc$usion Criteria for ANC sentine$

sur%ei$$ance 2. Age grou# -/* 1ears. 9. 7regnant &omen attending the

antenata$ c$inic for the Krst time duringthe current round of sur%ei$$ance.


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Inc$usion Criteria If the #regnant &oman "ecomes e$igi"$e "1 the a"o%e

criteria! she shou$d "e inc$uded in sur%ei$$ance!irres#ecti%e of

. (ate of antenata$ registration. 2. HIV #ositi%it1 status ,if +no&n to counse$$or or

treating doctor. 9. 7artici#ation in #re%ious rounds of sur%ei$$ance. /. Dhether she is "eing tested for HIV under 77TCT

,or not. -. A #regnant &oman shou$d "e recruited on$1 once

during a round of sur%ei$$ance. To ensure this! %erif1the date of her #re%ious %isit to ANC c$inic.

8. If the date of her #re%ious %isit to ANC c$inic fa$$sduring the current round of sur%ei$$ance! she shou$d"e ec$uded from the sam#$e.

R it t P t


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Recruitment Process at

ANC Sentinel Site

Eligibility Criteria &

Consecutiveness

applied here


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Case discussion 2 1ear o$d 5eeta is stud1ing in 2nd 1ear 4A. She is 3 months #regnant and has come to the

ANC G7( on 2th ;arch 209. This is her second %isit and she had ear$ier

come to the ANC c$inic on *th (ecem"er 202. Sur%ei$$ance at 1our ANC c$inic started from st Manuar1 209.

Her hus"and is a c$er+ in a $oca$ "an+ and the1$i%e in the same to&n.

Is this &oman e$igi"$e for sur%ei$$anceJ


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Case discussion 2 A / 1ear o$d tri"a$ gir$ is "rought to the

ANC G7( on -th Manuar1 209 "1 her

mother &ith - months amenorrhea. She is unmarried! does not go to schoo$

and he$#s her mother in the house. This is her Krst #regnanc1.

This is her Krst %isit to the c$inic. Is this fema$e e$igi"$e for sur%ei$$anceJ


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Com#onents of Sam#$ing ;ethodo$og1

Bor each sentine$ site! the same a##roach must "ea##$ied during e%er1 round of sur%ei$$ance. 9

things need to "e constant . Sam#$e si


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Sam#$e Si


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Consecuti%e Sam#$ing . Brom the start of sur%ei$$ance! a$$ indi%idua$s

attending the sentine$ site faci$it1 &ho are e$igi"$e forinc$usion in sur%ei$$ance as #er the deKned criteria!

shou$d "e recruited in the order the1 attend the c$inic. 2. E%er1 successi%e indi%idua$ shou$d "e recruited in

HSS ti$$ designated sam#$e si


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Consecuti%e Sam#$ing -. In c$inics &ith $arge dai$1 attendance! it is

recommended that not more than 20 consecuti%e

e$igi"$e attendees "e recruited #er da1 ,to ensure=ua$it1 of sur%ei$$ance data co$$ection. 8. In such cases! the Krst 20 e$igi"$e attendees on

a gi%en da1 shou$d "e recruited. 3. Sam#$e co$$ection shou$d "e sto##ed once the

target of 400 has been achieved! or at the end of the three month #eriod! even if the

target of 400 is not achieved.


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Consecuti%e Sam#$ing ). In order to reach the target! sentine$

sites SHGUL( NGT recruit #regnant &omen

admitted in the hos#ita$'$a"our &ard orthrough s#ecia$ cam#aigns to increase G7(attendance or "1 ho$ding s#ecia$ cam#s or"1 an1 other means.

*. (ata from sentine$ sites are much moreusefu$ and re$ia"$e &hen the strateg1 ofconsecuti%e sam#$ing is strict$1 adhered to.


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Im#$ications of not doingConsecuti%e Sam#$ing

. There ma1 "e chances of se$ection "ias inenro$$ing the &omen "1 sentine$ site sta.

2. There ma1 "e a chance of inc$uding orec$uding indi%idua$s &ith a s#eciKccharacteristic that ma1 aect HIV#re%a$ence. ,E.g. If &omen &ith +no&n HIVstatus get #referentia$$1 enro$$ed or

e$iminated! the HIV #re%a$ence in the&omen sam#$ed ma1 "e o%erestimated orunderestimated


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Case discussion 9 An ANC sur%ei$$ance site has not

managed to get the re=uisite sam#$e

si


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Case discussion / The siteincharge at Mam"hi CHC &hich

is a sentine$ sur%ei$$ance site! as+s the

hos#ita$s c$ose to his faci$it1 to refer#regnant &omen to the CHC as sentine$sur%ei$$ance is ongoing.

Are these instructions correctJ


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Case discussion - In a district hos#ita$ &ith an a%erage dai$1 G7(

of /0 #regnant &omen at the ANC c$inic!

sur%ei$$ance &as not initiated from thedesignated date as doctor &as on $ea%e. To&ards the end of sur%ei$$ance! &hen the

doctor Foins dut1! he as+s the nurse to startco$$ecting sam#$es from a$$ #regnant &omen

&ho come to the c$inic and com#$etes the targetin 0 da1s! &ithin the three month #eriod. Is this the right a##roachJ


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Testingstrateg1 for ANC

sentine$ sites


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Un$in+ed Anon1mous Testing . HIV Testing is done on a #ortion of "$ood s#ecimen

co$$ected for routine diagnostic #ur#oses ,such as S1#hi$is!He#atitis 4 after remo%ing a$$ #ersona$ identiKers.

2. The information co$$ected in the data form! or the HIV testresu$t from the "$ood s#ecimen shou$d NEVER "e $in+ed to

the indi%idua$ from &hom the information's#ecimen isco$$ected. 9. Neither the sta co$$ecting the "$ood s#ecimen nor the

sta testing the "$ood s#ecimen must "e a"$e to trac+ theresu$ts "ac+ to the indi%idua$.

/. Therefore #ersona$ identiKers such as name! address! G7(registration num"er etc. shou$d NGT "e mentioned an1&hereon the data form! "$ood s#ecimen! data form trans#ortationsheet or sam#$e trans#ortation sheet.


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Un$in+ed Anon1mous Testing

-. Simi$ar$1! HSS sam#$e num"er or an1 mar+indicating inc$usion in HSS shou$d not "ementioned in the ANC register or ANC #atientcard' G7( card.

8. 7art of the "$ood s#ecimen &ith identiKers is

used on site for conducting routine test for&hich it has "een co$$ected. 7art of the "$oods#ecimen &ithout identiKers is sent for HIVtesting under HSS.

3. Re#ort of the #rescri"ed diagnostic test ,e.g.

s1#hi$is test ;UST "e communicated to the#artici#ant.


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Case discussion 8 The $a"orator1 technician after dra&ing

"$ood for s1#hi$is testing and HSS! $a"e$s

"oth a$i=uots &ith the #atient name andANC registration No.'G7( No. and testsre=uired.

He then sends the HSS sam#$es to the

HSS testing $a" and retains the other fors1#hi$is testing at the $oca$ $a".

Is this the correct #rocedureJ


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Case discussion 3 The $a"orator1 technician dra&s "$ood s#ecimens

from e$igi"$e #regnant &omen during the Krst &ee+of sur%ei$$ance.

He sends the sam#$es as #er #rotoco$ to the HSStesting $a".

He ma+es a note of the HSS sam#$e num"er on theANC'$a" register and ca$$s u# the HSS testing $a" to+no& &hich sam#$es &ere #ositi%e.

He ca$$s the #ositi%e &omen to $et them +no& sothe1 can see+ immediate medica$ he$#.

Is this the correct #rocedureJ


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Case discussion ) In an ANC c$inic! the counse$$or mar+s SS! in

the ANC registration card for a$$ e$igi"$e

attendees to ma+e a note for ANC attendees &hoha%e "een inc$uded for HSS! to a%oid du#$ication. As attendees come in! he Krst chec+s for this

mar+ on the registration card and inc$udes on$1those that do not ha%e the SS mar+! and &homeet the e$igi"i$it1 criteria.

Is this a##roach %io$ating an1 #rinci#$es of HSSthat 1ou ha%e $earnt so farJ


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References

htt#''&&&.naco.go%.in'NACG'Nationa$AI(SContro$7rogram'03'


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6. h.i.v. sentinel surveillance - sap.pptx

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