1. Unit 6: Second-Generation HIV/AIDS Surveillance
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2. Warm Up Questions: Instructions
Take five minutes now to try the Unit 6 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.
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3. What You Will Learn By the end of this unit you should be able to:
describe the concept of second-generation surveillance
discuss the various elements of a second-generation HIV surveillance system
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4. Second-Generation HIV Surveillance
Developed by the WHO and UNAIDS as a response to the increasing complexity of the HIV epidemic
Outlines more sophisticated surveillance activities
Provides a more comprehensive understanding of epidemic trends
Improves effectiveness of control and prevention efforts
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5. Figure 6.1. The Components of Second-Generation Surveillance
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6. Goals of Second-Generation HIV Surveillance
Better understanding of trends over time
Better understanding of behaviours driving the epidemic in a country
Increased focus on sub-populations at highest risk for infection
Flexible to change with the stage of epidemic
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7. Table 6.1. Biological Indicators
HIV prevalence
STI incidence and prevalence
TB prevalence
number of adult AIDS cases
number of pediatric AIDS cases
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8. Table 6.1. Behavioural Indicators
sex with a non-regular partner in last 12 months
condom use at last sex with non-regular partner
age at first sex for youth
use of unclean injection equipment by drug injectors
reported number of clients in the last week by sex workers
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9. Table 6.1. Socio-demographic Indicators
age, sex
socio-economic and educational status
residency or migration status
parity (for antenatal sites)
marital status
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10. Table 6.2. Basic Data Collection Methods
Sentinel surveillance in defined sub-populations (such as antenatal clinic attendees, STI clinic patients, sex workers)
Serial cross-sectional behavioural surveys in high-risk sub-populations
Regular HIV screening of donated blood
AIDS case surveillance
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11. Table 6.2. Additional Data Collection Methods
Regular screening of occupational cohorts or other sub-populations (such as factory workers, military recruits)
HIV screening of specimens taken in general population surveys
Serial cross-sectional behavioural surveys in the general population
HIV case surveillance
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12. Table 6.2. Additional Data Collection Methods, Cont.
Death registration and mortality surveillance
STI and TB surveillance
Data from VCT and treatment programmes
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13. Figure 6.2. HIV Prevalence and Condom Use Among Female Sex Workers, Abidjan, Côte d’Ivoire, 1992-98
Year
Source: Ghys et al. AIDS 2001.
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14. Stages of the HIV/AIDS Epidemic
low-level (Madagascar, Seychelles)
confined to persons with high-risk behavior
not above 5% in any sub-population
concentrated (Mauritania, Senegal)
above 5% in one or more risk populations
not above 1% in ANCs or pregnant women in urban areas
generalised (most of sub-Saharan Africa)
well established in general population
consistently above 1% in ANCs or pregnant women in urban areas
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15. Surveillance Needs for Low-Level Epidemics
Are there groups with risk behaviours?
What are the main risk behaviours?
How much HIV infection is there?
Who else might be affected and to what extent?
Note: this information corresponds to
Table 6.3 in your participant manual
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16. Surveillance Needs for Concentrated Epidemics
How much HIV infection is there?
What are the main risk behaviours and how do they change over time?
Who else might be affected and to what extent?
Note: This information corresponds to
Table 6.4 in your participant manual
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17. Surveillance Needs for Generalised Epidemics
What are the trends in HIV infection?
Is behaviour changing?
Do recorded changes help explain trends in HIV infection?
What is the impact of HIV?
Note: This information corresponds to
Table 6.5 in your participant manual
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18. In Summary
The goal of second-generation HIV surveillance is to provide a more complete picture of the HIV/AIDS epidemic using surveillance methods that are flexible.
The components that may be used include behavioural surveillance, HIV/AIDS case reporting, death registration and STI surveillance.
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19. 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.
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20. Answers to Warm Up Questions
1. Which of the following is the goal of second-generation HIV surveillance?
a. better understanding of behaviors driving the epidemic
b. surveillance more focused on sub-populations at highest risk for infection
c. surveillance of the children of patients who acquired HIV in the first wave of infections
d. a and b
e. none of the above
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21. Answers to Warm Up Questions, Cont.
1. Which of the following is the goal of second-generation HIV surveillance?
a. better understanding of behaviors driving the epidemic
b. surveillance more focused on sub-populations at highest risk for infection
c. surveillance of the children of patients who acquired HIV in the first wave of infections
d. a and b
e. none of the above
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22. Answers to Warm Up Questions, Cont.
2. The types of elements included in second-generation surveillance vary according to the type of epidemic. List the three types of HIV/AIDS epidemics.
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23. Answers to Warm Up Questions, Cont.
2. The types of elements included in second-generation surveillance vary according to the type of epidemic. List the three types of HIV/AIDS epidemics. Low-level, concentrated, generalised
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24. Answers to Warm Up Questions, Cont.
3. True or false? Second-generation surveillance is flexible and can change with the needs and state of the epidemic in a particular country.
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25. Answers to Warm Up Questions, Cont.
3. True or false? Second-generation surveillance is flexible and can change with the needs and state of the epidemic in a particular country. True
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26. Answers to Warm Up Questions, Cont.
Which of the following is not yet a regular element of second-generation surveillance?
Screening of donated blood
Behavioural surveillance
Surveillance for coexisting opportunistic infections
AIDS surveillance
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27. Answers to Warm Up Questions, Cont.
Which of the following is not yet a regular element of second-generation surveillance?
Screening of donated blood
Behavioural surveillance
Surveillance for coexisting opportunistic infections
AIDS surveillance
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28. 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.
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29. Small Group Reports
Select one member from your group to present your answers.
Discuss with the rest of the class.
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30. Case Study: Instructions
Try this case study individually.
We’ll discuss the answers in class.
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31. Case Study Review Follow along as we go over the case study in class.
Discuss your answers with the rest of the class.
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32. Questions, Process Check
Do you have any questions on the information we just covered?
Are you happy with how we worked on Unit 6?
Do you want to try something different that will help the group?
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