1. Unit 8: Uses and Dissemination of HIV Sentinel Surveillance Data #3-8-1

2. Warm Up Questions: Instructions  Take five minutes now to try the Unit 8 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. #3-8-2

3. What You Will Learn  By the end of this unit you should be able to: © discuss various uses for HIV sentinel surveillance data © discuss how to develop a clear and understandable message about surveillance data © understand the tools for disseminating data to target groups #3-8-3

4. Uses of HIV Surveillance Data  Data can be used for a variety of public health actions: © targeting prevention and care programmes © monitoring and evaluation © monitoring indicators © resource allocation and programme planning © informing and educating the public © guiding scientific research © triangulation © mobilising political commitment © advocacy #3-8-4

5. Using Sentinel Surveillance Data to Target Programmes Advantages  helpful in determining where the burden of disease is greatest in a country  shows which demographic groups are most severely affected  increased attention directed to high- prevalence areas Disadvantages  not very useful in identifying specific high- risk behaviours since only limited behavioural data are collected  If sentinel surveillance is only directed at ANCs, trends in STI clinic patients will be missed. #3-8-5

6. Monitoring and Evaluation  Evaluation refers to determining: © how well a programme is functioning (process evaluation) © what its impact is (impact evaluation)  Monitoring refers to looking at a programme’s performance over time. #3-8-6

7. Monitoring Indicators  HIV sentinel surveillance data are used as indicators for evaluating the impact of prevention programmes.  Indicators are specific data, gathered to measure how well a prevention or treatment programme is doing.  UNAIDS has developed the concept of ‘Impact Indicators’ to communicate these outcomes most effectively. #3-8-7

8. Monitoring Indicators: Indicators 1 & 3 #3-8-8 Impact Indicator 1 Impact Indicator 3 Population(s) it reflects Pregnant womenSub-populations with high-risk behaviour Epidemic state(s) in which it is used GeneralisedLow-level or concentrated

9. Monitoring and Evaluation Limitations  There are two limitations in using prevalence for monitoring and evaluating prevention programmes: © Prevalence surveys measure prevalence, not incidence. © Populations targeted for prevention are usually exposed to more than one prevention message. #3-8-9

10. Resource Allocation and Programme Planning  HIV sentinel surveillance can be used to estimate the number of HIV-infected persons in a country.  Short-term projections on the annual incidence of AIDS cases can be made using: © HIV prevalence data © average time from HIV infection to AIDS diagnosis © survival after an AIDS diagnosis © population size #3-8-10

11. Public Education  Public education on local HIV prevalence can give people a realistic perception of their risk of infection.  Extremely important for those in high prevalence areas who continue to engage in high-risk behaviours.  Reinforces basic information and specific prevention messages.  May help in removing stigma of HIV infection. #3-8-11

12. Guiding Scientific Research  Higher prevalence in certain populations will suggest where disease transmission is highest.  This will be where its epidemiology and prevention are most easily studied. #3-8-12

13. Triangulation  The process of examining several different sets of data, which are measuring different things in order to come up with a better understanding of how and where the epidemic is spreading  Second-generation surveillance stresses comparing HIV sero-surveillance data to HIV behavioural surveillance data #3-8-13

14. Triangulation, Cont.  Integrating these data with other sources of data gives a better picture of the HIV epidemic.  Some other sources of data may include: © STI and TB surveillance data © blood donor data © AIDS case reporting © death registration information #3-8-14

15. Mobilising Political Commitment  It is challenging to maintain political commitment, and HIV prevalence data can often help  Selected kinds of people who need to be informed about HIV prevalence include: © politicians © potential donors or funders © public health planners © health personnel at national and local levels © health promotion and prevention staff © the media © individuals, groups and communities #3-8-15

16. Advocacy  Governments and NGOs are less able to ignore the reality of HIV when its existence and spread are documented thoroughly.  The state of an epidemic helps to determine what kind of advocacy is necessary #3-8-16

17. Disseminating HIV Surveillance Data  establish the message you want to communicate  select the audience to which you want to deliver the message  select the channel through which the message will be delivered  select the tool for delivering the message  evaluate the impact of the message #3-8-17

18. Establish the Message  What is the most important information that the surveillance team and public health officials want to convey?  Is the epidemic increasing or decreasing?  Is there evidence that what is being done is working?  Note that messages will differ from audience to audience as well #3-8-18

19. Select the Audience(s)  Once the message has been established, the target audience should be defined.  Important potential target audiences include: © health professionals © general public © policy and decision makers © media #3-8-19

20. Select the Audience(s), Cont.  Other important potential target audiences: © non-governmental organizations (NGOs) © other national and international organisations © surveillance staff members at national and local levels who help conduct sero-surveys  The content of the message and the target audience should be linked. #3-8-20

21. Select the Communication Channel(s)  Communication channels for disseminating HIV surveillance results include: © television © radio © newspapers © scientific journals © conferences © newsletters © press releases © the internet © epidemiologic bulletins and technical reports © face-to-face briefings with decision-makers #3-8-21

22. Table 8.3. Select the Tool(s) Audiences ChannelsTools Technical professionals involved in NACP and monitoring and evaluation Dissemination or evaluation workshops Full technical report on HIV, STI & behavioural surveillance Non-governmental organisations, other sectors and partners ConferencesA non-technical review of data from different sources Media, journalists, general population Press conferences A press release highlighting the main findings Policy-makers, decision- makers Face-to-face briefings and planning meetings Brief summaries of main findings with some graphics #3-8-22

23. Evaluate Impact  An important final step is an informal evaluation of how well the surveillance message was delivered, through, for example: © informal conversations with the press © conversations with aides to senior policy-makers © asking people in behavioural surveys about the most effective ways to communicate messages about HIV #3-8-23

24. 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. #3-8-24

25. Answers to Warm Up Questions 1.True or false? Reading or hearing about HIV in the media strengthens basic information and prevention messages. True #3-8-25

26. Answers to Warm Up Questions, Cont. 2.List two potential audiences for the dissemination of surveillance data. Technical professionals, NGOs, policy makers, journalists, etc. #3-8-26

27. Answers to Warm Up Questions, Cont. 3.List three potential uses of HIV surveillance data. Targeting intervention activities, program monitoring and evaluation, resource allocation, political mobilisation, etc. #3-8-27

28. Answers to Warm Up Questions, Cont. 4.True or false? When disseminating HIV surveillance results, a single message that can be used for all target audiences in the best way to transmit the information. False #3-8-28

29. 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.  Take 15 minutes for this exercise. #3-8-29

30. Small Group Reports  Select one member from your group to present your answers.  Discuss with the rest of the class. #3-8-30

31. Case Study: Instructions  Try this case study individually.  We’ll discuss the answers in class. #3-8-31

32. Case Study Review  Follow along as we go over the case study in class.  Discuss your answers with the rest of the class. #3-8-32

33. Questions, Process Check  Do you have any questions on the information we just covered?  Are you happy with how we worked on Unit 8?  Do you want to try something different that will help the group? #3-8-33