1. Unit 6: Second-Generation HIV/AIDS Surveillance #1-6-1

2. Warm Up Questions: Instructions v Take five minutes now to try the Unit 6 warm up questions in your manual. v Please do not compare answers with other participants. v Your answers will not be collected or graded. v We will review your answers at the end of the unit. #1-6-2

3. What You Will Learn v 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 #1-6-3

4. Second-Generation HIV Surveillance v Developed by the WHO and UNAIDS as a response to the increasing complexity of the HIV epidemic v Outlines more sophisticated surveillance activities v Provides a more comprehensive understanding of epidemic trends v Improves effectiveness of control and prevention efforts #1-6-4

5. Figure 6.1. The Components of Second-Generation Surveillance #1-6-5

6. Goals of Second-Generation HIV Surveillance v Better understanding of trends over time v Better understanding of behaviours driving the epidemic in a country v Increased focus on sub-populations at highest risk for infection v Flexible to change with the stage of epidemic #1-6-7

7. Table 6.1. Biological Indicators v HIV prevalence v STI incidence and prevalence v TB prevalence v number of adult AIDS cases v number of pediatric AIDS cases #1-6-8

8. Table 6.1. Behavioural Indicators v sex with a non-regular partner in last 12 months v condom use at last sex with non-regular partner v age at first sex for youth v use of unclean injection equipment by drug injectors v reported number of clients in the last week by sex workers #1-6-9

9. Table 6.1. Socio-demographic Indicators v age, sex v socio-economic and educational status v residency or migration status v parity (for antenatal sites) v marital status #1-6-10

10. Table 6.2. Basic Data Collection Methods v Sentinel surveillance in defined sub- populations (such as antenatal clinic attendees, STI clinic patients, sex workers) v Serial cross-sectional behavioural surveys in high-risk sub-populations v Regular HIV screening of donated blood v AIDS case surveillance #1-6-11

11. Table 6.2. Additional Data Collection Methods v Regular screening of occupational cohorts or other sub-populations (such as factory workers, military recruits) v HIV screening of specimens taken in general population surveys v Serial cross-sectional behavioural surveys in the general population v HIV case surveillance #1-6-12

12. Table 6.2. Additional Data Collection Methods, Cont. v Death registration and mortality surveillance v STI and TB surveillance v Data from VCT and treatment programmes #1-6-13

13. #1-6-14 Year Figure 6.2. HIV Prevalence and Condom Use Among Female Sex Workers, Abidjan, Côte d’Ivoire, 1992-98 Source: Ghys et al. AIDS 2001.

14. Stages of the HIV/AIDS Epidemic v low-level (Madagascar, Seychelles) © confined to persons with high-risk behavior © not above 5% in any sub-population v concentrated (Mauritania, Senegal) © above 5% in one or more risk populations © not above 1% in ANCs or pregnant women in urban areas v generalised (most of sub-Saharan Africa) © well established in general population © consistently above 1% in ANCs or pregnant women in urban areas #1-6-15

15. Surveillance Needs for Low-Level Epidemics v Are there groups with risk behaviours? v What are the main risk behaviours? v How much HIV infection is there? v Who else might be affected and to what extent? Note: this information corresponds to Table 6.3 in your participant manual #1-6-16

16. Surveillance Needs for Concentrated Epidemics v How much HIV infection is there? v What are the main risk behaviours and how do they change over time? v Who else might be affected and to what extent? Note: This information corresponds to Table 6.4 in your participant manual #1-6-17

17. Surveillance Needs for Generalised Epidemics v What are the trends in HIV infection? v Is behaviour changing? v Do recorded changes help explain trends in HIV infection? v What is the impact of HIV? Note: This information corresponds to Table 6.5 in your participant manual #1-6-18

18. In Summary v 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. v The components that may be used include behavioural surveillance, HIV/AIDS case reporting, death registration and STI surveillance. #1-6-19

19. Warm Up Review v Take a few minutes now to look back at your answers to the warm up questions at the beginning of the unit. v Make any changes you want to. v We will discuss the questions and answers in a few minutes. #1-6-20

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 #1-6-21

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 #1-6-22

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. #1-6-23

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 #1-6-24

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. #1-6-25

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 #1-6-26

26. Answers to Warm Up Questions, Cont. 4.Which of the following is not yet a regular element of second-generation surveillance? a.Screening of donated blood b.Behavioural surveillance c.Surveillance for coexisting opportunistic infections d.AIDS surveillance #1-6-27

27. Answers to Warm Up Questions, Cont. 4.Which of the following is not yet a regular element of second-generation surveillance? a.Screening of donated blood b.Behavioural surveillance c.Surveillance for coexisting opportunistic infections d.AIDS surveillance #1-6-28

28. Small Group Discussion: Instructions v Get into small groups to discuss these questions. v Choose a speaker for your group who will report back to the class. #1-6-29

29. Small Group Reports v Select one member from your group to present your answers. v Discuss with the rest of the class. #1-6-30

30. Case Study: Instructions v Try this case study individually. v We’ll discuss the answers in class. #1-6-31

31. Case Study Review v Follow along as we go over the case study in class. v Discuss your answers with the rest of the class. #1-6-32

32. Questions, Process Check v Do you have any questions on the information we just covered? v Are you happy with how we worked on Unit 6? v Do you want to try something different that will help the group? #1-6-33