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Zhao J, Garcia SA, Ngoksin E, Calleja JMG, Ogbuanu C, Kuzmanovska S, Oliphant N, Lowrance D, Zorzi N, Hansen PM, Sabin K. Are monitoring and evaluation systems adequate to report the programmatic coverage of HIV services among key populations in countries? Infect Dis Poverty 2019; 8:58. [PMID: 31262365 PMCID: PMC6604138 DOI: 10.1186/s40249-019-0570-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 06/18/2019] [Indexed: 11/11/2022] Open
Abstract
There was no global guidance or agreement regarding when a country has an adequate system to report on the service packages among human immunodeficiency virus (HIV) key populations. This article describes an approach to categorizing the system in a country for reporting the service package among HIV key populations. The approach consists of four dimensions, namely the epidemiological significance, comprehensiveness of the service packages, geographic coverage of services, and adequacy of the monitoring system. The proposed categorization approach utilizes available information and can inform the improvement of the service delivery and monitoring systems among HIV key populations.
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Affiliation(s)
- Jinkou Zhao
- The Global Fund to fight AIDS, Tuberculosis and Malaria, Chemin du Pommier 40, Grand-Saconnex 1218, Geneva, Switzerland. .,Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China. .,Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China.
| | - Sonia Arias Garcia
- Strategic Information and Evaluation Department, the Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland
| | - Ed Ngoksin
- The Global Fund to fight AIDS, Tuberculosis and Malaria, Chemin du Pommier 40, Grand-Saconnex 1218, Geneva, Switzerland
| | | | - Chinelo Ogbuanu
- The Global Fund to fight AIDS, Tuberculosis and Malaria, Chemin du Pommier 40, Grand-Saconnex 1218, Geneva, Switzerland
| | - Sandra Kuzmanovska
- The Global Fund to fight AIDS, Tuberculosis and Malaria, Chemin du Pommier 40, Grand-Saconnex 1218, Geneva, Switzerland
| | - Nicholas Oliphant
- The Global Fund to fight AIDS, Tuberculosis and Malaria, Chemin du Pommier 40, Grand-Saconnex 1218, Geneva, Switzerland
| | - David Lowrance
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Nathalie Zorzi
- The Global Fund to fight AIDS, Tuberculosis and Malaria, Chemin du Pommier 40, Grand-Saconnex 1218, Geneva, Switzerland
| | - Peter M Hansen
- The Global Fund to fight AIDS, Tuberculosis and Malaria, Chemin du Pommier 40, Grand-Saconnex 1218, Geneva, Switzerland
| | - Keith Sabin
- Strategic Information and Evaluation Department, the Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland
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Hakim AJ, MacDonald V, Hladik W, Zhao J, Burnett J, Sabin K, Prybylski D, Garcia Calleja JM. Gaps and opportunities: measuring the key population cascade through surveys and services to guide the HIV response. J Int AIDS Soc 2018; 21 Suppl 5:e25119. [PMID: 30033654 PMCID: PMC6055128 DOI: 10.1002/jia2.25119] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 05/12/2018] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION The UNAIDS 90-90-90 targets to diagnose 90% of people living with HIV, put 90% of them on treatment, and for 90% of them to have suppressed viral load have focused the international HIV response on the goal of eliminating HIV by 2030. They are also a constructive tool for measuring progress toward reaching this goal but their utility is dependent upon data availability. Though more than 25% of new infections are among key populations (KP)- sex workers, men who have sex with men, transgender people, people who inject drugs, and prisoners- and their sex partners, there is a dearth of treatment cascade data for KP. We assess the availability of cascade data and review the opportunities offered by biobehavioral and programme data to inform the HIV response. DISCUSSION The emphasis on the collection of treatment cascade data among the general population in higher prevalence countries has not led to a similar increase in the availability of cascade data for KP. The limited data available for KP highlight large gaps in service uptake across the cascade, particularly in the first 90, awareness of HIV status. Biobehavioral surveys (BBS), with linked population size estimation, provide population-based data on the treatment cascade and should be conducted every two to three years in locations with services for KP. With the inclusion of viral load testing, these surveys are able to monitor the entire treatment cascade among KP regardless of whether these populations access HIV services targeting the general population or KP. BBS also reach people accessing services and those who do not, thereby providing a unique opportunity to learn about barriers to service uptake including stigma and discrimination. At the same time high-quality programme data can play a complementary role in identifying missed opportunities that can be addressed in real-time. CONCLUSIONS Data are more important than ever for guiding the HIV response toward reaching 90-90-90 targets and eliminating HIV, particularly in the face of decreased funding for HIV and specifically for KP. Timely high-quality BBS data can be triangulated with high-quality programme data to provide a comprehensive picture of the epidemic response for KP.
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Affiliation(s)
- Avi Joseph Hakim
- Division of Global HIV and TuberculosisUS Centers for Disease Control and PreventionAtlantaGAUSA
| | | | - Wolfgang Hladik
- Division of Global HIV and TuberculosisUS Centers for Disease Control and PreventionAtlantaGAUSA
| | - Jinkou Zhao
- The Global Fund to Fight AIDS, Tuberculosis and MalariaGenevaSwitzerland
| | - Janet Burnett
- Division of HIV/AIDS PreventionUS Centers for Disease Control and PreventionAtlantaGAUSA
| | - Keith Sabin
- United Nations Joint Programme for HIV/AIDSGenevaSwitzerland
| | - Dimitri Prybylski
- Division of Global HIV and TuberculosisUS Centers for Disease Control and PreventionAtlantaGAUSA
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Baggaley R, Johnson C, Garcia Calleja JM, Sabin K, Obermeyer C, Taegtmeyer M, Zaba B, El-Hayek C, Singh JA. Routine feedback of test results to participants in clinic- and survey-based surveillance of HIV. Bull World Health Organ 2015; 93:352-5. [PMID: 26229207 PMCID: PMC4431522 DOI: 10.2471/blt.15.153031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 01/23/2015] [Indexed: 11/27/2022] Open
Abstract
Surveillance for human immunodeficiency virus (HIV) in low- and middle-income countries started in the 1980s. However, the questions of whether the results of HIV tests should be given to participants, and if so how, has still not been resolved. In the absence of effective treatment, it was considered acceptable to withhold results from HIV-positive participants. However, when antiretroviral treatment is available, some argue for beneficence – that it is the researcher’s duty to return the test results to all those who provide samples for surveillance. The corollary is that only participants who wish to receive their test results would be eligible to participate in surveys. Others argue for autonomy – that to obtain a more representative result for the general population, surveys should not exclude participants who do not wish to receive their test results. This round table discussion takes a closer look at those two arguments. We believe that the global community should work towards routine feedback of HIV surveillance while ensuring that participants receive and understand their test results.
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Affiliation(s)
- Rachel Baggaley
- World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Cheryl Johnson
- World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | | | - Keith Sabin
- Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland
| | | | | | - Basia Zaba
- London School of Hygiene & Tropical Medicine, London, England
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Abu-Raddad LJ, Ghanem KG, Feizzadeh A, Setayesh H, Calleja JMG, Riedner G. HIV and other sexually transmitted infection research in the Middle East and North Africa: promising progress? Sex Transm Infect 2014; 89 Suppl 3:iii1-4. [PMID: 24191291 PMCID: PMC3841741 DOI: 10.1136/sextrans-2013-051373] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medical College-Qatar, Cornell University, , Doha, Qatar
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Bozicevic I, Riedner G, Calleja JMG. HIV surveillance in MENA: recent developments and results. Sex Transm Infect 2013; 89 Suppl 3:iii11-16. [PMID: 23434789 PMCID: PMC3841745 DOI: 10.1136/sextrans-2012-050849] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 01/09/2013] [Accepted: 01/23/2013] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To provide an overview of the current level of development and results from the national HIV surveillance systems of the 23 countries of the Middle East and North Africa (MENA), and to assess the quality of HIV surveillance systems in the period 2007-2011. METHODS A questionnaire was used to collect the information about the structure, activities and the results of HIV surveillance systems from the National AIDS Programmes. Assessment of the quality was based on four indicators: timeliness of data collection, appropriateness of populations under surveillance, consistency of the surveillance sites and groups measured over time, and coverage of the surveillance system. RESULTS Only in four countries did surveillance systems enable assessment of epidemic trends in the same populations and locations over time, such as in pregnant women (Morocco, Iran), injecting drug users (Iran, Pakistan), female sex workers (Djibouti, Morocco) and male sex workers (Pakistan). There is increasing evidence of HIV infection being firmly established in at least one of the populations most at risk of HIV in nine MENA countries, while lower risk populations show elevated HIV prevalence in South Sudan, Djibouti and some parts of Somalia. CONCLUSIONS The performance of HIV surveillance systems in several of the MENA countries has improved in recent years. The extent of HIV epidemics in the populations most at risk of HIV is still largely unknown in 10 countries. Multiple data sources that most of the countries still lack would enable indirectly estimation not only of the patterns of HIV epidemics but also the effectiveness of HIV responses.
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Affiliation(s)
- Ivana Bozicevic
- World Health Organization Collaborating Centre for HIV Surveillance, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Gabriele Riedner
- World Health Organization Regional Office for Eastern Mediterranean, Cairo, Egypt
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van Schalkwyk C, Mndzebele S, Hlophe T, Garcia Calleja JM, Korenromp EL, Stoneburner R, Pervilhac C. Outcomes and impact of HIV prevention, ART and TB programs in Swaziland--early evidence from public health triangulation. PLoS One 2013; 8:e69437. [PMID: 23922711 PMCID: PMC3724860 DOI: 10.1371/journal.pone.0069437] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 06/08/2013] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Swaziland's severe HIV epidemic inspired an early national response since the late 1980s, and regular reporting of program outcomes since the onset of a national antiretroviral treatment (ART) program in 2004. We assessed effectiveness outcomes and mortality trends in relation to ART, HIV testing and counseling (HTC), tuberculosis (TB) and prevention of mother to child transmission (PMTCT). METHODS Data triangulated include intervention coverage and outcomes according to program registries (2001-2010), hospital admissions and deaths disaggregated by age and sex (2001-2010) and population mortality estimates from the 1997 and 2007 censuses and the 2007 demographic and health survey. RESULTS By 2010, ART reached 70% of the estimated number of people living with HIV/AIDS with CD4<350/mm(3), with progressively improving patient retention and survival. As of 2010, 88% of health facilities providing antenatal care offered comprehensive PMTCT services. The HTC program recorded a halving in the proportion of adults tested who were HIV-infected; similarly HIV infection rates among HIV-exposed babies halved from 2007 to 2010. Case fatality rates among hospital patients diagnosed with HIV/AIDS started to decrease from 2005-6 in adults and especially in children, contrasting with stable case fatality for other causes including TB. All-cause child in-patient case fatality rates started to decrease from 2005-6. TB case notifications as well as rates of HIV/TB co-infection among notified TB patients continued a steady increase through 2010, while coverage of HIV testing and CPT for co-infected patients increased to above 80%. CONCLUSION Against a background of high, but stable HIV prevalence and decreasing HIV incidence, we documented early evidence of a mortality decline associated with the expanded national HIV response since 2004. Attribution of impact to specific interventions (versus natural epidemic dynamics) will require additional data from future household surveys, and improved routine (program, surveillance, and hospital) data at district level.
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Affiliation(s)
- Cari van Schalkwyk
- The South African Department of Science and Technology / National Research Foundation Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), University of Stellenbosch, Cape Town, South Africa
| | - Sibongile Mndzebele
- Strategic Information Department, Swaziland Ministry of Health, Mbabane, Swaziland
| | - Thabo Hlophe
- Strategic Information Department, Swaziland Ministry of Health, Mbabane, Swaziland
| | | | - Eline L. Korenromp
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Rand Stoneburner
- Independent consultant . Former Senior Advisor on Strategic Intelligence and Analysis, UNAIDS, Geneva, Switzerland
| | - Cyril Pervilhac
- Independent consultant (pervilhacc@gmail.com). Formerly at Department of HIV/AIDS. World Health Organization, Geneva, Switzerland
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Prüss-Ustün A, Wolf J, Driscoll T, Degenhardt L, Neira M, Calleja JMG. HIV due to female sex work: regional and global estimates. PLoS One 2013; 8:e63476. [PMID: 23717432 PMCID: PMC3662690 DOI: 10.1371/journal.pone.0063476] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 04/03/2013] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Female sex workers (FSWs) are at high risk of HIV infection. Our objective was to determine the proportion of HIV prevalence in the general female adult population that is attributable to the occupational exposure of female sex work, due to unprotected sexual intercourse. METHODS Population attributable fractions of HIV prevalence due to female sex work were estimated for 2011. A systematic search was conducted to retrieve required input data from available sources. Data gaps of HIV prevalence in FSWs for 2011 were filled using multilevel modeling and multivariate linear regression. The fraction of HIV attributable to female sex work was estimated as the excess HIV burden in FSWs deducting the HIV burden in FSWs due to injecting drug use. RESULTS An estimated fifteen percent of HIV in the general female adult population is attributable to (unsafe) female sex work. The region with the highest attributable fraction is Sub Saharan Africa, but the burden is also substantial for the Caribbean, Latin America and South and Southeast Asia. We estimate 106,000 deaths from HIV are a result of female sex work globally, 98,000 of which occur in Sub-Saharan Africa. If HIV prevalence in other population groups originating from sexual contact with FSWs had been considered, the overall attributable burden would probably be much larger. DISCUSSION Female sex work is an important contributor to HIV transmission and the global HIV burden. Effective HIV prevention measures exist and have been successfully targeted at key populations in many settings. These must be scaled up. CONCLUSION FSWs suffer from high HIV burden and are a crucial core population for HIV transmission. Surveillance, prevention and treatment of HIV in FSWs should benefit both this often neglected vulnerable group and the general population.
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Affiliation(s)
- Annette Prüss-Ustün
- Department of Public Health and Environment, World Health Organization, Geneva, Switzerland.
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