Transcript AIDS Surveillance - UCSF Global Health Sciences

Module 4: Final Case Study
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Case Study: Instructions
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Try this case study individually.
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We’ll discuss the answers in class.
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Answers to Final Case Study
Question 1
1. What are the benefits of conducting STI
surveillance in:
a. A country with a low-level HIV epidemic?
In countries with a low-level HIV epidemic, STI
surveillance can act as an early warning system
for HIV infection and emergence of HIV in new
groups or new geographical areas. STI
surveillance can also be used as an evaluation
tool for HIV prevention programmes
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Question 1, continued
1. What are the benefits of conducting STI
surveillance in:
b. A country with a concentrated HIV
epidemic?
In a concentrated HIV epidemic, the presence of
STIs can serve as a marker for the emergence of
HIV in new groups. STI surveillance can also
measure how successful prevention programmes
have been in high-risk populations.
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Question 1, continued
1. What are the benefits of conducting STI
surveillance in:
c. A country with a generalised HIV
epidemic?
In generalized HIV epidemics, STI surveillance can
help to measure how successful prevention
programmes have been in the general population.
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Answers to Final Case Study
Question 2
2.
You are a public health officer for Inyo
Province in the Mono Republic. Your
province currently conducts syndromic STI
surveillance with universal reporting. Your
province has recently been given funds to
begin aetiologic case reporting to determine
the prevalence of the micro-organisms that
cause urethral discharge and genital ulcer.
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Question 2, continued
a. Which micro-organisms would you include to
determine the causative agent of genital ulcer
disease in men and women?
syphilis, chancroid and HSV-2
b. Which micro-organisms would you monitor to
determine the most common causes of urethral
discharge in men?
Gonorrhoea and chlamydia
c. How frequently should STI aetiologies be assess?
Syndrome aetiologies should be assessed every two
to three years or more frequently if the need arises.
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Question 3
3. Looking at last years surveillance data for Inyo Province
you find that many of the variables indicated on the data
collection forms were left blank and that there were many
inconsistencies in the way data was collected. How would
you improve the completeness and consistency of
reporting?
You must establish processes to ensure that data collection and
reporting is as complete and consistent as possible. At the health
facility level, data should be double-entered to avoid errors and must
be carefully checked before analysis. A frequency tabulation can be
run after data are entered to re-check for implausible values. You
should follow up with any health facility site that has missing or
inconsistent data. Do this before forwarding the forms to the regional
or national level. When the district level carefully reviews facility
forms, the quality of data received at the national level is high.
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Question 4
4. Due to sub-optimal prescribing practices and
poor adherence to prescribed regimens,
resistance to the drugs that treat N.
gonorrhoeae has recently become a
problem in Inyo province.
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Question 4, continued
a. What are the laboratory requirements of
monitoring anti-microbial resistance?
Surveillance surveys for anti-microbial
resistance of STI pathogens are usually
organised and conducted by the national
AIDS/STI control programme. The laboratory
should have the facilities necessary to culture
the organism, perform biochemical and
serologic confirmatory tests and perform
minimum inhibitory concentration (MIC) agar
dilution testing of anti-microbial agents.
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Question 4, continued
b. If your country’s national reference laboratory
does not have the capacity to conduct
susceptibility testing, what would you do?
You may send isolates to a regional laboratory
in another country for testing. Regional
networks supported by WHO Collaborating
Centres have been established in several WHO
regions to conduct anti-microbial susceptibility
testing.
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Question 4, continued
c. How often would you review the results of
resistance testing?
Results of resistance testing should be
reviewed each quarter to ensure that data
are complete and that patterns are generally
consistent from quarter to quarter.
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Question 4, continued
d. What information would you include when nationally
distributing data on anti-microbial resistance? How
frequently would you distribute this data?
Reports should summarise the proportion of isolates
that were found to be resistant to the anti-microbial
agents and should be stratified by sentinel site. It may
also be useful to summarise the proportion of isolates
that were of intermediate sensitivity. Reports should
include: the gender of patients, the clinic setting where
the patients were tested and changes that have
occurred in the sentinel sites over time. Reports should
be distributed nationally at least once a year. New
resistant strains should be reported as soon as possible
to a WHO Collaborating Centre.
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Answers to Final Case Study
Question 5
5. Syndromic STI surveillance in Inyo Province
conducted in 2005 found the following data:
Site 1
Site 2
Site 3
Site 4
Site 5
158
209
196
233
240
Genital ulcer disease
11%
16%
22%
8%
13%
Urethral discharge
(among men only)
26%
21%
29%
14%
18%
HIV
7%
5%
12%
2%
3%
Total number tested
Prevalence of:
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Question 5, continued
A figure that shows the prevalence of genital ulcer
disease, urethral discharge and HIV in Inyo Province by
site.
35%
Prevalence of genital ulcer disease, urethral
discharge and HIV in Inyo Province (2005)
prevalence
30%
Genital ulcer
disease
Urethral
discharge
25%
20%
15%
HIV
10%
5%
0%
Site 1
Site 2
Site 3
Site 4
Sentinel sites
Site 5
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Question 5, continued
At all sentinel sites, the prevalence of urethral discharge
among men was higher than that of genital ulcer
disease or HIV among men and women. Whereas, site
4 had the lowest prevalence of genital ulcer disease
(8%), urethral discharge (14%) and HIV (2%), site 3 had
the highest prevalence of genital ulcer disease (22%),
urethral discharge (29%) and HIV (12%). The limitations
of this data include: Only one year of data was
presented; the sample size at each site was small;
surveillance assess STI syndromes opposed to STI
aetiologies.
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Questions, Process Check
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Do you have any questions on the information
we just covered?
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final case study?
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help the group?
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