Transcript AIDS Surveillance - Global Health Sciences

Unit 3: Universal Case
Reporting and Sentinel
Surveillance for STIs
#4-3-1
Warm Up Questions: Instructions

Take five minutes now to try the Unit 3 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.
#4-3-2
What You Will Learn

By the end of this unit, for STI universal case reporting
and sentinel surveillance, you should be able to:

discuss the purpose of each system of surveillance

discuss the advantages and disadvantages of each

define when each should be implemented

define the population studied for each

discuss reporting under IDS
#4-3-3
Two Case Reporting Approaches

This unit compares and contrasts two
different approaches to STI case reporting:

In universal STI case reporting, all healthcare
facilities report all STI cases to public health
authorities.

In STI sentinel surveillance, selected sites collect
more detailed data on STI cases.
#4-3-4
Universal STI Case Reporting

Minimal data elements about STIs are collected from all
health facilities.

Two types of reports may be used:
 syndromic reports, which provide data on patients’
set of symptoms (syndromes)
 aetiologic reports, which provide data on which
micro-organism is causing symptoms. These
determinations can only be made in a laboratory.

General lack of lab support in the African region means
that syndromic reports will be the primary method used.
#4-3-5
Advantages of Universal Case
Reporting

Universal case reporting provides the most readily
available source of STI surveillance data.

It provides data which is easy to collect from health
facilities.

It provides data on the burden of STIs at the health facility
level, important for planning health services.

When consistent, it can be used to track population-level
STIs trends.
(This information can be found in Table 3.1 in the text.)
#4-3-6
Disadvantages of Universal Case
Reporting

Universal case reporting is based on recognition of
symptoms and thus provides a poor assessment of the
true disease burden among women.

It does not provide a direct estimate of the population
burden of STIs because people with asymptomatic
infection do not realise they are infected so they do not
seek care.

It is affected by fluctuations in health-seeking behaviours
of the population not related to the burden of disease.
(This information can be found in Table 3.1 in the text.)
#4-3-7
Reporting Form for
Universal Case Reporting

WHO recommends the IDS form for universal
case reporting in the African region.

This form is used for all priority communicable
diseases.

The STI syndromes reported in IDS are:
 male urethral discharge
 male genital ulcer disease
 female genital ulcer disease
#4-3-8
STI Sentinel Surveillance

A pre-arranged sample of health facilities and
other sites agrees to report one or more notifiable
conditions.

More demographic and risk data on STI cases are
collected and reported.
#4-3-9
STI Sentinel Surveillance, Cont.

Site trends in STI case reports are used to infer trends at
other health facilities.

Take care in interpreting the results, since sentinel sites
are not necessarily representative of the whole region.

Health facilities known to be diligent in reporting STI
cases are selected as the sentinel sites.

Detailed high-quality data are collected from these sites.
#4-3-10
Sentinel Site Case Reporting

STI cases are reported from a small number of sentinel
sites using either the syndromic or aetiologic reporting.

Syndromic case reporting:
 More common in African countries, where lab support
is not usually available.
 Same case definition at all sites, for easy comparison.

Aetiologic:
 Lab support must be available.
 Cases classified as confirmed or probable, depending
on strength of laboratory evidence.
#4-3-11
Advantages of Sentinel Site Case
Reporting

Regular supervision, feedback and logistical support can be
provided because sentinel sites are located in fewer facilities.

Higher quality data can be obtained from a few sites with
intensive support of training, supervision and logistics.

Sentinel STI case reporting system is less expensive to run
and maintain than a universal reporting system.

It is more flexible than universal case reporting. Additional
studies can be added without changing the basic structure.
(This information can be found in Table 3.2 in the text.)
#4-3-12
Disadvantages of Sentinel Site
Case Reporting

Sentinel STI surveillance cannot provide minimum
population-based estimates of disease burden.

Sentinel sites are located in only a few health facilities and
may not be representative of sites outside of their
catchment areas.
(This information can be found in Table 3.2 in the text.)
#4-3-13
Selection of Sentinel Sites

Convenience sampling: the selection of sites
based on their availability and accessibility

Probability sampling: the selection of sites
that ensures that each site has an equal
probability of being selected

Probability sampling gives more
representative results, but it is more difficult
and inconvenient.
#4-3-14
Selection of Sentinel Sites, Cont.

Selection is influenced by:




the objectives of the system
the structure of the country’s health system
the extent to which STI case reporting is incorporated into primary
healthcare
The sites should:






see a large number of STI cases and provide care
include both urban and rural areas
have qualified staff
include high-risk groups
integrate STI surveillance with other surveillance activities
include public and private sectors
#4-3-15
Developing the Reporting Forms

The national AIDS/STI control programme
should develop the forms.

The same form should be used at all sites.

Reporting forms should be simple.

To protect patients’ privacy, reporting forms
should not have personally identifying
information.
#4-3-16
Table 3.3. Core and Additional
Data Elements
Core data elements





reporting site
date of visit
gender
age group, age or date
of birth
syndrome
Potential additional data elements











residence
education or socio-economic status
marital status
occupation
anatomic site of infection
date of symptom onset
risk behaviour
pregnancy
previous episodes of STI
treatment
other information deemed necessary
#4-3-17
Implementing Surveillance

Site staff should be trained in data collection using
the standard reporting forms.

There should be enough forms at sites.

There should be supervision from the national
AIDS/STI control programme.

There should be a system of data transfer to the
central office.

Sentinel sites should be monitored for data quality.
#4-3-18
Combined Universal and Sentinel
Surviellance Case Reporting

Universal case reporting through IDS provides basic
estimates of incidence and prevalence.

Sentinel case reporting supplements universal reporting
by providing epidemiological and clinical detail on a
subset of cases.

Sentinel sites should report through both the universal
and sentinel reporting systems.

Universal case reporting through IDS should be the
priority. If this is not possible, sentinel surveillance can
be conducted instead.
#4-3-19
Syphilis Screening at
Sentinel Sites

Distinct from sentinel STI case reporting

Data are collected from routine clinical syphilis screening
programs.

Prevalence can be calculated for all tested patients, or by
demographic or risk group.

Examples of sentinel sites include:
 antenatal clinics
 STI clinics
#4-3-20
In Summary

STI surveillance can occur through universal case
reporting, sentinel surveillance or a combination of the
two.

Sentinel surveillance gives higher quality data than
universal case reporting, at lower cost.

Sentinel surveillance data are not representative of the
general population, while universal case reporting data
can be.

Through IDS, priority is given to universal case reporting.
#4-3-21
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.
#4-3-22
Answers to Warm Up Questions
1. Which of the following is an advantage of
universal STI case reporting?
a. It is the most readily available source of
surveillance data and easy to collect from health
facilities.
b. It provides data on the burden of STIs at the health
facility level, which is important for planning health
services provisions.
c. Under stable conditions and consistent reporting,
data arising from STI case reporting can serve as
a proxy for population dynamics of STIs.
d. All of the above
#4-3-23
Answers to Warm Up Questions
1. Which of the following is an advantage of
universal STI case reporting?
a. It is the most readily available source of
surveillance data and easy to collect from health
facilities.
b. It provides data on the burden of STIs at the health
facility level, which is important for planning health
services provisions.
c. Under stable conditions and consistent reporting,
data arising from STI case reporting can serve as
a proxy for population dynamics of STIs.
d. All of the above
#4-3-24
Answers to Warm Up Questions,
Cont.
2. True or false? Data collected from sentinel
sites can be easily generalised to a broader
population.
#4-3-25
Answers to Warm Up Questions,
Cont.
2. True or false? Data collected from sentinel
sites can be easily generalised to a broader
population. False
#4-3-26
Answers to Warm Up Questions,
Cont.
3. In countries where information about STIs is
obtained through a universal reporting
system, sentinel STI surveillance
a. is unnecessary
b. should replace universal reporting as the
primary method to study STIs
c. should supplement information obtained
from the universal reporting system
#4-3-27
Answers to Warm Up Questions,
Cont.
3. In countries where information about STIs is
obtained through a universal reporting
system, sentinel STI surveillance
a. is unnecessary
b. should replace universal reporting as the
primary method to study STIs
c. should supplement information
obtained from the universal reporting
system
#4-3-28
Answers to Warm Up Questions,
Cont.
4. True or false? Supervision and feedback are
easier to provide for a sentinel surveillance
system than for a universal system.
#4-3-29
Answers to Warm Up Questions,
Cont.
4. True or false? Supervision and feedback are
easier to provide for a sentinel surveillance
system than for a universal system. True
#4-3-30
Answers to Warm Up Questions,
Cont.
5. True or false? Universal case reporting
provides a poor assessment of the true
disease burden among women.
#4-3-31
Answers to Warm Up Questions,
Cont.
5. True or false? Universal case reporting
provides a poor assessment of the true
disease burden among women. True
#4-3-32
Answers to Warm Up Questions,
Cont.
6. What system of surveillance is recommended
for reporting all priority communicable
diseases?
#4-3-33
Answers to Warm Up Questions,
Cont.
6. What system of surveillance is recommended
for reporting all priority communicable
diseases? Integrated Disease Surveillance
#4-3-34
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.
#4-3-35
Small Group Reports

Select one member from your group to
present your answers.

Discuss with the rest of the class.
#4-3-36
Case Study: Instructions

Try this case study individually.

We’ll discuss the answers in class.
#4-3-37
Case Study Review

Follow along as we go over the case study in
class.

Discuss your answers with the rest of the
class.
#4-3-38
Questions, Process Check

Do you have any questions on the information
we just covered?

Are you happy with how we worked on Unit 3?

Do you want to try something different that will
help the group?
#4-3-39