(WP)HSIIICP/HSII3 .5/00 I Report series number: RS/2002/GE/23(FIJ) English only
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REPORT
WORKSHOP ON STI/HIV/AIDS SURVEILLANCE IN THE PACIFIC
25-29 November 2002 Suva, Fiji
Convened by:
WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC
Not for sale Printed and distributed by: World Health Organization Regional Office for the Western Pacific Manila, Philippines
WHO/\\,PRO LIBRARY
i\i.\,\iL\, PIULlPPLNES
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}I NOTE
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The views expressed in this report are those of the participants in the Workshop on ST/IHIVIAIDS surveillance in the Pacific and do not necessarily reflect the policies of the Organization.
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This report has been prepared by the World Health Organization Regional Office for the Western Pacific for governments of Member States in the Region and for those who participated in the Workshop on STIIHIVIAIDS surveillance in the Pacific, 25 to 29 November 2002.
Table of Contents
SUMMARY
I. Introduction ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2 2. Proceedings............... ..... ....... ... ...... ...... ... .... ....... ....... ... . .. ...... .... ... 3 3. Conclusions and recommendations ....................................................... 5 ANNEXES: ANNEX I - LIST OF PARTICIPANTS, TEMPORARY ADVISERS, REPRESENTATIVES AND OBSERVERS, CONSULTANT AND SECRETARlA T ANNEX 2 - COUNTRY PLAN OF ACTION
Keywords: Sexually transmitted diseases - epidemiology I Acquired immunodeficiency syndrome - epidemiology I HIV infections - epidemiology I Pacific islands
SUMMARY
The World Health Organization Regional Office for the Western Pacific organized a five-day meeting on HIV/AIDS and sexually transmitted infections (ST!) surveillance in the Pacific to assist participant countries in reviewing their HIV/ AIDS situation and their current surveillance system, developing their surveillance protocols, and drafting country-specific plans of action for implementation of these protocols. Participating countries were Fiji, French Polynesia, Kiribati, Papua New Guinea, Solomon Islands, Tonga and Vanuatu. After presentations on country situations and an overview of surveillance principles and methodology, followed by a more detailed description of the components of specific types of surveillance systems, participants were provided with updates on the development of the second generation HIV surveillance in the Western Pacific Region and experiences with specific surveillance activities in the Pacific islands. The meeting participants were divided into groups and classified the country activities under a number of standard headings, identified gaps in current systems, and outlined the framework of a proposed national surveillance system. A draft of key contents of surveillance protocol for each participant country was developed which includes surveillance activities, a time frame and resources needed. There were existing activities to be improved and new activities to be initiated. Additional activities of high cost (STI and behavioural surveys) were recommended to be started on a small scale, considering target sub-populations, local expertise and laboratory capacity in the Pacific region. It was agreed that participant countries will continue developing their documentation on surveillance systems, and begin the process of consultation and obtaining approvals for changes in the surveillance systems. Resources for these improved or additional activities would be facilitated by WHO in consultation with other partner agencies. A follow-up plan and a workshop to evaluate the implementation progress at the end of 2004 were proposed. Interim reports on progress on the action plans by the end of 2003 were requested.
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I. INTRODUCTION
In November 2002, WHO sponsored a workshop involving a number of Pacific island countries, with the objective of strengthening capacity in surveillance for HlV/AIDS, sexually transmitted infections (STI), and risk behaviour related to sexual transmission of infection. Participating countries were Fiji, French Polynesia, Kiribati, Papua New Guinea, Solomon Islands, Tonga and Vanuatu. Most countries of the Pacific have small populations spread over wide distances and very limited resources. They therefore face particular challenges in implementing population-based public health initiatives, including disease surveillance. Although the number of HIV infections detected to date in these countries remains very low (apart from Papua New Guinea), the limited information that is available shows high vulnerability, as indicated by levels of STIs and risk behaviours. A WHO-sponsored workshop in 1999 held in Nadi had produced Pacific island guidelines for surveillance of HIV I AIDS, STIs and risk behaviour. Some surveillance initiatives were implemented following this workshop, but there remained much room for further capacity development. The 2002 workshop was intended to assist participating countries to assess their surveillance requirements, and develop plans for specific areas of surveillance activity that could be strengthened or introduced. I. I Objectives At the end of the workshop, the participants will have: I. reviewed the HIV/AIDS situation in the seven focus countries based on available data on STIs/HIV I AIDS, relevant risk behaviours and other factors driving the HIV epidemic;
2. developed a surveillance protocol related to STI/HIV/AIDS for the pilot countries, focussing on: STI/HIV reporting (case definition, reporting system); HIV sentinel surveillance; developing STIiHIV and/or behavioural surveys, including identification of survey populations based on risk assessment, sampling methodologies, frequency and other issues; and 3. developed country-specific plans of action for implementation of the surveillance strategy at the national level, including the time frame and resources required.
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2. PROCEEDINGS
The workshop was conducted over four and a half days. After the formal opening by the Fiji Minister of Health, and the Responsible Officer from the WHO Regional Office for the Western Pacific, introductory presentations were made by WHO advisers. They mentioned the objectives and expectations of the workshop and discussed the global status of HIY /AIDS, STIs and risk behaviours, and the ways in which different types of surveillance could assist in planning and assessing programmatic responses. Representatives from participating countries then informed the workshop about the situation in their countries. Specifically considered in the various presentations were the demographic and social context, health system responses, and the information that was available about the occurrence ofHIY/AIDS, STIs and risk behaviour. These presentations revealed a diversity of approaches to surveillance, but a consistency in the need to review and strengthen the overall strategies for data collection and analysis. The country presentations were followed by talks from the WHO consultant for the workshop, who gave an overview of surveillance principles and methodology, followed by a more detailed description of the components of specific types of surveillance systems. The following day, after the update of the development of the second generation HIY surveillance in the Western Pacific Region, there was a series of presentations on specific surveillance related topics drawing on experience from Pacific island countries. These talks covered a range of issues, including routine case reporting, surveys for STIs, and behavioural research. The participants then broke up into country specific groups to conduct inventories and critiques of the surveillance activities that had been undertaken thus far in their countries. The groups were invited to classify the activities under a number of standard headings, and to identify gaps in current systems. They were also asked to outline the framework of a proposed national surveillance system, which would be made up of a combination of existing and new activity areas. This analysis was followed by presentations from each group to the meeting as a whole, and open discussion of the issues raised in each presentation. Again, an impressive diversity in approach emerged, with some countries proposing that surveillance activities be largely maintained as they are, while others suggested a number of substantial developments to their surveillance mechanisms. The country groups then reformed with the objective of further refining the surveillance proposals, and specifying the specific actions, resources and time-frame that would be required to bring them to fruition. After a further day in subgroups, the countries again reported back on their plans to the meeting as a whole. Further discussion took place after each presentation. The workshop consultant and WHO advisers then summarized the main issues and themes from the workshop, and proposed further steps that WHO and the countries would pursue after the workshop.
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2.1
Key issues in country plans
The surveillance mechanisms proposed by the countries fell into three broad methodological categories. Routine case reporting (RCR) for STIs and HIV has been the standard mechanism of surveillance in all countries, and will be continued. Nevertheless all countries recognized the potential for improving their practice in a number of ways, while recognizing that routine case reporting falls within countries' overall systems for communicable disease surveillance, and may not be easily modified. Some particular areas were noted for action.
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Case definitions: For STIs there has been confusion between syndromes and aetiological agents, and most countries presented proposals for revising reporting forms to make the distinction clear. Responsibility for reporting and analysis: The responsibilities of different elements of the health system for reporting cases, and analysis the findings, needed to be clearly defined and supported. Confidentiality: Some countries had concerns about the protection of health information related to individuals diagnosed with HIV or STIs.
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Monitoring at selected sites (MSS) where testing for HIV or STIs is undertaken for individual diagnosis or institutional purposes (such as military recruitment or blood screening) was also recognized as a key component for countries to include in their surveillance systems. All countries proposed the use of prevalence results arising from blood donor screening for HIV and syphilis, and antenatal testing for syphilis within this framework. Others will use prevalence estimates from HIV testing at antenatal services, anonymous clinics, outreach services and/or STI clinics. Particular discussion arose on a few points:
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The need to recognize that such reporting sources could playa crucial role in building up a surveillance picture in a country, but were often seen as separate from the public health system. Therefore attention needs to be paid to ensuring regular analysis of the data, and their inclusion in national surveillance reporting. As surveillance was not the primarily role of testing in these contexts, it was essential that the service provision being undertaken was not compromised by the surveillance activity.
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Repeated surveys (RS) of HIV prevalence, STI prevalence or risk behaviour had not been conducted in any of the countries except for in Papua New Guinea. Some countries had experience with baseline surveys ofSTI prevalence. There was nevertheless a clear recognition that the responses in the Pacific countries needed to be increasingly guided by behavioural monitoring. Among the countries, only Papua New Guinea proposed extensive use of HIV sentinel surveillance, but all expressed a strong interest in conducting surveys of STI prevalence and risk behaviour. A number of issues nevertheless remain to be addressed.
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The choice of populations to be surveyed: In the Pacific island countries, there is limited experience in accessing populations of interest, such as sex workers, as well as the problem of small sample sizes. There is often an inverse relationship between the ease with which a group can be accessed (e.g. young people, women
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attending antenatal clinics), and its relevance for behavioural risk monitoring (in low HIV epidemic areas). A number of countries expressed an interest in surveying sex workers, but had more difficulty in devising ways to access male client populations. • Laboratory expertise: The STI surveys required specialized expertise. The ones conducted to date have relied on sending specimens to Australia, but it would be desirable to build capacity in the Pacific to carry out the relevant assays such as PCR for bacterial STIs. Social science expertise: Conduct of behavioural surveys also required expertise that might not be available at the country level. Academic institutions such as the University of South Pacific have experience in this area, and might be invited to become involved as a resource for the development of behavioural surveillance. Cost of surveys: It was recognized that STI and behavioural surveys are likely to be expensive, and that it would not be realistic to begin at many sites on a large scale. A more practical approach would be to conduct one or two surveys, perhaps selecting populations at lower and higher risk, as a basis for gaining regional experIence.
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3. CONCLUSIONS AND RECOMMENDATIONS
The countries agreed to continue developing their documentation to describe both existing and newly proposed elements of the surveillance systems. They would also begin the process of consultation and obtaining approvals for new components of the systems. There would be a need to identify resources for these components, a process that would be facilitated by WHO in consultation with other partner agencies. WHO proposed to hold a follow up workshop at the end of 2004. The countries would provide interim reports on progress on the action plans by the end of 2003.
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Comments of the workshop on the presented country plans of action for surveillance activities Fiji
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Sub'populations at high risk have been addressed and included for repeated surveys; reasonable sample sizes were planned. There is a need to analyse annual HIV prevalence based on existing data on HIV and syphilis among blood donors and women attending antenatal clinics.
French Polynesia • • • The same comment is given as that for Fiji on HIV prevalence among blood donors and women visiting antenatal clinic. There is a need to have further collection of prevalence data on STI. Although careful reporting AIDS in a tourism country is necessary, the criteria for reporting AIDS cases to WHO in areas with antiretroviral treatment needs to consider experiences from other developed countries (like Australia) with reports on AIDS cases at first diagnosis.
Kiribati • There is a need to clarify the frequency of repeated surveys: HIV surveys among sex workers and seafarers could be conducted annually while behavioural surveys and STI surveys need to be repeated after three to five years in areas where interventions are undertaken.
Papua New Guinea • • • HlV sentinel surveillance needs to be continued with repeated HIV surveys and with consistent methodology for existing sites before creating new sites. While many groups were planned for HIV, STI and behaviour surveys, careful consideration needs to be given to the capacity and capability of local staff. Surveys among male clients of sex workers outside STD clinics are more difficult and need expertise and strong financial support.
Solomon Islands • • As for a very low prevalence country, groups at high risk were addressed properly in surveillance type of repeated surveys. The inclusion of some low risk groups (women attending antenatal clinics. students) in these surveys should be revised carefully, considering its relevance and cost. An STI survey among women attending antenatal clinics is costly but can be justified if it leads to increased advocacy and targeted STI interventions if high STI prevalence is expected.
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Tonga • Three low risk groups included in repeated surveys should be revised carefully, considering their relevance and cost. It is realistic to start with a group at high risk and a group at low risk for which there are ongoing or possible interventions.
Vanuatu • Some specific groups considered as high risk in Vanuatu (e.g. police, governmental officers) may need to be assessed before they are included in the behavioural sentinel surveillance survey. There is a need to analyze annual HIV prevalence based on existing data on HIV and syphilis among blood donors and women attending antenatal clinics.
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ANNEX 1
LIST OF PARTICIPANTS, TEMPORARY ADVISERS, REPRESENTATIVES/OBSERVERS, CONSULTANT AND SECRETARIAT
1. PARTICIPANTS
KIRIBATI Mr loelu Tatapu Senior Health Infonnation Officer Ministry of Health P.O. Box 268 Nawerewere, Tarawa Island Tel. no.: (686) 28100 ext. 213 Fax no.: (686) 28152 Dr Kabwea Tiban Public Health Consultant Ministry of Health P.O. Box 268 Nawerewere, Tarawa Island Tel. no.: (686) 28871 Email: kabweatiban@yahoo.co.nz FRENCH POLYNESIA Dr Gilles Soubiran Internal Medicine Centre Hospitalier Regional BP 1640 98713 Papeete Tel/fax: (689) 46 6247 Email: gilles.soubiran@cht.pf FIJI
Dr Eric Rafai Medical Officer Taveuni Hospital P.O. Box 28, Waiyeno Tel No. (679) 8880444 Fax No. (679) 315393; 8880831 Email: evrafai@yahoo.com Ms Litiana Raikuna Assistant Statistician Ministry of Health Box 2223, Govermnent Building Suva Tel No. (679) 3306177 Fax No. (679) 3306163
PAPUA NEW GUINEA Dr Daoni Esorom Technical Adviser STI and HIV / AIDS National Department of Health Tel No. (679) 3013732 Fax No. (679) 3254933; Email: edaoni@health.gov.pg Dr James Wangi Director, Infectious Diseases Section Papua New Guinea National Department of Health P.O. Box 807, Waigani National Capital District Tel No: (657) 301 3738 Fax No: (657) 3239710 Email: jwangi@Health.gov.pg
Dr Sophaganine Ty Ali Medical Officer in charge of Reproductive Health Clinic Ministry of Health 92 Amy Street Toorak Tel No. (679) 3311312 Email: musnin@is.com.fj
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Annex 1
2. TEMPORARY ADVISERS SOLOMON ISLANDS Mr Andrew Darcy Laboratory Manager National Pathology Services Central Hospital Honiara Tel No. (677) 23600 ext 309 Fax No. (677) 23761 Email: labnrh@solomon.com Mr Amos Lapo STI/HIV I AIDS National Coordinator Ministry of Health & Medical Services Honiara Tel No. (677) 208 31 Fax No. (677) 200 85 Email: who@who.rog.com.sb TONGA Mr Eva Mati Health Education Assistant Ministry of Health Box 59 Nuku'alofa Tel No. (676) 23 200 Ext. 25 Fax No. (676) 24 291 E-mail: mOh@kanianet.to Mr Sosaia Penitani Public Health Assistant Ministry of Health Box 59 Nuku'alofa Tel No (676) 41 603 Fax No. (676) 24 291 VANUATU Mr Len Tarivonda National ARIICDD/IMC) Coordinator Ministry of Health PMB 009 Port Vila Tel No: (678) 22 512 Fax no: (678) 25 438 Email: ltarivonda@vanuatu.gov.vu Dr Seini Kupu Senior Medical Section Communicable Diseases Section Ministry of Health P.O. Box 59 Vaiola Hospital Nuku'alofa, Tonga Tel No. (676) Fax No: (676) 24291 Email: seinik@kalianet.to Dr Salanieta Saketa Epidemiologist Ministry of Health Dinem House Toorak, Suva Fiji Fax No: (676) 3 306163 Email: ssaketa@health.gov.fj
3. CONSULT ANT Dr John Kaldor Deputy Director and Professor of Epidemiology National Centre in HIV Epidemiology and Clinical Research 376 Victoria Street Darlinghurst, New South Wales 2010 Australia Tel No: 61 2 9332 4648 Fax No: 61 29332 1837 Email: Jkaldor@nchecLunsw.edu.au Internet: www.med.unsw.edu.au/nchecr
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Annex 1
4. OBSERVERS MINISTRY OF HEALTH AIDS TASK FORCE OF FIJI Ms Jane Keith Reid Executive Director AIDS Task Force of Fiji 2nd Floor Narsey's Building Ellery Street Suva Fiji Tel: (679) 3313 844 Fax: (679) 3314 199 Email: aidstasktiji@connect.com.fj Ms Christine Sturrock Nurse AIDS Task Force of Fiji 2nd Floor Narsey's Building Ellery Street Suva Fiji Tel: (679) 3313 844 Fax: (679) 3314 199 UNITED NATIONS DEVELOPMENT FUND FOR WOMEN Ms Arieta Matalomani Moceica National Programme Officer 6 Ma' afu Street (UNIFEM) c/o UNDP Private Mail Bag Suva Fiji Tel No. (679) 330 1178 Fax No. (67 9) 330 1654 E-mail: registry@unifempacific.com UNITED NATIONS POPULATION FUND HIV/AIDS (UNFPA) Ms Jiko Luveni Focal Point for United Nations Population Fund Private Mail Bag - Suva- Fiji Tel No: (679) 331 2785 Fax No: (679) 330 8022 Email: registry@unfpa.org.fj Ms Julie Sutherland HIV / AIDS Project Officer Ministry of Health Dinem House Suva Fiji Telephone No.: (679) 3221485 Email: jsutherland@health.gov.fj
5. SECRETARIAT
WHO/WPRO Dr Nguyen Thi Thanh Thuy Public Health Specialist/Epidemiologist World Health Organization Western Pacific Regional Office United Nations Avenue Manila Philippines Tel No. (632) 528 9717 Fax No. (63 2) 521 1036 E-mail: thuyn@wpro.who.int Ms Gaik Gui Ong Technical Officer World Health Organization Western Pacific Regional Office United Nations Avenue Manila Philippines Tel No. (63 2) 528 9718 Fax No. (632) 521 1036 E-mail: ongg@wpro.who.int WHO/SOUTH PACIFIC Dr Kevin Carroll Medical Officer World Health Organization P.O. Box 113 Suva Fiji Tel No. (67 9) 3 304 600 Fax No. (67 9) 3 300462 E-mail: carrolk@fij.wpro.who.int
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Annex 1
WHO/TONGA Dr Niklas Danielsson Country Liaison Officer World Health Organization P.O. Box. 70 Nuku'alofa Tonga Tel No. (676) 23 217 Fax No. (67 6) 23 938 E-mail: cioton@kalianeLto WHO/KIRIBA TI Dr K. S. Park Country Liaison Officer World Health Organization P.O. Box 210 Bikenibeu Tarawa Kiribati Tel No. (686) 28 231 Fax No. (68 6) 28 188 E-mail: who@kir.wprD.who.int
WHO/VANUATU Dr Corinne Capuano Medical Officer/Epidemiologist World Health Organization P.O. Box 177 Port Vila Vanuatu Tel No. (67 8) 27 683 Fax No. (67 8) 22 691 E-mail: capuanoc@van.wpro.who.int
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ANNEX 2
PLANS OF ACTION
• Fiji • French Polynesia
• Kiribati • Papua New Guinea • Solomon Islands
• Tonga • Vanuatu
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Annex 2
Plan of Action for STI/HIVI AIDS surveillance activities FIJI
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Annex 2
RCR (Gndc,syp)
EXISTING ACTIVITY UNCHANGED • Routine Weekly Notification [certificate of Notifiable Diseases] to MOR from 4 levels & GPs.
EXISTING ACTIVITY CHANGED • Add Case definition for Syndromic vs Etiologic Reporting.
ACTIVITY • Form working group to develop case definition & submission to NACA for approval.
TIMELINES • 1st 114,2003.
RESPONSIBILITY • Epi. Department Programme Manager
RESOURCES • MOR Resources
RCR(HIV) EXISTING ACTIVITY UNCHANGED
• • •
Laboratory Reporting Con tinned Case by Case to Central Unit.
EXISTING A CTIVITY CHANGED
*Report to Programme Manager within 7 days of test result. *Fonnat of reporting fonn.[M.Status, Aids Related illness, status of patient, MTCT] . ACTIVITY • *Report to Programme Manager within 7 days of test result. • *Fonnat of reporting fonn.[M.Status, Aids Related illness, status of patient, MTCT] . TlMELINES
•
JSI y., 2003.
RESPONSIBILITY
• Sub-committee ofNACA RESOURCES • MOHINACA(can request from donors].
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Annex 2
MSS-Blood Donors EXISTING ACTIVITY UNCHANGED • Laboratory Reporting Confirmed Case by Case to Central Unit. EXISTING ACTIVITY CHANGED • Report to Programme Manager within 7 days oftest result. • Format of reporting form.[M.Status, Aids Related illness, status of patient, MTCT]. ACTIVITY • Consultation & Education of Laboratory Staff. • Working group. TIMELINES
• 1st 14, 2003. RESPONSIBILITY
• Sub-committee ofNACA RESOURCES • MOHINACA[can request from donors].
MSS-Blood Donors EXISTING ACTIVITY UNCHANGED • Screening all blood donations for HIV, Syphilis, HepB.,Hep.C. EXISTING ACTIVITY CHANGED • Establish Reporting mechanism. ACTIVITY • Devise a monthly reporting form to include proportion of all confirmed tests. • Training. TIMELINES
• 2nd Y4, 2003. RESPONSIBILITY • RedCross • MOH RESOURCES
• MOHINACA • Donors • Red Cross
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Annex 2
MSS-ANC EXISTING ACTIVITY UNCHANGED • Laboratory Reporting Confirmed Case by Case to Central Unit EXISTING ACTIVITY CHANGED • *Reporting by proportion. • * Uniform testing Policy. ACTIVITY • *Devise a monthly reporting form to include proportion of all confirmrc. tests. • *Training. • [same as for Blood donors] • *Raise Public Awareness. • *Training of Counsellors .. TIMELINES • I" 114,2003 • End of December, 2002. RESPONSIBILITY • Working Group
RESOURCES *MOHINACA.
• •
NACA Programme Manager
MSS-Prisons EXISTING ACTIVITY UNCHANGED • Routine testing of Syphilis, • Hepatitis B,GNDC • at Public [?HIV]. EXISTING ACTIVITY CHANGED • Depends on Prisons HIV Policy. ACTIVITY • Analyse NEW Prison HIV Policy. TIMELINES • 1st 114,2003
RESPONSIBILITY • NACA RESOURCES • Prisons Department.
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Annex 2
MSS-Military EXISTING ACTIVITY UNCHANGED • Routine testing of Syphilis,Hepatitis B,GNDC, HIV for New Recruits or PK. • Renewal of Contracts. EXISTING ACTIVITY CHANGED • Irregular reporting for Syphilis, GNDC, HIV . ACTIVITY • Consistent & proportional reporting to a central unit. • Design form as for above (blood donors, ANC, etc.) . TIMELINES • 1st 114,2003 • Dec, 2002 RESPONSIBILITY • Working Group
• NACA • Programme Manager RESOURCES
• MOHINACA.
SURVEILLANCE WORKPLAN FOR STI/HIV/AIDS, RS Populations Objectives Method Sample Size
Resp.Agency
Tirneline
Resource
Transactional Sex Work [CSW]
·estimate Prev.STI,HIV
*RCR.
100
'ATFF(STl) &MOH
·BSS STI facility & outreach
·ISl Quarter to 6 months
*NACA 'MOH
Behaviours ·evaluate intervention programmes
(Programme Manager]
"Research Grants SFJ6,OOO
School Age 13-17yr Youths
*KABPs *Eva1uate Intervention Programmes
* Research 'BSS
500urban 500ruraL
Govt.Ministry
Ministry Education
AU SAID UNDP UNA IDS WHO
SFJ20,OOO Tourism Workers -KASPs
*Quest. *BSS
500
·condom use. ·assess for Intervention.
·Hotel Assoc. "Ministry Tourism
2nd Y2 of
Tourism
2003
Industry MOH Donors
'NGO 'MOH
$FJlO,ooO
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Annex 2
Plan of Action for STI/HIV IAIDS surveillance activities FRENCH POLYNESIA
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Annex 2
People living with HIV in FrP (year 2002)
Analysis from medical records of H IV infections
People living with HIV in FrP (year 2002)
• Include people living at least 6 months in FrP • Exclude temporary visitors
2
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Annex 2
People living with HIV in FrP (year 2002) • 96 believed to have been present in FrP during the year 2002 Prevalence 96 I 250 000 4 I 10.000
=
=0,04% 3
SuYI :.z~29 novembtt 2002
People living with HIV in FrP (year 2002) • 31 women .) 32% • 65 men .) 68% Sex ratio == 1:2
SIN, 2.S-29 novem~r 2002
•
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Annex 2
People living with HIV in FrP (year 2002) • 6 children under 15 y. Youngest: 8 y.
• 90 adults above 15 y. Oldest: 73 y.
Medial age
= 37 y. •
Fl'Mth Po/ynesil ~
Suvl 25-29 nowembIr 2002
People living with HIV in FrP (year 2002) Transmission mode • 3 unknown -) 3% • 5 mother to child -) 5% • 7 transfused -) 7% • 7 IV drug users -) 7% • 33 homo/bisexual -) 34% • 41 heterosexual -) 43%
•
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Annex 2
People living with HIV in FrP (year 2002) • Born in FrP : 46 -) 48% • Born in a foreign place : 50 -) 52%
Ratio == 1:1
French Poly"'" PreHnIItlon
SUv. 2$-29 llO'famber 2002
7
People living with HIV in FrP (year 2002) • 74 came for medical follow-up and went to the pharmacy to get ARV treatment • 9 came for medical follow-up and were not seen at the pharmacy • 5 were seen in FrP but denied any medical follow-up • 6 kept unfound • 2 who previously stopped medical followup died in Tahiti SiN. 25-29 nov.mber 2002
•
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Annex 2
People living with HIV in FrP (year 2002)
· == 11 % out of medical control
• == 89% under medical control
SiN. 25-29 no¥MIber 2002
•
People living with HIV in FrP (year 2002) • • • • Movements of HIV positive people in FrP along the year 2002: 4 definitively left 2 died 2 HIV positive people newly arrived from abroad 6 were newly HIV positive tested in FrP 90 believed to be present on 20/11/02
,.
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Annex 2
People living with HIV in FrP (year 2002) The 2 who died were not compliant to treatment 1 was born in FrP 1 was born in a foreign country
FIWIICh Polynllil PreHntatlon
8v¥1 25-29 rtOVembtr 2002
11
People living with HIV in FrP (year 2002) New cases 0 0 0 0 0 0
Case Case Case Case Case Case
1 : 2: 3: 4 : 5: 6:
male, female, female, male, male, male,
homosexual, heterosexual, IV drug user, homosexual, homosexual, heterosexual,
born born born born born born
In in in in in in
FrP FrP France France FrP Africa
Suvl 2$.29........,., 2002
12
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Annex 2
People living with HIV in FrP (year 2002) ARVcost During last 12 months, pharmacy delivered ARV to 74 patients for total cost of 63 423 275 XPF (US$ 530.000)
Per day & person cost
== $20
13
French Polynesian HIV Registry
Presentation : Data from the FrP anonymous HIV Infection Registry. This data is yearly reported to WHO
SUva 25-29 no"""'" 2002
••
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Annex 2
French Polynesian HIV Registry
Cumulative data 226 HIV infections registered from the first case in 1985 to 31 October 2002. 58 -) 26 % are dead 81 .) 36 % definitively left FrP 3 kept unknown 84·) 37% still present in FrP on 31 October 2002
--French Polynesian HIV Registry Yearly distribution 18 r-----------or----------------------~
"
16 14 12 10
Introduction of Prote ••• Inhibitors
8 6 4
2
oIA-IL......... 1984 1986 1988 1990 1992 1994 1996 1998 2000
"
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Annex 2
French Polynesian HIV Registry Sex and age distribution .. ~ 4."
...
~ (
-.;~;.
.'~"""~:-rvv. .4"),""~~~~"l'~1:"'··; :T.l"
.. ...
-;t!.;~ .",~....
.,,1' '" ,;_w._ 0,8 0,0 0,6 1,0
,~.
.
~y.
5 1
• 0 3
0 1 8 110
5-14'1. 15-19'1.
5 38 10 0
"" .% <0% 27% 13%
'"
20-29 '/. 31).31 'I.
.. " 5 2
n
M ' ,0
.. 30
..... y. 50-58 y. 6G-fi9 y.
1 0
M
0
3% 1% ~'.,
2 ,~-;r
•
.~ • - ..
,,,..1'
.,.~ ','r'ih"" ";;:~i·"""ITtt~.
~ ~....
}\'
..
,I ' . . .
'-',' ".
"j~
>~;;; \'
;'f " .••. , ,~
.'
French Polynesian HIV Registry Transmission mode
<'901
lf1O.ll1M
>,'"
....
IIkItMr 10 child
-
.
. "
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Annex 2
HIV surveillance mechanisms
• Inventory • Critique • Planning
,.
HIV surveillance mechanisms
Inventory Cases Reporting
-I I --L
FNllCIa Polynesia y-
f..,ypaienl es~ posH Jl'tilntl m lng avaIable is re~red 1::1 HIV rtcommandtd by ttY an)V!tlere i'I FtP 1985unilnow name,das olbl'tl,sex& jdocto(l or specialist. colecl!i (blood sample are l,olontlltyIHting sent b tab by plane) Speciaislll charge I !ofFrP Hf\I illecion$ age, sexe, i'ansmissi:ln dati is compu2rtzed il 1985L11lilnow /TIOde,mi:Ience, H IV, AI>S jtIVlnltc:tIons economc S Btn, TetTbIaI' or ' hstlJl occupabl el:_
I
I~'''''''
_---.l"-. ~
AI populabl :
-----'"
,"'''''
-
_mod... """'"
,.
- 32 -
Annex 2
HIV surveillance mechanisms
Inventory Regular screening
SU'II2$-lII_tImbw 2002
"
HIV surveillance mechanisms
Inventory Surveys Indbtor Popu~tIon
-. Tahit and tie most
v ....
F• ..".
yearofksl i1 ~rcourse ,
Sexual behaviour
Representative sample of 1.000
Inhabitants from
populaild
1999
RepresenillYe ipamers, condom :samplflg tom 1996 number of
15 to 35 years old. islands
use, contacepiYe populaion census list use, sexual
oletlrences '10.
KABPlurvey (11m round)
22
- 33 -
Annex 2
HIV surveillance mechanisms
Critique Cases Reporting
HIV surveillance mechanisms
Critique Regular screening
- 34 -
Annex 2
HIV surveillance mechanisms
Critique Surveys Popollllon Representative
.u.... "'ry llbonalle bula bIoI popu~lon,
sample 01 1.000 represenlalle olhe inhabitants ri:ht,<
Irom 15 to 35 IIbonalle, old.
y.'"
dala sl noliJlyused, e~vaEd cost nollequenly repealab~ , do nol screen sexualy aclle people under 15 orabo", 35.
(first round)
.. HIV surveillance mechanisms Planned change Cases Reporting
.
- 35 -
Annex 2
HIV surveillance mechanisms Planned change Regular screening
HIII, IIIV, ItCY,
--
"
HIV surveillance mechanisms Planned change Surveys • No new plan for sentinel surveillance for HIV • No new selected sites and groups for regular screening except those enforced by law Data from existing screening and surveys can be used for surveillance purpose
..
- 36 -
Annex 2
HIV surveillance mechanisms Planned change Surveys
• Repeated KABP surveys on sexual behaviour of the population every 5 years • shorter interval if any change in specific trends • target population to be evaluated
"
HIV surveillance mechanisms KABP surveys Commentary
male female
11%
19% 10%
20% 16%
45%
4%
43%
Condom use at the first sexual intercourse
- 37 -
Annex 2
HIV surveillance mechanisms Planned change Surveys Data available from screening and surveys have to be reported according to International standards for trends and comparisons, particularly: HIV prevalence by year and by group for -Blood -donors -Pregnant women -Sex workers -Men who have sex with men
31
HIV surveillance mechanisms Planned change Health schema • The COS (Care Organisation Schema) is a on-golng governmental program to rationalize care offer and care demand. The PHN (Polynesian Health Network) Is a on-golng governmental program to connect all health professionals to a central server archiving the medical record of each Polynesian Medical records will be soon available any where in FrP for medical follow-up, health system evaluation, epidemiologic research, communicable disease surveillance Including HIV and STI.
•
SuY, 2.S-29 ~tmber z002
- 38 -
Annex 2
HIV surveillance issues AIDS definition How were AIDS cases reported in areas where ARV treatment was introduced ? Need for further comments and experiences from developed countries, In contact with WHO
..
HIV surveillance issues Data analysis • Further data analysis must be proceeded to provide data which can be comparable to data of other countries (HIV extent and trends) e.g HIV Prevalence by year among ANC women, sex workers, blood donors••• • A communicable disease surveillance working group including clinicians, epidemiologists and statisticians Is planned for 2003. • Funds are available: all those activities are going on with lack of coordination.
- 39-
Annex 2
HIV surveillance issues Polynesian Health Network
• PHN is a governmental program on MOH responsibility initiated on 1999. Central server will operate in 2003. • The central main hospital database (the biggest one) is ready for connection to PHN • Other health professionals will be connected in 2003-2004 targeting at the whole population coverage
HIV surveillance issues Polynesian Health Network
From 2004, a working group with statisticians, epidemiologists and public health specialists will closely monitor population health. • Relevant et accurate data on every aspect of population health will be regularly reported by the working group for wider dissemination.
- 40 -
Annex 2
HIV/STI surveillance data Available documentation • A lot of documentation already available at MOH : BISES, specific topic reports, WHO reports ••• Observatoire de la sante Polynesie Fran(faise Direction de la sante BP611 98713 Papeete Polynesie fran(taisa • On 2004, PHN will produce European standardized data comparable with data from other health European systems.
- 41 -
AIUlex 2
Plan of Action for STI/HIV IAIDS surveillance activities KIRIBATI
- 42 -
Annex 2
Improvement of existing surveillance mechanisms
Surveillance Activity: S~.droll'lic Reportl., for STI Type:: Routme Case reporting (RCR) DOCUMENTATION None
LIST OF COMPONENTS Reporting !iOurces
PERSON TO WRITE HIV.'STI Desk, MOH
WHEN January
RESOURCES
REQUIRED Cl1$t' definilion orST[ Central Unit fro reporting Ho ..... should reports be made Frequenc) orreportmg Additional mformation with
Health Information Unil Principal Nursing Officer for STI and other PHPNOs, Laboratory Superidentent
~Meeling facilitation @Stationery ~Printing costs
@PilOllOg
@Rcview @incorporation
I
IntO
each case Mechanisms for call back and \"ahdation
eXisting sUI"\'eiHance forms
Surveillance Acliyity: Roulinlt rrporting (or HIV Type: Routme ReportmgtCRCl DOCUMENT AriON
LIST OF COMPONE:-.:TS Reporting sources Case definition of HI V Central Umt fro reponing How should reports be made Frequency of reportmg Add.tional infonnallon I.I,--Ifh each case Mech.anisms for call back and validation
PERSO:-.l TO WRITE HIVISTI Desk, MOH Health Information Unit Principal Nursing Officer for STI and other PHP:r-.;Os Penn.ment Secrelltr}', DPHS. DHS
WHEN JanuaI)
RESOURCES REQUIRED liMeetmg facilitahon ClSlationery tiPnnung costs "Pilotmg !lRc,,-iew IllncorporatJon into eXlstmg surveillance fonns
None
1
- 43 -
Annex 2
New Activities 2003-2004
Surveillance Activity: Etiologic reporting of STI Type:RCR COMPONENTS IDENTIFIED COMPONENTS TO BE IDENTIFIED LATER WHO WILL MAKE THE DECISION WHEN
@Reporting sources: TeH Laboratory <iLaboratory @Monthly @Additlonal information: oDemograpbic oClinical
(leases to be reported (case definitions)
@Reporting formats and protocols ~MKhanisms
HIVISTI Desk. MOH Health Information Unit Principal Nursing Officer (or STI and other PHPNOs, Laboratory Superidentent
3'" quarter
for
validation
2
- 44-
Annex 2
Surveillance Acti..-ity: Regular monitoring of HI V trends in selected high risk porulations (annually) Type: MSS COMPONENTS IDENTIFIED ('OMPONEl'.TS TO BE IDEr..'TIFIEO LATER
WHO WILL MAKE THE
DEC1SI0~
WHE:-'
Siles or utlvlly: I.Ue!io RH. ARH, Hospital 2.TCH laboratory
S.mple lizH (200 per group or lake all for 2· 3 months except blood
Selected corumiuee
2"" quarter-3·d quarter
l.X·mas Haith Center The sites are chosen based 0f1 thl: current STI reporting trends_ The Sites repol1 the highest figures
donon) Validalioa metbods
Selected commiuee
Ceftl,.lllak for reportilll: HIViAIDS (k~k olliee Heahh InfonnallOfl Unit LabonCory hwllvW...1 for tettlac ~lIwortm.
Seafarers male casH. blood doooI-s
sn
I.rora..... rer eadI penetI <tDemognphlC" IIClinieal
I ............... Secure computet files &t locked
cabinets. 1...........raMl'er e-mail ifavailllhlt' hand delIVery
Surveillance Acti,,-ity: Repeated STr and HIV (sao- and BSS) on selected high nsk populations (]-5 yean)
Type: kS
lOMPONE~TS
IDENTIFIED
c-OMPOSE...:TS TO BE IDENTIFIED LA TER
WHO WILL "tAKE THE
D[nSIO~
WHE~
Targt't populltion: Commercial sex workers, Seafarers, (high risk and bridge populations) Recruitmrat of largt't populalions Voluntary. approaching gate· keepers, NGOs (FSP) Whert' will the contact take place <i'Routine scrc:eningfmedlcal eXamlnallons, list from SPMS of returning seafarers !lAt bars, mght clubs (before fully drunk)
Rt'fuSt'n Dlta collection tools lad iastnaments Deliakt'ci n.llabd of spetirnt'D Laboratory praced.res T ulel sample 1U:t'$ aDd j.slilication Ethical issues
I,
1" quarter
[./
3
- 45 -
Annex 2
Budget estimate for 2003-2004
HIV & STI Surveillance In KIribati 2003·2004 DESCRIPTION 1 1.1 1.2 1.3 Monitoring of Surveillance Sit. . (MSS) Short Term Consultant APW SUpplies & equipment Survey design f01 MSS and laboratory study lor RS
Budge' Estimate (USD)
5,000 00 6,000,00
Conduct 3 MSS annually@USD3,oooparyear Supply for lab lest and Logistical Sl.Jpport
10,000.00
2 2.1
Rapeated Surveys (RS) Behevioral Surveillance 2 Nabonal training workshop for MAs, PHN from all outer islands on survellance. reporting
2.1.1
STI
10.000.00
Conduct survey.!! on leeferers & CSW & Report @ USC
LC 2.1.2 APW
1,5OOOI3·5yrs AnalysIS ollne resulls laboratory 5tL.ldieS par survey
7._ 2.000.00 4.000 00
2.2 3 3.1 3.1.1
APW
Routine Ca.. Reporting (RCR) LC STC Tralnang of PubliC Health Nurses and Medical AssiStants Hie staff lraining & design of data comml,ll'llC8tiOn systems Logistic support
see 211 8,000.00
Sf
4,000.00
Total of estimate
58,500.00
4
- 47 -
Annex 2
Plan of Action for STI/HIV IAIDS surveillance activities PAPUA NEW GUINEA
- 48 -
Annex 2
Inventory of surveillance mechanisms Country name: _Papua New Guinea Type RCR
# 1
Indicator SrI N(i. CT, TV, '8\1. TP, DON
Population snPAm~T5
Areas AlL
Years 1997-TO
I Factors I " __At«_ 1-I I ...... ~coNn<r ~""""""'of
""IT
I """" but-t«/>Po/
i 2
liN AIDS
.LL
ALL
1987·DAT'E
.......... 1oco.<ton.
Ioi-Mf.............."i"<
~~ A~,.... ut.rLO{~
M.SS
, •
liN
AAX;
MOTHERS
'M"" ALL 8TS AU
I!J90·t)ATE
............,.....,...iIoP ItJ.,rwJ(~ ~tMI
_..........
1981-'OAlY
8LOOO OONORS AAIC IoWTH£RS
USO-OATE
Sl'I'HIUS
---
1oco.<ton.""'"'
1oco.<ton. "...,.......,. "'iOo"",",
Inventory of surveillance mechanisms Country name: _Papua New Guinea RS
S
NG
S1'O PA TrrNT5
."''''' .""""u ~
1998
IlACiE"
""11 SrI 6 cc~
8ASW SURV£Y
£!Ip POltr
I99B 2000
---. -.. Ates~~
1oco.<ton. ... of
-~ but-_ ~
~-
HNISTI
SEX kIO"RKFRS
Ioi1"\C;~~locA-
"'ORSEllY LA> ~<lRO""
2002 2001
liN
s~~
CiIlII
~
ANe MOTHERS SID PA TlENrS ~ i!>li<Ifl!!>lp
''''~II
~-
2001 2002 1998/99
c""""'"'_ Id.-r\D;
........... ""'" -~ ""''*-
~
""""'-"""""""-
~~Joe«.llDo ~f'\O'"of~
- 49 Annex 2
Critique of surveillance mechanisms Country name: Papua New Guinea Type RCR 1
#
Strengths Gives somel prevalence information,
Weaknesses Unreliable, incomplete and subject to bias. no new infection information,
show trend, gives TPP information, indicate resource requirement
slow.no way to valid''Io1c,tDo much work, denominator unclear., does not give true picture
Show some indication of prevalence.
2
gives trend, gi yes TPP info, gives info whether procedures are followed
(consent, counseling etc),
Too much work. subject to incompleteness, biased, passive, slow. no way to validate, denominator unsure, does not give true picture, no info on new
infections
MSS
3
Give estimate prevalence info in general population for Port Moresby city and may be pregnant mothers there. opportunity for treatment Blood donon- show blood is safe. good indication of spread of HIV to gen pop,
Unable to tell what is happening in other centers and pregnant women there, unnecessary ( epidemic low) • wasteful use of resources. needs validation Bias results. needs validation. not good for control and mtervention work( not measuring HIV in risk groups)
Critique of surveillance mechanisms Country name: Papua New Guinea Type ~ss
#
Strengths Gives indication of prevalence ofsyphiJjs and indication ofsexual risk in gencl1ll pop, show trend. givcs TPP information, indicate resource requirenlCDt., denominator known Indication ofSTf prevalence in high risk group. gives trend info, show differences or similanties in different sites), rapId .active, early warnmg. some info on risk behavior Indication ofSTI prevalence in rural community
Weaknesses Unreliable, incomplete and SUbject to bias. no new infection information, slow.no way 10 validate.,too much work, ., does not give: lrue picture Unrepresentative, bias, does nol give total true picture. too much work. resources reqUired
" 'RS
S
As above
6
Gives a bit more useful details Sex workel'!- sec prevalence and trends in HfV and STls m nsk and link or bndge groups in the thTee major towns and cities whcre high n$k activities are prevalent. lnd.icates whether level of risk (condom use, no of partners ctl;), rapid early warning
Biased, unrepresentative,does nol give sufficicnt info about risk b<;havior•. Ethical issue involved, a lot of resources required
2
- 50 -
Annex 2
Critique of surveillance mechanisms Country name: Papua New Guinea Type # 'RS 6 MI'
Strengths Has a little more details.
Weaknesses Not truly representative, subject to bias, intrusive, ethical issues involved, expensive,
.u.
Rapid early warning, gives prev~lence in nt high risk and low risk groups in different u., areas.give trend info;n different risk
groups in different sites, gives indicalion of prevalence and trend of risk behavior. gives TPP information and sexual contact ( link ~roup)
Inventory of surveillance mechanisms Country name: _PNG_ _ _ _ _ _ __ Type 'RS
# Indicator Population Areas Years Factors 7
CONOO/.4 USE"
SEX lliORKE'RS POUC£
P/MOR£: 1999 S8Y, LA£:
V~ ",,~!ed-
9«'
3
- 51 Annex 2
Critique of surveillance mechanisms Country name: ________ Type # Strengths Weaknesses
Planned surveillance mechanisms Country name: Papua New Guinea Type # 1 2
Indicator
Population sro ""TTE>1T.< All . 8LCOO OONORs (~DUt"A~
Areas All All All
Factors ASA'80Y£
Agency _1oXi ~of'loXi
""" MSS
sn lilY lilY
..u"""""", .... ALLor ABCvr.AOO f<lS1{
""ohow,
3
~of'loXi
~....uwHSS)
~""\IIaLbet
BalAVIOR QU£SITON5
Maa...y~
• RS 5
SYl'HIUS N~
AM: Mc::rrnms sro~
-. All
AS ....'80YE Demogruphi<:, drug sensitivity
GoPNG WHO, AUSAID, ?OTHERS
P"'~.
A/oXiAU
//A_ NSH
6
fltv(STI
S£X WORKt'RS
4
- 52 -
AlUlex 2
Planned surveillance mechanisms Country name: Papua New Guinea Type lIS
# 6
Indicator HIVISTI
Population SEX IIIORJ<£RS
Areas AS ABOVE" ?
Factors AS ASOVE"
Agency III/(O,AUSAI 0, OTllERS
r.,......, tD-
IlW\d.
bmdu ........ ........."
~ ...AS AlIOYE" AOO8SS QU£STIONS 111/(0, AUSAl'D
HIV
SENTINES SURVANC /.IOTllERS, sro PA TI£NTS, 7T'8 PA TI£NTS 8SS
AS AlIOYE",
INCR£AS ETO 3 /.fORE 5lTES
OTllERS
STI
~.....,
3_
Planned surveillance mechanisms Country name: Papua New Guinea Type # Indicator Population Areas Factors Agency 'RS Suw;W actwity H~~
Cot\dom- .......
~(0 be-~)
Port Demogm.- GoPNG, MOf'e.6by AUSAl'D, ciJ;y L....
~~ eS~ ....
WHO,
UNZVE'RSIT ru
sex WORK£'RS CLIENTS
.wow,
Go-PNG, AUSAl'D, WHO
(TRUCK VRIVE'RS)DISCUSS
CMMlIFRSOf COMMFRC£
wrrn
UNZVE'RSIT ru,AVS
5
- 53 Annex 2
PNG HIV/STI SURVEILLANCE ACTION PLAN • 1. EXISTING ACTIVITIES NOT NEEDING CHANGE • 2. EXISTING ACTIVITIES NEEDING CHANGE • 3. NEW ACTIVITIES
• Existing Activities No Change Activities RCR MSS RS l.STI surveillance, requires regular reporting 2. HIV surveillance 3.HIV testing in blood donors and ANC Mothers in Port Moresby 4.Syphilis testing in ANC Mothers 5. NG Survey with more emphasis on drug sensitivity testing 6.HIV/STI testing in sex workers in Port Moresby, Lae, Goroka
6
- 54 -
Annex 2
• Existing surveillance activities that need change RCR.STI surveillanceMSS- none RS -none
New activities RCR-none MSS -none RS- STI/HIV surveillance in clients of sex workers in Pon Moresby, Lae , and Goroka STII HIV surveillance into mining areas and logging companies
BSS of condom use and knowledge of risk factors in high school students and long distance truck drivers and sex workers
7
- 55 Annex 2
EXISTING ACTIVITIES NOT NEEDING CHANGE SURVEILLANCE ACTIVITY: STI SURVEILLANCE IN STD PATIENTS IN PNG RCR • • Ensure all sites are reporting monthly using exiting reporting forms Active checking of all health facilities reporting STIs from HQ by phone by STI Unit ( person responsible to be identified) Completed forms to be sent by fax transmission followed by mail Data validation method to be decided on STI unit to analyze data and provide quarterly feed back
• •
Surveillance Activity: HIV prevalence testing in all health facilities in PNG RCR • • Improve existing channel of reporting HIV positive cases to the Director National Aids Council Secretariat All public and private clinicians ordering the HIV test is the person solely responsible to complete and forward existing reporting forms for HIV positive cases after confirmation by CPHL to NACS Data management of confirmed HIY positive cases need to be improved and strengthened to safe guard patient confidentiality(new) Explore the possibility of setting up AIDS death registry at NACS to keep record of all confirmed AIDS deaths.
•
8
- 56· Annex 2
Surveillance activity: HIY prevalence testing in blood donors in PNG and ANC Mothers in Port Moresby MSS Regular testing of all ANC mothers in Port Moresby needs to be reviewed with the chief obstetricians. This is in the light of the fact that the previous and continuous testing has so far showed low prevalence rates. There is a need to stop this continuous testing and replace it with yearly sentinel surveillance testing. Testing for HIY prevalence in blood donors is to continue without behavioral survey in this population. This information need to be feed into the main surveillance system. Regular analysis of data and reporting to be undertaken by disease control in collaboration with BTS.
• •
Surveillance activity: Gonorrhea Drug treatment sensitivity survey in STD patients in Port Moresby General, Angau, Goroka, Mt Hagen and Nonga Base Hospitals RS The survey is currently conducted by PNG Institute of Medical Research. There needs to be more close collaboration between the institute and national health department in order for the department to access their current surveillance protocol to avoid duplication. future survey results need to be feed to the national health department surveillance system regularly upon availability of survey results.
9
- 57 -
Annex 2
Surveillance Activity: Syphilis prevalence survey in antenatal mothers in PNG MSS Current practice of routine screening for Syphilis during first ANC visit and current standard clinical management of VORL positive cases be continued. Information need to be freely fed into the main surveillance system.
Existing surveillance Activities that need change Survei1\ance Activity: STI prevalence in SID patients in PNG RCR
STI surveillance- incorporate syndromic diagnosis reporting into existing STI reporting form. Add urethral discharge syndrome, vaginal discharge syndrome, genital ulcer syndrome and lower abdominal pain syndrome in females.
10
- 58 -
Annex 2
New Surveillance Activities Surveillance Activity:STI prevalence survey in clients of sex workers in Port Moresby, Lae and Goroka RS
Objective To detennine the prevalence of STI in clients of sex workers in Port Moresby, Lae and Goroka by the end of 2004 and repeat every 2 years. Methods Study type: cross sectional survey Sample size: 250
• Sampling method: convenience sampling Test: ------STI- test urine based PCR ..... .
• Who will do it: Disease Control coordinate PNG IMR - carry out study as they are already doing the sex worker survey
How to identify participants: Use existing peer group network established by IMR ( ? Truck drivers)
II
- 59 Annex 2
• What information to report: Demographic information- age, sex, id no, location, employment status, marital status, no of sex partners, condom use, number of sex workers visited in last month.
How often to carry out survey Every 2 years in line with sex worker study
Analysis and Dissemination To be analyzed by IMR in collaboration with Disease Control NDOH
• Dissemination Provide report of survey finding to research participants, executive management of NDOH and NACs and its implementing agencies
Budget estimated cost: depend on sample size and accessiblity to participants ??? PCR cost, transport, interviewer cost, treatment (USD 15,000 (USD5000 per site). to be finalized
Funding Source: AUSAID, GoPNG, IMR,WHO, to be finalized. Note: STI prevalence survey in sex worker and antenatal mothers need to be considered
12
- 60 -
Annex 2
Surveillance Activity: HIV prevalence in selected mining and logging sites • Objective To determine the prevalence of HIV in employees of selected mining and logging sites by the end of 2004 and repeat every 3 years.
Method Study type: cross-sectional survey Sample size: 300 from each site ( to be finalized) Sampling method: simple random sampling using sample frame (staff list) from company. ?? Anonymous unlinked or veT based depending on current health service structure.
• Who will do it: NDOH to coordinate Public health section of each of the mining and logging companies to cany out the study
How to Identify Participants laise with company executive on how best to select/identify survey participants
What information is reported Demographics: age, sex, id no, site, marital status, employment type, duration of employment on that site, education level, minimal data on behavioral aspect
13
- 61 -
Annex 2
• How often Every 3 years, however discuss with individual companies
Budget Cost estimate: companies USD 10,000 per site- to be discussed with individual
Funding Source To be sourced from existing company tax exemption scheme
• Analysis and Dissemination - to be done by Disease Control NDOH And reports sent to participating companies, SEM ofNDOH, and NACs and their implementing agencies, provincial Chambers of Commerce, and Department of Mining and Petroleum
14
- 62 -
Annex 2
Surveillance activity: Behavioral survey in long distance truck drivers and high school students
• Objective: 1. To conduct survey to measure prevalence of sexual risk behavior in long distance truck drivers ( high risk group) by the end of 2003 and repeat every 3 to 5 years 2. To conduct survey to measure prevalence sexual risk behavior in high school students ( low risk) by the end of 2003 and repeat every 3 to 5 years.
Method Study type: cross-sectional survey. self administered questionnaires Sample size: truck drives- 250 students-300 Sampling method: students - liase with selected schools. obtain list and use simple random sampling Drug divers:- convenient sampling
Who will do it : Student survey: Disease Control to coordinate with respective schools Long distance truck drivers: Disease control to coordinate! private trucking companies\ Collaboration with social science researchers
How to Identify Participants: Schools students: identifY school using simple random sampling. liase with teachers in selected schools~ use simple random sampling to select students Truck drivers: use company network and select participants by convenience sampling
15
- 63 -
Annex 2
• What information is reported • Demographics: age,sex, id, employment status, and information on sexual behavior, alcohol and drug use ( standard questionnaires to be adopted to specific conditions)
• Howoften • Start 2003 and repeat every 3 to 5 years
• Budget • • Cost estimate: USD 5000 Funding source: AUSAID - Sexual Health Project, NDOH
• Analysis and Dissemination • Analysis to be done by Disease control and report to be disseminated to respective trucking companies, schools, education department, SEM ofNDOH, NACs and implementing agencies and AUSAID. Note: BSS on sex workers and antenatal mother added later.
16
- 65 -
Annex 2
Solomon Islands DIV / AIDS Surveillance protocol
This protocol has three components; .:. Syndromic reporting .:. Etiologic reporting .:. Behavioural surveys The three components will into the types of method used for reporting: o Case reporting o Agregate number reporting o Surveys
11.0
~------ ----~---------------------------------------------------------
Case reporting
> I~ N
1.0 New Protocol:
Only confirmed HIV positive case will be reported as an individual case.
C,"i lid Reported by
Reported to HIV AIDS committee
What to report Name Sex age Race occupation Mode of transmission Monthly aggregate with sex & age groups only. Design a reporting form Lab to obtain the missing information from clinicians Write up a sop for lab reporting ·Computerization of lab data Minimal Lab Manager 3 months
Medical Lab.
Data analysis & info Dissemination National HIV AIDS Coordinator
,
HIS Activities Document who is in it and review its role.
HIS Include in the current IT system the additional info thus making it as part of quarterly! annual reporting.
0\ 0\
I ! ,
Budget Person responsible Time frame
nil National HIV AIDS Coordinator (NAC) Dec Jan
2500SBD HIS Manager 3 months! Support maybe needed in computer programming
I 2.
AGGREGATE REPORTING
----]
2.1 STI Syndromic Reporting Protocol All Penile discharges, Vaginal discharges & Genital ulcers are to be reported as aggregate data from all clinic at the end of each month. Reported by Reported to What to report Data analysis & info Dissemination
All clinic and hospital OPO Activities Inclusion of NRH OPO & find info about private practitioners Hospital based HIS (AUSAIO) Andrew & Roger (NRH Consultant)
HIS Check on change of age groups for STI only in the form & data base nil Andrew Peter Dec Jan
Monthly aggregate with sex & age groups only. Use existing form
HIS As it is unless sex group can introduced. 0\
-...J
Budget Person
minimal Andrew & Peter HIS Manager
Time frame
Dec Jan
3 months/ Support maybe needed in computer programming
>
~
tv
2.1 Etiological Reporting - RPRITPHA Protocol: All Medical Laboratory to report the number of RPRITPHA positive over the number tested every month.
i What to report sex & age groups population (Blood donor.,Antenatal, patients & STI ) Design a reporting form Data analysis & info Dissemination HIS-restricted info N.path - detail analysis HIS to include into its data base.
;x tv
Reported by All provincial Hospital labs & Serology Lab NRH Reporting form
Reported to National pathology HIS *Provide computer Create a data base for national pathology 20,OOOSBD Andrew & Peter ( HIS Manager) Dec Jan
Activities
0\ 00
Budget Person
Hospital based HIS (AUSAID) Andrew & Roger (NRH Consultant}
minimal Andrew & Peter HIS Manager
Time frame
Dec Jan
3 months! Support maybe needed in computer programming
2.1 Etiological Reporting -HIV Protocol All Medical Laboratory will report the number of HIV positive over the number tested every month.
Reported by All provincial Hospital labs & Serology Lab NRH Activities Reporting form
Reported to National pathology HIS
What to report sex, age groups and population (Blood donor Antenatal, Patients & STI) Design a reporting form
Data analysis & info Dissemination HIS-restricted info N.path - detail analysis
Budget Person
Hospital based HIS (AUSAID) Andrew & Roger (NRH Consultant)
*Provide computer Create a data base for national pathology 20,000SBD Andrew & Peter ( HIS Manager) Dec Jan
HIS to include into its data base. 0\ \0
minimal Andrew & Peter HIS Manager
Time frame
Dec Jan
3 months! Support maybe needed in computer programming
> ;.< t-.J
~
2.1 Etiological Reporting N.gonorrhoea & Antibiotic Sensitivity Protocol
i >< N
All Blood bank will report the number of HIV HBsAg & RPR/TPHA positive over the number tested every month.
Reported by All provincial Hospital labs & Serology Lab NRH Reporting form
Reported to National pathology HIS *Provide computer Create a data base for national pathology 20,OOOSBD Andrew & Peter ( HIS Manager) Dec Jan
What to report sex & age groups only. Design a reporting form
Data analysis & info Dissemination HIS-restricted info N.path - detail analysis HIS to include into its data base.
Resources
Activities
o
-.J
Budget Person
Hospital based HIS (AUSAID) Andrew & Roger (NRH Consultant)
minimal Andrew & Peter HIS Manager I
Time frame
Dec Jan
3 monthsl Support maybe needed in computer programming
I
2.1 Surveys
G Population Antenatal mothers ~
-
~
~e
of test Etiological STI &
Rational For intervention & treatment guidelines
Period Whole year After every 5 years
Activities Literature review & Preserit data analysis Laboratory reagent
Personnel N A coordinator Laboratory
Behavioral survey
Consecutive 500 mothers After 5 years For treatment & treatment guidelines Whole year Every 10 years ?sample size
Literature review
NHA Coordinator HIS & Andrew NHA coordinator HIS & Andrew SIPPA, Women group, MOH NGOs MOH
Family Planning clinics attendees
Etiology STI & Behavioral survey
Questionnaire design Literature review &
......
-I
questionnaire design Director High risk & very mobile group All and where ever they are Every 10 years
Sea farers
Mobile group Overseas Students and conference attendees
Behavioral surveys & Unlinked HIV Behavioral surveys
Change in the behavior.
One year
Every 5 years
Mo Education MOH Students association
-
i >< N
- 73 Annex 2
Plan of Action for Strengthening of STI & HIV surveillance • In Tonga
- 74 -
Annex 2
Goal: To provide information for action Components • Routine case reporting of sexually transmitted infections including HIV • Monitoring of sentinel populations • Repeated surveys
Desired characteristics The surveillance system: • Should be sustainable over time • Should not interfere with health service delivery. • Should provide information critical to planning purposes. • Should respect personal integrity and individual rights.
1
- 75 Annex 2
Plan of Action 2003 - 2005 Routine Case Reporting Activity Milestones Agency Cost
Finalize Notifiable Disease Forms Finalize SMFC and distribute to peripberal HC andOPD Revise guidelines for screening for HIV Develop guideline for reporting and treatment for RPR positive cases in tbe absence of TPHA confirmation
New Forms endorsed from NHDC by Mar 03 All HC and OPD using tbe F1ow-cbart by June 03
MOH MOH
No extra cost External support needed for Training
All newly diagnosed STIs (botb MOH lab confirmed and SM) and TB be screened for HIV by Oct 03. Guideline to be completed and distributed by Mar 03 MOH MinImal cost
Increase supply of mv test Minimum of 5000 tests by kits to allow 5-6 tbousandlyr 2004.
MOH
Moderate
Monitoring of Sentinel Sites Activity Milestones Agency Cost
Revise blood donor consent forms Develop a Proposal for routine HIV and RPR testing on ANC attendees.
New forms be used by June 03 Proposal be submitted to DOH by Oct 03.
MOHlRed Cross
No new cost
MOH (O&G/CDS)
US$ 5000 per year (Expensive!!)
2
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Annex 2
Repeated Surveys Activity Develop and test survey forms for 6" Formers on SRB
Milestone Forms completed and approved by NHERC by Oct 03
Agency
Cost
MOHIMOE/Churh No new cost Ed. Dept.
Conduct Survey of Survey results ready Form 6 students by Mar 04 Develop and validate questionnaires on SRB for young people 15-24 years Forms completed and approved by NHERC by June 03 Survey results ready by Dec 03
MOHIMOE/CDE ?STC MOHIFHAlTNYC ? STC
SUS6000-OO
USS20,000-OO
Repeated Surveys (cont) Activity Plan for population survey on SRB. Plan for HIV ISTI Prevalence and Beb. Survey for bigb risk population (CSW/Seamenl Gay) STI Prevalence Survey for ANC Attendees
Milestones Proposal submitted to NHERC by Mar 04 Proposal submitted to NHERC by Dec 03
Agency MOHIFH/ HIVWC STC MOHIFHlHIV WC ?STC
Cost USSlS,OOO
USS30,OOO
Proposal submitted by June 04
MOH
USS6000
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-77Annex 2
Analysis and Dissemination of Information for Action Activity Annual workshops to analyse surveillance data
Milestones First analysis workshop conducted by December 2003 Written and verbal dissemination by January 2004
Agency Cost MOHI CDS
Disseminate lnformation to MOH, health service providers, schools,partners and community Review preventive interventions for STI & HIV
MOH
First review completed by MOHI January 2004
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Annex 2
Plan of Action for STI/HIV IAIDS surveillance activities VANUATU
- 80 -
Annex 2
Inventory of surveillance mechanisms
VANUATU Type R~
# 1 2
Indicator T~f<w
Pop Areas Years Factors AU, AU, AU, ~..,.,
AU, AU, AU, AU, AU, fcui,y 1990t' ~
V~ T~f<wPro T~f<w
3
ClWYlci1:1.r If
~~ T~f<w
_dates
fa,ciUty
~~ (.a, L.f'\I tH.ef\I
5
T~f<w wphali4(~
AU,
~
Inventory of surveillance mechanisms
VANUATU Type ~ss
# Indic 6
Pop alood, cimlot'l' alood, cimlot'l'
Areas VCI< ND1I PI<
Years Factors 1988 -
I<lV
voa.
Names
s_
7 Wphil4-
1980t' n.&
locaUty
lXcod,. baM)
<>r>.o/.
(~
8 I<lV 9 wphil4-
A~ A~
1988 -
VCI< NVtl
1980t'
Names VOB. locaUty
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Annex 2
Inventory of surveillance mechanisms VANUATU Type # 'RS
Indic N(i syp~
Pop
Areas
Years
Factors AfI<!<
10 11
12 13 14
llIY ChlAm<
1999A~
l«.aUty, parity,
~~
PortV£la,
2000
~"ifeI cc--~
Tridt-o: chlAm<
15 16
AfI<!<~ ~
l«.aUty,
Tridt-o:
AU,,,,.,,...,...,
W~
2002
Parity, c()--~ ed<.~
Ambae-
pap-..-
~
Critique of surv. Mechanisms VANUATU Type RCR
# 1-5
Strengths O~collec;t:Cmvof ~frrjmt ..u,~
Weaknesses c~(orm. t\&~ l<UeIt\&~W-C No-tffi'~
(ru1llXLe4-
U¥Idu-~~ "'eal<-~atPf!ew.l. ~sW~~~ La.clc.-of~owne.nhq>
MSS
6-7 8-9
o~ o~
No-~ z.:.....:ad,~ No-~ z.:.....:ad,~
(......-ep~),poor~ (......-ep~),poor~
'RS
10-14
S~~ ( collec;t:Cmvof ~H41 e.tl», fint
pop~
£~~~of
~: P01t-~ ~
~w-PICrr,
15-16
5~_.=
p~. ccmp~
o~= ~~ pop~
(5TI,~~)
2
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Annex 2
Planned surveillance mechanisms VANUATU Type # 'RCR 1-5
Indic. Sy~
Pop AlL
Areas AlL
Factors Su.
Agency NOH
Budget
fHY otne.;. (~)
dat:t.
~~r WS8, VRlA,
'he4J.dI,
(acilituw AlL
sn(HN
Port Va.., C~ ~
WS8
~
VRfA P~
NOH NOH
pract: NSS 6-7 sypMi.6HN Slood.-
dcnon-
AlL Cod.i.ng~ctz<4. ~~
~ q~
NOH WHO
~ WHO~S NOH~S
.....:.-e-
8-9
sypMi.6HN
A~
VCH NVH
Cod.i.ngp~
<Xl,
~
NOH
~ 5
Planned surveillance mechanisms VANUATU Type ~
Indic. Tr'idIb;
Pop A~
Areas POrt-Va.., Lug.uwilk
Factors S"""'" .... 1999
Agency NOH ~
Budget NOHRS
Chla-m., HN
L-
'" ,,-.<; <>fficer> ScJw04P~ V~rfpoUa-
parl;>1.ery
WHORS otne.;.7
sss
C~ p~
Port va.., S~ ~Wa-
Su. ~
NOH WS8 VRlA UNf'PA 7
P~
~ rttaritl;U, ~
WHO 7 AU4Aid- 7
a<:ceH' u>- sn
R", v~
ru4
NOH NOH P~ I~ Prince Wales Hospital?
z,
~
Port va..,
Su. ~ pr'eN~
NOH AU4Aid- 7 N~ ~
OR.S
~
(Ri<'~ ~itya..t") ~£n, RU~L ~7
R1<iSn
or
RepMtluLsn 1. 2.
,
SSS ~ ifRt"rilk-beNwl.OY
. (.:.
~
.' L
6
3
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Annex 2
2003-2005 Vanuatu Plan of Action (to be endorsed Dec 2002 by MOH EB) Objectives ReviewRCR form Training of HWon form (I workshop for p:fOV. managers/ Activities Who mainly responsible HIS unit Where Possible Indicators/output Modified formiSTI
Time frame
Est. cost (Agency) 60000 Vt (MOH) 155000 Vt
MOH
section·
Jan. to June 03
HIS unit
MOH
Number of staff trained No offorms filled correctly
Improve RCR
6 workshops in provinces) Training of HIS staff / data analysis & interpretation
Provincial managers
Provin cia/ level
July to Dec. 2003
(MOH HSMDP) (Provincial budget ?)
No of staff trained Director of planning and admin MOH No of quarterly reports produced No of quarterly feedback reports Last quarter 2003
NoEAC (MOH HSMDP)
Proposed adaptation to the monthly report STI section ME-18 SEXUAL TRANSMITTED INFECTIONIINFECTIONS SEXUELLEMENT TRANSMISSIBLES* SYNDROME Urethral discharge Persistent/recurrent urethral discharge in men Genital ulcers Inguinal bubo Scrotal swelling Vaginal discharge Lower abdominal pain Neonatal conjunctivitis OTHERS (diagnosis) HIV TOTAL Men Women
* Use Syndromic approach 0
4
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Annex 2
2003-2005 Vanuatu plan of action (10
be endorsed Dec 2002 b MOB EBI Who mainly
Objeclives
Activities
Where
Possible
responsible STIlHlV monthly WSB.VFHA. Private Drs Port Vila Luganv.
indicators/out put No of monthly reports received by MOH No of HIV tested
Time frame June 03 Dec 05
Est. cost IAgency No additional cost
Improve RCR (cont'd)
reports from MOH partners
Blood donors Introduce coding
By June ZOO3
PLOs
All hospitals
donors with <,ode and q'naire
syst, BSS q'nalre
Improve quality of MSS
ANC Introduce coding system
PLOsand ANC heads
VCH
NDH All hospitals
No of HIV tested women with code
By June Z003
NoEAC PLOs To be discussed
Dvplof monitoring system for HIV lab supplies Pre and post counselmg
By June Z003
PLOs, ANC'. physicians
All hospitals
All HIV tested person counseled
From now
9
2003-2005 Vanuatu plan of action (10
be endorsed Dec 2002 by MOB EB) Wbere Possible Indicators!oul pUI
Objec-
Acti,,'jties
Who mainly
lives RS Collect RS Chl.m., Tricho., HIV BSS STI trends, Sexual
responsible ANCin Director PH Port Vila Luganville Director PH WSB. VFHA
Time frame Nov 2003 to Feb 2004
Est. cost IAgeocy $US 10 000 ,>
Prevalence of the 3 STI Age first sex.condom use in last sexi At risk behaviors & at risk groups identified Level of resistance of STI drugs used in VAN
WHO and
data on;
Port Vila (Students. Gvt officers Prisoners
By 2005
MOH regular budget
Behavior Drug
Police Politicians)
Quotation By 2005 "eeded (donors)
resistance
DRS
Director PH PLOs
Port Vila ANC
Total extra-budget for 2003-2005 POA
~
1.595.000 vatu ($US 12 000) \0
5