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BACKGROUND: Global surveillance of human immunodeficiency virus (HIV) and sexually transmitted infections (STI) is a joint effort of the World Health Organization (WHO) and the Joint United Nations Programme on HIV/ AIDS (UNAIDS). The UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance, initiated in November 1996, is the main coordination and implementation mechanism for UNAIDS and WHO to compile the best information available and to improve the quality of data needed for informed decision-making and planning at the national, regional and global levels. INTRODUCTION: What is second generation surveillance? First generation surveillance relied solely on data on AIDS cases and some sentinel studies on HIV prevalence. In 2000, a new strategy named second generation surveillance (SGS) was promoted to tailor surveillance systems to the epidemic state of a country. More specifically, the strategy proposed the following: 1. to concentrate strategic information resources where they would yield information that is useful in reducing the spread of HIV and in providing care for those affected;2. to concentrate data collection in key populations at higher risk of HIV exposure, such as populations with high levels of risk behaviour that places them at increased risk or young people at the start of their sexual lives;3. to compare information on HIV prevalence and on the behaviours that spread the infection to build up an informative picture of changes in the epidemic over time;4. to make the best use of other sources of information, such as communicable disease surveillance and reproductive health surveys, to increase understanding of the HIV epidemic and the behaviours that spread it.
Recency assays use one or more biomarkers to identify whether HIV infection in a person is recent (usually within a year or less) or longstanding. Recency assays have been used to estimate incidence in representative cross-sectional surveys and in epidemiological studies to better understand the patterns and distributions of new and longstanding HIV infections. This technical guidance outlines best practices regarding the appropriate use of HIV recency assays for surveillance purposes and updates 2011 technical guidance from the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) on the use of HIV recency assays.
These guidelines provide guidance on the diagnosis of human immunodeficiency virus (HIV) infection, the use of antiretroviral (ARV) drugs for treating and preventing HIV infection and the care of people living with HIV. They are structured along the continuum of HIV testing, prevention, treatment and care. This edition updates the 2013 consolidated guidelines on the use of antiretroviral drugs following an extensive review of evidence and consultations in mid-2015, shared at the end of 2015, and now published in full in 2016. It is being published in a changing global context for HIV and for health more broadly.
As the HIV/AIDS epidemic imposes an ever-larger burden globally, surveillance for HIV becomes more critical in order to understand the trends of the epidemic and make sound decisions on how best to respond to it. This is especially true in low- and middle-income countries, which account for a disproportionate share of new and long-standing infections. To help countries focus their surveillance activities in the context of their epidemic state (low-level, concentrated or generalized), the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) have developed a conceptual framework to improve HIV surveillance, known as Second Generation HIV Surveillance (SGS)1 Guidelines for SGS suggest approaches to make better use of data so that the response to the HIV epidemic can be enhanced. As serosurveillance is an important component of most HIV surveillance activities, an understanding of current HIV testing technologies is important. In the context of SGS, these guidelines suggest methods for selecting, evaluating and implementing HIV testing technologies and strategies based on a country's laboratory infrastructure and surveillance needs. The guidelines provide recommendations for specimen selection, collection, storage and testing, and for the selection and evaluation of appropriate HIV testing strategies and technologies to meet surveillance objectives. Quality assurance issues are also addressed.
On cover and title page: United Nations General Assembly Special Session on HIV/AIDS
A goal of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) is to strengthen collaborative work across disease areas and integrate services that are provided by state and local programs* for prevention of HIV/AIDS, viral hepatitis, other sexually transmitted diseases (STDs), and tuberculosis (TB). A major barrier to achieving this goal is the lack of standardized data security and confidentiality procedures, which has often been cited as an obstacle for programs seeking to maximize use of data for public health action and provide integrated and comprehensive services. Maintaining confidentiality and security of public health data is a priority across all public health programs. However, policies vary and although disease-specific standards exist for CDC-funded HIV programs, similarly comprehensive CDC standards are lacking for viral hepatitis, STD, and TB prevention programs. Successful implementation of common data protections in state and local health departments with integrated programs suggest implementation of common data security and confidentiality policies is both reasonable and feasible. These programs have benefited from enhanced successful collaborations citing increased completeness of key data elements, collaborative analyses, and gains in program efficiencies as important benefits. Despite the potential benefits, however, policies have not been consistently implemented and the absence of common standards is frequently cited as impeding data sharing and use. Adoption of common practices for securing and protecting data will provide a critical foundation and be increasingly important for ensuring the appropriate sharing and use of data as programs begin to modify policies and increasingly use data for public health action. This document recommends standards for all NCHHSTP programs that, when adopted, will facilitate the secure collection, storage, and use of data while maintaining confidentiality. Designed to support the most desirable practices for enabling secure use of surveillance data for public health action and ensuring implementation of comprehensive evidence-based prevention services, the standards are based on 10 guiding principles that provide the foundation for the collection, storage, and use of these public health data. They address five areas: program policies and responsibilities, data collection and use, data sharing and release, physical security, and electronic data security. Intended for use by state and local health department disease programs to inform the development of policies and procedures, the standards are intentionally broad to allow for differences in public health activities and response across disease programs. The standards, and the guiding principles from which they are derived, are meant to serve as the foundation for more detailed policy development by programs and as a basis for determining if and where improvements are needed. The process includes seven main steps: designating an overall responsible party; performing a standards-based initial assessment of data security and confidentiality protections; developing and maintaining written data security policies and procedures based on assessment findings; developing and implementing training; developing data-sharing plans or agreements as needed; certification of adherence to standards; and performing periodic reviews of policies and procedures. CDC will work with state and local health departments to monitor the implementation of the guidelines and evaluate their impact on securing data, facilitating data use, and increasing program effectiveness.
This fully updated edition of Infectious Disease Surveillance is for frontline public health practitioners, epidemiologists, and clinical microbiologists who are engaged in communicable disease control. It is also a foundational text for trainees in public health, applied epidemiology, postgraduate medicine and nursing programs. The second edition portrays both the conceptual framework and practical aspects of infectious disease surveillance. It is a comprehensive resource designed to improve the tracking of infectious diseases and to serve as a starting point in the development of new surveillance systems. Infectious Disease Surveillance includes over 45 chapters from over 100 contributors, and topics organized into six sections based on major themes. Section One highlights the critical role surveillance plays in public health and it provides an overview of the current International Health Regulations (2005) in addition to successes and challenges in infectious disease eradication. Section Two describes surveillance systems based on logical program areas such as foodborne illnesses, vector-borne diseases, sexually transmitted diseases, viral hepatitis healthcare and transplantation associated infections. Attention is devoted to programs for monitoring unexplained deaths, agents of bioterrorism, mass gatherings, and disease associated with international travel. Sections Three and Four explore the uses of the Internet and wireless technologies to advance infectious disease surveillance in various settings with emphasis on best practices based on deployed systems. They also address molecular laboratory methods, and statistical and geospatial analysis, and evaluation of systems for early epidemic detection. Sections Five and Six discuss legal and ethical considerations, communication strategies and applied epidemiology-training programs. The rest of the chapters offer public-private partnerships, as well lessons from the 2009-2010 H1N1 influenza pandemic and future directions for infectious disease surveillance.