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The aim of the WHO/GPA Special Project was to help different countries of central and eastern Europe (CCEE), the Newley Independent States (NIS) and theRussian Federation design an appropriate and cost effeicient surveillance system for HIV infection according to WHO/GPA recommendations and according totheir countries' specific needs. Two intercountry workshop on surveillance of HIV with specific objecties to review basic epidemiological principles underlying HIV surveillance, and to develop draft protocols for HIV surveillance or revise or further develop the existing protocols for HIV surveillance were implemented during 1995. Participants from Albania, Croatia, the Czech Republic, Poland, Romania, the Slovak Republic, Slovenia, and the Former Yugoslav Republic of Macedonia attended the first one in Bratislava and participants from Belarus, Estonia, Latvia, Lithuania, the Republic of Moldona, the Russian Federation, and Ukraine attended the second one in Minsk. Representatives from all invited countries accepted WHO/GPA recommendations for HIV surveillance and felt confident to be able to implement proposed surveillance systems intheir countries, however, not all considered immediate widespread implementation feasble. Support to further development and strengthening of methodologically sound and effective surveillance systems for HIV and integration with the surveillance systems forsexually transmitted diseases should be one of the priorities for WHO and UNAIDS.
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.
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.