HIV This Week

Lyerla R, Gouws E, Garcia-Calleja JM. The quality of sero-surveillance in low- and middle-income countries: status and trends through 2007. Sex Transm Infect. 2008 Aug;84 Suppl 1:i85-i91.

Lyerla et al examined the quality of HIV sero-surveillance systems in 127 low-income and middle-income countries by 2007, as well as gaps in data needed for reliable estimates of HIV prevalence and size of populations at risk for infection. They scored quality of countries’ surveillance systems using information from 2001 through 2007. Sero-surveillance data were compiled from the US Census Bureau’s HIV/AIDS Surveillance Database, from countries’ national HIV surveillance reports available to UNAIDS, from demographic and health survey (DHS) data, from the scientific literature, and from countries’ Estimation and Projection Programme (EPP) data files. The quality of systems was scored according to the classification of the epidemic in each country (generalised, concentrated, or low-level). The authors found that the number of countries that were categorised as fully functioning in 2007 was 40. Forty-three countries were identified as partially functioning while 44 were categorised as poorly functioning. Low scores were most often attributed to a lack of recent data or lack of data from appropriate risk populations. They concluded that many countries still have poorly functioning surveillance systems. The inclusion of HIV testing in national population-based surveys in recent years has resulted in some countries with generalised epidemics receiving higher coverage scores, but many countries with concentrated or low-level epidemics continue to lack data on populations at higher risk of HIV.

Editors’ note: This review found wide variations in the quality of surveillance systems monitoring the HIV epidemic both within and across regions. Two-thirds of the countries evaluated had weaknesses. Even countries that had information about marginalised populations at risk of HIV exposure did not have consistent data collection over time to make trend analysis possible. To act on the challenge to ‘Know your epidemic, know your response’, many countries need to strengthen HIV surveillance systems while intensifying prevention programmes – the two go hand in hand for effective responses.