The WHO Collaborating Centre is committed to assisting countries to develop strategic information to guide more effective responses to HIV. One of our central concerns in providing technical assistance is to ensure that surveillance systems are based on the best biological and behavioural methods and that the information obtained from surveillance meets the needs for the development of HIV prevention and control.
We provide technical assistance in the following areas and aspects relevant to HIV surveillance:
- Assessment of the quality of existing HIV surveillance systems, including STI and behavioural surveillance
- Identification of priority groups and areas where HIV surveillance needs to be established
- Assistance in identification and implementation of operational research and pre-surveillance assessment
- Assistance in implementation of surveillance surveys, including clinic- and facility- based surveillance, and population-based surveys among most-at-risk groups
- Development of surveillance protocols and operation manuals
- Selection of HIV and STI tests and testing algorithms
- Training of surveillance professionals and field staff who work on survey implementation
- Analysis and interpretation of data, and report writing
- Development of HIV surveillance strategy, workplans and budgets for HIV surveillance
A short overview of the technical assistance projects undertaken by the WHO Collaborating Centre since 2005
The technical assistance to the National AIDS Control Programme in Azerbaijan in 2007 included carrying out pre-surveillance assessment before implementation of bio-behavioural surveys among FSW and IDUs, and assistance in design and implementation of the surveys. In 2009 and 2010, we have assisted in carrying out pre-surveillance assessment and an RDS survey among MSM in Baku.
The work in Belarus focused on the capacity building in HIV programme monitoring and evaluation. The aim of the course was to provide participants with practical guidance on how to design and carry out evaluation of HIV programmes in groups at higher risk of HIV, and how to conduct the evaluation of larger-scale HIV prevention interventions. Participants have also learned the principles of conducting population size estimation studies and HIV data triangulation. The content of the training addressed the findings from the recent review of the M&E system in Belarus. The training was carried out in collaboration with the UNDP Office in Belarus and the National AIDS Programme.
Bosnia and Herzegovina
The technical assistance was provided to the Ministry of Health in Bosnia and Herzegovina for setting up an M&E system and defining key programme indicators as a pre-condition for signing the approved GFATM grant in 2006. In 2007, we carried out three RDS bio-behavioural surveys among IDUs in three cities in Bosnia and Herzegovina. Our work consisted of planning, design and implementation of the surveys. These were the first such surveys in Bosnia and Herzegovina carried out in a high-risk group. The project was commissioned by the UNICEF Bosnia and Herzegovina and carried out in collaboration with three local NGOs.
Work in Croatia includes the leading role in the design and implementation of several HIV surveillance surveys. These include the first national-level cluster-based survey on young people’s sexual behaviours carried out in 2005, behavioural surveys among migrant workers (sailors, construction workers and truck drivers) using time-location and convenience sampling, a bio-behavioural survey using RDS among MSM and PWID.
In collaboration with the Croatian National Public Health Institute and the University Clinic for Infectious Disease, the Centre’s team was the principal investigator in the design and implementation of a bio-behavioural survey using RDS among MSM in Zagreb. The aims of the study were to assess the prevalence of HIV (PCR, ELISA, WB), HCV (PCR), HVB (ELISA), syphilis (TPHA), Chlamydia (PCR on urine and rectal samples), gonorrhea (PCR on urine and rectal samples), HSV (ELISA, WB) as well as the magnitude of risk behaviors among MSM. This was the first study conducted among MSM using a probabilistic sampling method in Croatia, and the most comprehensive such surveys in Eastern Europe. The work of the Centre included:
- Establishing partnerships between key stakeholders including the University Hospital, Public Health Institute, Ministry of Health, and the NGOs
- Extensive planning and development of work protocols and staff manuals
- Adaptation of a behavioural questionnaire and RDS forms
- Pre-surveillance assessment and focus group discussions
- Organisation of the RDS site
- Training of staff and follow up supervision
- Data analysis and report writing
During the conference HIV in European Region: Unity and Diversity held in May 2011 in Tallinn, satelite workshop was organized in collaboration with the National Institute for Health Development in Estonia, WHO HQ and GFATM. The aim was to present the process and results of the current HIV triangulation activities in Eastern Europe (Ukraine, Moldova, Estonia). The needs, opportunities and benefits of carrying out other HIV data triangulation in the eastern European countries were thoroughly discussed. The Center staff was involved in triangulation in all three countries. As a recommendations rit was stressed the need to include triangulation in GFATM programme reviews and to prepare a resource guide specific to the Region with relevant case studies (e.g. from Estonia, Ukraine, and Republic of Moldova) as the current guidelines focus on sub-Saharan Africa.
Former Yugoslav Republic of Macedonia
The mission in 2006 included provision of the training course in HIV surveillance for the staff who work on HIV surveillance at the national level, with an emphasis on surveillance data analysis and interpretation. In 2009, we did a training of site staff on RDS, as part of the preparations to implement RDS surveys among IDUs in several cities in Macedonia.
The Centre staff assisted the National AIDS Programme in Macedonia in 2009 to train field staff in RDS and to design RDS surveys among IDUs, SW and MSM.
In November 2011, the Center staff in collaboration with WHO Country Office in Macedonia held the training course for the main stakeholders to review the STI surveillance system in Macedonia; reviewing the current structure of national STI system and develop the recommendations for its strengthening; prepare detailed report describing current situation on STI surveillance and concrete recommendations for its strengthening.
The Centre staff assisted the National AIDS Programme in Georgia to analyse data from RDS surveys among IDUs in five cities - Tbilisi, Batumi, Zugdidi, Telavi, Gori, and to write up the report on these surveys.
Assistance in writing-up a research paper Determinants of risky sexual behavior among IDUs in Georgia (Chikovani I, Goguadze K, Bozicevic I, Rukhadze N, Gotsadze G. Unsafe injection and sexual risk behaviors among injecting drug users in Georgia. J Urban Health) which was submitted to AIDS and Behaviour in December 2011.
The terms of reference for this mission in December 2005 were to hold a training workshop on HIV surveillance for disease control managers and epidemiologists from different sectors (Centres for Disease Control, Ministry of Health, prisons organisations, NGOs), and to assist in the development of the second generation HIV surveillance. Technical assistance was also provided to Iran during 2006 and tasks included the development of a 4-years work plan for HIV surveillance, and work plans and the budget for implementing two WHO-funded HIV surveys: (1) a prison-based HIV surveillance survey; (2) an RDS study among non-injecting drug users in Teheran.
The aim of the mission in February 2011 was to review the STI surveillance in Iran; revise the national STI surveillance plan; review and propose plausible was to increase coverage for STI surveillance in clinics in different geographical zones in the country; check the feasibility of linking the data from clinics to other services in a way that patients' outcomes could be followed; develop a 2-year action plan; develop the recommendations for the implementation of the 2-year action plan.
Technical assistance to WHO and NAP Iraq was provided from May-July 2011, and included training workshops in Zagreb in May 2011 and a follow-up training of a field team in Erbil, Iraq in July 2011. In addition to trainings, the Centre staff developed protocols for pre-surveillance assessment in IDUs and prisoners with the focus on the following cities: Najaf, Karbala, Baghdad, Basra, Erbil, Sulemaniya and Diyala.
The aim of the project in Kosovo in May 2011 was to carry out a training workshop and prepare four study teams for implementation of RDS in IDUs and MSM in Prishtine, and facility-based studies in FSWs in Prizern and Ferizaj, and to support the Kosovo teams in the implementation of these studies.
A mid-term review of the Lithuanian National AIDS programme was commissioned by UNDP. One of the Centre’s consultants joined a team that visited key stakeholders in Lithuania and developed a comprehensive analysis of programme achievements and shortfalls.
Technical assistance was provided in 2005 to Montenegro for the development of the 5th round GFATM proposal, development of M&E guidelines and manuals, definition of key indicators, and linkages between the HIV surveillance system and M&E system.
In April 2007 we provided assistance to the NACP Montenegro in implementation of bio-behavioural surveys using RDS among MSM and SW, and training of local staff in pre-surveillance assessment and RDS.
In collaboration with WHO EURO and WHO Collaborating Centre for STIs at University of Orebro, Sweden, we did the assessment of the STI surveillance system in Moldova in 2013 – the report is available at http://www.euro.who.int/en/health-topics/communicable-diseases/sexually-transmitted-infections/news/news/2014/08/strengthening-of-sti-surveillance-in-the-republic-of-moldova
In 2014, we participated in an ECDC mission that aimed to assess the communicable disease surveillance system, and our role was to evaluate the HIV surveillance system and follow up on the recommendations for the STI surveillance system strengthening that were made in 2013.
The assistance to NAP in Morocco was done in collaboration with WHO EMRO in several areas: evaluation of the HIV surveillance system, HIV data triangulation in the region Souss Massa Draa (done in 2010 and 2011) and assistance in setting up a system of monitoring resistance to antimicrobials in Neisseria gonorrhoeae.
In 2013 and 2014 the Croatian Ministry for Foreign and European Affairs provided funding for a an IBBSS based on cluster-based sampling in female seasonale workers in the region Souss Massa Draa. The aim of this study is to determine the prevalence of HIV and HIV-related risk behaviours in this vulnerable group Two missions were conducted in Morocco related to the survey preparations, training and implementation – one in October 2013 and the other in March 2014.
Technical assistance was provided in April 2013 on evaluation of HIV surveillance system (funded by the Croatian Ministry for Foreign Affairs), and since October 2013 on design of pre-surveillance assessment in MSM and PWID and design of IBBS in PWID in nine cities in Myanmar.
The tasks were to develop a protocol for carrying out the STI prevalence study in ANC clients and STI patients in Oman and to discuss the plans for the studies with the key stakeholders (NAP staff and clinicians working on STI care provision in public and private clinics).
The Centre staff co-organised and thaught at the training course on Methods for HIV Surveillance and Population Size Estimates in High-Risk Populations, held in November 2009 in St Petersburg. The course was done in collaboration with North-West District AIDS Centre in Saint Peterbsurg, International AIDS Alliance in Ukraine, Moscow Office of the US CDC and WHO Country Office in Moscow. The course was attended by 29 participants from 5 countries. The countries represented were: Azerbaijan, Moldova, Russian Federation, Ukraine and Uzbekistan.
We also lectured at the training course on HIV Data Triangulation that was held in January 2010 in Moscow, and was organised by UCSF, US CDC and WHO Country Office in the Russian Federation.
Technical assistance was provided to the Ministry of Health and the CCM for the development of the 6th round GFATM proposal in June 2006 and the 8th round GFATM proposal in June 2008.
This mission included an assessment of the STI surveillance system and development of a strategy for the STI surveillance system implementation in Pakistan. We also carried out a workshop on STI surveillance in 2005.
In 2008, we provide technical advice on the Somali bio-behavioural surveys among most-at-risk populations, including all aspects of design, implementation, data analysis and interpretation of results. Our tasks are to review the protocol for a bio-behavioural survey among FSW and an RDS operational manual; review and comment on three additional protocols for truck drivers (likely to be using time location sampling), police and military (likely to be using cluster-based sampling); provide support throughout data collection and advise on the duration of the survey and recruitment of participants; review of data analysis strategy, support for data management and data analysis using RDSAT and STATA; provide comments on the final report.
The work in Sudan carried out in 2006 included the review of the studies done for most-at- risk groups and provision of recommendations to improve the quality and methodological aspects of surveillance of most-at-risk groups; development of protocols for surveillance among FSW, MSM, truck drivers, raksha drivers, prisoners, tea sellers, soldiers and young people. During the mission, we also carried out a training workshop on designing surveillance protocol for most-at-risk populations.
June-August 2011 - Sudanese National AIDS Programme (SNAP) is conducting integrated Bio-Behavioral Surveys (IBSS) using RDS in 15 northern Sudanese states among two populations at increased HIV risks-MSM and FSWs, in total 30 studies were planned. The Centre stuff carried out the following activities:
- Provided technical assisstance to the research team on how to prepare data from RDS studies to be analyzed using RDSAT (respondent-driven sampling analysis tool v6.0.1) software:
- Provide technical assisstance to the research team on how to analyze data using RDSAT and how to write a technical report;
- Facilitate training workshop (focused on points 1 & 2);
- Provide suggestions to the research team regarding the planned RDS studies in the remaining 13 states;
- Analyse four RDS studies - in MSM and FSW in Damazine (Blue Nile state) and Gadarif (Gadarif state) and write up technical repors
In 2009, we carried out a training on Introduction to HIV Surveillance in Asghabat in collaboration with WHO EURO and WHO Country Office in Turkmenistan. The aim of this course was to introduce main concepts and principles of the 2nd generation HIV surveillance to epidemiologists working on communicable disease control. Participants were working in groups with the aim to develop protocols on HIV surveillance among groups at-risk.
In collaboration with the International AIDS Alliance in Ukraine we did a training course in Research Methods for HIV Surveillance in High-Risk Populations in Yalta in 2009. The course was attended by 22 participants from 8 countries in the region.
In 2011-2013 we participated in the HIV data triangulation project together with the Global Health Sciences, UCSF and CDC. The aim of this project was to interpret recent changes in HIV transmission and find out the extent to which HIV prevention programmes, policies and resources are correctly aligned with the epidemic patterns.
WHO CC is since 2012 a sub-recipient of a CDC project grant aimed at strengthening the system of monitoring and evaluation of the national AIDS programme in Ukraine. The principal recipient of a grant is Ukraine AIDS Alliance, and another sub-recipient is UCSF. The aims of the M&E-related Technical Assistance and Improved Data Application in HIV (METIDA) Project are to determine core strategic information gaps in M&E and ways of addressing them; to determine the key unaddressed capacity building needs of decision makers and M&E staff in regards to strategic data collection and use. As part of the project, three training courses were held in 2013 in Ukraine as well as the assessment of the M&E system. Another product was a protocol for a study that will assess the reported mode of HIV transmission in HIV cases in Ukraine in the period 2012-2014.
In May 2007, our staff carried out pre-surveillance assessment among FSW in Aden, and a workshop on pre-surveillance assessment in order to identify the appropriate design for the surveillance survey among FSW. The subsequent mission carried out in November 2007 assisted the NACP in preparations of RDS and training of staff in RDS. The assistance has been also provided during the implementation of RDS and in data analysis.