The WHO Collaborating Centre is committed to assist 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, work plans 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 and 2010 included carrying out a pre-surveillance assessment before implementation of bio-behavioural surveys among FSW and PWID, and assistance in design and implementation of the RDS-based surveys. In 2015, we analysed RDS data from several RDS surveys in key populations and wrote up the report on results of these surveys.
The work in Belarus in 2014 focused on the capacity building in HIV programme monitoring and evaluation via the training workshop. The content of the training addressed the findings from the 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
Technical support was provided to the Ministry of Health in Bosnia and Herzegovina in setting up an M&E system and defining key programme indicators as a pre-condition for signing the GFATM grant in 2006. In 2007, we carried out RDS bio-behavioural surveys among PWID in three cities in Bosnia and Herzegovina. Our work consisted of planning, design and implementation of the surveys. 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 HIV and STI research studies. These included the national-level cluster-based survey on young people’s sexual behaviours carried out in 2005 and 2010, behavioural surveys among migrant workers (sailors, construction workers and truck drivers) using time-location and convenience sampling and bio-behavioural surveys based on RDS in MSM and PWID.
In collaboration with the University Clinic for Infectious Disease, the Centre’s team was the principal investigator in the design and implementation of bio-behavioural RDS surveys in MSM in Zagreb in 2006 and 2010. The aims of the studies were to assess the prevalence of HIV (PCR, ELISA, WB), HCV (PCR), HVB (ELISA), syphilis (TPHA), Chlamydia trachomatis (PCR on urine and rectal samples), Neisseria gonorrhoeae (PCR on urine and rectal samples), HSV (ELISA, WB) as well as the magnitude of risk behaviors among MSM. Similar studies were carried out in PWID in Zagreb, Split and Rijeka in 2015, and assessed the prevalence of HIV and HCV.
The Centre staff assisted the National AIDS Programme in Georgia to analyse data from RDS surveys among PWID in five cities - Tbilisi, Batumi, Zugdidi, Telavi, Gori, and to write up the report on these surveys.
The collaboration was further extended to writing up two research papers on determinants of risky sexual behaviour among PWIDs (published in AIDS and Behavior) and unsafe injection behaviour (published in the Journal of Urban Health).
Building capacities in HIV data interpretation and synthesis were provided via the training workshop in 2018, organised by the WHO Country Office in Indonesia and the National AIDS Programme. Support was also given to the preparation of the protocols of studies that aim to evaluate the HIV treatment and PMTCT programmes, and to data synthesis protocol for the West Papua province.
The first mission to Iran was carried out in 2005 and the main task was to hold a training workshop on principles of HIV surveillance for disease control managers and epidemiologists from different agencies (Centres for Disease Control, Ministry of Health, prisons organisations, NGOs), and to assist in planning further development of the HIV surveillance system in key populations. Technical assistance was further provided during 2006 on the development of a 4-years work plan for HIV surveillance, and work plans and the budget for implementing of two WHO-funded HIV surveys (a prison-based HIV surveillance survey, and an RDS study among non-injecting drug users in Teheran).
The aim of the next mission in 2011 was to review the STI surveillance in Iran, revise the national STI surveillance plan, review and propose plausibly was to increase coverage of the STI surveillance in clinics in different geographical zones and develop a 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 mapping field team in Erbil, Iraq in July 2011. In addition to training, the Centre staff developed protocols for pre-surveillance assessment in PWID and prisoners in the following cities: Najaf, Karbala, Baghdad, Basra, Erbil, Sulemaniya and Diyala. Later on, we analysed the collected data and prepared a report on the findings from the pre-surveillance assessment.
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. In 2016, we evaluated Moldova's progress towards elimination of MTCT of syphilis. Moldova was later validated by the WHO Global Committee as a country that achieved elimination of MTCT of syphilis.
Technical assistance was provided in 2005 to Montenegro for the development of the GFATM proposal, development of M&E guidelines and manuals, the definition of key indicators, and linkages between the HIV surveillance system and the M&E system.
In April 2007 we provided assistance to the NAP Montenegro in the implementation of bio-behavioural surveys using RDS among MSM and SW, and training of local staff in pre-surveillance assessment and RDS. Further to that, in 2015 we delivered a training workshop on population size estimation in Montenegro.
The assistance to the NAP in Morocco was done in collaboration with the 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 for monitoring resistance to antimicrobials in Neisseria gonorrhoeae.
In 2014 the Croatian Ministry for Foreign and European Affairs provided funding for an IBBSS based on cluster-based sampling in female seasonal workers in the region Souss Massa Draa. The aim of this study was to determine the prevalence of HIV and HIV-related risk behaviours in this vulnerable group. We analysed the data and wrote up a report on the survey. The paper describing the survey results with the focus on correlates of HIV testing was published in the STI journal in 2017.
Technical assistance was provided in 2013 in the evaluation of the HIV surveillance system (funded by the Croatian Ministry for Foreign Affairs). Later on, in 2014, we designed pre-surveillance assessment in MSM and PWID and IBBS in PWID in nine cities in Myanmar.
The activities included work on a protocol for an STI prevalence assessment study in ANC clients and STI patients and a protocol for an RDS study in PWID. We also did a formative research to understand which IBBS study design would be most feasible for recruitment of PWID.
This mission in 2005 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.
The Centre staff co-organized and taught at the training course on Methods for HIV Surveillance and Population Size Estimates in Key Populations held in November 2009 in St Petersburg. The course was done in collaboration with the North-West District AIDS Centre in Saint Petersburg, International AIDS Alliance in Ukraine, Moscow Office of the US CDC and WHO Country Office in Moscow. We also lectured at the training course on HIV Data Triangulation that was held in January 2010 in Moscow and was organized by UCSF, US CDC and WHO Country Office in the Russian Federation. Further activities included reviews of the protocols for IBBS based on TLS and RDS in PWID, FSW and MSM in 2016. This work was done for the Open Health Institute in Moscow.
Technical assistance was provided to the Ministry of Health and the CCM for the development of the 6th round GFATM proposal in 2006 and the 8th round GFATM proposal in 2008.
In 2008, we provided technical advice on the Somali bio-behavioural surveys among key populations, including all aspects of design, implementation, data analysis and interpretation of results. Our tasks were to review the protocol and operational manual for a bio-behavioral survey among FSW based on RDS; review protocols for truck drivers using time location sampling), police and military (based on 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. Similar technical assistance in IBBS implementation was provided in 2015.
During 2017 and 2018 technical assistance was provided to the NACP in Sri Lanka in the implementation of population size estimation (geographical mapping, enumeration and multiplier) and IBBS using RDS in PWID, MSM, FSW, beach boys and transwomen. Our work included preparations of protocols and operation manuals for PSE and IBBS, behavioural questionnaires and all other data collection forms, data analysis and writing of reports. IBBS was done in the cities of Anuradhapura, Galle, Colombo, Jaffna and Kandy, and in the same cities, programmatic data from NGOs were collected for the service-based multipliers. Mapping with enumeration was done at the level of divisional secretariats and estimates were extrapolated to the district and national level. Geographical mapping aimed to identify locations frequented by KPs, and characterize specific spots in terms of operational typologies and the types of KPs present. As part of capacity building activities, several training workshops were held on topics such as population size estimation, data management and data analysis in RDS-A.
The work in Sudan carried out in 2006 included the review of the HIV bio-behavioral studies done in key populations and provision of recommendations to improve the quality and methodological aspects of surveillance in key populations; 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 in key populations.
The Centre staff carried out the following activities in 2011 in collaboration with the Sudanese National AIDS Programme (SNAP) on the implementation of IBSS based on RDS in MSM and FSW in15 Sudanese states:
- Provided technical assistance to the research team on how to prepare data from RDS studies to be analyzed using RDSAT software:
- Provide technical assistance to the research team on how to analyze data using RDSAT and how to write a technical report;
- Analysed four RDS studies - in MSM and FSW in Damazine (Blue Nile state) and Gadarif (Gadarif state) and wrote up technical reports
Technical assistance to Tanzania was provided via WHO HQ in 2016 and included a training workshop for the staff of the Ministry of Health on a range of issues relevant to the implementation of HIV case-based surveillance. The workshop offered an opportunity to develop a guidance document for implementation of case-based surveillance. The system aims to be built on the already functioning patient monitoring system, which at that time was operational in approximately 70% of ART facilities.
In 2009, we carried out a training workshop on Introduction to HIV Surveillance in Ashgabat in collaboration with the WHO EURO and WHO Country Office in Turkmenistan. The aim of this course was to introduce the main concepts and principles of the 2nd generation HIV surveillance to epidemiologists working on communicable disease control. Discussions were held with the participants on how to start with the pre-surveillance activities in key populations.
Collaboration with the partners in Ukraine started with the delivery of a training course in Research Methods for HIV Surveillance in High-Risk Populations in Yalta in 2009.
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 were correctly aligned with the epidemic patterns.
WHO CC was from 2012-2017 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 was the Ukraine AIDS Alliance and another sub-recipient UCSF. The aims of the M&E-related Technical Assistance and Improved Data Application in HIV (METIDA) Project was to determine core strategic information gaps in M&E and ways of addressing them and 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, a number of capacity building activities were carried out in Ukraine from 2012-2017. Other work included a protocol for a study that assessed the reported mode of HIV transmission in HIV cases and assistance to regional-level HIV data triangulation projects.
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. Assistance was also provided during the implementation of RDS and in data analysis.