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/AIDS 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
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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.
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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.
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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, and a bio-behavioural survey using RDS among MSM.
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
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The mission in 2006 included provision of the training course in HIV/AIDS 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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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. The countries represented were: Azerbaijan, Kazakhstan, Kyrgyzstan, Moldova, Russian Federation, Tajikistan, Ukraine and Uzbekistan. The Centre is a part of the team composed of the experts from Global Health Sciences, UCSF and CDC that is working on the HIV Data Triangulation Project in Ukraine. The aim of this project is to interpret recent changes in HIV transmission and find out the extent to which HIV prevention programmes, policies, strategies, and resources are correctly aligned with the epidemic patterns. As part of this project, two stakeholders’ workshops were carried out, and the final one is planned for autumn 2011.
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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.
