Setting the Scene

Setting the scene

Current surveillance tools in low and middle income countries must be strengthened. National HIV programs can benefit from surveillance platforms that correctly and quickly identify geographic areas and populations that are hotspots of new infection, provide ongoing information on the impact of HIV prevention and treatment programs and identify interventions (biomedical, behavioural and structural).

There are major challenges in strengthening measurement and surveillance;

MeSH_30_30Most of the high HIV-burden countries lack complete vital registration systems, so all-cause and HIV-related mortality are not systematically recorded.
MeSH_30_30Population-based HIV incidence measures can be acquired from community cohort studies, but these currently only exist in a few sites and are unlikely to be a feasible approach at scale.
MeSH_30_30Data systems and capacity to inform real-time surveillance at more local levels are lacking.
MeSH_30_30Program data on service delivery, HIV testing and engagement with prevention, care and treatment, while abundant, may not systematically capture key indicators and are often incomplete, limiting their use. Particular challenges include difficulties in interpreting the data that are collected (e.g. characterizing program catchment populations and determining the representativeness of program participants), under-resourced data systems including many paper-based registers, and capturing information on those currently missed (e.g. participants lost to follow up throughout the care cascade).
MeSH_30_30Key populations that are stigmatized or hidden, such as sex workers, injecting drug users, and men who have sex with men, pose particular challenges in all respects.