Case Based Surveillance

Effective HIV Case Based Surveillance systems (CBS) can provide up to date population level data collected from medical records to inform decisions at local, regional, and national levels.  This data can be used to determine and describe the geographic, demographic and risk factor distributions for HIV. The quality of information is improved for decision makers in program planning and evaluation.

While the benefits of CBS are well-known and such systems serve as the backbone of HIV surveillance in developed countries,  there are no national HIV CBS systems in operation in sub Saharan Africa.


What does MeSH aim to do in this area?

MeSH_30_30To carry out a series of in-country SWOT analyses to determine the readiness of individual countries for the implementation of CBS
MeSH_30_30Identify a series of countries which have effective CBS systems and carry out a review of these to identify determinants of best practice.
MeSH_30_30To explore the potential to link HIV laboratory results with other forms of HIV treatment data

What is MeSH working on and achieved so far?

MeSH_30_30In Tanzania we are investigating the feasibility of linkage between clinic and surveillance data in the Kisesa DHSS site, this project commenced in January 2017.
MeSH_30_30A situational analyses protocol and tool to assess CBS preparedness has been developed and SWOT analyses carried out using it in Tanzania, South Africa and Kenya.
MeSH_30_30We also supported the WHO and the National Alliance of State and Territorial AIDS Directors (NASTAD) in carrying out a SWOT analysis in Haiti to understand how their existing case based surveillance system was designed, implemented and supported to serve as a potential model for other countries.
In June 2016, we presented a joint report of the four SWOTs to the Bill & Melinda Gates Foundation, WHO and the Global Fund. The Global Fund has subsequently applied our situational analyses protocol and tool in the Philippines, Papua New Guinea and Vietnam.
MeSH_30_30A major problem in developing individually linked HIV care and treatment cascades is that where data is available it is located in separate data silos. Unique identifiers are needed allowing records in these separate data systems to be linked. To this end, a pilot study is being carried out in South Africa, in partnership with the National Health Laboratory Service (NHLS) based in the Western Cape Province, in which a system to link point-of-care HIV test results to central laboratory records is being developed and tested. Following this pilot study HIV treatment cascades which begin at HIV testing will be constructed. These cascades will enable us to measure and validate estimates of the first ‘90’ in the UNAIDS 90:90:90 targets.
MeSH_30_30Continue to work on the use of routinely collected HIV surveillance data to describe progress along the HIV care and treatment cascade. This has to date focussed on the Tanzanian national care and treatment programme.
MeSH_30_30CBS best-practice surveys are being carried out in countries in Europe, North America and South-East Asia.

What is Case Based Surveillance?

MeSH_30_30An approach to surveillance that involves the reporting of individual-level information from each person diagnosed with HIV to the public health agency responsible for monitoring and controlling the HIV epidemic.
MeSH_30_30Information along the course of disease from diagnosis to entry into care, initiation of ART, viral suppression, and death are needed to measure progress towards epidemic control, data on each of these events is collected and maintained longitudinally. This is a distinctive characteristic of CBS systems and distinguishes it from aggregate reporting.
MeSH_30_30CBS data can be collected from medical records in real time or at regular intervals (monthly, quarterly, or annually) providing data-for-action at all levels of the public health system.