No Time to Lose Getting More from HIV Prevention (2001) / Chapter Skim
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Tracking the Epidemic
Tracking the Epidemic
Pages 14-25
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From page 14... ...
, due to the development of newer and more effective antiretroviral therapies that slow disease progression and extend the lives of people with AIDS, and in part, to a combination of successful HIV prevention efforts. However, recent data suggest that the declines in AIDS incidence and deaths may be stabilizing (CDC, 2000a)
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. Until the era of potent antiretroviral therapies, AIDS case reporting, although imperfect, provided a relatively accurate picture of trends in HIV infection, especially relative HIV prevalence in groups defined by geography, race and ethnicity, and primary mode of infection.
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Incidence data are needed to judge the effectiveness of prevention programs and to set priorities for prevention programs (see Chapter 3~. Optimally, an HIV surveillance system would also allow tabulation of sociodemographic and behavioral risk information on newly infected individuals which would offer a more precise picture of the HIV epidemic in the United States (see Text Box 2.1~.
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. The CDC maintains that HIV case reporting will provide additional epidemiological data about HIV-infected populations to enhance prevention efforts, improve allocation of treatment resources, and assist in evaluating the impact of HIV prevention programs (CDC, 1999a)
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. Thus, HIV case reporting data exclude individuals who are infected but have not been tested, as well as those who use anonymous testing sites or home collection test kits (CDC, 1999a)
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With this in mind, the Committee proposes the use of sentinel surveillance, a method that would obtain incidence data from targeted samples of "sentinel" populations using advanced testing technology, in combination with statistical modeling to extrapolate these incidence data to larger subsets of the population or the population as a whole (Johri et al., 1998~.
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has recommended that the CDC family of surveys be reformulated as two-stage probability samples (NRC, 1989~. First, a random sample of nationwide drug treatment centers, sentinel hospitals and primary care facilities, clinics devoted to sexually transmitted diseases and tuberculosis, and clinics serving women of reproductive age would be chosen.
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From page 21... ...
that would improve estimates of HIV prevalence, the use of detuned assays could yield more accurate national estimates of HIV incidence. It should be noted that because blood samples are tested anonymously, sentinel serosurveillance methodologies are not suitable for facilitating linkages to care.
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The Centers for Disease Control and Prevention create a surveillance system that can provide national population-based estimates of HIV incidence. The recommended surveillance system would estimate new HIV infections using blinded serosurveys of well-characterized sentinel populations (e.g., drug users in treatment, people attending sexually transmitted disease clinics and tuberculosis clinics, clinics serving women of reproductive age)
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However knowing one's serostatus is only helpful if it results in obtaining medical care and treatment for HIV infection. The Committee's proposal for HIV surveillance based on anonymous test results at sentinel sites separates surveillance (a statistical activity)
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1997. The Hidden Epidemic: Confronting Sexually Transmitted Diseases.
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From page 25... ...
American Journal of Public Health 89(7)
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