Washington, D.C., 20 November 2012 (PAHO/WHO) — Experts on HIV in Latin America and the Caribbean have made a series of recommendations for improving the region’s response to the epidemic through enhanced surveillance and monitoring and better use of the information these generate.

The recommendations were issued following a regional consultation held Nov. 7–9 in Panama City, which brought together health experts from 26 countries and international agencies active in the region.

“The region of Latin America and the Caribbean is one of the low- and medium-income regions with the best response to HIV in terms of antiretroviral treatment coverage and prevention of mother-to-child transmission,” said Dr. Federico Hernández-Pimentel, Representative in Panama for the Pan American Health Organization/World Health Organization (PAHO/WHO), which coordinated the meeting.

“Nevertheless, there are enormous inequalities in the region in the level of health, access to antiretroviral treatment, prompt diagnosis, prevention, effective and efficient control of transmission, exposure to risks, and, in general, access to needed health care. Epidemiological surveillance and monitoring in the health sector are key elements of the response to these challenges, by providing data and information for decision-making.”

Participants discussed priority areas of epidemiological information on HIV and other sexually transmitted infections (STIs) and identified actions needed to close information gaps in these areas. Their recommendations included:

• HIV surveillance should be based on cases of HIV infection (rather than cases of AIDS) and should track the evolution of each case over time (longitudinal approach).
• he standard definition of a case should be “any new HIV diagnosis regardless of the clinical and immunological stage.”
• Unique case identifiers should be used to facilitate longitudinal tracking and integration of information from different sources (health services, laboratories, pharmacies, vital statistics).
• Specific measures should be instituted to protect patient confidentiality and data security in systems that use name-based reporting.
• Data should be collected for a minimum set of standardized variables, including risk behaviors and factors (such as sexual behavior, injecting drug use, and exposure to transfusion) and immunologic and treatment variables (such as viral load, CD4 cell count and initiation of ART).
• Global funding and technical cooperation organizations should harmonize the indicators they use, to reduce the burden of reporting, facilitate research and analysis, and promote sharing of information and experiences in HIV surveillance, prevention and care.
• Monitoring should include assessment of access to and quality of care through the continuum of care, from diagnosis through entry into care and treatment, retention in care and treatment, and control of viral load.
• Special attention should be paid to key populations such as men who have sex with men, sex workers, and injecting drug users.
• Surveillance of exposed children should be strengthened through better monitoring of mother-infant pairs in coordination with maternal-child health services.

Participants also called for expanded training and human resources development in such areas as how to collect data on risk behaviors in a culturally appropriate and respectful way, and statistical and epidemiological analysis of longitudinal surveillance data on HIV, among others.
 
An estimated 1.6 million people in Latin America and the Caribbean have HIV, including some 96,000 new infections last year, according to UNAIDS (2011 data). In Latin America, the epidemic is most concentrated among men who have sex with men, whereas in the Caribbean, heterosexual transmission is the main route of HIV infection.

Both subregions have high rates of coverage with antiretroviral treatment (ART): in Latin America, an estimated 68% of people in Latin America who need ART receive it, and in the Caribbean, an estimated 67%. Deaths from HIV have declined significantly in both subregions in recent years as a result of expanded access to ART.

Participants in the special regional consultation included health officials in charge of epidemiological surveillance of HIV in PAHO member countries as well as representatives of U.N. agencies involved in HIV/AIDS (PAHO/WHO, UNAIDS, UNICEF, UNFPA), the U.S. Centers for Disease Control and Prevention (CDC), Health Focus-GIZ, the Organization of Eastern Caribbean States (OECS), COMISCA, ORAS and nongovernmental organizations.

PAHO, which celebrates its 110th anniversary this year, is the oldest international public health organization in the world. It works with its member countries to improve the health and the quality of life of the people of the Americas. It also serves as the Regional Office for the Americas of WHO.

 

HIV Case Surveillance

• Estimating HIV Incidence at the National Level: example of Canada
• Evolution of the HIV/AIDS Case Surveillance System in Haiti
• HIV Case Reporting and Second Generation Surveillance
• HIV Case-Based Surveillance Systems
• HIV Incidence Surveillance and Estimation in the United States
• Measuring HIV incidence: Where are we?: Update on HIV incidence assays



Information for Treatment Program Management

• Continuum of care monitoring framework
• WHO recommendations for HIVDR surveillance and their application in Latin America and the Caribbean



Integration of Information Systems

• Datos sobre VIH y sífilis materno- infantil. Brasil (in Spanish)
• Global Monitoring Framework for Elimination of New HIV Infections among Children by 2015 (EMTCT)
• Strategic information for a sustainable response
• TB/HIV Collaborative Activities and Indicators in the Americas
• Vínculos entre los sistemas de información sobre el monitoreo de las actividades colaborativas TB/VIH, El Salvador (in Spanish)



Surveillance of Key Populations

• Argentina Vigilancia Epidemiológica VIH
• Bolivia Vigilancia Epidemiológica VIH
• Colombia Vigilancia Epidemiológica VIH
• Costa Rica Vigilancia Epidemiológica VIH
• El Salvador Vigilancia Epidemiológica VIH
• Guatemala Vigilancia Epidemiológica VIH
• Haiti Vigilancia Epidemiológica VIH
• Panamá Vigilancia Epidemiológica VIH
• Paraguay Vigilancia Epidemiológica VIH
• Review of HIV surveillance activities in Latin America and the Caribbean
• Santa Lucia Vigilancia Epidemiológica VIH
• Suriname Vigilancia Epidemiológica VIH
• Uruguay Vigilancia Epidemiológica VIH



STI Surveillance

• Strengthening STI surveillance globally



Documents

• a. Agenda
• b. Conceptual note
• c. Meta, Objetivos y Agenda de Trabajo (Spanish)
• d. Conclusions
• f. Lista de participantes (Spanish)
• g. Meeting report: Regional consultation on HIV epidemiologic information in Latin America and the Caribbean

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