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To guide HIV prevention and treatment activities up to 2020, we need to generate and make better use of high quality HIV surveillance data. To highlight our surveillance needs, a special collection of papers in
In 2014, targets were set to diagnose 90% of all people living with HIV, provide antiretroviral therapy for 90% of those diagnosed, and achieve viral suppression among 90% of those treated by 2020 [
To guide HIV prevention and treatment activities up to 2020 and beyond will necessarily require developing a new surveillance architecture that better delivers and leverages high quality HIV surveillance data. We must plan for more sustainable, country-led, action-oriented HIV surveillance platforms that can serve both local decision making and global reporting and modelling needs. In May 2015 the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS held their third global consultation meeting on HIV surveillance [
The galvanizing consensus around the 90-90-90 targets highlights our need to more accurately track the reach of testing and treatment programs. This will be best achieved by drawing on data generated through the delivery of these services rather than self-reports in surveys or the screening of non-HIV test blood specimens. A number of the papers in the special collection explore how existing information from HIV testing and treatment services can be valuable surveillance data, particularly for monitoring achievement of HIV care goals. Dee et al assessed how the move away from unlinked anonymous testing among pregnant women attending select antenatal clinics to surveillance based on routine HIV testing in these facilities may enhance our surveillance efforts [
To ensure broader national surveillance and monitoring and evaluation (M&E) systems do not go the same way as antenatal sentinel surveillance, they must evolve. Rice et al and Bozicevic et al considered how best to strengthen existing systems [
A majority of national surveillance and M&E systems are limited in how information can be presented since they rely on the collection of aggregate data. To overcome the limitations of aggregate data, we need to develop comprehensive strategic HIV information systems that leverage individual-level data collected at HIV diagnosis and over time. Case-based surveillance (CBS) is such a system. Currently, no such system exists in sub-Saharan Africa, where the burden of disease is greatest. To identify systems that may be utilized in the development of CBS, Harklerode et al conducted situational assessments in Tanzania, South Africa, and Kenya [
Commenting on the importance of surveillance data in program implementation, Low-Beer et al highlighted the need for integrating HIV activities with those related to sexually transmitted infections, hepatitis, and health [
Despite understandable skepticism with regard behavioral surveillance, which has been undermined by social desirability biases and poor data quality, it will be critical to improve our capacity to track risk if we are to accurately predict epidemic pathways and reinvigorate HIV prevention efforts. To substantially reduce levels of HIV transmission, it is essential we improve strategic information among key populations, including better leverage of data on the size and location of populations most at risk. A number of the papers in the special collection focus on methods to improve surveillance activities with key populations at risk of HIV infection.
Reviewing the adequacy and relevance of current surveillance methods in key populations, Weir et al proffer a number of strategies to improve strategic information and estimates [
To promote comprehensive HIV and general health programing, it is essential to include adolescents who sell sex, engage in same-sex relationships, and/or inject drugs. It is also important to integrate validated stigma scales to characterize key populations. These were the principal recommendation of Johnston et al [
As testing and treatment have expanded, so has the amount of data on HIV infections generated through service delivery. These data now dwarf those collected through bespoke research or surveillance activities. The rapid expansion of networked infrastructures provides an opportunity to develop a new surveillance architecture to harness these data at scale. The collection and secure storage of routine individual level data, linked within and across systems, will deliver more accurate, disaggregated and sustainable measurements of HIV incidence, HIV transmission risk, and HIV acquisition risk at a level and timeliness that can support resource allocation decisions and targeted action that will accelerate the reduction of HIV incidence.
World Health Organization
monitoring and evaluation
case-based surveillance
None declared.