The UNAIDS/WHO Working Group on global HIV/AIDS and STI Surveillance
Global surveillance of HIV/AIDS and sexually transmitted infections (STIs) is a joint effort of WHO and UNAIDS. The UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance, initiated in November 1996, is the coordination and implementation mechanism for UNAIDS and WHO to compile and improve the quality of data needed for informed decision-making and planning at national, regional and global levels.
The primary objective of the working group is to strengthen national, regional and global structures and networks for improved monitoring and surveillance of HIV/AIDS and STIs. For this purpose, the working group collaborates closely with WHO Regional Offices, national AIDS programmes and a number of national and international institutions.
During the past six years, the Working Group has established itself as one of the best examples of synergistic collaboration between UNAIDS and its co-sponsors. The Working Group is chaired on rotation and meets regularly every Monday to discuss an agreed agenda. In its present form the Working Group is a co-ordination mechanism cutting across several WHO clusters and UNAIDS. It consists therefore of several stakeholders that include:
- UNAIDS (Epidemiology, Monitoring and Evaluation Team)
- WHO/FCH/SRM (Surveillance, Monitoring and Evaluation and Research Team)
- WHO/NMH/MSD/MSB (Mental Health and Substance Dependence)
In addition, the Working Group collaborates closely with the six WHO Regional Offices (AFRO, AMRO, EURO, EMRO, SEARO, WPRO), with national collaborating centers (US Bureau of Census, EUROHiv, US CDC, Robert Koch Institute, Health Canada and others). Experts reference groups on specific issues (HIV estimates and projections, HIV surveillance in hard-to-reach populations) have been constituted to provide guidance and technical advice on selected issues.
The Working Group provides a forum for information sharing, co-ordination, joint planning and evaluation of activities. It helps avoiding duplication of activities and fosters the involvement of other partners and institution, making extensive use of a network of collaborating centres, institutions and experts to support epidemiological work on HIV/AIDS and STI.
Areas of work
The Working Group deals with a wide range of issues directly or indirectly related to the global surveillance of HIV/AIDS and STI. For description purposes, these activities can be grouped into four main areas of work.
1. Global surveillance of HIV, AIDS, STI and related risk behaviours
This involves the collection of information from all Member States, normally through WHO Regional offices, its compilation into global database and the regular analysis and feedback through global reports and publications. Data are collected directly from the national AIDS programs, from the scientific press, from reports of consultants and missions and from international conferences, in collaboration with international and national institutions like the US Bureau of Census and the European Center for AIDS Epidemiology. Every effort is made to ensure that the information is as complete and updated as possible.
The information compiled in the global database is used to produce HIV Epi Fact Sheet for each individual country. The Epi Fact Sheet contains the most updated information relevant to HIV, including demographic, social, behavioral and STI data. The first issue of the Epi Fact Sheets was released in June 1998. The last update was in June 2002.
The data are also used to develop estimates of HIV prevalence and mortality for the global updates released in occasion of World AIDS Day (December 1st) every year. Since there is no direct measurement of HIV prevalence or AIDS mortality, the global, regional and country estimates have often been the object of controversy, with experts and activists often suggesting that the official estimates were either too low or too high. The Working Group ensures that single estimates are produced jointly by UNAIDS and WHO with feedback from all Member States and WHO Regional Offices. In addition, there are continuous efforts to improve both the availability of data and the methodologies used to produce estimates and projections. A reference group composed of HIV epidemiologist, demographers and modelers was established to assist the Group in this task.
2. Development of guidelines and tools for surveillance of HIV, AIDS and STI
The Working Group gathers examples of best practices and experiences from all regions on the collection of HIV, AIDS, STI and behavioural data at country level and uses them to develop global guidelines and training materials to be used in designing, monitoring and evaluating national surveillance systems. Existing HIV surveillance systems are still often based on the model developed by the WHO Global Programme on AIDS at the end of the 80s which was based on the experience gained in the African epidemic. Taking stock of the experience gained since and looking at the differences in the epidemic scenarios across the world a revised system, the so called “2nd generation HIV surveillance” has been developed through series of collaborative meetings. The new system builds on the existing HIV surveillance activities and focuses more on the monitoring of “mature” epidemics, the adaptation of the tools to slow progressing epidemics and the more consistent collection and use of behavioural data for risk assessment and evaluation of preventive interventions.
3. Support to regional and national surveillance activities
The main responsibility for country support remains with WHO regional offices and the UN Theme Groups. The Working Group provides support to regional and national HIV, STI and behavioral surveillance activities through regular regional and inter-country meetings and workshops, fielding of staff or external consultants, briefing of national and international staff in headquarters and, in some cases, direct financial support. UNAIDS and the EC have recently signed a three-year project that will provide financial and technical support to eight ACP countries while field-testing the basic concepts of 2nd generation surveillance. Through the mechanism of the UNAIDS Unified Budget and Workplan, the Working Group provides technical and financial support to all WHO Regional Offices for intercountry HIV surveillance activities. Funding is also available for support to few countries in the implementation of STI surveillance.
4. Research and development of new epidemiological tools
Continuous research into new epidemiological tools for monitoring the spread of HIV and other aspects related to the HIV epidemic are required due to changing realities of the epidemic and the development of new sampling and testing methodologies. The UNAIDS/WHO Working Group, in collaboration with international and national institutions, plays a leading coordinating role in the development of new methodologies, in operational research and in the assessment of new and emerging problems related to the HIV epidemic. Examples include the use of Demographic Health Surveys for HIV prevalence studies, the utilization of mapping tools (Health Map) and GIS for HIV surveillance, the integration of HIV with other disease surveillance systems, the monitoring of Antiretroviral resistance, the use of alternative HIV testing methodologies (saliva, urine) in surveillance.
In addition, more advanced tools for the estimation and projection of the HIV epidemic are being developed in a effort to improve the accuracy of the information and its usefulness for planning and monitoring of preventive and care efforts.