HIV/AIDS Epidemiologic Surveillance Modules

This training module presents an introduction to the HIV epidemic and gives an overview of public health surveillance measures to combat the infection. After completing this module, participants should be able to:

• Know the three HIV epidemic states and be able to characterize the HIV/AIDS epidemic in their country
• Be familiar with the predominant routes of HIV transmission and the key risk factors of transmission
• Describe the components of an effective HIV surveillance system and the elements of second generation HIV surveillance
• Understand the ethics involved in HIV surveillance and be aware of potential harm to individuals and to populations
• Develop a plan for evaluating their own country's surveillance system.

This module is meant primarily for district-level surveillance officers and also can be used for self-study.

• Download module in English

This training module introduces HIV case surveillance with an emphasis on WHO clinical staging and surveillance case definitions, ethics and confidentiality, analysis and presentation of surveillance data, and operationalizing an HIV case reporting system. After completing this module, participants will learn how to:

• Set up an HIV case-reporting system
• Analyse reported HIV and AIDS data
• Use surveillance data for planning prevention, care and treatment services
• Monitor the HIV case reporting system
• Prepare national guidelines on HIV/AIDS case reporting.

This module is meant primarily for district-level surveillance officers and also can be used for self-study.

• Download module in English

This training module presents key issues in HIV sentinel surveillance and complementary surveillance techniques for tracking the epidemic, focusing on the steps to conduct unlinked anonymous HIV sero prevalence surveys at antenatal clinics. After completing this module, participants should be able to:

• Understand the criteria for selecting sentinel populations and be able to identify specific groups and sites in their district that are suitable for sentinel surveillance
• Identify appropriate sampling schemes depending on the situation and the target population and create a sampling frame
• Understand how to determine which HIV testing approach is suited for HIV surveillance in their country and describe the advantages and disadvantages of different HIV testing options
• Describe the staffing, training and supervising requirements of HIV sentinel surveillance
• analyse, document, and use HIV sentinel surveillance data.

This module is meant primarily for district-level surveillance officers and also can be used for self-study.

• Download module in English

This training module describes the interaction between HIV infection and sexually transmitted infections (STIs) and describes how to develop and operate systems for STI surveillance. After completing this module, participants should be able to:

• Understand the interrelationship between HIV and STIs
• Explain the difference between aetiologic and syndromic case reporting
• Understand the advantages, disadvantages, and timing of STI universal case reporting and sentinel surveillance
• Ensure confidentiality when collecting, archiving, and reporting STI data
• Identify the STIs most suitable for inclusion in combined STI/HIV biological and behavioural surveillance.

This module is meant primarily for district-level surveillance officers and also can be used for self-study.

• Download module in English

This module introduces behavioural surveillance with an emphasis on presurveillance activities, measures and indicators, survey methods, sampling approaches, data use and ethical considerations. After completing this module, participants should be able to:

• Identify the uses of behavioural surveillance
• Select indicators most suited to particular situations
• Understand sampling issues and options for behavioural surveillance and understand the criteria for choosing a sampling approach
• Describe the types of data analysis commonly used in behavioural surveillance and understand the steps in ensuring appropriate data analysis and use
• Discuss the ethical consideration unique to behavioural surveillance.

This module is meant primarily for state- and national-level surveillance officers, planners, and decision makers and also can be used for self-study.

• Download module in English

This module introduces HIV surveillance among high-risk populations. Eight high-risk populations are described in-depth and recommended surveillance techniques are presented. Detailed case studies are provided for each population to help participants plan implementation. After completing this module, participants should be able to:

• Discuss the importance of surveillance in high-risk populations
• Understand the purpose of pre-surveillance assessments and the role of qualitative and quantitative research in these assessments
• Discuss the advantages and disadvantages of various sampling approaches
• Discuss how to choose the most effective biological and behavioural measures in surveys of high-risk groups
• Understand the special ethical considerations of conducting behavioural and biological surveillance among high-risk groups.

This module is meant primarily for state- and national-level surveillance officers and also can be used for self-study.

Surveillance of HIV Risk Behaviours (Module 5) is a prerequisite for this module.

• Module - In Development

This module is a natural follow-up to Electronic Data Processing, Analysis and Reporting for HIV Sentinel Surveys although data from any source may be used. The module will focus on writing and presenting national or regional surveillance information.

This training module is meant primarily for staff who will assist surveillance officers to develop an annual surveillance report then deliver the information to a variety of audiences.

During the module, participants will:

• Decide the overall design of the report
• Create charts, tables, and other data displays using their own cleaned data
• Practice developing a communication approach for different audiences.

• Module - In Development

Respondent-driven sampling is a variant of the chain-referral method, also known as snowball sampling, designed to sample hard-to-reach populations. It is a probability-based sampling method that reduces bias associated with chain-referral methods using a dual system of structured incentives where participants recruit peers from their social networks using coupons in several recruitment waves. The first wave subjects are purposively selected for certain characteristics. After several waves, however, the sample obtained becomes independent of the first wave. Using a mathematical model, the sample is weighed to compensate for its non random means of collection.

Although still experimental, RDS is currently applied in a variety of international settings as an effective method to recruit hard-to-reach populations. Part of the focus of the module is to share lessons learned during RDS studies. In this way, RDS can be used most effectively to benefit the study populations, local communities, national HIV/AIDS objectives, and researchers collecting data in diverse settings. A more detailed description of the methods and statistical tests used in RDS can be found at Respondent Driven Sampling.

This module provides details on how to conduct an RDS study. Lessons learned from studies completed to date are provided. The module provides step-by-step procedures with tools and samples and emphasizes:

Pre-study preparations

• Identifying and recruiting seeds
• Selecting and managing interview sites
• Designing coupons, determining incentives
• Developing questionnaires
• The interview and claim process
• Staff management
• Documentation and management of data
• Controlling sample growth, ending recruitment
• Analysis of data.

Additional time can be provided on the development of RDS protocol at each country's request.

• Download an Introduction to Respondent Driven Sampling

The module provides participants with basic technical skills in data processing, analysis, and report writing for survey data. It introduces best practice techniques for systematically collecting, managing, processing, and reporting HIV survey data.

This module is meant for data managers with or without familiarity with Epi Info.

To benefit from this module, participants should be able to:

• Use the Microsoft Windows computing environment (move, copy, and rename files and file folders).
• Perform and interpret simple and more complex data analyses, using either computer- or paper-based statistical methods
• Understand the basic approach to conducting public health sentinel surveillance, such as in antenatal clinics, in resource-limited settings. Familiarity with this type of surveillance can be obtained by reading the WHO Second Generation Surveillance Guidelines, your country's HIV sentinel surveillance protocol, and other published literature.

By the end of the module, the participants will be able to:

• Design easy-to-use data collection and electronic data entry forms
• Develop simple and complex check code to validate data entry
• Oversee and perform data entry
• Develop and document data cleaning and database storage strategies
• Conduct simple exploratory analyses for data cleaning
• Clean and prepare data for analysis
• Perform simple and complex descriptive analyses
• Develop clear and concise national and regional reports.

• Download module in English

Based on the use of the BED assay and protocol developed at the Centers for Disease Control and Prevention for HIV-1 incidence surveillance in resource-limited countries, this module includes both classroom and hands-on laboratory training, but it also can be presented as lab only or surveillance only.

This module is primarily meant for surveillance and laboratory personnel.

Participants will plan BED implementation for their country, including requirements for protocol development and human subjects approval; personnel management; study population and data management; specimen storage, handling, and testing; equipment and supplies; and the timeline for assay implementation and analysis of results.

At the conclusion of the module, participants will have an overview of laboratory methods and epidemiological study designs to measure HIV-1 incidence. In addition, laboratory staff will learn:

• Laboratory procedures for conducting the BED HIV-1 incidence assay
• Management of BED laboratory data
• Procedures for quality control
• Calculation of incidence estimates from BED laboratory results.

Epidemiological staff will learn:

Epidemiological and ethical requirements for integrating the HIV-1 BED Incidence assay into cross-sectional sero surveys used for HIV surveillance, including HIV-1 sentinel surveillance and general population-based surveys.

• Management and merging of laboratory and HIV surveillance data.
• Analysis of BED results, including calculation of HIV-1 incidence estimates and 95% confidence intervals and basic statistics for comparing HIV-1 incidence between populations and over time.

• Module - In Development

The training guide provides useful information about planning and organizing training activities for surveillance of HIV, AIDS, Sexually transmitted infections (STIs), and risk behaviours. It also describes steps for adapting the surveillance curriculum for staff working at district, regional/provincial, and national levels. The guide will be useful for training directors and facilitators. It includes:

• Scheduling suggestions
• Ideas for what to include in the training
• Planning tips and checklists
• Adult education training and presentation tips.

• Download guide in English