Unaids update 2013

Finally, the surveillance system only collected data for 1 month and could not account for potential seasonality in mortality rates or associations between season and cause of death or HIV positivity among persons who died. Timeliness refers to the speed between steps of the surveillance system Data collection began approximately 3. Once the surveillance system pilot was implemented, specimen collection, laboratory testing, data extraction, and data entry were timely. Data were received by the surveillance team as anticipated without major delays.

Timeliness of specimen collection was a concern because delays can affect specimen quality. The target of specimen collection was set within 48 hours of death; however, this evaluation could not confirm whether specimens were collected within 48 hours of death because time of death was rarely documented.

The median time between specimen collection and sample receipt at the laboratory was approximately 1 hour After data collection was complete, it took about 6 months to enter and clean the data set to prepare it for analysis.

This was mainly because of human resource constraints, which delayed data analysis and dissemination of findings. The data collection was completed in March , and the final report was published in July Stability refers to the reliability and availability of the system over time This cost included all study-specific consumables, laboratory testing, salaries for surveillance system pilot staff, and logistics but excluded salaries for mortuary and laboratory staff.

These costs could be lower for a replication or continuation of the pilot. Costs can further be lowered if testing can be done on oral saliva specimens, which has not been validated yet but is planned to be implemented in the next surveillance system replication in Kenya. Additional compensation was provided to the current mortuary staff, but no additional staff was hired for the pilot at the mortuaries.

The surveillance pilot system was relatively inexpensive compared with other HIV surveillance systems in Kenya. However, the expansion or replication of the surveillance system will depend at least in part on funding from sources external to MOH because mortality surveillance is not incorporated into the national AIDS strategic framework or the national health policy This report describes the evaluation and certain attributes of an HIV mortuary surveillance system pilot in Nairobi, Kenya.

The evaluation indicated that although the system was complex to implement, it was flexible and accommodated multiple changes. In addition, in spite of compensation for the staff involved, the system was relatively inexpensive to implement compared with other surveillance systems. However, the replication or expansion of the system depends on external funding. The main strength of the evaluation is the breadth of the assessment. As part of the evaluation, in-depth, face-to-face interviews were conducted with surveillance staff including mortuary and laboratory staff at all levels and with various stakeholders involved in the funding or implementation of the pilot.

This evaluation is subject to at least two limitations. First, sensitivity and PVP of the system were unable to be measured because of lack of data on actual number of cases among the population.

Second, cause of death for the majority of cadavers included in the pilot could not be independently ascertained i. The system provides unique information on HIV mortality that is not available from other sources in many countries and can help determine epidemic control, which is defined as the point at which new HIV infections decline below the total number of deaths among HIV-infected persons The lack of global HIV mortality data hinders the measurement of epidemic control.

The findings from this pilot suggest that a mortuary surveillance system can provide these data. Because most sub-Saharan African countries lack HIV-related mortality data, an ongoing mortuary surveillance system could be considered. However, because most sub-Saharan African countries do not have strong systems, Spectrum models rely on other nonmortality data to produce mortality estimates, which are subject to the robustness of the data used. Thus, inclusion of mortuary surveillance data in Spectrum models would improve national HIV mortality estimates.

In addition to mortuary surveillance, implementing simple automated procedures for tabulating cause of death when deaths are registered could help Kenya improve the robustness of mortality indicators. To obtain accurate cause of death tabulations that are comparable across geography and time, all deaths should be attended by a health practitioner and ICD codes should be used for coding all deaths attended This would require ICD coding training for all relevant staff.

Kenya, with support of U. For example, replication of this pilot in Western Kenya will provide important data about HIV-associated mortality in a high-prevalence region. As part of the replication, HIV tests also will be conducted on oral fluid specimens and assessed against the blood specimen. The use of oral fluid for HIV testing will allow for noninvasive testing, the addition of children in future studies because collecting cardiac blood from child cadavers is difficult , and, potentially, the ability to test preserved bodies.

The HIV-related mortuary surveillance system provided data on HIV positivity among cadavers and HIV-associated mortality, which are not readily available from other sources. A mortuary surveillance system paired with improved cause of death reporting can provide important insights into HIV epidemic trends.

Conflict of Interest: No conflicts of interest were reported. National Center for Biotechnology Information , U. Published online Dec Peter W. Andrea A. Kevin M. De Cock. Author information Copyright and License information Disclaimer. Corresponding author. Telephone: ; E-mail: vog. Copyright notice. All material in the MMWR Series is in the public domain and may be used and reprinted without permission; citation as to source, however, is appreciated.

This article has been cited by other articles in PMC. Description of the System The surveillance system objectives were to determine HIV positivity among cadavers at two mortuary sites in Nairobi, Kenya, and to determine annual cause-specific and HIV-specific mortality rates among the cadavers. Evaluation The evaluation was conducted using CDC guidelines for evaluating public health surveillance systems.

Results and Interpretation Implementation of the pilot mortuary surveillance system was complex because of extensive paperwork and the need to collect and process specimens outside of business hours. Public Health Actions Mortuary surveillance can provide data on HIV positivity among cadavers and HIV-related mortality, which are not available from other sources in most sub-Saharan African countries.

Introduction Routine monitoring of mortality is vital for public health planning. Summary of Findings from the Surveillance System Findings from the surveillance system have been published elsewhere 27 , Evaluation of the Surveillance System To assess the performance attributes and identify the strengths and weaknesses of the HIV-related mortuary surveillance system pilot, CDC conducted an evaluation in November , using the CDC guidelines for evaluating public health surveillance systems Evaluation Findings Simplicity Simplicity of a public health surveillance system refers to both structure and ease of operation Flexibility Flexibility of a public health system refers to its ability to accommodate changes in information needs or operating conditions with little additional time, personnel, or allocated funds Data Quality Data quality reflects completeness and validity of the data Variable No.

Open in a separate window. Acceptability Acceptability reflects the willingness of persons and organizations to participate in the surveillance system Sensitivity and Predictive Value Positive In the evaluation of a traditional disease surveillance system, sensitivity refers to first, the proportion of cases of a disease in the monitored population detected by the surveillance system and second, the ability to monitor changes over time; PVP is the proportion of reported cases that actually have the health-related event Representativeness Representativeness compares the characteristics of reported events to all such actual events Timeliness Timeliness refers to the speed between steps of the surveillance system Stability Stability refers to the reliability and availability of the system over time Discussion This report describes the evaluation and certain attributes of an HIV mortuary surveillance system pilot in Nairobi, Kenya.

Notes Conflict of Interest: No conflicts of interest were reported. References 1. Local-level mortality surveillance in resource-limited settings: a case study of Cape Town highlights disparities in health. Bull World Health Organ ; 88 — Implementation and utilisation of community-based mortality surveillance: a case study from Chad.

Confl Health ; 6 — Preventing HIV among drug users 3. Eliminating new HIV infections among children 4. Avoiding TB deaths 6.

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