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Developing a National HIV/AIDS Surveillance System in Haiti
NASTAD Haïti
Juillet 2012
Reportable HIV/AIDS Events in Haiti
HIV disease sentinel events
HIV exposure(exposed infants or
sexual transmission)
HIV infection 1st positive
HIV test1st CD4 count 1st CD4
count <350
1st viral load 1st CD4
<200AIDS-related Opportunistic
Infection Death
Monitor HIV Disease
HIV disease sentinel events
HIV exposure(exposed infants or
sexual transmission)
HIV infection 1st positive
HIV test1st CD4 count 1st CD4
count <350
1st viral load 1st CD4
<200AIDS-related Opportunistic
Infection Death
HIV Case Reporting
Monitor AIDS Disease
HIV disease sentinel events
HIV exposure(exposed infants or
sexual transmission)
HIV infection 1st positive
HIV test1st CD4 count 1st CD4
count <350
1st viral load 1st CD4
<200AIDS-related Opportunistic
Infection Death
AIDS Case Reporting
(MESI, Haiti, Daily/Weekly)-“Surveillance”-Online
(MESI, Haiti, Daily/Weekly)-“Surveillance”-Offline
(I-TECH, WA, Biweekly/Monthly)-EMR
(GHESKIO, Haiti, Biweekly/Monthly)-EMR
(PIH, MA, Biweekly/Monthly)-EMR
HAITIHIV SURV
MOH
MESI
ITECHMESI 1
De-duplication
Surveillance Loop
System Design of Haiti’s HIV/AIDS Surveillance System (HASS)
System Design of Haiti’s HIV/AIDS Surveillance System (HASS)
MESI – flux hebdomadaire“Surveillance”-Online
MESI-offline – Flux hebdomadaire“Surveillance”-Offline
National EMR – Flux mensuel
GHESKIO EMR – Flux mensuel
HAITI Base de donnees
SurveillanceHIV/SIDA epuree
MoH
MESI
ITECHMESIDeduplication automatisee et
manuelle intra/inter systemes
Surveillance Loop: - Rapports de tendance - Rapports de processus - Rapports de qualite
PIH EMR – Flux mensuel
Balises automatisees de saisie de donnees
Feedback de duplication Intra-EMR
Feedback aux sites sur la qualite des
donnees
152 of 270 VCT sites reporting HIV cases to HASS (56%)
HIV reported cases by sex category (MESI, HASS 2004-2012)
2004 2005 2006 2007 2008 2009 2010 2011 2012 (1er trim)
0
100000
200000
300000
400000
500000
600000
0
1
2
3
4
5
6
7
8
9
47801
136196
219341
305177
439056
491802
405780
190639
5642132853 39223
72920118582
186312207484
165355
329560
98585
8.4
5.6
4.5 4.2 3.2
4.9 4.8
5.65.6
Femmes testeés Hommes testés % VIH + (HASS)
Unique HIV cases reported to HASS (2004-2012)
2004 2005 2006 2007 2008 2009 2010 2011 2012 (1er trim)
0
5000
10000
15000
20000
25000
30000
35000
40000
6830
9981
13274
1812320147
34671
2796029199
8752
Departmental Distribution of HIV Cases at Diagnosis, vs.
Population Distribution (HASS 1983-2011)
Departement Population Estimée (1)
% de Population
Est. cas vivant avec HIV/SIDA
(2010)
% Total vivant avec HIV/SIDA
Ouest 3,664,620 36.9% 77,431 54.50%Nord 970,495 9.8% 14,900 10,48%
Grande-Anse 425,878 4.3% 5,195 3,65%Nord-Ouest 662,777 6.7% 6,310 4,44%
Nord-Est 358,277 3.6% 3,106 2,18%Sud 704,760 7.1% 9,126 6,42%
Sud-Est 575,293 5.8% 3,079 2,16%Nippes 311,497 3.1% 1,413 0,99%
Artibonite 1,571,020 15.8% 12,718 8,95%Centre 678,626 6.8% 8,785 6,18%Haiti* 9,923,243 142,063
Departmental Distribution of HIV Cases at Diagnosis, vs.
Population Distribution
Outer: Estimated departmental HIV prevalence
Center: % Haiti population
per department
Commune of residency distribution of HIV cases at diagnosis (HASS 1983-2011)
Estimated HIV/AIDS leaving cases distributed by commune of Residence
Commune Cases Classification % de TotalPORT-AU-PRINCE 25,940 1 17.53%
CARREFOUR 14,186 2 9.59%DELMAS 13,339 3 9.01%
CAP HAITIEN 6,384 4 4.31%PLAINE 4,765 5 3.22%CAYES 4,543 6 3.07%
PETION-VILLE 4,500 7 3.04%PORT DE PAIX 3,618 8 2.44%
GONAIVES 3,076 9 2.07%Jacmel 1841 10 1.24%Jeremie 1733 11 1.17%
HIV diagnoses rate in all age group population per department (HASS, 2006-2011)
*Unique individuals, 2006-2011 (6 years), department of first report, 2009 population
71 - 80
81 - 106
107 - 145
146 - 201
202 - 240
OUEST217
SUD201
CENTRE106
ARTIBONITE131
NORD240
SUD-EST80
NIPPES71
NORD-EST139
NORD-OUEST145
GRAND' ANSE182
Haiti 182 per 100,000
Unique HIV cases reported to HASS (1983-2011), by System and Total
First HIV Diagnosis in
Haiti
(GHESKIO)
First HIV Diagnosis in
Central Plateau (PIH)
Foreign Assistance Programs increase in Haiti (PEPFAR,
Global Fund)
MESI launched (Solutions)
Earthquake of 2010• Health facilities destroyed.• Health staff perished.• Millions displaced.
Case Surveillance pilot begins (MSPP, NASTAD)
----- iSanté----- GHESKIO----- PIH/ZL----- MESI
Patient Mobility Within and Between Networks (% of patients in network EMR diagnosed in same network)
61,9%91,537
55,9%47,934
3%8,409
Chart Title
FMFE
Sex Distribution of HIV Cases at Diagnosis, vs. Population Distribution (HASS 1983-
2011)
HIV prevalence among tested pregnant women (MESI 2008-2011)
2008 2009 2010 20110
50000
100000
150000
200000
250000
0
0.5
1
1.5
2
2.5
3
3.5
140298162917
139063
1910313.1
2.83
2.5
FEMMES ENCEINTES TESTÉES POUR LE VIH % F. Enceintes VIH+
Gender and age distribution of HIV at diagnosis (HASS 1983-2011)
< 15 15 - 19 20 - 29 30 - 39 40 - 49 50+0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
Age at Diagnosis
# U
niqu
e Ca
ses
Repo
rted
Marital status reported at Diagnosis (HASS 1983-2011)
22%
13%
36%
8%
6%
15%
CélibataireMariéPlacéSéparéVeufInc
Most Reported risk factors HASS(1983-2011)
Statut V
IH du parten
aire m
atrim
onial
R/S av
ec tr
avail
leuse
de sex
e
Heterosex
ual sex
with
HIV+
R/S san
s condom
0%20%40%60%80%
100%
139351619
16813 75323623
26134539
26274
13622092530
125410 112956
Negatif Positif Inc
Reported vs. Estimated VIH, SIDA Deaths in HASS, (1983-2011)
Of the 146,762 unique patients in HASS and according to information originally received from the report- 87% are diagnosed with HIV, 8% with AIDS, and 5% dead. Using estimated information (below), 68% are diagnosed with HIV, 19% with AIDS, and 13% are presumed dead.
People are presumed dead if they were diagnosed prior to 2000 and do not have another report in HASS or they are 65 years or older and reported prior to 2006.People are presumed to have SIDA if they have a CD4 count <= 350 per ml blood.Note: These amounts may be subject to change as the methods for estimating death and out-migration are refined.
127269; 87%
11698; 8%
7795; 5%
100191;
68%
27811;
19%
18760;
13%
VIH
SIDA
DECES
Reported Estimated
Conclusion
Since 2009, an estimation of 95% of all HIV cases diagnosed in Haiti have been reported to the case surveillance system.
252 sites (56%) are periodically reported HIV diagnosis cases. By early 2012, all four major electronic data sources were
providing data feeds on a monthly basis. Crucial reporting variables are present in more than 99% of all
case reports. Though the end of 2011, a total of 193,065 HIV cases were
reported to HASS. Of those cases, 23.4% were reports related to a person reported more than once in the system.
With the existing and use of the de-duplication algorithm 147,880 unique HIV cases are identified in the national HIV/AIDS case surveillance system
Thank You !
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