HIV/AIDS surveillance in the United States, 1981-2001

We review the HIV/AIDS reporting system, including the legal basis for reporting, the methods and infrastructure for reporting, evaluation of the completeness and quality of the data, and analysis and dissemination of reports. Other information systems (e.g., seroprevalence surveys and behavioral surveys) that collect useful information for HIV prevention and care programs are also described. Multiple data collections systems are needed to monitor the HIV/AIDS epidemic in the United States and to collect the information needed to plan, implement, and evaluate prevention and care programs.     

HIV/AIDS surveillance in Germany

In Germany, since 1982, information on AIDS cases has been collected at the AIDS Center of the Robert Koch Institute. Since 1987, all laboratories performing HIV confirmatory testing have been required to report positive results anonymously. AIDS incidence peaked at about 2000 cases per year in 1993 and began to decline in 1995 following the widespread use of highly effective antiretroviral treatment. Current data indicate that the AIDS incidence has stabilized at a level of 750 cases per year since 1998. The number of newly diagnosed HIV infections has remained fairly stable at approximately 2000 to 2500 per year since 1993. Unlinked anonymous testing of dried blood spots from newborns is carried out in two federal states. The average prevalence of HIV seropositivity from 1993 to 1997 among women bearing children was 0.57 per 1000 in Berlin and 0.14 per 1000 in Lower Saxony.     

HIV/AIDS surveillance systems in Australia

We review the HIV/AIDS reporting protocols in Australia, and describe the technical components of surveillance and its guiding principles, including a strict adherence to confidentiality at all levels. The majority of AIDS diagnoses in Australia have occurred in men who acquired HIV infection through male-to-male sex. The annual incidence of AIDS peaked in 1994, and then declined sharply over the subsequent 4 years. Advances in treatment effectiveness have focused attention on ensuring that people with HIV infection have access to optimal therapy, and emphasized the role of AIDS case reports as indicators of treatment failure. Analyses of the date of HIV diagnosis in people with AIDS have been used as indicators and predictors of undiagnosed HIV infection in the population. Australia's linkage of program funding to AIDS case counts provides an incentive for both health departments and community-based organizations to actively support AIDS surveillance activities. The challenge for surveillance is to maintain vigilance for shifts in HIV infection rates, or in behavior patterns that may be related to transmission.     

The context of HIV/AIDS surveillance

HIV surveillance and diagnostic testing for HIV infection share elements in common, yet differ notably in context. Clinical testing provides vital information for individual medical and behavioral decisions, whereas surveillance, which focuses on populations, provides information to develop policy, direct resources, and plan services. HIV/AIDS surveillance has evolved over the course of the epidemic, reflecting changes in scientific knowledge, populations affected, and information needs. Likewise, the benefits of early diagnosis of HIV have become increasingly apparent with advances in HIV treatment. This article examines the changing context of HIV/AIDS surveillance and discusses the potential impact of HIV surveillance practices and policies on HIV testing behaviors. Special emphasis is placed on the importance of protecting the confidentiality of HIV/AIDS surveillance data and on the role of health department in monitoring the impact of surveillance policies on test-seeking patterns and behaviors.     

2005-2015年北京同仁医院艾滋病监测检测分析

目的 分析北京同仁医院艾滋病检测和疫情报告特征,探讨医疗机构在艾滋病监测检测和病例发现中的作用.方法 2005-2015年,对到北京同仁医院接受咨询检测、有创诊疗、住院治疗和术前检查等患者进行艾滋病检测.将HIV-1抗体阳性病例报告至传染病报告信息管理系统,对人口统计学资料进行描述性流行病学统计分析.结果 2005-2015年,北京同仁医院累计进行575 669人次艾滋病筛查.检出艾滋病筛查阳性反应病例191例次(0.332‰),确证阳性病例150例(0.261‰),确证阳性预期比例为78.5％.报告阳性病例以男性为主(占84.0％),20-50岁年龄段为最主要受累群体(83.3％).30.0％以上病例具有大专及以上学历.56.0％的病例最可能通过男男性行为途径感染,其次为异性性接触(27.3％).最主要报告病例来源科室为眼科(约占30.7％)和内科(约占26.7％),其次为皮科(约占24.7％)和耳鼻喉科(约占8.7％).结论 北京同仁医院总体艾滋病检出率略低于北京地区平均水平,但是病例构成和人群分布与北京地区流行特征相近.加强相关医疗机构眼科、耳鼻喉科就诊患者的艾滋病检测和病因学研究,发现更多可能的感染者,避免医源性艾滋病播散和职业暴露事件发生.     

北京市某三级综合医院2012-2016年AIDS/HIV感染者情况分析

目的分析北京市某三级综合医院艾滋病检测和疫情特征,探讨医疗机构在艾滋病监测中的作用.方法2012-2016年,对到北京市某三级综合医院接受咨询检测、术前检查、有创诊疗、住院治疗患者进行艾滋病检测.针对HIV-1抗体阳性病例进行描述性流行病学统计分析.结果2012-2016年,累计进行152 019人次HIV筛查,检出确诊HIV阳性感染者237例(0.16％),HIV新发现感染者161例(0.11％),报告阳性病例以男性为主(94.51％),＜40岁年龄段为最主要受累群体(88.61％).绝大多数病例经性传播(97.5％),MSM传播占比66.2％,174例来自于皮肤科(73.4％).结论该北京市三级综合医院艾滋病检出率与北京地区平均水平相符,病例构成和人群分布与北京地区流行特征相近.应加强医疗机构HIV检测以发现更多的感染者.     

HIV/AIDS surveillance in Denmark: the challenges ahead

In Denmark, AIDS has been a mandatory reportable disease since 1983, and confirmed HIV infection has been the same since August 1990. The annual AIDS incidence increased initially and peaked in 1993 (4.6 per 100,000 inhabitants), then decreased to 1.2 per 100,000 inhabitants in 1998 and further to 0.9 in 2000. Most AIDS cases occur among men who have sex with men (MSM), representing 92% in 1980-1985 and 31% in 2000. Recently, AIDS incidence and mortality has decreased due to the new antiretroviral drugs. In 1995, 43 per million inhabitants died of AIDS, compared with 5 per million in 1998. HIV reporting in Denmark is anonymous. The annual number of new identified cases has been fairly stable at approximately 5.7 per 100,000 inhabitants. Immigrants represent 24% of identified HIV-infected persons and represent nearly 50% of all heterosexually acquired cases. Estimates show that HIV prevalence as of 2000 is 0.1% of the total population, distributed at 0.03% among heterosexuals and 4.8% among MSM. Estimated annual HIV incidence is around 5.6 per 100,000 inhabitants; three times higher among men than women, and as high as 220 per 100,000 among MSM. The spread of HIV is limited in Denmark but the prevalence is increasing due to the effect of antiretroviral therapy. This is a challenge to the existing HIV/AIDS surveillance and prevention strategy.     

2010—2012年中山市孕产妇艾滋病哨点监测情况分析

目的了解中山市孕产妇艾滋病感染情况及艾滋病防治相关知识水平,为预防控制工作提供依据。方法按照《全国艾滋病哨点监测实施方案》要求,2010—2012年对1198名孕产妇进行问卷调查和血清学检测。结果监测的1198名孕产妇中,仍存在孕产妇受教育程度低、有多性伴以及其配偶有吸毒、多性伴等高危行为。艾滋病知识知晓率可能与调查对象的文化程度、怀孕次数、生育次数有关（P〈0．001）,即文化程度越高、初次怀孕及尚未生育,艾滋病知识知晓率越高;2010、2011、2012年监测对象的艾滋病防治知识知晓率分别为45．48％（181／398）、82．25％（329／400）、78．25％（313／400）,3年知晓率比较差异有统计学意义（X2=150．93,P〈0．001）。艾滋病防治总知晓率为68．70％,孕产妇艾滋病HIV阳性率为0。结论中山市孕产妇艾滋病感染率还处在较低水平,但艾滋病防治相关知识仍存在误区,应加强健康教育和行为干预、艾滋病HIV筛查工作,预防艾滋病母婴传播。     

Current situation and regional perspective on HIV/AIDS surveillance in europe

AIDS reporting has been the principal means of monitoring the HIV/AIDS situation in Europe since 1984 [corrected]. HIV reporting was set up at the European level in 1999, although it has existed in most European countries since the 1980s. Anonymous individual data on AIDS and, if available, new HIV diagnoses, and data on HIV prevalence in various populations are reported from the 51 countries of the WHO European Region to EuroHIV, and aggregate data on HIV prevalence in various populations [corrected]. Data are presented after grouping the 51 countries into three geographic areas: the West, Center, and East. At end of 2000, in the West, AIDS incidence continued to decline except among those infected heterosexually; numbers of newly diagnosed HIV infections are relatively stable, but rising among heterosexually infected persons, many of whom originate from countries with generalized HIV epidemics. In the East, numbers of newly diagnosed HIV cases (mostly injection drug users) continue to rise steeply, particularly in the Russian Federation, Latvia, and Estonia. In the Center, levels of HIV and AIDS remain low. HIV reporting is becoming a central element of HIV/AIDS surveillance in Europe. Heterogeneity between countries in health care systems, HIV testing patterns and surveillance systems remain challenging for data standardization at the European level. Efforts should be made to use surveillance data for evaluating the effectiveness of HIV/AIDS prevention interventions.     

A mathematical analysis of the spread of HIV/AIDS in Japan

The spread of HIV/AIDS in Japan was analysed using a mathematicalmodel incorporating pair formations between adults and sexualcontacts with commercial sex workers. The parameters involvedin the model were carefully specified as realistically as possibleto the actual situation in Japan. Plausible ranges were assignedto those parameters for which values are not known precisely.The model was used to simulate the effect of HIV infected commercialsex workers introduced into a population without HIV. It wasshown that the model could generate different scenarios, anexplosive infection or a temporal spread, according to differentsettings of the parameters. Then the condition for occasionalintroduction of HIV infected commercial sex workers to be ableto cause an explosive spread of HIV infection was analysed.This condition was summarized in terms of the critical transmissionprobability so that we could easily evaluate the degree of therisk. For some unclear parameters, sensitivity to the criticaltransmission probability was calculated. We also calculateda plausible range of the critical transmission probability usingthe Latin hypercube sampling method where the parameters weredistributed on the plausible ranges. According to the analysesof the model it is concluded that the actual situation of HIVspread in Japan should lie very near the critical point thatdetermines whether the explosive HIV spread actually takes place.This also suggests that effective action taken immediately couldbe useful to prevent explosive HIV infection in Japan.     

艾滋病与咨询

1　艾滋病流行概况艾滋病 (ＡＩＤＳ)是人类免疫缺陷病毒 (ＨＩＶ )引起的、通过性、血液和围产期母婴三种途径传播的传染病。根据联合国艾滋病规划署 (ＵＮＡＩＤＳ)和世界卫生组织 (ＷＨＯ) 1999年 12月公布的数据 ,自艾滋病流行以来 ,全世界累计已有 1880万人死于艾滋病 ,目前存活的艾滋病毒感染者和艾滋病人估计为 3430万[1] 。艾滋病已成为世界上仅次于心脏病、脑卒中和急性下呼吸道感染的第四个主要死因 ,是造成死亡最多的传染病 ,它已成为发展中国家主要的疾病负担[2 ] 。艾滋病流行对社会、经济和人口方面的毁灭性冲击是独一无二的[…     

广州市白云区1991—2007年艾滋病疫情监测

目的总结广州市白云区艾滋病流行特征，评估监测效能，为下一步防治工作的深入开展提供依据。方法运用SAS统计软件对广州市艾滋病疫情数据库中白云区属的病例进行相关描述性统计分析。结果截至2007年底，白云区共发现病例1136例，男女比为3．5：1；年龄以15-49岁为主（94．01％）。传播途径以静脉吸毒为主（61．10％），流动人口占疫情的大部分（71．48％）。性传播（x^2=12．009，P=0．001）和职业人群（x^2=44．935，P=0．001）随年份比例增加；常规监测发现病例日趋增加（x^2=5．533，P=0．019）。结论白云区已进入疫情的快速增长期，疫情主要侵袭青壮年男性，吸毒人群和无业人士所占比例较大。由于白云区在经济和生活上的一些特点，流动人口的疫情负担较重，且传播途径向多元化发展。加大监测力度包括高危人群干预专项和监测效能，将有助于迅速准确的掌握疫情。     

Accurate monitoring of the HIV epidemic in the United States: case duplication in the national HIV/AIDS surveillance system

OBJECTIVE: To assess the degree of duplicate reporting in the US HIV/AIDS surveillance system as compared with a performance standard of <5%, and to assess the effect of duplicate removal on epidemiologic trends. METHODS: Multistate evaluation of HIV/AIDS case surveillance. Potential duplicate HIV or AIDS case reports in the national surveillance system matched on Soundex, birth date, and sex were assessed for duplication by state and territorial health departments. RESULTS: Of the 990,175 cases of HIV infection and AIDS in the surveillance system on December 31, 2001, 44,945 (4.5%) were identified as duplicate reports. The duplication rate was higher for HIV cases (8.2%) than for AIDS cases (3.8%). The median of 322 duplicate AIDS reports per area (range: 1 to 3947) represented a median of 5% of all AIDS reports per area (range: 1% to 11%). The median of 369 duplicate HIV reports per area (range: 1 to 1247) represented a median of 11% of all HIV reports per area (range: 1% to 30%). DISCUSSION: The overall duplication rate was within acceptable limits in the national HIV/AIDS surveillance system but did not meet the standard for HIV cases. Ongoing centrally coordinated efforts are necessary to minimize duplicate reporting in the future.     

HIV/AIDS in Sub-Saharan Africa

Sub-Saharan Africa is the region most severely affected by the HIV/AIDS pandemic. Of the 40 million HIV infected individuals at the end of 2003, 26 million (65%) were living in the area. Reasons for the high infection rate include historical, political, economic, and cultural factors. The diversity of populations, combined with destitution, political and economic instability and hunger, has led to a number of strategies for combating the disease in Sub-Saharan Africa. These include voluntary counseling and testing, community involvement, facilitating behavior modifications, which include consistent and correct use of condoms, reduction in the number of sexual partners, increasing antiretroviral availability, and the involvement of non-governmental organizations in prevention, treatment, care, and support of the infected population. While Uganda has accomplished significant success through these mechanisms, other countries have not yet been able to control the disease. The populations requiring special attention include women of child-bearing age, who make 55% of the Sub-Saharan Africa's HIV infected population, children and the elderly. In this review, the current state of HIV/AIDS in Sub-Saharan Africa will be explored, in many cases referring to the situation in the southern African country of Malawi. Lessons will be highlighted and hopefully will contribute to the debate on HIV/AIDS and success of current and future prevention and control efforts.