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 !