Transcript Division of Viral Hepatitis

[email protected]
Integrated Surveillance
for HIV, Viral Hepatitis,
and Sexually Transmitted Diseases
in Central Asia Region
CDC Central Asia Program, DIH, EPO;
Division of Viral Hepatitis, NCID;
Centers for Diseases Control and Prevention, Atlanta
In Partnership with: USAID, USA Embassies,
and Ministries of Health of
Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, Uzbekistan
Surveillance
The process of systematic collection,
collation and analysis of data with
prompt dissemination to those who
need to know, for relevant action to be
taken.
Protocol for the Assessment of National Communicable Disease Surveillance
and Response Systems.
Guidelines for Assessment Teams
WHO/CDS/CSR/ISR/2001.2
http://www.who.int/emc-documents/surveillance
What is Integrated Surveillance ?
Surveillance that identifies persons with
conditions, infections, diseases
that often have overlapping risk factors,
to achieve better public health interventions
‘Provisional Definition’
H.S. Margolis, MD - ‘Provisional Definition’, 2001
Reasons to Combine
Viral Hepatitis, HIV/AIDS and STD
Surveillance, Control, and Prevention
• Major public health problems
• Routes of transmission overlap
• Effective prevention tools
– Immunization, treatment, risk reduction
• Lack of national programs for integrated
prevention activities leads to transmission of
viral hepatitis, HIV/AIDS and STD
Major public health
problems
Bloodborn diseases transmission related
activities in Central Asia
production, trafficking, dissemination and consumption
of illicit drugs
Heroin
Khanka
Heroin
Khanka
Heroin
Routes of transmission
overlap
Risk Factors for Transmission of Hepatitis
Viruses and HIV in the US
Proportion of Infections (%)
Risk Factor
HBV
HCV
HIV
Injection drug use
14
60
31
MSM
Heterosexual partners
15
40
1
20
47
10
Rare
Past
Past
7- 20
<<1
2
<<1
10
9
Transfusion
Occupational
Unknown
5-7
(past)
30
Effective prevention tools Immunization
Missed Opportunities for Prevention of
Hepatitis B Virus Infection
• Of persons with acute hepatitis B:
–36% previously treated for an STD
–25% previously incarcerated
–11% both incarcerated and treated for
an STD
Lack of national programs for
integrated prevention activities
leads to transmission of viral
hepatitis, HIV/AIDS and STD
HIV, STI, and HCV among IDUs in
Karaganda Oblast, Kazakhstan, 2002
Sites
HIV
(anti-HIV +
EIA+IB)
Karaganda
City
Chronic
syphilis syphilis
(VDRL +;
TPPA +)
Diseases
Temirtau
City
Acute
(VDRL -;
TPPA +)
Other STI
(symptoms
and sign)
HCV
(two + by
consec. tests;
Abbott)
222\899
25%
103\899
11.5%
50\899
5.6%
52\899
5.8%
576\646
89.2%
21\890
2.4%
116\890
13.0
57\890
6.4%
58\890
6.5%
442\605
73.1%
Anti-HIV among IDUs by lengths of drug
use, Karaganda Oblast, Kazakhstan, 2002
35%
30%
N = 1799
25%
20%
Temirtau
Karaganda
15%
10%
5%
0%
<1
1-2
2-3
3-5
5-10
> 10
HIV, HCV, HBV, and Syphilis among IDUs
by lengths of drug use, Kazakhstan, 2002
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
p<0.001
p<0.001
p<0.001
p>0.1
<1
1-2
2-3
3-5
5-10
Years
N = 1799
H IV
H CV
H BV
Syphilis
10+
Main principles for integrated sentinel
surveillance building
• Populations under surveillance:
IDUs, SW, Prisoners, Pregnant, Clients of STD clinics, MSM, Donors,
Police.
• Comprehensive Integrated sentinel
surveillance sites selection
• Site specific samples size calculation
• Unified outreach (response driven sampling)
• Standardize Laboratory Methods
• Standard Reporting (Computerized)
• Unified timelines
HIV, VH, Syphilis integrated sentinel
surveillance sites in Central Asia
Kostanai
Pavlodar
Temirtau
Almaty
Yange Yul
Osh
Functioning and
proposed HIV surveillance sites
HIV, HCV regional integrated sentinel
surveillance data from IDUs, 2003-2004
Prevalence of:
Anti-HCV
Anti-HIV
Anti-HIV, anti-HCV among Sex
Workers in Kazakhstan , sentinel
surveillance data, 2004
20%
20%
2%
12%
30%
6%
8%
Antibody to Syphilis among IDUs in
Kazakhstan, sentinel surveillance data, 2004
Karaganda
Pavlodar
Chimkent
Uralsk
Total
IDUs
12/270
(4.4%)
14/250
(5.6%)
1/270
(0.4%)
0/250
(0%)
27/1040
2.6%
SWs
20/150
(13.3%)
8/100
(8.0%)
3/221
(1.4%)
4/64
(6.3%)
35/535
6.5%
Prisoners
3/500
(0.6%)
9/440
(2.0%)
3/400
(0.8%)
3/200
(1.5%)
18/1540
1.2%
Pregnant
4/470
(0.9%)
1/600
(0.2%)
1/600
(0.2%)
1/500
(0.2%)
7/2170
0.05%
STD
28/270
(10.4%)
43/460
(9.3%)
71/339
(20.9%)
54/500
(10.8%)
9.1%/1569
MSM
0/100
(0%)
Challenges
• Funding and/or referral sources for: vaccines,
•
•
•
lab tests, medical care
Funding of prevention services flows through
separate programs (hepatitis, HIV/AIDS, STD,
immunization, corrections)
Staff of other programs (HIV/AIDS, STD, drug
treatment, corrections) may not see viral
hepatitis and STI prevention as part of their
job
Incorporation of viral hepatitis and STI
prevention messages into “client-centered”
counseling
Integrating prevention services for
viral hepatitis, HIV/AIDS,STDs and
drug abuse is
GOOD PUBLIC HEALTH
Acknowledgement Tatiana Kalashnikova MD, Ph.D., D.Sc., Gulzhan Muratbayeva MD, Ph.D., Umid Sharapov MD,
Andrew Dadu MD, Baurzhan Zhussupov, Maureen Sinclair MHP, Ed Maes Ph.D.;
Central Asia Program, Division of International Health, Epidemiology Program Office,
Rachel Bronzan, MD, MPH, Shakarishvili, Anna, MD, MPH, Ryan, Caroline MD, MPH;
International Activities Unit, Division of STD Prevention, National Center for
HIV, STD and TB Prevention,
Harold Margolis MD, Jan Drobeniuc MD, Ph.D.; Division of Viral Hepatitis,
Centers for Disease Control and Prevention Atlanta, USA
Nikolay Kuznetsov MD, Valeriya Kryukova MD, Zoya Tukhtina MD,
Karaganda HIV Control and Prevention Center,
Sholpan Baimursina MD, Temirtau HIV Control and Prevention Center,
Isidora Erasilova MD, Nataliya Kovtunenko MD, Viktoriya Zeman MD;
Kazakhstan Republic HIV Control and Prevention Center,
Kanat Ermekbaev MD; Karaganda Oblast Health Commissioner,
Anatoliy Belonog MD, Aigul Kairolapova; Ministry of Health,
Svetlana Demenkova MD, Andrew Mikhailov, Ric Golubjatnikov Ph.D.,MPH,
John Doyle MD, Ph.D.;
Almaty Sexual Transmitted Infection Diagnostic Laboratory in affiliation with Wisconsin State
Laboratory of Hygiene, Wisconsin, USA
Nurali Amanzhelov, NGO “Shapagat”
Almaz Sharman MD, Ph.D., D.Sc., Jennifer Adams Ph.D., Kerry Pelzman
Central Asia Office,
The United States Agency for International Development