Assessment of available HIV case data to determine the ability of the Hiati national HIV case notification system to estimate disease burden
National Alliance of State and Territorial AIDS Directors, Global Program, Washington, United States
Background: In 2008, the Haitian 2004 HIV prevalence estimate (5.6%) was revised to 2.2% (+/-120,000 HIV+ Haitians). To assess the ability of the national HIV case notification system to estimate disease burden in Haiti, NASTAD undertook a two part point-in-time data assessment of all available HIV case data.
a) Comparison of routine national HIV M&E data, of those tested positive and those in treatment/care, to the national HIV prevalence estimate.
b) Comparison of identified case data from the HIV case notification system with that from the largest EMR system to create a unique count of HIV cases.
a) i. Aggregate data, over five years, show that 1,580,000 people were screened for HIV; 106,909 (7%) were HIV+; 99,980 (89%) were enrolled in palliative care.
ii. Case counts of unique individuals within each of the three EMR systems show 50,000 individuals enrolled in HIV services.
b) In five years, the national EMR reported 29,295 unique HIV cases. The HIV case notification system, in its first year, showed 9,501 unique HIV cases. Together these data represent 105 sites in Haiti, and 36,910 unique cases (5% duplication).
Conclusions: Compared to DHS, either more people than estimated have tested for HIV, and prevalence is lower, or people are re-testing and not enough have been reached for HIV screening. Furthermore, EMR data may indicate that less than half of the official estimate of PLWHA have tested positive for HIV and entered care; people may be testing about two times each, and/or positive people are being lost from care.
Unduplicated national M&E data often provide the best option to evaluate impact, but likely duplication of cases provides an inaccurate assessment. Comparison data from Haiti may influence planning for HIV prevention and testing, a greater focus on loss-to-follow-up, and possibly reassessment of the estimated HIV prevalence.
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