We very much appreciate the letter that Dr Haghdoost and colleagues
wrote in relation to some of the issues outlined in our paper HIV
surveillance in MENA: recent developments and results and, in addition,
described some more recent developments in HIV surveillance in Iran.
We would like to reflect on several issues that they raised.
Our paper states that Djibouti, Iran, Morocco and Pakistan can be
classified as having fully functioning HIV surveillance systems as trends
in HIV prevalence in these countries can be assessed over time for certain
population sub-groups. Surveillance systems in these countries have a
sufficient quantity and quality of the data that can be used to guide the
programmatic responses. We also mentioned other nine countries that have
partially functioning HIV surveillance systems.
As described in the Methods section of our paper, the assessment of
the quality of HIV surveillance systems was based on the questionnaire
sent to National AIDS Programmes (NAPs) of the countries of the WHO
Eastern Mediterranean Region (EMR) in 2009, 2010 and 2011, and not on the
data presented in the paper by Garcia Calleja et al published in Sexually
Transmitted Infections in 2010. As described in our paper, to assess the
quality of HIV surveillance systems we adapted a method developed by WHO
and UNAIDS.123
As one of the limitations, we outlined that data were provided by the
NAPs, which might have missed data sources collected by other agencies
that Haghodoost et al. mention, such as surveys in partners of IDUs.
However, as planning of surveillance and programmatic responses is lead by
the NAPs, we think that collecting data from NAPs gives an appropriate
insight into the type and quality of data that the countries use for
planning and evaluating the national HIV response. We are aware that many
studies might be undertaken in the EMR, but their results are not
disseminated, and this is particularly the case with studies done in
groups at higher risk of HIV that are heavily stigmatized.
In relation to some other issues that the colleagues raised, surveys
using respondent-driven sampling were done in many other countries in the
Region (some of these are referenced in the paper) as well as Mode of
Transmission studies.4
We have not reflected on the reasons for the improvements in HIV
surveillance in North Africa and the Middle East, but we believe this has
been due to greater availability of funding provided by the Global Fund to
Fight AIDS, Tuberculosis and Malaria and capacity building efforts of
numerous international and national agencies.
We agree with Dr Haghdoost and the colleagues that there are
substantial improvements in HIV surveillance in Iran though significant
challenges remain in bridging the gaps that the system still has. One of
them is certainly in conducting studies on HIV and sexually transmitted
infections in MSM and transgendered individuals, which due to prevailing
stigmatization are still lacking throughout the Region.
References:
1. Garcia Calleja JM, Jacobson J, Garg R, et al. Has the quality of
serosurveillance in low- and middle-income countries improved since the
last HIV estimates round in 2007? Status and trends through 2009. Sex
Transm Infect 2010;86(Suppl 2):ii35-42
2. Walker N, Garcia-Calleja JM, Heaton L, et al. Epidemiological
analysis of the quality of HIV sero-surveillance in the world: how well do
we track the epidemic? AIDS 2001;15:1545-54
3. Lyerla R, Gouws E, Garcia-Calleja JM. The quality of sero-
surveillance in low- and middle-income countries: status and trends
through 2007. Sex Transm Inf 2008;84: i85-91.
4. Mumtaz G, Hilmi N, Zidouh A, El Rhilani H, Alami K, Bennani A,
Gouws E, Ghys P, Abu- Raddad L. HIV Mode of Transmission Analysis. Rabat:
Kingdom of Morocco. Ministry of Health, Department of Epidemiology and
Disease Control, 2010.
Conflict of Interest:
None declared
We very much appreciate the letter that Dr Haghdoost and colleagues wrote in relation to some of the issues outlined in our paper HIV surveillance in MENA: recent developments and results and, in addition, described some more recent developments in HIV surveillance in Iran.
We would like to reflect on several issues that they raised.
Our paper states that Djibouti, Iran, Morocco and Pakistan can be classified as having fully functioning HIV surveillance systems as trends in HIV prevalence in these countries can be assessed over time for certain population sub-groups. Surveillance systems in these countries have a sufficient quantity and quality of the data that can be used to guide the programmatic responses. We also mentioned other nine countries that have partially functioning HIV surveillance systems.
As described in the Methods section of our paper, the assessment of the quality of HIV surveillance systems was based on the questionnaire sent to National AIDS Programmes (NAPs) of the countries of the WHO Eastern Mediterranean Region (EMR) in 2009, 2010 and 2011, and not on the data presented in the paper by Garcia Calleja et al published in Sexually Transmitted Infections in 2010. As described in our paper, to assess the quality of HIV surveillance systems we adapted a method developed by WHO and UNAIDS.123
As one of the limitations, we outlined that data were provided by the NAPs, which might have missed data sources collected by other agencies that Haghodoost et al. mention, such as surveys in partners of IDUs. However, as planning of surveillance and programmatic responses is lead by the NAPs, we think that collecting data from NAPs gives an appropriate insight into the type and quality of data that the countries use for planning and evaluating the national HIV response. We are aware that many studies might be undertaken in the EMR, but their results are not disseminated, and this is particularly the case with studies done in groups at higher risk of HIV that are heavily stigmatized.
In relation to some other issues that the colleagues raised, surveys using respondent-driven sampling were done in many other countries in the Region (some of these are referenced in the paper) as well as Mode of Transmission studies.4
We have not reflected on the reasons for the improvements in HIV surveillance in North Africa and the Middle East, but we believe this has been due to greater availability of funding provided by the Global Fund to Fight AIDS, Tuberculosis and Malaria and capacity building efforts of numerous international and national agencies.
We agree with Dr Haghdoost and the colleagues that there are substantial improvements in HIV surveillance in Iran though significant challenges remain in bridging the gaps that the system still has. One of them is certainly in conducting studies on HIV and sexually transmitted infections in MSM and transgendered individuals, which due to prevailing stigmatization are still lacking throughout the Region.
References:
1. Garcia Calleja JM, Jacobson J, Garg R, et al. Has the quality of serosurveillance in low- and middle-income countries improved since the last HIV estimates round in 2007? Status and trends through 2009. Sex Transm Infect 2010;86(Suppl 2):ii35-42
2. Walker N, Garcia-Calleja JM, Heaton L, et al. Epidemiological analysis of the quality of HIV sero-surveillance in the world: how well do we track the epidemic? AIDS 2001;15:1545-54
3. Lyerla R, Gouws E, Garcia-Calleja JM. The quality of sero- surveillance in low- and middle-income countries: status and trends through 2007. Sex Transm Inf 2008;84: i85-91.
4. Mumtaz G, Hilmi N, Zidouh A, El Rhilani H, Alami K, Bennani A, Gouws E, Ghys P, Abu- Raddad L. HIV Mode of Transmission Analysis. Rabat: Kingdom of Morocco. Ministry of Health, Department of Epidemiology and Disease Control, 2010.
Conflict of Interest:
None declared