Guyana HIV Case Surveillance System - NASTAD · Additionally, this SOP is intended for use by National AIDS Programme Secretariat (NAPS) staff, Ministry of Health (MoH) Statistical

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GuyanaHIVCaseSurveillance

SystemStandardOperatingProceduresManual

May2013

Surveillance Unit Ministry of Health Lot 1 Brickdam

Georgetown, Guyana

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Table of Contents

Foreword ........................................................................................................................................................ 4

Glossary of Terms ........................................................................................................................................... 5

I. Mission Statement ................................................................................................................................. 7

II. Introduction ........................................................................................................................................... 8

A. Purpose of the Standard Operating Procedures Manual ................................................................... 8

B. Intended Users ................................................................................................................................... 8

C. Organizational Chart .......................................................................................................................... 8

D. Updated HIV Case Surveillance System and Form ........................................................................... 10

E. HIV Case Definitions ......................................................................................................................... 10

III. HIV Case Reporting ........................................................................................................................... 12

A. Definition of HIV Case Based Surveillance ....................................................................................... 12

B. HIV Case Surveillance Form (HCSF) .................................................................................................. 12

C. Testing Procedures and Reportable Events ..................................................................................... 18

D. Reporting Sources ............................................................................................................................ 19

E. Reporting Procedures ...................................................................................................................... 19

F. Description of Data Flow Diagram for Guyana’s HIV Case Surveillance System .............................. 22

G. Program Specific Data Flow Diagrams ............................................................................................. 27

IV. Security and Confidentiality ............................................................................................................. 35

A. Training............................................................................................................................................. 36

B. Standards for Monitoring and Evaluating the HIV Case Surveillance System .................................. 36

Appendix A1: WHO clinical staging of HIV infection for adults and adolescents with confirmed HIV

infection ....................................................................................................................................................... 40

Appendix A2: WHO clinical staging of HIV infection for children with confirmed HIV infection ................. 42

Appendix B: Guide for Constructing the PUID on the HIV Case Surveillance Form (HCSF) ......................... 43

Appendix C: HIV Case Surveillance Form (HCSF) .......................................................................................... 46

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Appendix D: HCSF Completion Procedures .................................................................................................. 47

Appendix E: HCSF Initial Review Procedures ............................................................................................... 53

Appendix F: HCSF Secondary Review Procedures ........................................................................................ 55

Appendix G: Data Entry Procedures ............................................................................................................. 58

Appendix H: Matching Procedures .............................................................................................................. 60

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Foreword

Epidemiological surveillance is amajorpublichealth strategy inpreventionandcontrolofHIV in

developinganddevelopedcountries.TheMinistryofHealth(MOH),inpartnershipwiththeCenters

forDisease Control and Prevention (CDC) and theNational Alliance of State and Territorial AIDS

Directors(NASTAD)hasdevelopedthefollowingguidancetoprovidethenecessaryproceduresto

ensure a strong integrated HIV Case Surveillance System at the national level. HIV surveillance

cannotbedoneinisolation.Hence,keystakeholdersfrombothpublicandprivatesectors,andthe

national HIV prevention monitoring and evaluation programmes were involved in the effort to

improvethequalityandstandardsoftheHIVCaseSurveillanceSystem.

The strengthening of the HIV Case Surveillance System will serve to efficiently and accurately

monitor theHIV epidemic over time by providing information onpersons affected byHIV in our

society.Additionally,thequalityinformationobtainedfromthecasebasedHIVSurveillanceSystem

is used to organize, plan, and implement programs in response to the HIV pandemic. Hence, the

upgradedHIVsurveillanceinformationinformsresourceallocation,andadvocacygroups;measures

the burden and impact on health services; and provides information for developing broad based

strategiestomitigateagentsthatimpactHIVinGuyana.

_______________________________

Dr.ShamdeoPersaud

ChiefMedicalOfficer

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GlossaryofTerms

AIDS AcquiredImmunodeficiencySyndrome

ANC AntenatalCareorAntenatalClinic

ART Antiretroviraltherapy

C&T CareandTreatment

CDC CentersforDiseaseControlandPrevention

CD4 CD4Tcells

CMO ChiefMedicalOfficer

DOB DateofBirth

EDB ElectronicHIVSurveillanceDataBase

ELISA EnzymeLinkedImmunosorbentAssay

HCSF HIVCaseSurveillanceForm

HIV HumanImmunodeficiencyVirus

HIV+ HIVpositive

HIV‐ HIVnegative

MARPS MostatRiskPopulations

M&E MonitoringandEvaluation

MCHMaternalChildHealth

MOH MinistryofHealth

MSM MenwhohaveSexwithMen

NAPS NationalAIDSProgrammeSecretariat

NASTAD NationalAllianceofStateandTerritorialAIDSDirectors

NGO Non‐GovernmentalOrganization

PII PersonallyIdentifyingInformation

PLWH PeopleorPersonLivingwithHIV

PMTCT PreventionofMother‐to‐ChildTransmission(ofHIV)

PUID PatientUniqueIdentifier

RHO RegionalHealthOfficer

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SOP StandardOperatingProcedures

UNAIDS JointUnitedNationsProgrammeforHIV/AIDS

VCT VoluntaryCounsellingandTesting

WHO WorldHealthOrganization

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I. MissionStatement

Theaimof theMinistryofHealth is to improvethephysical, socialandmentalhealthstatusofall

Guyanese by ensuring that health services are accessible, acceptable, affordable, timely and

appropriate as possible given available resources and enhancing the effectiveness of health

personnelthroughcontinuingeducation,trainingandmanagementsystems.

Toachievesuchgoalsoneof thecomponentsof theNationalHealthSectorStrategy2008‐2012 is

the strengthening of strategic information, developing a capacity to lead relevant data collection,

analysisanduseinplanning,managementandevaluationatalllevels.

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II. Introduction

A. PurposeoftheStandardOperatingProceduresManual

Thisproceduralmanual(referredtoasSOPhenceforth)iscomprehensiveinscope,andintendedtoprovidenecessaryinformationandguidancefortheimplementation,managementandutilizationofthenationalHIVcasesurveillancesystemacrossvoluntarycounselingandtesting,HIVcareandtreatment,antenatalcare(includingpreventionofmothertochildtransmission(PMTCT))programsandlaboratoriesandtheBloodBank.ThisincludesclearanddescriptiveinstructionsandrolesandresponsibilitiesforthecompletionoftheHIVcasesurveillanceform(HCSF),submissionofHCSFformstotheappropriateadministrativeunit,dataentryandreporting.

B. IntendedUsers

TheSOPshouldbereferencedandutilizedbyanyandallclinicalstaffparticipatinginHIVtesting,careandthecompletionandtransportationoftheHCSF.Additionally,thisSOPisintendedforusebyNationalAIDSProgrammeSecretariat(NAPS)staff,MinistryofHealth(MoH)StatisticalUnitstaff,MoHSurveillanceUnit staff,MoHMaternalChildHealth (MCH)staffworking in theANCprogramandMoHManagementInformationSystemsUnit(MISU).

C. OrganizationalChart

TheMinistryofHealthcomprisessevenprogrammes,eachwithvariousnumbersofsub‐programs.Sixunitsarespecifically identifiedtomanageHIVsurveillanceandprogramdata; theSurveillanceUnit, Health Statistics Unit, Management Information Systems Unit, Voluntary Counseling andTesting(VCT),PreventionofMother‐to‐ChildTransmission(PMTCT)atantenatalclinics,andCareandTreatment(C&T).Togethertheseunitsworkcollaborativelytocoordinateandsupportalldatacollection, management, analysis and dissemination of HIV surveillance and program data. TheSurveillanceUnitcoordinates theprocedures forHIVsurveillancedataandworkswith theHealthStatisticsunittoproducehighqualityandreliabledatareportsandanalyses.

TheNationalAIDSProgrammeSecretariat(NAPS)islocatedwithintheDiseaseControlprogramanditoverseestheHIVpreventionandcareprogramsandit istheprimarystakeholdertoensureHIVsurveillancereportsareusedforprogramplanninganddecisionmaking.

Figure1:OrganizationalChart

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Minister of Health

Permanent Secretary

Chief Medical Officer

Health Planning

Human Resources

Development

General Administration

Central Procurement Unit

Field Auditor

Management Information

System

Director, Disease

Control

Director, Primary

Health Care

Health Sciences

Education

Chronic, Non‐ Communicable

Diseases

HIV/AIDS & STDs

Mental Health Unit

Epidemiology & Surveillance

Port Health

Vector Control Services

TB/Chest Disease

Hansens Disease Alexander

Maternal & Child Health

Adolescent Health

Food & Nutrition

Program

Dental Health

Environmental Health

Quality Assurance

& Management

National Public Health

Reference Laboratory

Biomedical

National Blood

Transfusion Service

Veterinary Public Health

Personnel Department

Government Analyst/

Food & Drug Department

Central B

Pharmacy

General Nu

Medical Co

Chief Nursing Officer Pharmacy

C

Nation

Cent

Reha

Coastal Communities

Coordinator

Indigenous Peoples

Communities

Training Programs

Budgeting, Finance,

Accounting & Auditing

Health Sector

Development Unit

Pre ‐Medex & Medex

Rehabilitation

Pharmacy Assistant

Audiology

X‐ Ray Technician

Community Health Worker

Dental Assistant, Dentex,

Community Dental

Rural & Single Trained

Professional Nursing & Nursing

Environmental Health

Medical Laboratory

Health Education &

Promotion

Drug Demand

Reduction Services

Health Statistics

Government Pharmacy

Service

Chief MEDEX

National Support

National Laboratory

Services

Radiology Unit

Standards & Technical

Services

R

Deputy Permanent

Secretary

Regional Health

Services

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D. UpdatedHIVCaseSurveillanceSystemandForm

In order to facilitate the scaling up of access to antiretroviral therapy (ART), in 2007 theWorldHealthOrganization(WHO)revisedHIVcasedefinitionsforsurveillanceofHIVandtheclinicalandimmunologicalclassificationofHIV‐relateddiseasesintoauniversalfour‐stagesystemthatincludessimplified standardized descriptors of clinical staging events1. The 2007 WHO HIV surveillancerecommendationscall forrevisingthecasedefinitionsto includeallstagesofHIV infectionandtoreplace AIDS case reporting with reporting of persons with advanced and severe HIV disease(clinicalstages3and4).TherearefourWHOclinicalstages:stage1(asymptomatic),stage2(mildsymptoms),stage3(advancedsymptoms),andstage4(severesymptoms,previouslyreferredtoasAIDS). In the light of these revisions, Ministry of Health revised and upgraded the HIV casesurveillance reporting form and the current HIV case reporting system to strengthen HIV casesurveillanceinGuyana.TheupgradedMoHHIVSurveillanceSystem:

MonitorstheHIVepidemicovertimebyrequiringreportingofallHIVinfectedpersonsfromeachsitewheretheypresentfortestingorcare&treatmentaswellasadditionalreportsonpersonsdiagnosedwithadvancedand/orsevereHIVinfectionorwhohavedied

Tracksindividualclientdiseaseprogressionfrompointofdiagnosisthroughstage3and4 IdentifiesthecareandtreatmentneedsofHIV‐infectedindividuals DeterminesthecharacteristicsandexposurecategoriesofpersonswithHIVinfection Determines the region’s disease burden that is attributable to HIV by measuring HIV

prevalence InformstheburdenandimpactofHIVonhealthservices ProvidesdatafordevelopingandmonitoringHIVpreventionprograms,toinformadvocacy

groups,resourceallocation,programplanning,andmonitoringandevaluationofprograms.

MeasurestrendsinmortalityamongHIV‐infectedpersons

E. HIVCaseDefinitions

TheHIVcasedefinitionsforHIVinfectionandadvancedHIVareinaccordancewiththe2007WHOcasedefinitions1:

1 World Health Organization 2007. WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV‐related disease in adults and children.

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Table1:WHOCaseDefinitionforHIVInfection

Adultsandchildren18monthsorolder

HIVinfectionisdiagnosedbasedon:

PositiveHIVantibodytesting(rapidorlaboratory‐basedenzymeimmunoassay).Thisis

confirmedbyasecondHIVantibodytest(rapidorlaboratory‐basedenzymeimmunoassay)

relyingondifferentantigensorofdifferentoperatingcharacteristics;

and/or;

PositivevirologytestforHIVoritscomponents(HIV‐RNAorHIV‐DNAorultrasensitiveHIV

p24antigen)confirmedbyasecondvirologicaltestobtainedfromaseparatedetermination.

Childrenyoungerthan18months

HIVinfectionisdiagnosedbasedon:

PositivevirologicaltestforHIVoritscomponents(HIV‐RNAorHIV‐DNAorultrasensitive

HIVp24antigen)confirmedbyasecondvirologicaltestobtainedfromaseparate

determinationtakenmorethanfourweeksafterbirth.

PositiveHIVantibodytestingisnotrecommendedfordefinitiveorconfirmatorydiagnosisof

HIVinfectioninchildrenuntil18monthsofage.

Table2:WHOcriteriafordiagnosisofsevere(Stage3)advanced(Stage4)HIV(AIDS2)forreporting

ClinicalandimmunologicalcriteriafordiagnosisofadvancedHIVinadultsandchildren

withconfirmedHIVinfection

Presumptiveordefinitivediagnosisofanystage3orstage4condition(seeAppendixA)

and/or;

ImmunologicalcriteriafordiagnosingadvancedHIVinadultsandchildrenfiveyearsorolderwith

confirmedHIVinfection:

CD4countlessthan350permm3ofbloodinanHIV‐infectedadultorchild.

2AIDSinadultsandchildrenisdefinedas;clinicaldiagnosis(presumptiveordefinitive)ofanystage4condition1)withconfirmedHIVinfection:ORimmunologicaldiagnosisinadultsandchildrenwithconfirmedHIVinfectionand>5yearsofage;first‐everdocumentedCD4countlessthan200permm3or%CD4+<15:ORamongchildrenwithconfirmedHIVinfectionaged12–35monthsfirsteverdocumented%CD4<20:ORamongchildrenwithconfirmedHIVinfectionandlessthan12monthsofagefirsteverdocumented%CD4<25.

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and/or;

ImmunologicalcriteriafordiagnosingadvancedHIVinachildyoungerthanfiveyearsofagewith

confirmedHIVinfection:

%CD4+<30amongthoseyoungerthan12months;

%CD4+<25amongthoseaged12–35months;

%CD4+<20amongthoseaged36–59months.

III. HIVCaseReporting

A. DefinitionofHIVCaseBasedSurveillance

HIV case based surveillance is the on‐going, systematic collection, analysis, interpretation, anddisseminationof informationaboutpersonsdiagnosedwithHIV. It is themethodused tocaptureindividual‐level informationonpersonswithHIV infection to supportpublichealthplanning.HIVcase surveillance monitors the entire spectrum of the disease from the initial HIV diagnosis toadvancedandsevereHIVinfection(AIDS),opportunisticillnesses,anddeath.Atitscore,casebasedsurveillanceistheuseofaHIVcasesurveillanceform(HCSF)containinginformationthatpertainstoonepersonwithHIVinfection.Eachpersoncanbereportedmultipletimesbutallcorrespondingformsareassignedthesame“CaseNumber”thatisuniquetoeachperson.

Thekeyadvantage to casebased surveillance is that it ispopulationbased.That is, the system isdesignedso thateveryonediagnosedwithHIV in thepopulationof thecountry iscapturedbythesurveillancesystem.Itisdesignedtoincludepeoplewhotestatbothpublicandprivatesitesofcare.ItcollectstheinformationneededtocalculateHIVprevalence,i.e.,thenumberofpeoplelivingwithHIV in the country, as well as trends among specific demographic or behavioral groups. Thisinformationis,inturn,usedtoplanandevaluatetheeffectivenessofpreventionprogramsandplancareprogramstoreachthosemostinneed.

In Guyana public health ordinanceNo. 15 of 1934 requires that sexually transmitted diseases bereported to the national health authorities. This ordinance applies to all health care providersdiagnosingand/orprovidingmedicalcareandtreatment toHIV infectedpersons.AllHIV infectedindividuals,regardlessoftheirstageatdiagnosis,shouldbereportedtotheChiefMedicalOfficer’sOfficeattheMinistryofHealthusingtheHIVcasesurveillanceform(HCSF)foundbelowinSectionIIIB.

B. HIVCaseSurveillanceForm(HCSF)

TheHCSFiscompletedanytimeapersontestspositiveforHIV,thisincludesinitialdiagnosisandindividualswithknownHIVstatus.IndividualsreferredtoandpresentingatcareandtreatmentsitesalsocompletetheHCSFform.

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MandatoryVariablesforCaseReporting

TocountaclientasanHIVcase,aminimumamountofinformationmustbereportedontheHCSF.ThefollowingvariablesmustbefilledinthecasereportformforallpersonsthatmeettheHIVcasedefinition:

Firstinitialofpatient’sfirstname; Firstinitialofpatient’slastname; Sex; Dateofbirth; Regionofpatient/clientresidenceatdiagnosis; ResultofHIVtests; DateofHIVdiagnosis‐i.e.,testdateoffirstpositiveHIVtest;and Dateofdeath,ifapplicable.

IfanyoftheabovevariablesarenotcapturedontheHCSFwhensubmittedtotheappropriateNAPSandMoHstaff,thenstaffaretofollowupwiththereportingsitetoretrievethemissingdata.Ifsitethatsubmitstheformdoesnothavetheinformationnecessarytocompletethemandatoryvariables,caseshouldbecheckedtoseeifithasbeenreportedalready.Ifnot,entercaseinelectronicdatabase(EDB)forcompletionatalatertime,shouldtheinformationbecomeavailable.

PatientUniqueIdentifier(PUID)

PatientsareidentifiedintheHIVcasesurveillancesystembyapatientuniqueidentifier(PUID)thatisconstructedusingthefirstinitialofthepatient’sfirstname,firstinitialofpatient’slastname,sexanddateofbirth(DD/MM/YYYY).BecausethePUIDisusedtodifferentiatebetweendifferentpeopleandtheintegrityoftheentirereportingsystemdependsoncountingeachcaseonlyonetimeitiscriticalthatthesefourvariablesandthePUIDbeconstructedasconsistentlyaspossible.Inordertodothateachclientisaskedtorefertothename,sexanddateofbirthonhis/herbirthcertificate.Ifpatientdoesnothaveabirthcertificateand/ordoesnotknowwhatisonittheymayusetheirnationalIDcard.AguideisprovidedforanyonecompletingtheHCSF,thatprovidesstandardlanguageforgettingthedataelementsofthePUIDfromclients.UsingthislanguagewillincreaseconsistencyandreliabilityincreatingthePUID.TheHCSFPUIDguidecanbefoundinAppendixB.

CaseSurveillanceFormbySection

A copy of the HIV case surveillance report form is presented in the Appendix C. The form iscomprisedof six sections,with the last sectionrelevant toMOHonly.Thesix sectionson theHIVcasereportformare:

I. PatientInformationII. ExposureCategoriesIII. HIVtestResultsIV. ClinicalInformationonAdvancedHIV

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V. ReportingFacilityinformationVI. MOHUseOnlyI. PatientInformation

Table3:SectionIVariables

Variable Descriptionofvariable

Firstnameinitial

Firstinitialofpatient’sfirstname(usingthenameonthebirthcertificate).Ifinitialisunknownreplacewitha9

Lastnameinitial Firstinitialofpatient’slastname(usingthenameonthebirthcertificate,nomarriednamesornicknames;forwomenaskformaidenname;ifmorethanonelastnameusethefirstlastname).Ifinitialisunknownreplacewitha9

Sex Sexas itappearson thebirthcertificate, regardlessofhowthepatientpresentshim/herself

Dateofbirth Calendarday(DD),Month(MM),andYear(YYYY),asitappearsonthepatient’sbirthcertificate(using9sforanyorallportionsofthedateofbirththatareunknown)

Iffemale,pregnant Ifpatientisfemale,isshepregnant?

Patientuniqueidentifier(PUID)

PUIDwith11characters:initialoffirstname,initialoflastname,sex(M/F),anddateofbirth(DD,MM,YYYY).Thisincludesusingthe#9forunknownvaluesasdescribedintheinitial,sexanddateofbirthboxesabove.

Testingpurpose IdentifywhetherthisreportisaninitialHIVdiagnosis,anAdvancedHIVdiagnosisoranAIDSdeathnotification.Iftheinitialdiagnosisismadeatanadvancestage,checkbothboxes.AIDSdeathnotificationincludesalldeathsamongpersonswithAIDS.Actualcauseofdeathshouldbewrittenintherighthandmarginoftheform.

Ifdead,dateofdeath Calendarday(DD),Month(MM),andYear(YYYY)whenthepatientdied.Replaceanunknowndayormonthwith9

Street Nameofstreetwherepatientresidesmostofthetimeatthetimeofthisreport

City/Town/Village Nameofcity/town/villagewherepatientresidesmostofthetimeatthetimeofthisreport

Regionno. Regionallocationofthecity/town/village(region1‐10)ofresidenceatthetimeofthisreport

Ethnicity Patient’sself‐reportingethnicity:Afro‐Guyanese,Amerindian,Chinese,IndoGuyanese,Portuguese,Mixed,orOtherorRefused.Indicateonlyoneethnicity.Indicateonlyone.

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Employmentstatus Currentstatusofemployment:employed,unemployed,student,refused.Ifemployed,stateoccupation.Employedincludesparttimeaswellasfulltimework.Forclientsthatarebothemployedandstudents,checkboth.

II. ExposureCategories

All applicable exposure categories are recorded on theHIV case surveillance form. An exposurecategory ischecked if thepatientacknowledges thathe/sheengaged in thatactivityat leastoncebeforethefirstHIV‐positivetestresult.ThecategoriesaredescribedinTable4,below.

Table4:SectionIIVariables


Sexwithmale Patienthadanal,oral,orvaginalsexwithamale

Sexwithfemale Patienthadanal,oral,orvaginalsexwithafemale

Sexwithcommercialsexworker

Patienthadanal,oral,orvaginalsexwithmaleorfemalesexworker

SexwithanHIVinfectedperson

Patienthadanal,oral,orvaginalsexwithapersonwhoisinfectedwithHIV.TheydonotneedtohaveknownthatthesexpartnerwasHIV‐infectedatthetimetheyhadsex–onlythatpatientcanreportthattheyhadsexwithanHIV‐infectedpersonatthetimeofHCSFcompletion.

Beenacommercialsexworker

Patienthasexchangedsexformoneyorothermaterialgoods

Sharedneedleswhenusingdrugs

Patientreportedsharingneedleswheninjectingdrugs

Sexwithmultiplepartners

Patienthadanal,oral,orvaginalsexwithmultiplepartnersinthepastyear

Receivedbloodtransfusionorbloodcomponents

Patientreportedbeingarecipientofabloodtransfusionorbloodcomponent

Receivedtransplantoftissueororganorartificialinsemination

Patientreportedhavingreceivedtransplantoftissueororgan,orhadanartificialinsemination

Occupationalexposureinhealthcaresettingorlaboratory

Patientreportedhavingbeenexposedtoblood/bloodcomponentswhileperforminghis/herjobinahealthcaresettingorlaboratory

PerinatalexposuretoHIV

PatienthadbeenexposedtoHIVthroughmother‐to‐childtransmission(borntoaHIV+mother)

Beenavictimofsexualassault

Patientreportedbeingavictimofsexualassault

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Unknown Patientdoesnotreporthowtheywereexposed.ThisoptionisselectedbyMoHifallotheroptionsareblank.Itshouldnotbecheckedbythepersoncompletingtheform.

III. HIVTestResults

Table5:SectionIIIVariables

Nameoftest Nameoftestkitused.Examplesinclude:

HIVrapidtests:Determine,UniGold,Stat‐Pack

HIVDNAPCR

ELISA:MurexHIV

WesternBlot

Testtype TypeoftestusedforHIVdiagnosis,whichincludes:

Antibodytest:Rapidtest,Enzyme‐linkedimmunosorbentassay(ELISA),Westernblot

Virologytest:HIVDNAPCR(forchildrenlessthan18monthsold)

Result HIVtestresult:positive(pos),negative(neg),indeterminate(ind)

Testdate DateofHIVtest:calendarday(DD),month(MM),andyear(YYYY)

IV. ClinicalandImmunologicalInformationonAdvancedHIV

Table6:SectionIVVariables

PresentingCD4Count/percent

ThisvariabledoesnotexistontheHCSF.TheonlyCD4resultsrequestedontheformarethetworowsbelowinthistable(CD4countbelow350inpersonsage5andoverandCD4%inpersonsunderage5).However,atclinicalsitesstaffaredirectedtoreportthefirstCD4count/percent(“presentingCD4”).Theycanusethe“CD4countbelow350µl”boxforcasesage5andolderorthe“%CD4below30”boxforcasesbelowage5torecordthisdata.Thereforeifpatientisage5orolderplacepresentingCD4countinthe“CD4countbelow350µL”fieldregardlessofthevalueoftheresult(i.e.,regardlessoftheactualnumber).Ifpatientisbelowage5placepresentingCD4percentinthe“CD4percentbelow30”fieldregardlessofthevalueoftheresult(i.e.,regardlessoftheactualnumber).

CD4countbelow350µL(≥5yearsold)

CD4+lymphocyte(CD4cells)countbelow350cells/µLisamarkerfordeterminingadvancedHIVinfectionamongpatientsaged5yearsandolder.RecordtheexactCD4countresultifbelow350cells/µL

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%CD4below30(<5yearsold)

PercentCD4below30%isamarkerfordeterminingadvancedHIVinfectionamongpatientslessthan5yearsofage.Recordthe%ofCD4below30

Testdate DateoftestforCD4count:calendarday(DD),month(MM),year(YYYY)

Stageofdisease(Stage3orStage4)

TheStage3orStage4boxistickedbasedonwhichcriteriathepatientmeets.Thestagingcriteriamaybemetbyeitherclinicalorimmunologiccriteria.ClinicalcriteriaarelistedinAppendicesA1andA2.Forimmunologicstagingcriteriasee:WHOimmunologiccriteriafortheseStagesintheTable“WHOimmunologicalclassificationforestablishedHIVinfection”foundinSectionIVoftheHCSF.

Dateofstagediagnosis RecorddateofCD4percentorcountthatcorrespondstothestagecheckedabove:calendarday(DD),month(MM),year(YYYY).

V. ReportingFacilityInformation

Table7:SectionVVariables

Facilityname Nameofthefacilitywherethecaseisreported

Facilitytype Typeofthefacilitywherethecaseisreported,including:PMTCTclinic,privatehospital,publichospital,privatehealthclinic,publichealthclinic,TBclinic,VCTsites,andother

Region Regionallocationofthereportingfacility(regions1‐10)

Dateformcompleted Datewhenthecasereportformiscompletedatthefacility:calendarday(DD),month(MM),year(YYYY)

Formcompletedby Fullnameofstaffwhocompletestheformshouldbewritteninblockletters

VI. MOHUseOnly(OnlyapplicableforMOHstaff)

Table8:SectionVIVariables

Typeofreport DetermineifthecasereportedisanewcaseoranupdatebysearchingforthePUIDintheelectronicdatabaseusingproceduresinSectionFbelow‐DataManagement/Cleaning.Ifacaseisdeterminedtohavealreadybeenreportedinthedatabase,check“update”.Otherwise,check“new”

Receiveddate DateoftheformreceivedattheSurveillanceUnitoftheMOH:calendarday(DD),month(MM),year(YYYY)

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Entereddate Dateofdataentryintotheelectronicdatabase:calendarday(DD),month(MM),year(YYYY)

Recordno. Anautomatednumbergeneratedfromtheelectronicdatabase

C. TestingProceduresandReportableEvents

Multiplehealthfacilities,programsitesandprovidersconductHIVtestinginGuyana.TheseincludeVoluntaryCounselingandTesting(VCT),AntenatalClinics(ANC)includingthosethathavePreventionofMother‐to‐ChildTransmission(PMTCT)programs,TBclinics,publicandprivateclinics,providersandhospitalsandprivatelaboratories.Aspartofthebloodsafetyprogram,thebloodbankalsotestsalldonatedbloodunitsforHIVinfectionandsomeadditionalinfectiousdiseases.

Bothpoint‐of‐caretesting(rapidtesting)andlaboratorytesting(venousblooddraw)arepracticedinGuyana. Inbothsituations,allpositivecasesareconfirmedusingaseparatetest. Indeterminatesamplesreceiveathirdtestasatie‐breaker.OnlyconfirmedHIVpositivecasesarereported.

SomefacilitiesprovideHIVpoint‐of‐caretestingandnoCD4testingisavailableorconducted.TheseincludeVCTsites,ANCsiteswithPMTCTservices,andthebloodbank.ClientsdiagnosedwithHIVare referred to Care andTreatment sites for clinicalmanagement of the disease. Patients receiveclinical diagnosis and immunology testing upon enrollment in care. Coded samples are sent to alaboratoryforCD4andviralloadtests.TestresultsarerecordedontheHIVtestrequestformandreturnedtotherequestingfacility.UponreceiptofthefirstCD4testresults,thefacilitycompletesanewHIV case surveillance form (HCSF); then submits this form to the appropriateNAPSorMoHstaff(asdescribedinSectionIIIE).

AllcasesofHIVarereportedusingtheHCSFwhen:

ApersonisnewlydiagnosedwithHIVatanyclinicalstage; AnHIV‐infectedperson(regardlessofwhetheranewdiagnosis)istestedorpresents

forcareatasiteorfacilityforthefirsttime; AnHIV‐infectedpersonhasprogressedtoadvancedHIV(stage3); AnHIV‐infectedpersonhasprogressedtosevereHIV(stage4);and AnHIV‐infectedpersondiesregardlessofcauseofdeath.

Insummary,allHIV‐infectedindividualsshouldbereportedwhentheyarenewtoatestingorcaresiteincludingVCT,C&TorANC/PMTCTsitesandprivatehospitalsandclinicsregardlessofwhethertheclientwasdiagnosedelsewhere.Clientsaretobere‐reportediftheyarestage3orstage4ordie;causeofdeathistobeincludedinreportsofclientswhodie(SeeAppendixD:HCSFCompletionProceduresfordetails).

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D. ReportingSources SourcesofHIVCaseSurveillanceReportForms

WiththesystemofHIVservicesdescribedabove,thefollowingarelocationswherepeoplearetestedforHIVand,therefore,aresourcesofHIVcasereports:

VCTsites ANCsiteswithandwithoutPMTCTservices TBclinics CareandTreatmentSites Publicandprivatehospitals Privateprovidersandclinics Privatelaboratories

AteachofthesesitespersonswhoconductHIVtestingareresponsibleforcompletingtheHIVCaseSurveillanceForm(HCSF)forallpersonsdiagnosedwithHIV.EachsiteisthenrequiredtosubmitallHCSFtotheMoH/NAPS(dataflowdescribedindetailinSectionIIIEbelow.InadditiontothesesourcesofHIVcasereports,theNationalPublicHealthLaboratoryConductsCD4testingandprovidestheresultstorequestingclinicalstaffwhoincludetheCD4resultsinSectionIVoftheHCSF.

• DeathRegistry

ObtainingreportsofdeathonpersonspreviouslyreportedwithHIVisessentialtoaccuratelymeasurethenumberofpeoplelivingwithHIVinGuyana.AmatchwillbeconductedannuallytoobtainvitalstatusofpersonsreportedwithHIVtoproducethemostreliableup‐to‐datecountofpersonslivingwithHIVinGuyana.AmatchtoobtaincauseofdeathusingverifiedICD‐10codesisconductedeverytwoyears.AprocedureforthisisinAppendixG.ReportsonHIVrelateddeathsarealsoacquiredwhen:

1. Sitescallclientsintheeventtheymissanappointment,onlytofindouttheclientdied;

2. VeryillclientsaresenttotheHospice,whothenreporttothereferringsiteintheeventtheclientdies;

3. Familymembersinformsitewhentheclientsdie;and

4. OutreachOfficerreceivesthisinformationwhenoutinthefieldscheckinguponclients.

E. ReportingProceduresTheprogramareasatNAPS/MoHresponsibleforprocessingHCSFsfromvariouspartsofthehealthsectorareasfollows:

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• VCTsites–sendreportstoVCTstaffatNAPS ANCsiteswithandwithoutPMTCTservices‐sendreportstoPMTCTstaffatMoH TBclinics‐sendreportstoVCTstaffatNAPS CareandTreatmentSites‐sendreportstoC&TstaffatNAPS Publicandprivatehospitals‐sendreportstoVCTstaffatNAPS Privateproviders,laboratoriesandclinics‐sendreportstoVCTstaffatNAPS

ThedataflowforHIVcasereportingbetweenthesiteslistedaboveandNAPSandMoHthroughtodatacleaning,analysisanddisseminationisdepictedinthedataflowdiagrambelow.Thisoverviewofthedataflowdiagramisfollowedbythreemorespecificdataflowdiagramsfor:1)VCT,2)C&Tand3)antenatalclinics.

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Figure2:DataFlowDiagramforGuyana’sHIVCaseSurveillanceSystem

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F. DescriptionofDataFlowDiagramforGuyana’sHIVCaseSurveillanceSystem

TheHIVCaseSurveillanceProcessincludesthestepsdescribedbelow.

1. DistributionofHIVCaseSurveillanceForms(HCSFs)

o NAPS distributes HIV Case Surveillance Forms to all sites conducting HIV testingexceptANCsites

o MoHPMTCTUnitdistributestheHIVCaseSurveillanceFormstoallANCsites

2. CompletionoftheHIVCaseSurveillanceForm(HCSF)

o ThecompletionoftheHCSFoccursat:

VCTsites

ANCsitesincludingthosewithPMTCTPrograms

C&Tsites

TBclinics

Healthcareproviders(publicandprivate)

Laboratories

Bloodbank

o RefertoSectionIIIBabovefordetaildescriptionofSectionsItoVIoftheHCSF

o SitesthatobtainCD4countresultsfromthelabarerequiredtocompleteSectionsI‐V.

o PMTCTandVCTarerequiredtocompleteSectionsI‐IIIandV.

o After forms are completed they are submitted for HCSF processing as listed inSection3belowwithin4‐weeksofpatientdiagnosis.However,everyeffortshouldbemadetosubmittheHCSFasquicklyaspossible.

o Questions regarding the completion of the HCSF should be directed to theSurveillanceUnitattheMinistryofHealth

3. HCSFSubmissiontoUnitsConductingHCSFProcessing

o AftercompletingtheHCSF:

VCT and C&T sites are responsible for securely transporting forms in a

timelyandsecuremannertoNAPS

23

PMTCTsitesareresponsibleforsecurelytransportingformsinatimelyand

securemannertoMCH

o PrivatefacilitiessubmitHCSFstovisitingEpi‐nursesinatimelyandsecuremanner.

EpiNursesareresponsibleforsecurelytransportingformsinatimelymannertothe

SurveillanceUnit.

4. HCSFProcessing

o HCSFProcessingiscompletedasfollows: NAPSVCT andC&Tunits andMoHPMTCT are responsible for completing

the following tasks as outlined in the HSCF Initial Review Procedures, inAppendixD:

Writedateofreceiptinthelefthandmargin,andinitial Ensurethatthemandatoryvariablesarecompleted Identifymissing,questionable,orincompletevariables,andfollowup

with the person who completed the form onsite to obtain missingvariables

EpidemiologicalNurses return formswithmissing, questionable, orincomplete variables, and follow up with personnel at the privatefacilitywhocompletedtheform/s.

After initial quality checks all HCSFs should be submitted to theSurveillanceUnitwithin aweek of receipt byNAPSorMoH staff. Ifcontactneedstobemadewithpersoncompletingtheformtoclarifyinformation every attempt should be made to submit form to theSurveillanceUnitwithintwoweeksofreceipt

Ministry of Health Surveillance Unit completes the following tasks asoutlinedintheHCSFSecondaryReviewProcedures,inAppendixE: Writedateofreceiptinthelefthandmargin,andinitial De‐duplicationusingtheelectronicdatabase CompletetheReportTypevariableasNeworUpdateinSectionVI AssigneachuniquepersonasequentialCaseNumber Forms should be submitted to Statistical Unit staff for data entry

withinaweekofreceipt

5. DataEntryo MinistryofHealthStatisticalUnitDataEntryClerkcompletesthefollowingtasksas

outlinedinDataEntryProceduresinAppendixF: CompleteDateReceivedandEntryDateinSectionVIofHCSF De‐duplicationusingtheelectronicdatabase Formsshouldbeenteredandfiledwithinaweekofreceipt.

24

6. DataManagementandCleaning

o The Statistical Unit facilitates datamanagement and cleaning on a quarterly basis.Thisincludescompletionofthefollowingtasks:

1. Statistical Unit Officer develops and runs a standard analytic program thatproduces lists of cases with potential duplicates as well as suspect,inconsistentor incompletedemographicordiagnostic information,orotherquestionableordiscrepantdata.

2. Establishes data cleaning schedule and routines (i.e., what computerprograms are used and what potential discrepancies are checked‐ forexample‐duplicates).IntheinitialphaseoftheHIVcaseSurveillanceSystemthese activities will be conducted monthly to any significant or obviouserrors.Oncethenumberoferrorsdecreasesaquarterlyschedulewillthenbeestablished.

3. Generatesalistofpotentialduplicates.

4. SubmitsresultstotheSurveillanceUnitStaffonamonthlybasis.

o TheSurveillanceUnitthencompletesthedatamanagementandcleaningprocessbycompletingthefollowingtasks:

1. PullpaperHCSFsandcomparethemwiththeinformationintheelectronicdatabasetoidentifyanydiscrepanciesandfollowupwithappropriatestafftorectify.

7. DataAnalysis

o This section contains a list of commonly used reports. However, it should not beconsideredastaticlist.Whatiscontainedinthereportsandhowfrequentlytheyarerunisadjustedinresponsetotheeffectiveutilizationofdataforprogramplanning,developmentandmonitoring.Additionalreportswillbeneededas thesurveillancesystemmaturesandthedataareusedtoplanandevaluatepreventionprogramsandplanforcareofpeoplelivingwithHIVAIDS(PLWH).Examplesoffuturereportstoconsiderare:

• Compareregionof facilitywithregionofpatient residence toquantifyhowmuch testing of PLWH is being done outside of the patient’s region ofresidence. You can use this type of analysis to decide where more testingservicesmaybeneeded.

• Analyzeoccupationbyregionofresidencetoassistwiththedevelopmentoftargetedpreventionprograms

25

• Measure howmany people are tested that do not go into care by sex, age,region,occupation,etc.

• MeasuretimebetweentestingandentrytoC&T

o TwiceayeartheSurveillanceUnitrunsthefollowingreports:

Numberofi)newlydiagnosedHIVcases,ii)prevalent(living)HIVcases,iii)advancedHIVcases(stage3),iv)severeHIVcases(Stage4),v)cumulativecasesandvi)deaths,stratifiedby:

o Agegroupatdiagnosis,Forexample: <1 year 1‐4 years 5‐12 years 13‐14 years 15‐19 years 20‐24 years 25‐29 years 30‐34 years 35‐39 years 40‐44 years 45‐49 years ≥ 50

Unknowno Sexo Regionofresidenceatdiagnosiso Race/Ethnicity

o Onceayear,theSurveillanceUnitrunsthefollowingreports:

Total number and percent of newly diagnosed HIV cases, advanced HIV cases(stage3),andsevereHIVcases(stage4).AllreportedHIVcasesstratifiedby:

o Agegroupandsexo Region and sex (may not be applicable for all areas, depending on

morbidity)o Ethnicityandsexo Exposurecategoryandsexo Exposurecategoryandethnicity(maynotbeapplicableforallcategories,

dependingonmorbidity) TrendsinnewlydiagnosedHIVcases,advancedHIVcasesanddeaths,stratified

byagegroup,sex,raceandexposurecategory.Inordertominimizetheinfluenceofreportingdelayontrendssuchanalysesisconductedoncasesreportedsixormore months before the analysis date. This decreases the likelihood that thetrendsarebasedonincompletedata.

8. DataDissemination

26

o Dataisdistributedtothefollowingentities:

NAPS VCT and C&T for the purpose of planning and evaluating preventionprograms, planning care programs, program management, monitoring andevaluation

MoH PMTCT for the purpose of program management, monitoring andevaluation

Stakeholders (i.e. MoH, NAPS, funders, partners) for policy and protocoldevelopment

TheNAPSwebsiteforpublicaccess

27

G. ProgramSpecificDataFlowDiagramsFigure3:DataFlowDiagramforHIVCaseSurveillanceForms(HCSF)OriginatingatVoluntaryCounselingandTesting(VCT)Sites

Client Presents for Testing at VCT Site:

Meets with VCT Counselor

Pre‐Test Counseling:

VCT Counselor Completes Intake Form

If HIV Negative If HIV Positive

VCT Counselor does

Post‐Test Counseling

Client returns in 3‐6

months for re‐testing

VCT Counselor does Post‐Test

Counseling and completes HIV

Case Surveillance Form and

Referral Form

Original

Goes to

NAPS VCT

Unit

Copy 2

goes to

Care &

Treatment

Copy 3

Stays at

VCT

Site

Client is referred to

Care and Treatment

Care and Treatment

completes additional HIV

Case Surveillance Form

(includes CD4 count)

Original

goes to

NAPS

C&T Unit

Copy 2

stays at

C&T

Site

National AIDS Programme

Secretariat

Ministry of Health

Surveillance Unit

Referral

Form goes

to Care &

Treatment

HIV Case Surveillance Form

Bottom half

of Referral

Form goes

to VCT Site


C & T

Unit

VCT

Unit

Ministry of Health

Statistical Unit

Data Entry Clerk

Data Quality

Checks Occur

Data Quality

Checks Occur

Data Quality

Checks Occur

Data Quality

Checks Occur

28

DescriptionofDataFlowDiagramforHIVCaseSurveillanceForms(HCSF)OriginatingatVoluntaryCounselingandTesting(VCT)Sites

ClientistestedforHIVatVCTsite:1. ClientpresentsforTestingataVCTsite.2. VCTcounselorconductspre‐testcounselingandcompletesanIntakeForm.3. VCTcounselorconductstherapidHIVtestalgorithm(twoparalleltests):

i. IfbothtestresultsindicatetheclientisHIVnegative,theVCTcounselorconductspost‐testcounselingandencouragestheclienttoreturnin3‐6monthsforre‐testing.

ii. IfbothtestresultsindicatetheclientisHIVpositive,VCTcounselorcontinueswithStep4,describedbelow.Ifonetestispositiveandtheotherisnegativeanothertestisimmediatelyconductedatthetestingsite.Ifthe“tie‐breaker”testispositive,theclientisreferredtocareandtreatment.Ifthetie‐breakertestisnegative,theclientiscounseledandadvisedtoreturnforadditionaltestinginthreemonths.

IfclientisdeterminedtobeHIVpositive:4. VCTcounselorconductspost‐testcounselingandcompletesthefollowingforms:

ReferralForm TriplicateHIVCaseSurveillanceForm(HCSF)

Originalcopy(white)oftheHCSFissenttotheNAPSVCTUnitsothatthemostlegiblecopyisavailablefordataentrytominimizedataentryerrors.

Copy#2(yellow)oftheHCSFandthereferralformareeithergiventothepatient,whopresentsittoCare&TreatmentorgiventotheCaseNavigatorwhopresentsboththeclientandcopyofHCSFtoCareandTreatment(C&T).

Copy#3(pink)remainsattheVCTreportingsite5. VCTcounselorreferstheclienttoaC&Tsite,andinstructstheclienttobringCopy#2

(yellow)oftheHCSFandtheReferralForm(perforated)withthemwhentheyenrollinC&T.WhenclientisreferredtoCare&Treatment:

6. ClientpresentsatC&TsitewithCopy#2(yellow)oftheHCSFandtheReferralForm.7. C&TstaffcompletesanewduplicateHIVCaseSurveillanceForm(HCSF)atintake:

C&TstaffrecordspresentingCD4countinSectionIVoftheHCSFatthetimeclientpresentsandchecksStage3orStage4,ifapplicable,basedoncurrentimmunologicstatusand/orclinicaldiagnoses(SeeWHOimmunologiccriterialistedinSectionIVoftheHCSFortheclinicalcriteriainAppendixA)

Original(white)copyoftheHCSFissenttotheNAPSC&TUnit Copy#2(yellow)oftheHCSFremainsattheC&Tsite

8. C&TstaffpresentsthebottomhalfoftheperforatedreferralformandsendsitbacktotheVCTsitethatreferredthepatient.ThisallowstheVCTstafftoknowthatthepatientenrolledinC&T.

NationalAIDSProgrammeSecretariat(NAPS)

9. TheNAPSVCTUnitreceivestheoriginalcopy(white)oftheHCSFthattheVCTcounselorcompletedattheVCTsiteforeachHIVpositiveclient.

29

i. NAPSVCTUnitstaffwritesthedatereceivedandhis/herinitialsintheleftmarginofeachHCSFthathe/shereceives

ii. NAPSVCTUnitstaffdoesaqualitycheckoneachHCSFthathe/shereceives(SeeHCSFInitialReviewProcedurefordetails)

iii. NAPSVCTUnitstaffsubmitsallHCSFstotheMinistryofHealthSurveillanceUnit10. TheNAPSC&TUnitreceivestheoriginalcopy(white)oftheHCSFthattheC&Tstaff

completedattheC&TsiteforeachHIVpositiveclient:i. NAPSC&TUnitstaffwritesthedatereceivedandhis/herinitialsintheleftmarginof

eachHCSFthathe/shereceivesii. NAPSC&TUnitstaffdoesaqualitycheckoneachHCSFthathe/shereceives(See

HCSFInitialReviewProcedurefordetails)iii. NAPSC&TUnitstaffsubmitsallHCSFstotheMinistryofHealthSurveillanceUnit

MinistryofHealth(MoH)11. MinistryofHealthSurveillanceUnitreceives2originalsoftheHCSFforeachHIVpositive

clientthatenterscare,onefromtheNAPSVCTUnitandonefromtheNAPSC&TUnit:i. MoHSurveillanceUnitstaffwritesthedatereceivedandhis/herinitialsintheleft

marginofeachHCSFthathe/shereceivesii. MoHSurveillanceUnitstaffchecksallHCSFsagainsttheelectronicdatabaseto

ensurethattherearenoduplicates(SeeHCSFSecondaryReviewProcedurefordetails)

iii. MoHSurveillanceUnitstaffassignseachuniquepersonaCaseNumber(SeeHCSFSecondaryReviewProcedurefordetails)

iv. MoHSurveillanceUnitstaffsubmitsallHCSFstotheMinistryofHealthStatisticalUnit(DataEntryClerk)

12. MinistryofHealthStatisticalUnit(DataEntryClerk):i. TheDataEntryClerkcompletes“DateReceived”and“EntryDate”fieldsinSectionVI

ofeachHCSFreceivedii. TheDataEntryclerkchecksallHCSFsagainsttheelectronicdatabasetoensurethat

therearenoduplicates(seeDataEntryProcedurefordetails)iii. TheDataEntryclerkentersthecaseintotheelectronicdatabaseandrecordsthe

“RecordNumber”generatedbytheElectronicDatabaseontheHCSF

30

Figure4:DataFlowDiagramforHIVCaseSurveillanceForms(HCSF)OriginatingatAntenatalCare(ANC)Sites

Woman tests HIV Positive at

Antenatal Clinic (ANC) OR at Labor and Delivery

Health Worker at Clinic does Post‐Test

Counselling and completes Intake Form and


Original

goes to

MoH

PMTCT Unit

Copy 2

stays at

clinic

Copy 3

goes to

Care &

Treatment

Client is referred to

Care and Treatment

Care and Treatment

completes additional HIV

Case Surveillance Form

(includes CD4 count)

Original

goes to

NAPS

C&T Unit

Copy 2

stays at

C&T

Site


Secretariat

Ministry of Health

Surveillance Unit



C & T

Unit

Ministry of Health

Statistical Unit

Data Entry Clerk

Data Quality

Checks Occur

Data Quality

Checks Occur

Data Quality

Checks Occur

Data Quality

Checks Occur

Infant is determined to be

HIV Positive (Infected)

Ministry of Health

PMTCT Unit

31

DescriptionofDataFlowDiagramforHIVCaseSurveillanceForms(HCSF)OriginatingatAntenatalCare(ANC)Sites

PREGNANTWOMANtestspositiveforHIVatAntenatalClinic(ANC)1. ANCnurseconductspost‐testcounselingandcompletesthefollowingforms:

PMTCTIntakeFormforPregnantWomen TriplicateHIVCaseSurveillanceForm Originalcopy(white)ofthecompletedHCSFissenttotheMoHPMTCTUnitso

thatthemostlegiblecopyisavailablefordataentrytominimizedataentryerrors.

Copy#2(yellow)ofthecompletedHCSFremainsattheANCreportingsite Copy#3(pink)ofthecompletedHCSFisgiventothepatient,whobringsitto

Care&Treatment(C&T)INFANTborntoanHIVpositivemotherisdeterminedtobeHIVpositive(infected):

1. Healthworkerconductspost‐testcounselingwithmotherandcompletesthefollowingforms:

PMTCTIntakeFormforExposedInfants(PostDelivery). TriplicateHIVCaseSurveillanceForm Originalcopy(white)ofthecompletedHCSFissenttotheMoHPMTCTUnitso

thatthemostlegiblecopyisavailablefordataentrytominimizedataentryerrors.

Copy#2(yellow)ofthecompletedHCSFremainsattheANCreportingsite Copy#3(pink)ofthecompletedHCSFisgiventothepatient,whobringsitto

Care&Treatment(C&T)WhenHIVpositivepregnantwomanAND/ORHIVpositiveinfantisreferredtoCare&Treatment:

2. ClientpresentsatC&TsitewithCopy#3(pink)oftheHCSF.3. C&TstaffcompletesanewduplicateHIVCaseSurveillanceForm(HCSF)atintake:

C&TstaffrecordspresentingCD4countinSectionIVoftheHCSFatthetimeeveryclientpresentsandchecksStage3orStage4,ifapplicable,basedoncurrentimmunologicstatusand/orclinicaldiagnoses(SeeWHOimmunologiccriterialistedinSectionIVoftheHCSFortheclinicalcriteriainAppendixA)

Original(white)copyoftheHCSFissenttotheNAPSC&TUnit Copy#2(yellow)oftheHCSFremainsattheC&Tsite

MinistryofHealthPMTCTUnit

4. TheMinistryofHealthPMTCTUnitstaffwillreceiveoriginalcopy(white)oftheHCSFforeveryHIVpositivepregnantwomanandeveryHIVinfectedinfant:i. MoHPMTCTUnitstaffwritesthedatereceivedandhis/herinitialsintheleftmargin

ofeachHCSFthathe/shereceivesii. MoHPMTCTUnitstaffdoesaqualitycheckoneachHCSFthathe/shereceives(See

HCSFInitialReviewProcedurefordetails)

32

iii. MoHPMTCTUnitstaffrecordsthePMTCTcodesinthemarginofeachHCSFthathe/shereceives

iv. PMTCTunitthensubmitsHCSFtotheSurveillanceUnit.MinistryofHealth(MoH)

5. MinistryofHealthSurveillanceUnitreceivestwooriginalsoftheHCSFforeachHIVpositiveclientthatenterscare,onefromthePMTCTUnitandonefromtheNAPSC&TUnit:i. MoHSurveillanceUnitstaffwritesthedatereceivedandhis/herinitialsintheleft





6. MinistryofHealthStatisticalUnit(DataEntryClerk):v. TheDataEntryclerkcompletes“DateReceived”and“EntryDate”fieldsinSectionVI

ofeachHCSFreceivedvi. TheDataEntryclerkchecksallHCSFsagainsttheelectronicdatabasetoensurethat

therearenoduplicates(seeDataEntryProcedurefordetails)vii. TheDataEntryclerkenterscaseintotheelectronicdatabaseandrecordsthe

“RecordNumber”generatedbytheElectronicDatabaseontheHCSF

33

Figure5:DataFlowDiagramforHIVCaseSurveillanceForms(HCSF)OriginatingatCareandTreatment(C&T)Sites

Health Worker at Care and Treatment completes

NEW HIV Case Surveillance Form (INCLUDING

CD4 COUNT) when:

Patient presents for the first time

Patient advances to Stage 3 Patient advances to Stage 4 Patient dies

Original

goes to

NAPS

C&T Unit

Copy 2

stays at

C&T Site


Secretariat

Ministry of Health

Surveillance Unit


C & T

Unit

Ministry of Health

Statistical Unit

Data Entry Clerk

Data Quality

Checks Occur

Data Quality

Checks Occur

Data Quality

Checks Occur

34

DescriptionofDataFlowDiagramforHIVCaseSurveillanceForms(HCSF)OriginatingatCareandTreatment(C&T)Sites

Care&TreatmentstaffcompletetheHIVCaseSurveillanceForm:1. AHealthWorkerataCare&Treatment(C&T)sitecompletesanewduplicateHIVCase

SurveillanceFormateachofthefollowingtimes:i. AnHIVpositivepatientpresentsforcareforthefirsttimeii. ApatientadvancestoStage3iii. ApatientadvancestoStage4iv. Apatientdies EverytimeahealthworkerataC&TsitecompletesaHCSF,he/sheincludestheCD4

countinSectionIVoftheHCSFandchecksStage3orStage4,ifapplicable,basedoncurrentimmunologicstatusand/orclinicaldiagnoses(SeeWHOimmunologiccriterialistedinSectionIVoftheHCSFortheclinicalcriteriainAppendixA)

2. HealthworkeratC&Tsubmitstheoriginal(white)copyofthecompletedHCSFtotheNAPSC&TUnitsothatthemostlegiblecopyisavailablefordataentrytominimizedataentryerrors.

Copy#2(yellow)oftheHCSFremainsattheC&TreportingsiteNationalAIDSProgrammeSecretariat(NAPS)

3. TheNAPSC&TUnitwillreceiveCopy#2(yellow)oftheHCSFthattheC&TstaffcompletedattheC&TsiteforeachHIVpositiveclientthatenterscare:i. NAPSC&TUnitstaffwritesthedatereceivedandhis/herinitialsintheleftmarginof

eachHCSFthathe/shereceivesii. NAPSC&TUnitstaffdoesaqualitycheckoneachHCSFthathe/shereceives(See

HCSFInitialReviewProcedurefordetails)iii. NAPSC&TUnitstaffsubmitsallHCSFstotheMinistryofHealthSurveillanceUnit

MinistryofHealth(MoH)4. MinistryofHealthSurveillanceUnitreceives2originalsoftheHCSFforeachHIVpositive

clientthatenterscare,onefromtheNAPSVCTUnitandonefromtheNAPSC&TUnit:i. MoHSurveillanceUnitstaffwritesthedatereceivedandhis/herinitialsintheleft





5. MinistryofHealthStatisticalUnit(DataEntryClerk):i. TheDataEntryclerkcompletes“DateReceived”and“EntryDate”fieldsinSectionVI

ofeachHCSFreceived

35

ii. TheDataEntryclerkchecksallHCSFsagainsttheelectronicdatabasetoensurethattherearenoduplicates(seeDataEntryProcedurefordetails)

iii. TheDataEntryclerkenterscaseintotheelectronicdatabaseandrecordsthe“RecordNumber”generatedbytheElectronicDatabaseontheHCSF

IV. SecurityandConfidentiality

HIVcontinues tobeassociatedwithsocial stigmaandanybreachof confidentialityposes risksofsocial, mental, economic and physical harm to HIV infected individuals. To ensure theconfidentialityofHIV infectedpatients, their informationmustbekept in secured areas and staffmust rigorously protect patient confidentiality. HIV case surveillance data collection, storage,transmission and use should follow procedures to protect any personally identifying information(PII). The policies below apply to any location where patient information is kept: clinics,laboratories,hospitals,NAPSandMoHoffices.

PersonallyIdentifyingInformation(PII)

PII is more than name. It includes any information that could potentially identify anindividual. On the HCSF PII includes initials of first and last name, date of birth and allcomponentsofthepatientaddress.

ThereforeanyHCSFthathasanyPIIwillbeprotectedasifithadthepatientnameonit.

PhysicalDataStorage

AllpaperHIVcasereportformsthatcontainanyPII,includingthosethatremaininthereportingfacilityandatMOH,mustbefiledandstoredinasecureplacesuchasalockedfilingcabinetthatcannotbeaccessedbyun‐authorizedstaffnorpatientsinthewaitingareaoranyothermembersofthegeneralpublic.

FormscontainingPIImustnotbeleftoutondesksorinanunsecuredfilefolderorenvelopewhenthepersonworkingatthedeskleaves.

IfsomeonecomesovertothedeskofanemployeeworkingwithformswithPIItheymustbecovered.

TransportingConfidentialInformation

WhentransportingcompletedHCSFstheymustbeplacedinasealedenvelopeandplacedinthetrunkorothercoveredareaofthevehicle.

Anystopsbetweenthefacilitycompletingtheformsandthedestinationshouldbekepttoaminimum.Workerstransportingthedatashoulddiscusswiththeirsupervisorwhethertheformsaremoresecurebeingbroughtwiththeemployeeorkeptinthevehicle.

ElectronicDataStorage

36

Electronicdatabaseshouldbepasswordprotectedandaccessedusingapasswordsecured.computerthatisbackeduponaserverandcannotbeaccessedbyun‐authorizedstaff

Datamustbebackedupregularly.OathsofConfidentiality

AllemployeeswithaccesstoPIIshouldreadandsigntheconfidentialityoathuponobtainingaccesstoPIIandannually.

SecurityandConfidentialityTraining

AllHIVhealthcareprovidersandMoHandNAPSstaffwhohaveaccesstoorworkwithHCSFsorotherformswithpersonallyidentifyinginformationshouldbetrainedonconfidentialityandsecurityprocedures.

Anannualtrainingshouldbeheld,thatincludesre‐signingtheoath.BreachProcedures

Aprocessforidentifyingandinvestigatingbreachesinsecurityandconfidentialityincludes:o Formsforreportingbreachesandproceduresforcompletingthemshouldbe

developed.o Consequencesforviolatingconfidentialityandsecurityshouldbedeveloped,and

staffeducatedontheramificationsforviolatingpoliciesandprocedures.

A. Training

SitesthatcompleteHCSFaretrainedminimallyonanannualbasis.Suchtrainingcanbeconductedinpersonoranonlinetrainingforsitestoaccessdirectly.PointstobecoveredinsuchtrainingsareoutlinedinHCSFCompletionProceduresinAppendixHandshouldincludeadherencetosecurityandconfidentialityprocedures.

B. StandardsforMonitoringandEvaluatingtheHIVCaseSurveillanceSystem

HIV case reporting data needs to maintain minimum quality standards to ensure the system isresponsiveandrelevanttoreflectwhoislivingwithanddyingfromHIV.Thequalityofthedataisregularly monitored, and results used to strengthen the relevant components through training.Periodic evaluation of the HIV case surveillance system includes measures for timeliness,completenessofreporting,andvalidity.TheseanalysesarerunbytheMoHStatisticalUnitOfficerandreviewedbytheSurveillanceUnit.

ThepurposesofmonitoringandevaluatingtheHIVcasesurveillancesystemaretodetermine:

37

Completeness:tomeasurewhatproportionofthediagnosedHIVcasesarecaptured; Timeliness:tomeasurehowsooncasesarereportedafterdiagnosis;and Validity:toevaluatetheaccuracyofdatareported.

Completeness

CompletenessofreportingreferstotheproportionofalltrueHIVpositivecasesthatarereportedtothe MoH. In order to monitor completeness, additional case finding methods should be found.Exampleswouldinclude1)listsofHIVdischargecodesfromplaceswherepeoplewithHIVreceivecare and 2) programmonitoring data from VCT, C&T and PMTCT to compare to the number ofuniqueHCSFsreceivedmonthlybythedesignatedunit(SeeIIEabove).

Because patients may not get into care once they are diagnosed, completeness measures areconducted on diagnostic tests not usingmeasures such as CD4 tests that are only conducted onpersonsincare.NPHRLregistriesareperiodicallyreviewedtoassessthecompletenessofreportingofpersonswhopresentforcare.

InadditiontodeterminingthecompletenessoftheHIVsurveillancesystem,staffwhoprocessforms(SeeIIEabove)followupwiththecorrespondingfacilityoncasesnotfoundintheHIVsurveillancedatabasestohavetheHCSFcompleted.

Timeliness

Timelinessmeasures the timebetweendiagnoseandreportedtoMoH.Timeliness ismeasuredbytwomethods:

1. Median timebetweendiagnosisofHIVor advanced/severeHIV andHIV case report formreceivedbytheunitdesignatedinIIEabove.

2. ProportionofthereportedcasesthatarereceivedbytheunitdesignatedinIIEabovewithinthreemonths,sixmonthsandtwelvemonthsofdiagnosis.

Standards

ThestandardsthattheHIVcasesurveillancesystemstrivestoachieveare:

66%ofcasesreportedwithinsixmonthsofdiagnosis 85%ofcasesreportedwithintwelvemonthsofdiagnosis

BelowarethestepsneededtocalculatetimelinessofHIVreporting,whichrequirestheuseofdateofdiagnosisanddatecaseisfirstreceivedbytheunitdesignatedinIIEabove.

Step1:Calculatecompletenessofreportingat12monthsafterthediagnosis.Ifcompletenessis≥85%,thengotoStep2.

Step2:Calculatetime(numberofmonths)fromdiagnosistoreport:

=(reportdate)‐(diagnosisdate)

=[(yearofreport)*12)+month]‐[((yearofdiagnosis)*12)+month]

38

Forexample,thereportdateisMay2004andthediagnosisdateisNovember2003.Thetimeinterval(inmonths)is:

[(2004*12)+5]‐[(2003*12)+11]=6months

Step3:Determinethenumberofcaseswithatimetoreport≤6months.

Step4:Calculatetimelinessofcasereporting:

NumberofcasesdiagnosedwithinayearandreportedwithinsixmonthsofdiagnosisNumberofcasesdiagnosedandreportedforthatdiagnosisyear

Validity

Validity measures the extent to which the information 1) on the case report form matchesinformationinthepatientrecordatthehealthcarefacilityaswellas2)intheelectronicdatabasematcheswhatisontheHCSF.

I. Casesurveillanceform/healthcarefacilitydatavalidity

Thevalidityof the information recordedon theHCSFcompared towhat is recorded in thepatient’s VCT or C&T or othermedical record can be measured by re‐abstracting data onpreviously reported cases and comparing the information contained in theoriginal and re‐abstractedforms.

Step1:Staffnotpreviouslyinvolvedwiththedataorsitedoesthere‐abstractioncheck.Thisperson works for the national surveillance program and is familiar with the casereport forms and methods for reviewing clinic records, abstracting data andcompletingthecasereportform.

Step2:Arandomsampleofcasesatasiteischosen‐5%chosenrandomlyifstaffinglevelsallow.

Step3:Atthesite,gobacktopatientrecordsorregistryforpersonschosenasthesample.CompleteanewHCSF.Besuretoonlyreviewthedatathatwasavailableatthetimeof the initial report and to exclude data received since the initial report wascompleted.

Step4:Comparetheinformationontheoriginalformandtheonecompletedduringthere‐abstractionphase.

Step5:Recordthediscrepanciesandsummarizeaccuracyforeachvariable.

II. Casesurveillanceform/electronicdatabasevalidity

ThevalidityoftheinformationenteredintotheelectronicdatabasecomparedtowhatisrecordedontheHCSFcanbemeasuredbyre‐enteringthedataonasampleofHCSFs.Thespecificmethodfor

39

doing this depends on how the EDB is structured. Ideally one would be able to re‐enter it andidentifyitasre‐entrysoitdoesnotoverwritetheoriginalform.Step1:Selectastaffpersonfamiliarwiththeformanddataentrytoperformthisstep.OneofthestafffromtheSurveillanceUnitinvolvedinthesecondaryreviewoftheformswouldbeideal.Step2:Randomlyselect5%ofenteredcases(ifstaffinglevelsallow)Step32:Re‐entertheform‐methodstobedeterminedafterconsultingwithMISUAlternativetoStep3:VisuallycomparewhatisontheHCSFwithwhathasbeenentered.Step4:Calculate theproportionsof errors for eachdata field. Separateout errors thatwill affecthowthedataareanalyzedfromthosethatshouldbecorrectedbutwhichhaveless impactonthedatareports.

40

AppendixA1:WHOclinicalstagingofHIVinfectionforadultsandadolescentswithconfirmedHIVinfection

ClinicalStage1(Asymptomatic)

1. Persistentgeneralizedlymphadenopathy

ClinicalStage2(Mild)

1. Moderateunexplainedweightloss(<10%ofpresumedormeasuredbodyweight)

2. Recurrentrespiratorytractinfectionssinusitis,tonsillitis,otitismediaandpharyngitis)

3. Herpeszoster

4. Angularcheilitis

5. Recurrentoralulceration

6. Papularpruriticeruptions

7. Seborrhoeicdermatitis

8. Fungalnailinfections

ClinicalStage3(Advanced)

1. Unexplainedsevereweightloss(>10%ofpresumedormeasuredbodyweight)

2. Unexplainedchronicdiarrhoeaforlongerthanonemonth

3. Unexplainedpersistentfever(above37.6°Cintermittentorconstant,forlongerthanonemonth)

4. Persistentoralcandidiasis

5. Oralhairyleukoplakia

6. Pulmonarytuberculosis(current)

7. Severebacterialinfections(suchaspneumonia,empyema,pyomyositis,boneorjointinfection,meningitis

orbacteraemia)

8. Acutenecrotizingulcerativestomatitis,gingivitisorperiodontitis

9. Unexplainedanaemia(<8g/dl),neutropaenia(<0.5×109perlitre)orchronicthrombocytopaenia(<50×

109perlitre)

ClinicalStage4(Severe)(AIDS)

1. HIVwastingsyndrome

2. Pneumocystispneumonia

3. Recurrentseverebacterialpneumonia

4. Chronicherpessimplexinfection(orolabial,genitaloranorectal

ofmorethanonemonth’sdurationorvisceralatanysite)

41

5. Oesophagealcandidiasis(orcandidiasisoftrachea,bronchiorlungs)

6. Extrapulmonarytuberculosis

7. Kaposi’ssarcoma

8. Cytomegalovirusinfection(retinitisorinfectionofotherorgans)

9. Centralnervoussystemtoxoplasmosis

10. HIVencephalopathy

11. Extrapulmonarycryptococcosisincludingmeningitis

12. Disseminatednon‐tuberculousmycobacterialinfection

13. Progressivemultifocalleukoencephalopathy

14. Chroniccryptosporidiosis(withdiarrhoed)

15. Chronicisosporiasis

16. Disseminatedmycosis(coccidiomycosisorhistoplasmosis)

17. Recurrentnon‐typhoidalSalmonellabacteraemia

18. Lymphoma(cerebralorB‐cellnon‐Hodgkin)orothersolidHIV‐associatedtumours

19. Invasivecervicalcarcinoma

20. Atypicaldisseminatedleishmaniasis

21. SymptomaticHIV‐associatednephropathyorsymptomaticHIV‐associatedcardiomyopathy

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AppendixA2:WHOclinicalstagingofHIVinfectionforchildrenwithconfirmedHIVinfectionClinicalstage1AsymptomaticPersistentgeneralizedlymphadenopathyClinicalstage2

Unexplainedpersistenthepatosplenomegaly Papularpruriticeruptions Fungalnailinfection Angularcheilitis Linealgingivalerythema Extensivewartvirusinfection Extensivemolluscumcontagiosum Recurrentoralulcerations Unexplainedpersistentparotidenlargement Herpeszoster Recurrentorchronicupperrespiratorytractinfections (otitismedia,otorrhoea,sinusitisortonsillitis)

Clinicalstage3

Unexplainedimoderatemalnutritionorwastingnotadequatelyrespondingtostandardtherapy Unexplainedpersistentdiarrhoea(14daysormore) Unexplainedpersistentfever(above37.5°Cintermittentorconstant,orlongerthanonemonth) Persistentoralcandidiasis(afterfirst6–8weeksoflife) Oralhairyleukoplakia Acutenecrotizingulcerativegingivitisorperiodontitis Lymphnodetuberculosis Pulmonarytuberculosis Severerecurrentbacterialpneumonia Symptomaticlymphoidinterstitialpneumonitis ChronicHIV‐associatedlungdiseaseincludingbrochiectasis Unexplainedanaemia(<8g/dl),neutropaenia(<0.5×109perlitre)andorchronicthrombocytopaenia

(<50×109perlitre)iUnexplainedreferstowheretheconditionisnotexplainedbyothercauses.Clinicalstage4*

Unexplainediseverewasting,stuntingorseveremalnutritionnotresponding tostandardtherapy Pneumocystispneumonia

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Recurrentseverebacterialinfections(suchasempyema,pyomyositis,boneorjointinfectionormeningitisbutexcludingpneumonia)

Chronicherpessimplexinfection(orolabialorcutaneousofmorethanonemonth’sdurationorvisceralatanysite)

Oesophagealcandidiasis(orcandidiasisoftrachea,bronchiorlungs) Extrapulmonarytuberculosis Kaposisarcoma Cytomegalovirusinfection:retinitisorcytomegalovirusinfectionaffectinganotherorgan,withonsetatage

olderthanonemonth Centralnervoussystemtoxoplasmosis(afteronemonthoflife) Extrapulmonarycryptococcosis(includingmeningitis) HIVencephalopathy Disseminatedendemicmycosis(coccidiomycosisorhistoplasmosis) Disseminatednon‐tuberculousmycobacterialinfection Chroniccryptosporidiosis(withdiarrhoed) Chronicisosporiasis CerebralorB‐cellnon‐Hodgkinlymphoma Progressivemultifocalleukoencephalopathy SymptomaticHIV‐associatednephropathyorHIV‐associatedcardiomyopathy

*Someadditionalspecificconditionscanalsobeincludedinregionalclassifications(suchasreactivationofAmericantrypanosomiasis[meningoencephalitisand/ormyocarditis]intheWHORegionoftheAmericas,disseminatedpenicilliosisinAsiaandHIV‐associatedrectovaginalfistulainAfrica).

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AppendixB:GuideforConstructingthePUIDontheHIVCaseSurveillanceForm(HCSF)

IntroductiontoUsers

WearerequiringtheuseofaguidetocollectboththeinformationtocreatethePUIDaswellastocollectalloftheinformationrequiredfromtheclienttocompletetheHCSF.

Textinboxescontainsnotestothepersonreadingtheguide.Theremainingtextiswhatistobeaskedoftheclient/patient.

AllquestionsaretobeaskedofallclientswhotestpositiveforHIV,maleandfemale.

BeginHere

WetestforHIVbycreatingacode,notbyusingyourname.InordertoaccuratelycountthenumberofHIVcasesinGuyanaweneedtomakesurethatpeoplearenotcountedmorethanonce.Inordertodothiswecreateacodeforyouthatshouldbeuniqueandbethesameanytimeyoucometogettested.

Iwillnotbeaskingyournamebutneedyourhelpincreatinganaccuratecode.

Ineedthefirstinitialofyourfirstnameandfirstinitialofyourlastname.

Forexample,mynameis[nameoftester]JaneSmith–sothefirstinitialofmyfirstnameisJandthefirstinitialofmylastnameisS.

Thinkingofthenameyouweregivenatbirthandthefirstandsurname(maidennameforwomen)thatareonyourbirthcertificate(nonicknamesormarriednames).

1) Whatisthefirstinitialofyourfirstname?

2) Whatisthefirstinitialofyourmaidennameorsurname?

If you think the patient seems confused you can say:

If patient is a married woman and seems concerned or offended by not using her married name explain that we

are using the name on the birth certificate because it doesn’t change and aids in consistency. You can reassure

her in whatever way seems appropriate. For example, telling her that you are not telling her not to use her

married name; this request is only to aid in constructing a code.

If patient does not have a birth certificate and/or does not know what is on it they may use their national ID

card. Let them know they are to use it each time they are asked the first initials of their first name and

surname.

No married names unless using ID card and then can use whatever last name is on it

If only one name is known use a 9 to replace the unknown initial (either first or last)

If more than one first name use the first name listed

If more than one last name use the first last name listed

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3) Whatsexisonyourbirthcertificate?

4) Whatisyourdateofbirth?

• For days less than 10 include 0 before the number (for example, 01 for January)

• If day is unknown use 99

• If month is unknown use 99

• If year is unknown use 9999

• Record whatever sex the person says is on their birth certificate even if s/he appears to be a different sex.

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AppendixC:HIVCaseSurveillanceForm(HCSF)

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AppendixD:HCSFCompletionProcedures

HIVCaseSurveillanceFormCompletionProceduresTheseproceduresareforanyonecompletingtheHIVcasesurveillanceform(HCSF)forreportingorupdatingacaseofHIV.ThereareeightmandatoryvariablesthatmustbecompletedforMoHtocountthecaseofHIV.Thesearelistedbelow.However,itisexpectedthatallvariableswillbecompletedbypersonsreportingorupdatingacaseofHIV.Thesevariablesarelistedonthetablebelow.

MandatoryVariables

Firstinitialofpatient’sfirstnameFirstinitialofpatient’slastnameSexDateofBirthRegionofpatient/clientresidenceatdiagnosisResultofHIVtestsDateofHIVdiagnosisdefinedastestdateoffirstpositiveHIVtestDateofdeath,ifapplicable

PatientsareidentifiedintheHIVcasesurveillancesystembyapatientuniqueidentifier(PUID)thatisconstructedusingthefirstinitialofthepatient’sfirstname,firstinitialofpatient’slastname,sexanddateofbirth(DD/MM/YYYY).BecausethePUIDisusedtodifferentiatebetweendifferentpeopleandtheintegrityoftheentirereportingsystemdependsoncountingeachcaseonlyonetimeitiscriticalthatthesefourvariablesandthePUIDbeconstructedasconsistentlyaspossible.Inordertodothateachclientisaskedtorefertothename,sexanddateofbirthonhis/herbirthcertificate.Ifpatientdoesnothaveabirthcertificateand/ordoesnotknowwhatisonittheymayusetheirnationalIDcard.AguideisprovidedinAppendixBoftheSOPwithquestionsthataretobeaskedoftheclientseverytimeaPUIDisbeingconstructed.Inordertoincreasethelikelihoodthatthisinformationwillbeusedconsistentlyregulartrainingonusingtheguide,includingroleplaysareconductedannually,socounselorscanpracticeintegratingthequestionsintothecounselingsession.

Regardlessofwhichnameisusedthereshouldbenoblanksinthenameinitialfieldsandtheseinitialsmustbelegible.SexasitappearsonthebirthcertificateshouldberecordedontheHCSF,regardlessofhowthepatientpresentshim/herself.ThereshouldbenoblanksintheSexfield.

DateofBirthisasitappearsonthebirthcertificate.ThereshouldbenoblanksintheDateofBirthFieldsandalldigitsmustbelegible:

i. Fordayslessthan10include0beforethenumber(forexample,01forJanuary)ii. Ifdayisunknownuse99iii. Ifmonthisunknownuse99iv. Ifyearisunknownuse9999

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I.PATIENTINFORMATION


Firstnameinitial FirstInitialofpatient’sfirstname(usingthenameonthebirthcertificate).Ifinitialisunknownreplacewitha9

Lastnameinitial FirstInitialofpatient’slastname(usingthenameonthebirthcertificate,nomarriednamesornicknames;forwomenaskformaidenname;ifmorethanonelastnameusethefirstlastname).Ifinitialisunknownreplacewitha9

Sex Sexas itappearson thebirthcertificate, regardlessofhowthepatientpresentshim/herself

DateofBirth CalendarDay(DD),Month(MM),andYear(YYYY)whenthepatientwasbornasrecordedonthebirthcertificate(using9sforanyorallportionsofthedateofbirththatareunknown)

IfFemale,Pregnant Ifpatientisfemale,isshepregnant?

PatientUniqueIdentifier(PUID)

PUIDwith11characters:initialoffirstname,initialoflastname,sex(M/F),anddateofbirth(DD,MM,YYYY).Thisincludesusingthe#9forunknownvaluesasdescribedintheinitial,sexanddateofbirthboxesabove.

Testingpurpose IdentifywhetherthisreportisaninitialHIVdiagnosis,anAdvancedHIVdiagnosisoranAIDSdeathnotification.Iftheinitialdiagnosisismadeatanadvancedstage,checkbothboxes.AIDSdeathnotificationincludesalldeathsamongpersonswithAIDS.Actualcauseofdeathshouldbewrittenintherighthandmarginoftheform.

Ifdead,dateofdeath CalendarDay(DD),Month(MM),andYear(YYYY)whenthepatientdied(using9sforanyorallportionsofthedateofdeaththatareunknown)

Street Nameofstreetwherepatientresidesmostofthetimeatthetimeofthisreport

City/Town/Village Nameofcity/town/villagewherepatientresidesmostofthetimeatthetimeofthisreport

Regionno. Regionallocationofthecity/town/village(region1‐10)ofresidenceatthetimeofthisreport

Ethnicity Patient’sself‐reportingethnicity:Afro‐Guyanese,Amerindian,Chinese,Info‐Guyanese,Portuguese,Mixed,orOtherorRefused.CHECKONLYONE

EmploymentStatus Currentstatusofemployment:employed,unemployed,student,refused.Ifemployed,stateoccupation.Employedincludesparttimeaswellasfulltimework.Forclientsthatarebothemployed

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andstudents,checkboth.

II.EXPOSURECATEGORIES:AllapplicableexposurecategoriesarerecordedontheHIVcasesurveillanceform.Anexposurecategoryischeckedifthepatientacknowledgesthathe/sheengagedinthatactivityatleastoncebeforethefirstHIV‐positivetestresult.Thecategoriesareasfollows:


Sexwithmale Patienthadanal,oral,orvaginalsexwithamale

Sexwithfemale Patienthadanal,oral,orvaginalsexwithafemale

Sexwithcommercialsexworker

Patienthadanal,oral,orvaginalsexwithmaleorfemalesexworker

SexwithanHIVinfectedperson

Patienthadanal,oral,orvaginalsexwithapersonwhoisinfectedwithHIV.TheydonotneedtohaveknownthatthesexpartnerwasHIV‐infectedatthetimetheyhadsex–onlythatpatientcanreportthattheyhadsexwithanHIV‐infectedpersonatthetimeofHCSFcompletion.

Beenacommercialsexworker

Patienthasexchangedsextoreceivemoneyorothermaterialgoods

Sharedneedleswhenusingdrugs

Patientreportedsharingneedleswheninjectingdrugs

Sexwithmultiplepartners

Patienthadanal,oral,orvaginalsexwithmultiplepartnersinthepastyear

Receivedbloodtransfusionorbloodcomponents

Patientreportedbeingarecipientofbloodtransfusionorbloodcomponent

Receivedtransplantoftissueororganorartificialinsemination

Patientreportedhavingreceivedtransplantoftissueororgan,orhadanartificialinsemination

Occupationalexposureinhealthcaresettingorlaboratory

Patientreportedhavingbeenexposedtoblood/bloodcomponentswhileperforminghis/herjobinahealthcaresettingorlaboratory

PerinatalexposuretoHIV

PatienthadbeenexposedtoHIVthroughmother‐to‐childtransmission(borntoaHIV+mother)

Beenavictimofsexualassault

Patientreportedbeingavictimofsexualassault

Unknown Patientdoesnotreporthowtheywereexposed.ITSHOULDNOTBECHECKEDBYTHEPERSONCOMPLETINGTHE

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FORM.ThisoptionisselectedbyMoHifallotheroptionsareblank.

III.HIVTESTRESULTS

Nameoftest Nameoftestkitused.Examplesinclude:

HIVrapidtests:Determine,UniGold,Stat‐Pack

HIVDNAPCR

ELISA:MurexHIV

WesternBlot

Testtype TypeoftestusedforHIVdiagnosis,whichincludes:

Antibodytest:Rapidtest,Enzyme‐linkedimmunosorbentassay(ELISA),Westernblot

Virologytest:HIVDNAPCR(forchildrenlessthan18monthsold)

Result HIVtestresult:positive(pos),negative(neg),indeterminate(ind)

Testdate DateofHIVtest:calendarday(DD),month(MM),andyear(YYYY).Ifspecimencollectiondateisdifferentfromdatetestwasrun,recordspecimencollectiondate

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IV.CLINICALINFORMATIONONADVANCEDHIV(forclinicalpractitioneruseonly)

PresentingCD4Count/percent

ThisvariabledoesnotexistontheHCSF.TheonlyCD4resultsrequestedontheformarethetworowsbelow.However,atclinicalsitesstaffaredirectedtoreportthefirstCD4count/percent(“presentingCD4”).Theycanusethe“CD4countbelow350µl”boxforcasesage5andolderorthe“%CD4below30”boxforcasesbelowage5torecordthisdata.Thereforeifpatientisage5orolderplacepresentingCD4countinthe“CD4countbelow350µL”fieldregardlessofthevalueoftheresult(i.e.,regardlessoftheactualnumber).Ifpatientisbelowage5placepresentingCD4percentinthe“CD4percentbelow30”fieldregardlessofthevalueoftheresult(i.e.,regardlessoftheactualnumber).

CD4Countbelow350µL(≥5yearsold)

CD4+lymphocyte(CD4cells)countbelow350cells/µLisamakerforadvancedHIVinfectionamongpatientsaged5yearsandolder.RecordtheexactCD4countresultifbelow350cells/µL

%CD4below30(<5yearsold)

PercentCD4below30%isamarkerfordeterminingadvancedHIVinfectionamongpatientslessthan5yearsofage.Recordthe%ofCD4below30

TestDate DateoftestforCD4count:calendarday(DD),month(MM),year(YYYY).Ifspecimencollectiondateisdifferentfromdatetestwasrunrecordspecimencollectiondate

Stageofdisease(Stage3orStage4)

TheStage3orStage4boxistickedbasedonwhichcriteriathepatientmeets.Thestagingcriteriamaybemetbyeitherclinicalorimmunologiccriteria.ClinicalcriteriaarelistedinAppendicesA1andA2intheSOP.Forimmunologicstagingcriteriasee:WHOimmunologiccriteriafortheseStagesintheTable“WHOimmunologicalclassificationforestablishedHIVinfection”foundinSectionIVoftheHCSF.

Dateofstagediagnosis RecorddateofCD4percentorcountthatcorrespondstothestagecheckedabove:calendarday(DD),month(MM),year(YYYY)

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V.REPORTINGFACILITYINFORMATION

FacilityName Nameofthefacilitywherethecaseisreported

FacilityType Typeofthefacilitywherethecaseisreported,including:PMTCTclinic,privatehospital,publichospital,privatehealthclinic,publichealthclinic,TBclinic,VCTsites,andother

Region Regionallocationofthereportingfacility(regions1‐10)

Dateformcompleted Datewhenthecasereportformiscompletedatthefacility:calendarday(DD),month(MM),year(YYYY).Ifformisstartedononedayandcompletedonadifferentdayusethelatestdate

Formcompletedby Nameofstaffwhocompletestheform

VI.MOHUSEONLY(onlyapplicableforMOHstaff)

Typeofreport DetermineifthecasereportedisanewcaseoranupdatebysearchingforthePUIDintheelectronicdatabaseusingproceduresoutlinedinHCSFSecondaryReviewProcedures.Ifacaseisdeterminedtohavealreadybeenreportedinthedatabase,check“update”.Otherwise,check“new”

Receiveddate DateoftheformreceivedattheStatisticalUnitoftheMOH:calendarday(DD),month(MM),year(YYYY)

Entereddate Dateofdataentryintotheelectronicdatabase:calendarday(DD),month(MM),year(YYYY)

Recordno. Anautomatednumbergeneratedfromtheelectronicdatabase.AfterthedatabasegeneratesthisnumberdataentryshouldrecorditontheHCSF

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AppendixE:HCSFInitialReviewProcedures

QualityCheckProcessforInitialReviewofHIVCaseSurveillanceForms(HCSF)byNAPSandMoHPMTCTStaffTheprimarypurposeofthequalitycheckprocessforinitialreviewoftheHIVcasesurveillanceforms(HCSF)istoensurethatthedatareceivedfrompersonswhocompletetheformsisasaccurateandcompleteaspossiblesothatthedataenteredintotheHIVelectronicdatabaseisalsoasaccurateandcompleteaspossible.ThedatawillbeusedtoplanforHIVpreventionandcareinthecountrysothesequalitychecksareacriticalpartofGuyana’sHIVsurveillancesystem.Stafftaskedwiththeseinitialreviewprocedureshave(orshouldestablish)relationshipswiththepersonscompletingtheforms.Thisprocessprovidestheopportunityforfeedbacktothosecompletingtheformssothaterrorscanbefoundassoonafterformcompletionaspossibleandcorrectedtoavoidfutureerrors.Thisprocessispartofthesystemscontinuousqualityimprovement.Thefollowingarethestepsforthequalitychecks:

1. WhenMoHorNAPSstaffreceiveinitialorupdatedHCSFsfromanyreportingsite(VCT,PMTCT,C&T,laboratories,privatehospitalsorotherproviders/testers)theywritethedateofreceiptinthelefthandmarginoftheHCSFandinitial.

2. Ensurethatthenomandatoryvariablefieldsareblank:a. Firstinitialofpatient’sfirstnameandfirstinitialofpatient’slastnameusingthenameonthebirth

certificate(nomarriednameornicknames).Ifpatientdoesnothaveabirthcertificateand/ordoesnotknowwhatisonittheymayusetheirnationalIDcard.Regardlessofwhichisusedthereshouldbenoblanksinthenameinitialfieldsandtheseinitialsmustbelegible.Ifthereisanydoubtaboutthelegibilityoftheinitials,contactthepersonwhocompletedtheformforconfirmation.

i. Ifonlyonenameisknownpersonscompletingformshavebeeninstructedtousea9toreplacetheunknowninitial(eitherfirstorlast)

b. Sexasitappearsonthebirthcertificate,regardlessofhowthepatientpresentshim/herself.ThereshouldbenoblanksintheSexfield.

c. DateofBirthasitappearsonthebirthcertificate.ThereshouldbenoblanksintheDateofBirthFieldsandalldigitsmustbelegible:

i. Fordayslessthan10include0beforethenumber(forexample,01forJanuary)ii. Ifdayisunknownuse99iii. Ifmonthisunknownuse99iv. Ifyearisunknownuse9999

d. Regionofpatient/clientresidenceatdiagnosise. ResultofHIVtests(bothinitialandconfirmatorytests)f. DateofHIVdiagnosis‐i.e.,testdateoffirstpositiveHIVtestg. Dateofdeath,ifapplicable

3. Identifymissing,questionable,orincompletevariables,andfollowupwiththepersonwhocompletedtheformtoobtainmissingvariables,asneeded.Examplesoftheseinclude:

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a. DateofbirthorothervariablethatmakesupthePUIDismissingb. PUIDwasnotconstructedproperlyc. Arethereobviouserrorssuchas:

i. Apregnantmale?ii. Arepeople120yearsold?iii. WerepeoplediagnosedwithHIVin1958?iv. DopeoplehavenegativeCD4values?v. Aretwoormoredatefieldsidenticalthatarenotlikelytobethesame?Forexample,dateof

birthmatchesdateofHIVpositivetestanditisnotaninfantvi. Casesthatarereportedasdeadbutdonothaveadateofdeath,vii. Missingvariablessuchasraceandlackofevenminimalpatientaddress(i.e.,allthree

addressfieldsareblank)d. Dothedatalook/feelcorrect?Aretheresultswithinnormalranges?

i. N/Ashouldnotbewritteninaresultsfieldii. ‘blank’iii. CD4>1000

e. EnsureRegionofpatientresidenceandRegionofreportingfacilityanumberbetween1and10(inclusive)?

4. Ensureallinformationthathasbeenwrittenintotheopentextfieldsarelegible.Thesefieldsare:

f. Patientresidencefields:Street,City/town/village,Region,(notethatwhileRegionisamandatoryfield,patientstreetandcity/town/villagearenotrequiredfields.However,allcompletedfieldsmustbelegible);

g. Occupation;h. NameofHIVTest;i. FacilityName;andj. Nameofpersonreporting.

5. The number of reports that do not meet the minimum case requirements (i.e., have all themandatory

variables completed, as listed above) shouldbe reviewedand reported to theNAPSandMoHunits thatreceivetheHCSFsfromthetestingandcaresitesattheendofeachmonth.Theproportionofcasesthatdonotmeet theminimum case requirements should be calculated for each facility and region in order toprovidefeedbacktotheappropriateprogram.

6. Returnformswithmissing,questionable,orincompletevariablestotheepidemiologicalnursesforfollowupwithlaboratoriesandanyotherhealthcareprovidersfromwhomtheyobtainedtheforms,asneeded.

7. VCT,C&TorPMTCTstaffchargedwithreviewingtheHCSFfollow‐upwithclinicalstaff,viaphone,toclarifyquestionabledataortopopulatemissingmandatoryfields.

8. Onceyoucompletethisinitialreview,submittheformstoMoHSurveillanceUnitstaffforsecondaryreviewandfordeliverytodataentry.

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AppendixF:HCSFSecondaryReviewProcedures

ProcessforSecondaryReviewofHIVCaseSurveillanceForms(HCSF)‐MoHSurveillanceUnitStaff

TheprimarypurposeofthesecondaryreviewoftheHCSFsistokeepduplicatereportstoanabsoluteminimum.UsingtheelectronicdatabaseMoHSurveillanceUnitstaffdetermineifanewcaseisactuallynewtothesurveillancesystemDeterminingpotentialduplicatesisamajorareaofreviewbecausetheintegrityoftheentirereportingsystemrestsonbeingabletodistinguishuniquecasesfromeachother.

StepsintheSecondaryReviewoftheHCSF

1. DateofReceipt‐‐WhenMoHSurveillanceUnitstafffirstreceiveHCSFsthathavebeenreviewedbyMoHPMTCTstafforNAPSVCTorC&TstafftheywritethedateofreceiptinthelefthandmarginoftheHCSFandinitial.

2. DeterminePotentialDuplicates:

a. If the case is not found and it is determined that this report is a new case the Surveillance Officer

assigns a new Case Number. Case numbers are maintained in a log book, located in the Surveillance

Unit. See below for how the numbers are assigned and how the log book is used. The Surveillance

Officers should select a case number from the log book and write it on the HCSF, in the top margin, thenwritethePUIDnexttothecorrespondingcasenumberinthelogbooktoensurethatitisnotusedagain.Everyuniquecaseneedsacasenumbertodistinguishitfromothercases.

i. WhentwocaseswiththesamePUIDaredeterminedtobedifferentpeopletheymustbeassigneddifferentcasenumbers.Ifthecasealreadyexistsinthedatabase,thentheexistingCaseNumberwillbewrittenontheform.

b. PotentialduplicatesarefoundbycomparingtheHCSFunderreviewwiththosethathavebeenenteredintotheEDB.Examplesofpotentialduplicatesarecasesthat;1)matchondateofbirthandsexbuthavedifferentPUIDsor2)havethesamePUIDanddateofbirth(DOB)butappeartobedifferentpeople(e.g.,samePUIDandDOBbuttestedonthesamedayintwodifferentregionsofthecountry).

i. Toincreasethelikelihoodofidentifyingduplicates,establishmultiplemethodsforsearchingforpotentialmatchesintheelectronicdatabase(EDB).Forexample,isitbesttoenteranexactdateofbirthandgetalistofallmatchesforthatdateordoesthesystemallowfor“fuzzymatches”?Thismeansthatif,forexample,youenterpartofavariablesuchasthedecadeoftheyearofbirthandnotthewholeyearvariable,thedatabasewillreturnalistofallcaseswiththatdecadeofbirthsoausercanscanthelisttofindapotentialmatchwiththecasebeingreviewed.TheSurveillanceUnitwillneedtoplayaroundwiththedatabasetodiscoverthebestwaytoidentifypotentialduplicates.

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3. Iftwocasesmatchon1)PUID,2)dateofbirth3)reportingsiteandtestdatetheyareprobablythesameperson.However,lookatotherinformation,suchasregionofresidence,toassistindeterminingwhetherthetwocasesarethesamepersonordifferentpeople.

4. IfaSurveillanceOfficerorotherpersondoingsecondaryreviewdiscoversthattwocasesinthedatabasehavethesameCaseNumberbuttheyhavereasontobelievethattheyaredifferentpeoplethenoneofthemisassignedanewCaseNumber(selectedfromtheCaseNumberLogBook,seebelow).ThenewnumberiswrittenbothontheHCSFandchangedinthedatabaseforALLHCSFformsthathavetheCaseNumberthatmatchesanothercase.Conversely,iftwocaseshavedifferentCaseNumbersbuttheyappeartobethesamepersonthenoneoftheCaseNumbersmustbedeletedsothattheeachHCSFforthissinglepersoncanbeassignedthesameCaseNumber.AllchangesmadeintheEDBarealsochangedontheHCSF,initialedanddated.DonotreusedeletedCaseNumbers,itisapotentialcauseoferrorandthereisnoneedtodoso.

5. OnceitisdeterminedthatthecasebeingreviewedmatchesonealreadyinthedatabasecheckReportTypeinSectionVIoftheHCSFasUpdateandwritetheexistingCaseNumberonthecurrentcase’sHCSF.IfitisdeterminedthattherearenomatchesintheEDBcheckReportTypeinSectionVIoftheHCSFasNewandselectanewCaseNumberfromtheCaseNumberLogBook(seebelow).

AssigningSequentialCaseNumbersUsingtheCaseNumberLogBook

UsingalogbooktoassignCaseNumbersmeansthateither:1)allstaffconductingthistaskmustbeinclosephysicalproximitysothatthelogbookiseasilyaccessibleor2)eachofficewithstaffwhoassignCaseNumbersaregivenaseriestousesothatseparateofficesarenotassignedthesamenumber.Forexample,eachofficethatassignscasenumbershasitsownlogbookandnumberseries.Anexampleofnumberserieswouldbenumbersthatstartwith100,000,200,000,etc.IfthereisonlyonelocationthattheCaseNumbersarebeingassignedthenjustselectastartingnumberandassignthemsequentially.Thelogbookissimplyawaytokeeptrackofwhichnumbershavebeenused.Onceitisdeterminedwhatseriesofnumberstouseandthefirstoneisassignedtheremainingnumbersareassignedsequentially.IfthefirstCaseNumberis500,000,thenextoneis500,001,500,002,etc.Examplesofwaysthesenumbersareassigned/used:

1. If,uponusingthelogbook,oneofthestaffdiscoversthatoneofthesequentialnumberswasmistakenlyskippednocorrectiveactionisneeded.

2. If500,103isassignedtoacaseanditislaterdeterminedthatitisthesamepersonascasenumber500,077thenthenumber500,103isdeletedfromtheforminthedatabaseandnotreused.Thecasethathad500,103assignedhasthenumber500,077enteredintotheEDBasitsCaseNumber.

a. CaseNumber500,054islaterdeterminednottobeHIV‐infected.TheHCSFisdeletedfromthedatabaseandthenumber500,054isnotreused.

Suggestedcolumnheadingsforthelogbookare:

CaseNumber.....PUID....Dateofbirth……..StaffName....DateCaseNumberIssued

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Thereasonsfortheseheadingsare:

1. CaseNumber‐tokeeptrackoftheissuednumberssotheyarenotusedmorethanonce.Thenumbershavenoinherentmeaningsoifoneisskippedthereisnoproblem.It’simportantistouseeachnumberonlyonce.

2. PUIDandDOB‐toidentifywhichpatientisassignedthenumber.ThishelpsifmorethanonepersonisassigningCaseNumbersandtwoformsforthesamepersonarewithtwodifferentstaff.WhengoingtoassignaCaseNumberifthePUIDandDOBarealreadyassignedanumberstaffpersonscanconsultwitheachothertomakesureeachindividualpersonisassignedthesameCaseNumber

3. Staffname‐tobeabletoidentifywhotookaparticularnumberasinthesituationin2)above.

4. DateCaseNumberIssued.

SelectingOccupation

InordertoanalyzetheoccupationvariablealistofoccupationsofinteresthasbeendevelopedbyNAPSandMoH.

Upon secondary review the Surveillance Unit staff select themost appropriate occupation based on what was

writtenontheHCSFandwritethatanywhereintheEmploymentStatusboxontheHCSF.Itwillbeenteredusinga

matchinglistthatisfoundinadropdownmenuintheelectronicdatabase.

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AppendixG:DataEntryProcedures

DataEntryProcedures‐StatisticalUnitDataEntryClerkThepurposeof thedataentryprocedures is toensurethatdataareentered inasystematicwaythatminimizes

errors.DataentryisconductedbytheMoHStatisticalUnitDataEntryClerkassignedandtrainedforthistaskafter

the initial and secondary review processes have been completed. The Data Entry Clerk repeats the search for

duplicatestoconfirmwhatwasfoundduringthesecondaryreviewprocedure(AppendixF).ReasonsthattheData

EntryClerkmightfindaduplicatethatwasnotfoundduringsecondarydatareviewinclude:1)apriorformonthe

patientmayhavebeenawaitingdataentrysotheformwasnotintheEDBatthetimethattheEDBwassearched

forduplicatesduringsecondaryreview,and2)asstaffbecomemorefamiliarwiththeEDBtheymaydeveloptheir

ownmethods of searching for duplicates so the two processes conducted by two different people can produce

differentresults.

1. RecordDateReceivedandEntryDateinSectionVIMOHUSEONLY

2. Checkforduplicatesusingtheelectronicdatabase(EDB).SeeHCSFSecondaryReviewProceduresfor

methodsfordeterminingpotentialduplicates.

3. EntertheHCSFinformationintheEDBasanewcaseifnoexistingrecordforthepatient,orupdatethe

patient’srecordifacasealreadyexist

4. EntereachvariableasitappearsontheHCSFanddirectanyquestionstotheMoHSurveillanceUnit.

5. Once data entry has begun this procedure document should include specific directions for any and all

variablesthatrequiremoredetailedexplanations.Examplesinclude:

o Entering occupation using the information written on the form by those conducting secondary

reviewintheSurveillanceUnitusingadropdownmenu.

o Wheretoenter“presentingCD4count”sinceitisnotspecifiedontheform/EDB

o Wheretoentercauseofdeaththatshouldbewritteninrighthandmarginof formwhenpersons

arebeingreportedashavingdied.

o Whattoenterifmorethanoneraceischecked

o WhattowriteontheHCSFiftheEDBcalculatesaPUIDthatdoesnotmatchtheonewrittenonthe

HCSF.

o WhattodoifthefacilitynamewrittenontheHCSFisnotincludedinthedropdownmenuinthe

EDB

6. RecordtherecordnumbergeneratedbytheelectronicdatabaseinSectionVIMOHUSEONLY.

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7. OncetheHCSFisenteredintothedatabase,storehardcopyinalockedfilecabinetinaroomwithlimited

access.

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AppendixH:MatchingProcedures

ProcessforMatchingofHIVCaseSurveillanceForms(HCSF)

MatchingProcedures

DatabasematchescanefficientlyaddvaluableinformationtotheHIVregistrywithouttheinformationbeingreportedonanHCSFandmanuallyenteredintotheHIVregistry.Thetwomostprominentexamplesarelaboratorydataanddeathinformation.

Iflabdata–CD4andviralloadresults‐canbeelectronicallymatchedtotheHIVregistryandtheresultsuploadedtotheHIVregistry,thesystemprovidesvaluableinformationonproportionofpersonswhopresentforcare,stayincareandtrendsinCD4countandviralloadvalues.Suchanalysescanbefurtherbrokendownbydemographicvariablestohelptargetservices.BecauseGuyanaisusingthePUIDinsteadofname‐basedreporting,itmaybedifficulttoidentifyrecordsatthelaboratoryandconductsuchamatch.

DeathRegistryMatchProcedure

ThepurposeofthismatchistofindouthowmanypeoplelivingwithHIVinGuyanahavedied.ItisonlybydoingthisthatthesurveillancesystemcanaccuratelymeasurehowmanypeoplearelivingwithHIVinthecountry.Withoutconductingthismatchonaregularbasis(e.g.,annuallyoreverytwoyears)surveillancesystemwilloverestimatethenumberoflivingcases.

AssumingthattheinformationfromtheRegistrationofDeathformisinanelectronicdatabaseandusingthesoftwareintheHIVelectronicdatabasethatcreatesthePUID,createthesamePUIDusingtheinformationfromtheRegistrationofDeathform.Thisformasksformaidennamesothesoftwareshouldpullthefirstinitialofthelastnamefromthatfieldforwomen.SinceweareaskingformaidennamewhenthePUIDiscreatedinVCTandothersettingsthiswillincreasethelikelihoodthatthesamePUIDisbeingusedinbothsystems.

OncethePUIDhasbeencreatedfortheyear(s)thatyouwishtomatchwiththeHIVdatabaseyoucanusethePUID,dateofbirthandsextofindthosepersonswithHIVwhohaveadeathregistrationform.ThematchisasoftwareprogramthatidentifiescasesthatareinboththeHIVelectronicdatabaseandthedeathregistry.AlistofcasesidentifiedasinbothdatabasesisproducedthatincludesthePUID,dateofbirthandsex,dateofdeathandallthecauseofdeathinformationavailablefromthedeathregistry.ASurveillanceOfficerreviewsthelisttoconfirmthatthesematchesdorepresentthesameperson.Oncethatisconfirmedtheinformationthatthepersonhasdied,dateofdeathandcause(s)ofdeathisuploadedintotheHIVEDB.Underlyingcausesofdeath(diseaseorconditionleadingdirectlytodeath,antecedentcausesgivingrisetodeathandothersignificantconditionscontributingtodeath)aresearchedforHIV‐relatedassociatedcausesofdeath.ThisgivesaminimumnumberofHIV‐relateddeathsforaparticularyear.

ThismatchisparticularlyimportantforcapturingdeathsamongHIV‐infectedpersonswhoneveraccessedcareordidsoonlysporadicallyand/oratmultiplelocations.

EvaluationoftheDeathRegistryMatch

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Evaluationofthedeathregistrymatchisaccomplishedinatleasttwoways:

1) Selectasampleofdeathsfoundfromthematchthatareamongpeoplewhoattendedcareclinics.NotifytheclinicthatthepatienthasdiedandconfirmthatthepatienthasnotbeenseentheresincethedateofdeathobtainedfromtheRegistrationofDeathform

2) SelectasampleofdeathsfoundfromverbalreportsorHCSFreportsofdeathsandseeifthedeathregistrymatchidentifiedthepersonashavingdiedthatyear.

Thismatchisconductedannuallyandevaluatedthoroughlyusingaslargeanddiverseasampleaspossible.Samplediversityisbasedondifferentregionsofthecountryanddifferentsitesofdeath.

Documents

Guyana HIV Case Surveillance System - NASTAD · Additionally, this SOP is intended for use by National AIDS Programme Secretariat (NAPS) staff, Ministry of Health (MoH) Statistical