Pakistan is going through a transition of the HIV epidemic to a concentrated epidemic from a low prevalence state. The condition of HIV is defined to be AIDS (acquired immunodeficiency syndrome. It occurs due to the exposure with infection known as HIV (human immunodeficiency virus). The problem of AIDS IS particularly increasing in Pakistan since last five to six years. The number of infected persons in Pakistan is supposed to be present in large numbers and can be identified if proper screening will be conducted. There are several factors that are responsible for increasing incidence of AIDS in Pakistan and behaviours of people is one of the common factors. Curiosity about drugs and sex, economic frustration and negative peer pressure are some of behaviours that are conductive to the spread of HIV infection. According to the UNAIDS (2016), 130000 are people are living with AIDS in Pakistan as compared to the almost 100000 in 2012. Though, the estimated prevalence in the general population of Pakistan is lower than 0.1 percent. However, the recent health surveys show that that the epidemic of HIV is started to establish among several groups of people. According to the study conducted by the Institute for Health Metrics and Evaluation (IHME), in Pakistan from 2000 to 2013 there is 11% increase in mortality rate from AIDS/HIV. Increase in incidences of HIV has been increased from less than 1 case/100000 in 1990 to 6.7 cases/100000 in 2013.
Both private and government sector including NGO’s have shown commitment and involvement in responding to the situation of increasing prevalence of HIV in Pakistan. Surveillance can play a significant role in this situation. By utilizing different methods, information can be collected from various subgroups, which is very important to create awareness about the patterns and trends of the spread of HIV and risk behaviours. It can help in planning for care and prevention services. The surveillance conducted in HIV can also provide technical assistance to the prevention and control programs of AIDS such as national AIDS program by identifying high risk groups and population and evaluating the effectiveness of current HIV prevention programs.
Objectives of HIV/AIDS surveillance
- To measure the extent of the HIV epidemic and the distribution of infection in the time and space.
- To recognize groups that are vulnerable to HIV and to develop a plan of action to decrease the risk of HIV.
- To help in the formation of policies and allocation of resources for the HIV prevention programs.
- To assess the effectiveness of the current prevention programs related to the HIV.
Challenges to HIV/AIDS surveillance
Three major features that make the HIV surveillance little difficult. Firstly, its long period of incubation, the complex socio-economic, behavioural and biological causation of the epidemic. Lastly, severe consequences that can be faced by individual with positive HIV test results.
The case surveillance data of the HIV include the information on the demographic characteristics of participants such as the place of diagnosis, age, race or ethnicity and Sex. Moreover, data related to viral load, initial immune status and mode of exposure or transmission category will also be collected.
Moreover, activities related to the case surveillance of HIV permit jurisdiction to assess the progression of HIV disease along with the utilization of health care services with the help of continuous data collection on laboratory test results (CD4 counts and viral load), opportunistic illnesses and infections and viral status.
Case Definition for the Surveillance purposes
According to the WHO, HIV is defined as the presence of HIV antibodies that are detected with the help of serological test with or without taking confirmation via the second test. The strategy use to identify the prevalence of HIV is dependent on resources for the testing of HIV, and the performance of particular HIV tests in the country where surveillance is conducted. For the purpose of diagnosis, it is necessary that their second test will also confirm their positive test results.
BSS data provide information on the proportion of the sentinel population engaging in the behaviour of interest. Those proportions may change over time. Simple statistics should be used to rule out apparent trends that are due to chance variation. Statistical techniques to determine whether changes over time are significant include the standard chi square analysis, chi square analysis for trend, test for difference in proportions and multiple regression analysis