If you run an HIV program, you need to know who is getting infected, who is dying, and whether your work is helping. A new review of HIV surveillance in five countries in sub-Saharan Africa (Ghana, Kenya, Lesotho, Malawi, and Zimbabwe) found that the way countries measure the epidemic looks very different from place to place.
The review looked at 66 documents. Each country uses between 80 and 103 HIV indicators, which are the specific things a country tracks to follow the epidemic and its programs. But how many of those indicators cover integrated services and non-biomedical measures like stigma and knowledge ranged from 22.8% in Ghana to 64.1% in Lesotho.
When it came to measuring new infections and deaths, countries relied mostly on mathematical modeling. And some specific surveillance activities, such as community or facility-based mortality tracking, drug resistance surveys, and bio-behavioral surveys, were only partially implemented or not documented at all.
This is a narrative review, not a trial, so it cannot tell us whether any approach works better than another. The authors note that implementation of reported surveillance activities was inconsistent. Still, they suggest countries could reassess whether their current indicators fit their needs and streamline them to estimate HIV burden more efficiently.
Common questions
How many HIV indicators does each country use?
The review found that each of the five countries uses between 80 and 103 HIV indicators. These are the specific measures a country tracks to follow the HIV epidemic and the impact of its programs. The number alone does not tell you whether the indicators are the right ones, which is part of what the authors question.
What share of indicators cover stigma or integrated services?
It varies a lot. The proportion of indicators for integrated services and non-biomedical measures like stigma and knowledge ranged from 22.8% (21 of 92) in Ghana to 64.1% (66 of 103) in Lesotho. That wide range suggests countries are not measuring the same things in the same way.
How do these countries measure new HIV infections and deaths?
The review reports that they relied predominantly on mathematical modeling for measuring incidence (new infections) and mortality (deaths). Some specific activities, such as community or facility-based mortality tracking, drug resistance surveys, and bio-behavioral surveys, were only partially implemented or not documented.
Does this review say which surveillance approach is best?
No. This is a narrative review, and it did not compare approaches to see which works better. It describes what countries report and notes that implementation of surveillance activities was inconsistent. The authors suggest countries could reassess their current indicators and streamline them to estimate HIV burden more efficiently.
