Epidemiological analysis of the quality of HIV sero-surveillance in the world: how well do we track the epidemic?

Objective: The objective of this paper was to analyse the quality of HIV/AI DS sentinel surveillance systems in countries and the resulting quality of the data used to make estimates of HIV/AIDS prevalence and mortality. Methods: Available data on sero-surveillance of HIV/AIDS in countries were compiled in the process of making the end of 1999 estimates of HIV/AIDS. Th ese data came primarily from the HIV/AIDS Surveillance Database developed b y the United States Census Bureau, from a database maintained by the Europe an Centre for the Epidemiological Monitoring of AIDS and all country report s on sentinel surveillance that had been provided to World Health Organizat ion or UNAIDS. Procedures were developed to score quality of surveillance s ystems based on four dimensions of quality: timeliness and frequency; appro priateness of groups; consistency of sites over time; and coverage provided by the system. In total, the surveillance systems from 167 countries were analysed. Results: Forty-seven of the 167 countries whose surveillance systems were r ated were judged to have fully implemented sentinel surveillance systems; 5 1 were judged to have systems that had some or most aspects of a good HIV s urveillance system in place and 69 were rated as having poorly functioning or non-existent surveillance systems. Conclusion: This analysis suggests that the quality of HIV surveillance var ies considerably. The majority of countries most affected by HIV/AIDS have systems that are providing sufficient sero-prevalence data for tracking the epidemic and making reasonable estimates of HIV prevalence. However, many countries have poor systems and strengthening these is an urgent priority. (C) 2001 Lippincott Williams & Wilkins.