Filling a gap: HIV pediatric surveillance in resource contrained settings

Abstract

ABSTRACT: Objectives and Background: While HIV surveillance systems have seen marked improvements in recent years, advances in pediatric surveillance have been limited. HIV prevalence data among children and youth are scarce, hindering prevention, care and treatment programs for these populations. Methods: This paper provides a review of approaches to pediatric HIV surveillance as discussed in March 2009 at the 2nd Global HIV/AIDS Surveillance Meeting in Bangkok, Thailand. Discussion: Pediatric HIV surveillance systems that incorporate data collection on risk factors and HIV prevalence should be established at the country level. A well-functioning case reporting system is ideal; however, this may not be possible in resource-constrained settings. Additional approaches to pediatric HIV surveillance include case-based reporting linked to prevention of mother to child transmission (PMTCT) or early infant diagnosis (EID) programs, population-based household surveys to provide prevalence and behavioral data, testing conducted at immunization clinic visits, and mortality surveillance through methods such as verbal autopsies. In addition, special surveys such as pediatric inpatient surveys, school-based surveys and out-of-school youth surveys may be incorporated to target specific groups for surveillance. Other data sources that may be considered include treatment, tuberculosis (TB), voluntary counseling and testing (VCT), and sexually transmitted infection (STI) registries. Conclusions: Pediatric HIV surveillance is necessary for understanding pediatric needs, improving adherence to international guidelines on HIV diagnoses and treatment of children, and monitoring the impact of intervention programs. As with any surveillance methodology, each approach to pediatric surveillance should be considered in light of available capacity and resources for implementation, sustainability, and limitations.