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Advances and future directions in HIV surveillance in low- and middle-income countries

Diaz, Theresaa; Garcia-Calleja, Jesus Mb; Ghys, Peter Dc; Sabin, Keitha

Current Opinion in HIV and AIDS: July 2009 - Volume 4 - Issue 4 - p 253–259
doi: 10.1097/COH.0b013e32832c1898
Epidemiology: Edited by Tim Mastro and Quarraisha Abdool-Karim

Purpose of review To present recent advances in HIV/AIDS surveillance methods in low- and middle-income countries.

Recent findings From 2001 to 2008, 30 low- and middle-income countries implemented national population-based surveys with HIV testing. Antenatal clinic HIV sentinel surveillance sites in sub-Saharan Africa increased from just over 1000 in 2003–2004 to almost 2500 in 2005–2006, becoming more representative of rural areas. Between 2003 and 2007, at least 122 behavioral surveys in low- and middle-income countries used respondent-driven sampling for surveillance among high-risk populations, although many countries with concentrated epidemics continue to have major sentinel surveillance gaps. Improvements have been made in modeling estimates of number of persons HIV infected, and systems are now in place to measure HIV drug resistance. However, the reliable monitoring of trends and the measuring of HIV incidence, morbidity, and mortality is still a challenge.

Summary In the past 5 years, there have been substantial improvements in the quantity and quality of HIV surveillance studies, especially in the countries with high prevalence. Further efforts should be made in countries that lack fully implemented surveillance systems to improve HIV incidence, morbidity, and mortality surveillance and to use data more effectively.

aCenters for Disease Control, National Center for HIV, Hepatitis, STD, and TB Prevention, Global AIDS Program, Atlanta, Georgia, USA

bWorld Health Organization, Switzerland

cJoint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland

Correspondence to Theresa Diaz, MD, MPH, Centers for Disease Control and Prevention, Global AIDS Program, MS E-30, 1600 Clifton Road Atlanta, GA 30033, USA Tel: +1 404 639 6312; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.