title: Strengthening HIV surveillance: measurements to track the epidemic in real time.
abstract: Surveillance for HIV as a public health initiative requires timely, detailed and robust data to systematically understand burden of infection, transmission patterns, direct prevention efforts, guide funding, identify new infections and predict future trends in the epidemic. The methods for HIV surveillance have evolved to reliably track the epidemic and identify new infections in real time. Initially HIV surveillance relied primarily on the reporting of AIDS cases followed by measuring antibodies to HIV to determine prevalence in key populations. With the roll-out of antiretroviral therapy (ART) resulting in better survival and the corresponding increase in HIV prevalence, the landscape of surveillance shifted further to track HIV prevalence and incidence within the context of programmes. Recent developments in laboratory assays that potentially measure and differentiate recent versus established HIV infection offer a cost-effective method for the rapid estimation of HIV incidence. These tests continue to be validated and are increasingly useful in informing the status of the epidemic in real time. Surveillance of heterogeneity of infections contributing to sub-epidemics requires methods to identify affected populations, density, key geographical locations and phylogenetically linked or clustered infections. Such methods could provide a nuanced understanding of the epidemic and prioritise prevention efforts to those most vulnerable. This paper brings together recent developments and challenges facing HIV surveillance, together with the application of newer assays and methods to fast-track the HIV prevention and treatment response.
authors.affiliation: a Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine , University of KwaZulu-Natal , Durban , South Africa.
authors.forename: Usangiphile E
authors.initials: UE
authors.lastname: Buthelezi
authors.affiliation: a Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine , University of KwaZulu-Natal , Durban , South Africa.
authors.forename: Candace L
authors.initials: CL
authors.lastname: Davidson
authors.affiliation: a Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine , University of KwaZulu-Natal , Durban , South Africa.
authors.forename: Ayesha Bm
authors.initials: AB
authors.lastname: Kharsany
mesh_terms: D000293:Adolescent; D001681:Biological Assay; D018563:Disease Notification / Q000706:statistics & numerical data; D058872:Epidemics; D005260:Female; D015483:HIV Antibodies / Q000097:blood*; D015658:HIV Infections / Q000097:blood / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D015994:Incidence; D008297:Male; D015233:Models, Statistical; D011247:Pregnancy; D015995:Prevalence; D062486:Public Health Surveillance / Q000379:methods*; D012367:RNA, Viral / Q000097:blood*; D035862:Vulnerable Populations; D055815:Young Adult
chemical_list: D015483:HIV Antibodies; D012367:RNA, Viral
keywords: HIV assays; geospatial locations; incidence; phylogenetics; prevalence; surveillance