Integrated surveillance of HIV care in low-income and middle-income countries

Abstract

HIV care should be seen as a continuum of health interventions that starts from HIV testing and counselling and ends with life-long provision of antiretroviral therapy (ART). All the interventions should be monitored with appropriate methods and indicators to constitute an integrated surveillance system of HIV care. This review outlines the different elements of this comprehensive surveillance, highlighting their public health importance. Data on HIV care programmes in developing countries are generally fragmented and weak, focusing primarily on outcomes of patients on ART. A global scale-up of ART should be accompanied by robust programmatic assessment of the whole spectrum of HIV care components, which include monitoring pre-ART and ART programmatic elements, routine surveillance of HIV drug resistance, pharmacovigilance and appropriate surveillance of HIV-related mortality. Comprehensive surveillance of HIV care that integrates multiple elements is needed in order to provide evidence-based data to optimize quality of care and improve survival. However, due to the increasing number of patients, the need for life-long interventions and the weakness of the health system, the implementation and sustainability of an integrated surveillance programme is challenging.