25/10/2015
Xaalada Fiditaanka Caabuqa HIV&AIDS oo Hoos u dhacay Berbera WHO sarfay ay Samaysay 2014.
WHO HIV Sentinel Surveillance Survey Findings Summary:
++++++++++++++++++++++++++++++++++++++++++++++++
HIV sentinel surveillance among selected populations such as pregnant women, s*xually transmitted infection (STI) and Tuberculosis (TB) patients has been practiced by many countries to monitor trends of their HIV/AIDS epidemics. It has provided countries with data evaluate and improve their
HIV/AIDS responses. In 2014, once again, the World Health Organization (WHO) Somalia office, with financial support from the Global Fund for AIDS, Tuberculosis and Malaria (GFATM), and in collaboration with Somaliland Health Authorities and AIDS Commission, conducted another round of HIV sentinel surveillance.
Objectives
The objectives of the survey were to:
i. Determine the sero-prevalence of HIV infection among pregnant women attending antenatal clinics at the selected sentinel sites.
ii. Determine the prevalence of syphilis among pregnant women attending antenatal clinics at the selected sentinel sites.
iii. Determine the sero-prevalence of HIV infection among patients with symptoms of s*xually transmitted infections (STIs) attending Hargeisa Group Hospital OPD STI clinic.
iv. Determine the sero-prevalence of syphilis infection among patients with symptoms of STIs attending the Hargeisa Group Hospital OPD STI clinic.
v. Determine the sero-prevalence of HIV infection among TB patients attending the selected TB sentinel surveillance sites.
vi. Compare the HIV point prevalence in 2004, 2007, 2010 and 2014 in Somaliland to determine trends
Methods
The linked anonymous testing approach was used in conjunction with rapid HIV and syphilis testing, and patients received pre and post-test HIV counseling, got their results shortly after blood was
drawn. Names and other identifying details were not captured on the survey documentation.
Blood samples were collected from 2, 550 pregnant women at six MCH sentinel clinics, 250 STI patients at Hargeisa Group Hospital, and 267 smear-positive tuberculosis patients at Borama, Burao
and Hargeisa TB hospitals.
By and large, the sentinel sites were the same sites that had participated in the preceding 2004, 2007 and 2010 sentinel surveys. The exception to this was Daami MCH that had not participated in the 2004 survey, and Las Anod central MCH which had been omitted from the 2004 and 2010 surveys because of security challenges. The samples from pregnant women and STI patients were tested for both HIV and syphilis, while those from TB patients were only tested for HIV . The HIV
testing strategy adopted was serial assay testing using Colloidal Gold, Determine, and Unigold HIV test kits in that order, with positive HIV results requiring reactivity with all three test kits. The SD Bioline 3.0 syphilis rapid test kit was used for syphilis testing. Quality control involved re-testing of all positive samples and at least 20% of the negatives. Demographic data and samples from the participants were collected from the 18thof January to 17thJune 2014 for STI patients, from the 18thof January to the 1st
of July 2014 for pregnant women. TB:___
Findings
A: Pregnant women HIV
1. The median HIV sero-prevalence among pregnant women at the six sentinel sites was 0.71%, with the mean at 0.67%9
2. The HIV prevalence among pregnant women aged 15-24 years was 0.48%.
3. We could not demonstrate any statistically significant correlation between being HIV seropositive and age, marital status, the number of wives in the marriage for the married,
educational attainment, and duration of residence in the area.
4. There were statistically significant declines in HIV sero-prevalence at Berbera, Borama and Daami MCHs, while trends at Burao, Hargeisa Central and Las Anod were not statistically
significant.
5. There was also a statistically significant decline in the aggregated mean HIV prevalence for the sites that had together taken part in the sentinel surveys between 2004 and 2014. These were Berbera, Borama, Burao, Hargeisa central and Daami MCHs.
Syphilis.
6. The median syphilis sero-prevalence among pregnant women at the six sentinel sites was 1.37%, with the median at 1.17%.
7. As in the previous two sentinel surveys, Borama MCH had the highest syphilis sero-prevalence among the Somaliland sentinel sites, while Burao continued to show no sero-positive cases for the third survey running. The reasons underlying this pattern remain unclear.
8. At 1.79% syphilis sero-prevalence was significantly higher among those with no formal education, as compared to those who had some formal education regardless of the level of attainment, 0.39%, p=0.0045 Fisher exact test. 10
9. There were no demonstrable statistically significant associations between being syphilis seropositive and age, marital status, and number of wives in the marriage. A shorter duration of residence came close to being significantly associated with being syphilis sero -positive (p=0.051)B: STI patientsHIV
10. The HIV prevalence among the STI patients at the sentinel site was 1.60%. By gender, the prevalence was 2.63% among males and 0.74% among females, although the difference was not
statistically significant (p=0.334).
11. There was no demonstrable statistically significant correlation between HIV sero-prevalence and gender, age, marital status, formal education or duration of residence in the area, for STI patients. However, this may have had to do with the low number of HIV positive patients, which could not allow robust correlative analysis, once stratified by the various demographic variables.
12. The trend of decline in HIV prevalence to the rate of 1,60% among STI patients at this site was an even more emphatic statistically significant drop from the high of 12.3% in 2004 , through the 7.0% found in the 2010 survey, p=0.00167 Chi square for trend.SYPHILIS
13. The syphilis sero-prevalence among the STI patients was 4.40%. By gender, the prevalence was 3.68% for females and 5.26% for males although this difference was not statistically significant.
14. The syphilis sero-prevalence was significantly higher among those who had resided in the area for less than five years, 9.52%, as compared to those who had been resident for longer, at 0.69%, p=0.000928, Fisher Exact test.
15. Owing to inadequate details in earlier sentinel survey reports, it was only possible to analyse the statistical significance of the change in the syphilis sero-positive rates between the 2010 and this 2014 survey. The analysis showed a statistically significant drop in syphilis sero-prevalence among STI patients from 12.5% in 2010 to 4.4% in 2014, p=0000025, Fisher’s Exact test.
Recommendations
1. While the statistically significant decline in prevalence among Pregnant women at half of the ANC sentinel sites, and among STI patients at Hargeisa group hospital is encouraging, any celebration of these trends needs to take into account the fact we are still ignorant about behavior and infection levels among most of the key populations at risk where the infection could be continuing to spread.
2. Furthermore, Somaliland still hosts three of every 5 patients living with HIV among the three Somali zones. Therefore, HIV prevention, care and treatment efforts in Somaliland need not let up, but rather should be continued, strengthened and better targeted to reach those who need them the most.
3. Additional sentinel surveillance surveys for pregnant women and patients with STIs in Somaliland should be conducted to clarify further on the trends of HIV in the zone, to monitor that the apparent gains are being consolidated and even expanded.
4. There is urgent need to conduct bio-behavioral surveillance studies among key populations at risk beyond the s*x workers in Hargeisa. This would provide much missed clarity on the state of the epidemic among these critical groups. These groups become even more critical in the face to the evidence of declining HIV prevalence in the general population proxy sentinel population of the pregnant women.
5. Operational research should be conducted to shed light on the repeated pattern of the highest syphilis positive rates among pregnant women in Somaliland being at Borama, and the absence of syphilis positive cases among pregnant women at the Burao MCH.
6. Bio-behavioral studies to provide clarity on the drivers of the HIV/AIDS epidemic in Somaliland should also be conducted. There is hardly any documentation of risk behavior in the Somali context. Such information is vital to ensuring that behavioural change communication messages are always well tailored to the actual behaviours and beliefs prevailing among the various
section of the vulnerable and at risk population sub groups.
7. Syphilis remains an infection with higher sero-prevalence than HIV/AIDS in Somaliland. The ongoing scaling up of activities for prevention/ elimination of mother to child transmission of HIV should be strengthened to include ensuring the uninterrupted availability of syphilis screening for all pregnant women, along with the required treatment for those found infected.
8. Services for syndromic management of STIs need to be scaled up, with HIV counseling and testing being part and parcel of such a scale up. In addition, the services should include s*xual partner tracing, HIV counseling and testing and treatment, as means to interrupt risk behavour.
where it has not yet resulted in HIV infection, and to detect HIV infection early for prompt
initiation of HIV care and treatment.
9. Considering its central and critical location on the trade routes linking Somaliland, Puntland and
South Central Somalia, HIV prevention efforts in Burao need to be stepped up to ensure that
there too the epidemic comes demonstrably under control. Rapid spread of HIV to the hitherto
still less affected hinterland, including the parts of South Central Somalia th at remain difficult to
access for HIV/AIDS interventions, needs to be prevented by all means.