HIV SURVEILLANCE
HIV surveillance is underway in the district, and there is important learning about HIV surveillance from the effort, as well as achievements that have resulted from the process. The pilot use of Integrated Disease Surveillance and Response (IDSR) approaches for HIV (IDSR-HIV pilot) has been successful in strengthening the capacity at community and district levels, integrating passive and active surveillance of HIV risk and infections into the normal business practice of the district’s HIV prevention efforts, and engaged communities in surveillance, detection, and response.
Importantly, the District has grown in its technical leadership and governance of HIV surveillance and response efforts. There is coordination happening around risk signals, existing hotspots, and response actions where there was none at the start of BPS. People in the community are cognizant of HIV risks, and there is shared language about issues and response activities. As a result, there is greater coherence and coordination of resources for HIV prevention across the district. Community Health Team participation in identifying risks and responding to the HIV epidemic in Blantyre is resulting in more effective and targeted public health interventions.
Elements of Blantyre’s HIV surveillance and response approach include:
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Use of a common data platform (PALMS) is a core element of Blantyre’s integrated HIV surveillance system. It allows for transparency across district and city health teams, facilities, partners, and others about areas of concern and enables quick identification of problem areas through its color-coded flags.
Capacitated human resources at district, facility, and community levels – In addition to having PALMS as a common platform, the capacities that have been built through BPS support such as governance and technical leadership, data access and use, and surveillance and response approaches are integral to enabling active and passive surveillance.
Passive Surveillance in Blantyre involves the systematic identification, collection, monitoring, analysis, and interpretation of structured data. It is conducted primarily at facilities; however, the district and city health teams, network model committees, and others review data routinely to identify issues and opportunities for response. Blantyre’s passive surveillance leverages the PALMS platform including monitoring of 13 defined indicators (diagnostic and risk). The thresholds for what triggers an investigation or response are included in the defined green, yellow, and red flags for each indicator in PALMS.
Active Surveillance in Blantyre is primarily community-based with signal reporting from key informants up to facilities and to the district health team. Blantyre’s approach to active surveillance has included responding to signals from known hotspots as well as event-based surveillance defined as the organized and rapid capture of information about events that are of potential HIV infection risk to public health. In addition to passive surveillance and active support in known hotspots, the District health team has trained Health Surveillance Assistants (HSAs), Community Health Team (CHT) members, and other community health workers to identify risk signals and support necessary and timely interventions. CHTs are often the first line of contact between communities and the health system and are well placed to provide critical insight into high-risk communities to inform where HIV prevention interventions should be targeted. In addition, in the CY 2024 Quarter 2, the District Environmental Health Office began training “surveillance informants”, i.e. CHTs and other community health structures and key informants (e.g. shop owners, village leaders, and schoolteachers) how to capture data about events in the 11 catchment areas.
An illustrative case study of passive surveillance leading to investigation and response comes from Kadidi. Health workers at Kadidi health centre used PALMS during a data review meeting and noted an increase in HIV infections. While investigating, the health workers on the Facility Rapid Response Team discovered new hotspots. They worked with the network model committee for the Kadidi catchment area to organize activities in the community to address the risk issues. There was a subsequent decrease in HIV positivity at Kadidi following implementation of the activities.
