Innovations in health and demographic surveillance systems to establish the causal impacts of HIV policies

Abstract

Purpose of Review Health and Demographic Surveillance Systems (HDSS), in conjunction with HIV treatment cohorts, have made important contributions to our understanding of the impact of HIV treatment and treatment-related interventions in sub-Saharan Africa. The purpose of this review is to describe and discuss innovations in data collection and data linkage that will create new opportunities to establish the impacts of HIV treatment, as well as policies affecting the treatment cascade, on population health, economic and social outcomes. Recent Findings Novel approaches to routine collection of (i) biomarkers, (ii) behavioural data, (iii) spatial data, (iv) social network information, (v) migration events and (vi) mobile phone records can significantly strengthen the potential of HDSS to generate exposure and outcome data for causal analysis of HIV treatment impact and policies affecting the HIV treatment cascade. Additionally, by linking HDSS data to health service administration, education, and welfare service records, researchers can substantial broaden opportunities to establish how HIV treatment affects health and economic outcomes, when delivered through public-sector health systems and at scale. Summary As the HIV treatment scale-up in sub-Saharan Africa enters its second decade, it is becoming increasingly important to understand the long-term causal impacts of large-scale HIV treatment and related policies on broader population health outcomes, such as non-communicable diseases, as well as on economic and social outcomes, such as family welfare and children’s educational attainment. By collecting novel data and linking existing data to public-sector records, HDSS can create near-unique opportunities to contribute to this research agenda.

Persistently high incidence of HIV and poor service uptake in adolescent girls and young women in rural KwaZulu-Natal, South Africa prior to DREAMS

“…The study drew on existing, longitudinal data collected by Africa Health Research Institute (AHRI) (formally the Africa Centre for Health and Population studies), in the Hlabisa sub-district located in the uMkhanyakude district in northern KwaZulu-Natal–an area for DREAMS investment [ 11 ]. The study area is predominately rural and poor compared with other parts of South Africa, with high levels of unemployment [ 11 ] and an antenatal HIV prevalence of more than 40% [ 12 ]. Since 2000, household-based surveys have been used to collect demographic data from a population of approximately 100,000 individuals living in an area of 438 km 2 in rural uMkhanyakude District.…”

Spatial clustering of drug-resistant tuberculosis in Hlabisa subdistrict, KwaZulu-Natal, 2011–2015

“…This includes individual residential locations mapped to an accuracy of less than two metres, and routine linkage to public sector records. 15,16 The aim of this study was to characterise the spatial distribution of drug-resistant TB (DRTB) in the sub-district, test for spatial clustering, and discuss implications for prevention and care.…”

Reaching, Engaging and Advancing Research (REAR); An Assessment of Health Managers’ Skills and Knowledge in Data Management, Analysis, Utilization, and Dissemination Kenya, Tanzania and Rwanda

“…Their leadership roles require them to plan, prioritize, implement, monitor, and evaluate public health actions to reduce morbidity and mortality (14). The HIV epidemic has received considerable investment to ensure data and strategic information are available to understand the epidemic in Kenya, Rwanda and Tanzania (15). Furthermore, there has been an increased advocacy to the implementation and use Health Information Systems (HIS) for management of longitudinal health records especially for HIV patients (16).…”