Unit 3: Universal Case Reporting and Sentinel Surveillance for STIs

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Unit 3 Universal Case Reporting and Sentinel
Surveillance for STIs
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Warm Up Questions Instructions

• Take five minutes now to try the Unit 3 warm up
  questions in your manual.
• Please do not compare answers with other
  participants.
• Your answers will not be collected or graded.
• We will review your answers at the end of the
  unit.

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What You Will Learn

• By the end of this unit, for STI universal case
  reporting and sentinel surveillance, you should
  be able to
• discuss the purpose of each system of
  surveillance
• discuss the advantages and disadvantages of each
• define when each should be implemented
• define the population studied for each
• discuss reporting under IDS

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Two Case Reporting Approaches

• This unit compares and contrasts two different
  approaches to STI case reporting
• In universal STI case reporting, all healthcare
  facilities report all STI cases to public health
  authorities.
• In STI sentinel surveillance, selected sites
  collect more detailed data on STI cases.

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Universal STI Case Reporting

• Minimal data elements about STIs are collected
  from all health facilities.
• Two types of reports may be used
• syndromic reports, which provide data on
  patients set of symptoms (syndromes)
• aetiologic reports, which provide data on which
  micro-organism is causing symptoms. These
  determinations can only be made in a laboratory.
• General lack of lab support in the African region
  means that syndromic reports will be the primary
  method used.

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Advantages of Universal Case Reporting

• Universal case reporting provides the most
  readily available source of STI surveillance
  data.
• It provides data which is easy to collect from
  health facilities.
• It provides data on the burden of STIs at the
  health facility level, important for planning
  health services.
• When consistent, it can be used to track
  population-level STIs trends.

(This information can be found in Table 3.1 in
the text.)
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Disadvantages of Universal Case Reporting

• Universal case reporting is based on recognition
  of symptoms and thus provides a poor assessment
  of the true disease burden among women.
• It does not provide a direct estimate of the
  population burden of STIs because people with
  asymptomatic infection do not realise they are
  infected so they do not seek care.
• It is affected by fluctuations in health-seeking
  behaviours of the population not related to the
  burden of disease.

(This information can be found in Table 3.1 in
the text.)
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Reporting Form for Universal Case Reporting

• WHO recommends the IDS form for universal case
  reporting in the African region.
• This form is used for all priority communicable
  diseases.
• The STI syndromes reported in IDS are
• male urethral discharge
• male genital ulcer disease
• female genital ulcer disease

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STI Sentinel Surveillance

• A pre-arranged sample of health facilities and
  other sites agrees to report one or more
  notifiable conditions.
• More demographic and risk data on STI cases are
  collected and reported.

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STI Sentinel Surveillance, Cont.

• Site trends in STI case reports are used to infer
  trends at other health facilities.
• Take care in interpreting the results, since
  sentinel sites are not necessarily representative
  of the whole region.
• Health facilities known to be diligent in
  reporting STI cases are selected as the sentinel
  sites.
• Detailed high-quality data are collected from
  these sites.

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Sentinel Site Case Reporting

• STI cases are reported from a small number of
  sentinel sites using either the syndromic or
  aetiologic reporting.
• Syndromic case reporting
• More common in African countries, where lab
  support is not usually available.
• Same case definition at all sites, for easy
  comparison.
• Aetiologic
• Lab support must be available.
• Cases classified as confirmed or probable,
  depending on strength of laboratory evidence.

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Advantages of Sentinel Site Case Reporting

• Regular supervision, feedback and logistical
  support can be provided because sentinel sites
  are located in fewer facilities.
• Higher quality data can be obtained from a few
  sites with intensive support of training,
  supervision and logistics.
• Sentinel STI case reporting system is less
  expensive to run and maintain than a universal
  reporting system.
• It is more flexible than universal case
  reporting. Additional studies can be added
  without changing the basic structure.

(This information can be found in Table 3.2 in
the text.)
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Disadvantages of Sentinel Site Case Reporting

• Sentinel STI surveillance cannot provide minimum
  population-based estimates of disease burden.
• Sentinel sites are located in only a few health
  facilities and may not be representative of sites
  outside of their catchment areas.

(This information can be found in Table 3.2 in
the text.)
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Selection of Sentinel Sites

• Convenience sampling the selection of sites
  based on their availability and accessibility
• Probability sampling the selection of sites that
  ensures that each site has an equal probability
  of being selected
• Probability sampling gives more representative
  results, but it is more difficult and
  inconvenient.

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Selection of Sentinel Sites, Cont.

• Selection is influenced by
• the objectives of the system
• the structure of the countrys health system
• the extent to which STI case reporting is
  incorporated into primary healthcare
• The sites should
• see a large number of STI cases and provide care
• include both urban and rural areas
• have qualified staff
• include high-risk groups
• integrate STI surveillance with other
  surveillance activities
• include public and private sectors

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Developing the Reporting Forms

• The national AIDS/STI control programme should
  develop the forms.
• The same form should be used at all sites.
• Reporting forms should be simple.
• To protect patients privacy, reporting forms
  should not have personally identifying
  information.

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Table 3.3. Core and AdditionalData Elements
Core data elements Potential additional data elements
reporting site date of visit gender age group, age or date of birth syndrome residence education or socio-economic status marital status occupation anatomic site of infection date of symptom onset risk behaviour pregnancy previous episodes of STI treatment other information deemed necessary
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Implementing Surveillance

• Site staff should be trained in data collection
  using the standard reporting forms.
• There should be enough forms at sites.
• There should be supervision from the national
  AIDS/STI control programme.
• There should be a system of data transfer to the
  central office.
• Sentinel sites should be monitored for data
  quality.

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Combined Universal and Sentinel Surviellance Case
Reporting

• Universal case reporting through IDS provides
  basic estimates of incidence and prevalence.
• Sentinel case reporting supplements universal
  reporting by providing epidemiological and
  clinical detail on a subset of cases.
• Sentinel sites should report through both the
  universal and sentinel reporting systems.
• Universal case reporting through IDS should be
  the priority. If this is not possible, sentinel
  surveillance can be conducted instead.

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Syphilis Screening at Sentinel Sites

• Distinct from sentinel STI case reporting
• Data are collected from routine clinical syphilis
  screening programs.
• Prevalence can be calculated for all tested
  patients, or by demographic or risk group.
• Examples of sentinel sites include
• antenatal clinics
• STI clinics

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In Summary

• STI surveillance can occur through universal case
  reporting, sentinel surveillance or a combination
  of the two.
• Sentinel surveillance gives higher quality data
  than universal case reporting, at lower cost.
• Sentinel surveillance data are not representative
  of the general population, while universal case
  reporting data can be.
• Through IDS, priority is given to universal case
  reporting.

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Warm Up Review

• Take a few minutes now to look back at your
  answers to the warm up questions at the beginning
  of the unit.
• Make any changes you want to.
• We will discuss the questions and answers in a
  few minutes.

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Answers to Warm Up Questions

• 1. Which of the following is an advantage of
  universal STI case reporting?
• a. It is the most readily available source of
  surveillance data and easy to collect from health
  facilities.
• b. It provides data on the burden of STIs at the
  health facility level, which is important for
  planning health services provisions.
• c. Under stable conditions and consistent
  reporting, data arising from STI case reporting
  can serve as a proxy for population dynamics of
  STIs.
• d. All of the above

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Answers to Warm Up Questions

• 1. Which of the following is an advantage of
  universal STI case reporting?
• a. It is the most readily available source of
  surveillance data and easy to collect from health
  facilities.
• b. It provides data on the burden of STIs at the
  health facility level, which is important for
  planning health services provisions.
• c. Under stable conditions and consistent
  reporting, data arising from STI case reporting
  can serve as a proxy for population dynamics of
  STIs.
• d. All of the above

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Answers to Warm Up Questions, Cont.

• 2. True or false? Data collected from sentinel
  sites can be easily generalised to a broader
  population.

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Answers to Warm Up Questions, Cont.

• 2. True or false? Data collected from sentinel
  sites can be easily generalised to a broader
  population. False

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Answers to Warm Up Questions, Cont.

• 3. In countries where information about STIs is
  obtained through a universal reporting system,
  sentinel STI surveillance
• a. is unnecessary
• b. should replace universal reporting as the
  primary method to study STIs
• c. should supplement information obtained from
  the universal reporting system

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Answers to Warm Up Questions, Cont.

• 3. In countries where information about STIs is
  obtained through a universal reporting system,
  sentinel STI surveillance
• a. is unnecessary
• b. should replace universal reporting as the
  primary method to study STIs
• c. should supplement information obtained from
  the universal reporting system

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Answers to Warm Up Questions, Cont.

• 4. True or false? Supervision and feedback are
  easier to provide for a sentinel surveillance
  system than for a universal system.

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Answers to Warm Up Questions, Cont.

• 4. True or false? Supervision and feedback are
  easier to provide for a sentinel surveillance
  system than for a universal system. True

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Answers to Warm Up Questions, Cont.

• 5. True or false? Universal case reporting
  provides a poor assessment of the true disease
  burden among women.

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Answers to Warm Up Questions, Cont.

• 5. True or false? Universal case reporting
  provides a poor assessment of the true disease
  burden among women. True

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Answers to Warm Up Questions, Cont.

• 6. What system of surveillance is recommended for
  reporting all priority communicable diseases?

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Answers to Warm Up Questions, Cont.

• 6. What system of surveillance is recommended for
  reporting all priority communicable diseases?
  Integrated Disease Surveillance

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Small Group Discussion Instructions

• Get into small groups to discuss these questions.
  
• Choose a speaker for your group who will report
  back to the class.

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Small Group Reports

• Select one member from your group to present your
  answers.
• Discuss with the rest of the class.

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Case Study Instructions

• Try this case study individually.
• Well discuss the answers in class.

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Case Study Review

• Follow along as we go over the case study in
  class.
• Discuss your answers with the rest of the class.

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Questions, Process Check

• Do you have any questions on the information we
  just covered?
• Are you happy with how we worked on Unit 3?
• Do you want to try something different that will
  help the group?

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