For countries it is important to know what the status of the HIV epidemic is, what the size of the health care response is, and if the latter has had an effect on the trends in the burden of disease. Based on this priorities can be given to particular areas, strategic plans may be refocused, and certain efforts intensified. In the past year I have conducted two epidemic and impact analyses, one for South Africa and one for Nepal, for the respective WHO country offices.
The WHO Country Office in South Africa, asked me mid 2013 to review both the Tuberculosis (TB) and the HIV programme to assess the level of, and trends in, HIV and TB disease burden and how these had been influenced by the implementation of prevention and treatment interventions. This epidemiological and impact analysis formed part of the desk review phase of the review and has been used as the basis of a report, that also included desk-review information from other consultants on policy and finances, as well as the outcomes from the field work.
This desk review only focussed on published and unpublished articles/reports and no analysis of data-sets was conducted. However, already analysed data from e.g. the HIV and TB programmes was included as well as data from estimation exercises (e.g. Spectrum). Documentation was retrieved via Pubmed, Google and with the assistance of staff of the WHO in Geneva, the South Africa WHO Country Office and partnering organizations. Data in the following areas was presented (current status and trends over time): TB prevalence, case notifications and mortality; TB diagnosis/case finding, treatment outcomes and drug resistant TB; HIV prevalence, incidence and mortality; HIV counselling and testing, treatment (ART) and prevention (PMTCT, medical male circumcision, male condom use); diagnosis and treatment of patients co-infected with TB and HIV. The changes in disease burden and programme efforts were linked and gaps in the data were identified and suggestions for improvements made.
In March this year, I was approached by the WHO Nepal Country office to conducted a similar exercise. However, now the focus was only on HIV. Furthermore, what made this report different from the South African one, is that Nepal has a concentrated epidemic (highest prevalences of HIV in certain key populations) while South Africa has a generalized HIV epidemic. This meant for example that the burden in female sex workers, people who inject drugs, men who have sex with men, male labour migrants was most important to review using Integrated Biological and Behavioural Surveillance (IBBS) survey data, and data from mapping and size estimation. With respect to the response, interventions like Behaviour Change Communication, Needle Syringe Exchange Programme and Opioid Substitution Therapy were now also included. After a period of desk-review of the data and reports that were electronically available, I went for 10 days to Kathmandu to meet with various stakeholders. Not only to see if I included all the relevant data, but also to discuss my ideas about the future response. This because my report formed, together with other documents, the basis for the concept note for the Global Fund, meant to secure future funding for the HIV response in Nepal.
Now that the Nepal project is almost finalized, it is time for a new challenge. A project for the WHO Country office in Mozambique is in the pipeline.