The MESH consortium: Measurement and Surveillance of HIV epidemics. James Hargreaves, Director Brian Rice, Deputy Director

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1 The MESH consortium: Measurement and Surveillance of HIV epidemics James Hargreaves, Director Brian Rice, Deputy Director

2 The Consortium partners, related projects and steering committee

3 Working Groups The Working Group Structure of MESH comprises four working groups: 1. Measuring HIV-related mortality (Egger, Zaba) 2. Routine case-based surveillance (Schwarz, Todd, Boulle) 3. Size and HIV epidemic dynamics among key populations (Weir, Baral) 4. Support for guideline development and dissemination (Rutherford)

4 Measuring HIV-associated mortality Mortality among those stated on ART (1) Mortality among those stated on ART (2) Cause of death HIV-attributable mortality Routine HIV case-based Surveillance Multi-country SWOT analysis Pilots and in-country support Key populations Combining programme and surveillance data Population Size Estimation Measuring Stigma Guidelines Tool and Guideline mapping Input to Guidelines as Requested Input to trainings and country support Other key milestones Steering Committee Meetings MESH Think Tank Meetings Interim and Final MESH Reports

5 1. Measuring HIV-related mortality Mortality on ART Systematic Review (CROI abstract) and MORTAL IPD (letters out) IeDEA-based analyses (today!) HIV attributable mortality ALPHA InSilico-VA Cause of Death re-analysis (ongoing) HIV-negative mortality (ongoing)

6 2. Routine case-based surveillance Phase 1: Assess and report on the current landscape of patient information and surveillance systems and provide recommendations for pilot activities to implement / strengthen case-based surveillance in Phase 2 of MESH SWOTs Tanzania completed Upcoming in partnership with WHO, NASTAD, CDC: South Africa, Kenya, Haiti Global HIV Cascade Workshop November, Marrakech, Morocco Phase 2: In-depth work and pilots Provide technical and strategic input to adapt or develop patient information systems to report into case-based surveillance; develop approaches to the analysis of data to support measuring outcomes along the care continuum

7 2. Routine case-based surveillance Tz SWOT - conducted in two regions (Dar es Salaam and Mwanza) 23 interviews with stakeholders, including national, and sub-national MoH staff, WHO, CDC and UNAIDS 9 site visits to facilities including hospitals, health centers, dispensaries, and laboratories Great interest among stakeholders in moving CBS forward Basic systems are in place to build a strong CBS system Data are collected at the individual level and entered into both individual patient records and MoH registers

8 3. Size and HIV epidemic dynamics among key populations Overarching aim to improve the value of surveillance for programs and to improve the use of program data for surveillance Compare and combine network-based vs venue-based vs programme data Compare estimates of key indicators: disease burden, uptake of HIV Prevention and Treatment Programs: Senegal, Cameroon, South Africa, Zimbabwe, china Status: Meeting Planned in South Africa in November to Compare Preliminary Analyses, ISSTDR Abstract on Programme and RDS data in Zimbabwe Optimising size estimation approaches Assess Life-Course Approach to Assess Availability and Use of Population Size Estimation Systematic Review of PSE Studies Quality Assessment, Assess uptake of PSE documents in Global Fund Proposals and in COP (PEPFAR) Proposals Method comparisons in sites Status: Search Protocol Developed and 15 Initial High Impact African Countries

9 3. Size and HIV epidemic dynamics among key populations Stigma Metrics Among Key Populations As part of extended mandate, review metrics of HIV-related stigma and for key populations at risk for or living with HIV Consider appropriate quantitative and qualitative methods for measuring stigma among key populations Status: Support Being Sought with Preliminary Analyses Completed (ISSTDR abstract) O08.3 Overlapping HIV and sex work stigma: Experiences from 14 sites across Zimbabwe.

10 4. Support for guideline development and dissemination Map existing guidelines, and develop a pipeline of planned guidelines, for HIV measurement and surveillance Completed February 2015 Support WHO/UNAIDS in convening and training countries in the measurement necessary to implement the cascade of measures Zagreb June 2015 pilot Marrakech November 2015 One year follow up (provisional) Provide implementation support on cascade analysis and case-based surveillance implementation in selected countries Provide input as requested to normative bodies preparing new or updated HIV measurement / surveillance guidance

11 Next steps UNAIDS Reference Group (London October 26/27) Extended mandate decision ( ) ALPHA IeDEA consultation (Bern November 2015) Global HIV Cascade Workshop (Marrakech Nov 2015) Case-Reporting SWOTs Tz, Haiti, Kenya (Dec Feb 2016) Steering Committee Meeting (Boston Feb 2016) MESH Think Tank (London May 2016) Phase 1 to Phase 2 (June 2016) World AIDS Conference (Durban July 2016) Global Cascade Workshop part 2 (Zagreb late 2016)

12 Measuring HIV-associated mortality Mortality among those stated on ART (1) Mortality among those stated on ART (2) Cause of death HIV-attributable mortality Routine HIV case-based Surveillance Multi-country SWOT analysis Pilots and in-country support Key populations Combining programme and surveillance data Population Size Estimation Measuring Stigma Guidelines Tool and Guideline mapping Input to Guidelines as Requested Input to trainings and country support Other key milestones Steering Committee Meetings MESH Think Tank Meetings Interim and Final MESH Reports

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