The objectives of HIV surveillance in Australia are to monitor the extent and characteristics of HIV infection to assist with planning public health strategies and informing governments and communities about:
- trends in HIV transmission and the profile of the epidemic
- behavioural, geographical and demographic factors associated with HIV transmission
- the numbers and demographic characteristics of people living with HIV
- morbidity and mortality due to HIV infection.
Work in this area will be undertaken with input from, and in collaboration with, the Australian Government together with state and territory health authorities, the Ministerial Advisory Committee on Blood Borne Viruses and Sexually Transmissible Infections, the National Centres in HIV research, and other research and community organisations in the sector. The National Centre in HIV Epidemiology and Clinical Research and the Communicable Diseases Network of Australia have a key role in national analyses and evaluation of surveillance data and public health programs under this strategy. Some jurisdictions do not have active surveillance systems that can provide good information about the dynamics of the spread of HIV. All jurisdictions are encouraged to carry out active surveillance of HIV diagnoses to inform policy and program planning and an understanding of the dynamics of the spread of the disease.
Over the life of this strategy the national HIV surveillance framework will be comprehensively reviewed to ensure that epidemic trends and population priorities are being consistently and appropriately measured and reported on at national and state and territory levels. Attention will be given to the unique epidemiology of HIV in each jurisdiction. The review will also consider the best evidence base for the mechanisms being used in the Australian context, how they are considered across the whole public health partnership approach, and legal or ethical implications requiring assessment. This will include surveillance of diagnoses and behaviours in emerging at-risk populations and improved approaches to measuring testing rates in priority populations.
Enhancing surveillance capacity to improve measures of HIV transmission, HIV sub-types, and patterns of treatments used and resistance across populations will be considered, including improving the efficiency and effectiveness of data transfer and retrieval, and database linkages and access.
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Behavioural surveillance—including unsafe injecting and sexual behaviour such as unprotected anal intercourse—must be maintained to provide information on trends in risk behaviours. Refinements to behavioural surveillance are enouraged, including considering incorporation of blood tests in periodic surveys. Improved approaches to measuring testing rates among priority populations should be supported. Protocols should be established for wider availability of behavioural surveillance data, including a public access data set.
The ongoing development of national surveillance programs need to be linked to the expert advice provided through monitoring and evaluating innovation and advances in scientific and health technology areas.
Extended evaluation and secondary analyses of surveillance data are recommended, including elucidation of how behavioural trends influence epidemic trends. Mathematical modelling is one approach to be used for this and for estimating incidence and prevalence levels for BBVs and STIs.
Priority actions in surveillance
- HIV surveillance will be reviewed to ensure data is being collected which best informs targeted prevention with priority populations-including nationally consistent data on Indigenous status and ethnicity, data relating to sex workers, transgender persons, sexuality, injection drug use and location where transmission has occurred.
- New technologies will be assessed that help identify the proportion of HIV diagnoses that are newly acquired.
- Refinements to behavioural surveillance of unprotected anal intercourse will be supported to help determine trends in high risk behaviours.
- Improved approaches to measuring testing rates among priority populations will be supported.