S07.4 Tools to enhance the global STI surveillance

Abstract

Without information, you don’t have a problem. Without a problem, you can’t advocate for resources. Without resources to tackle the problem, it grows bigger. However, without information, who would know? There is a vicious cycle of limited STI surveillance and limited funding and responses, especially in resource-limited settings. Strengthened strategic information for STIs is needed to guide programming and service delivery, to rally political commitment and build a strong national investment case. National strategic information systems that incorporate STI case reporting, prevalence assessments, assessment of the etiologies of sexually transmitted infection syndromes, and monitoring for antimicrobial resistance to gonorrhoea are required. Countries with STI surveillance systems rely on STI case reporting to estimate national incidence. Routine screening, currently most feasible for syphilis, address prevalence monitoring of priority populations. Routine reporting and prevalence monitoring have limitations. STI reporting underestimates the burden of STIs as the majority are asymptomatic, limited access to care and challenges to collect verifiable data including limited diagnostics. Without diagnostics, it is difficult to count STI cases reliably. Periodic prevalence surveys using standard methods, increase confidence in trends by validating routine data with population denominators. Specific studies including prevalence studies nested within DHS, biobehavioural surveys among key populations, a meta-analysis of STI data from other sources can enhance surveillance. Tools are available to support STI surveillance. Modelling tools including Spectrum STI and the congenital syphilis estimation tool are available for national-level analysis of incidence and prevalence trends. Prevalence survey tools for pregnant women and enhanced gonorrhoea antimicrobial resistance surveillance programme protocol are available. A review of reporting tools is underway. Striking the right balance of STI surveillance activities requires resources, building reporting systems and strengthening capacity at the national level to conduct and improve routine surveillance, while simultaneously investing in prevalence surveys and special studies.