Implementing a second-generation HIV surveillance system in Romania: experiences and challenges

Area of Science:

• Public Health
• Epidemiology
• Infectious Disease Surveillance

Background:

• Romania faces a unique HIV/AIDS epidemiological profile, marked by historical nosocomial transmissions in children and increasing adult infections among sexually active individuals and injecting drug users.
• The country's impending EU membership necessitated the implementation of robust, modern HIV surveillance systems.

Purpose of the Study:

• To develop and implement a second-generation surveillance (SGS) system for HIV in Romania.
• To adapt surveillance methodologies to Romania's specific epidemiological context and resource landscape.

Main Methods:

• A SWOT analysis informed the development of new survey methodologies, involving national conferences, working groups, and training workshops.
• Collaboration with specialists in epidemiology, infectious diseases, and health promotion was crucial.
• Discussions addressed testing methods, legal, and ethical considerations for sensitive behaviors.

Main Results:

• Surveys were tailored to district-specific HIV epidemiology and practical constraints.
• Implemented strategies included serological and behavioral surveillance in dermatovenereology clinics, hospital patients (ages 15-24), and high school students (ages 15-19).

Conclusions:

• Financial and human resource limitations are critical factors in SGS implementation.
• Effective teamwork and collaboration between epidemiologists and clinicians are paramount for successful HIV/AIDS surveillance.
• Lessons learned in Romania offer valuable insights for HIV surveillance system development in other European regions.