The quality of HIV/AIDS case-detection and case-reporting systems in Mozambique

Despite the underlying importance of surveillance systems for the management of HIV/AIDS prevention and control programmes, there has been limited analysis of the quality of HIV/AIDS case-detection and case-reporting systems, beginning with peripheral facilities through to those at national levels. In Mozambique, HIV cases are generally correctly detected despite some unreliable use of test kits beyond their expiry date, uneven distribution of test kits among facilities, frequent disregard for bio-safety measures and irregular external quality assessment. Furthermore, HIV/AIDS case-reporting is compromised by poor data quality, including under-reporting and discrepancies across different reporting channels and organisational levels, as well as a lack of standardised data forms, data items collected and report formats. Our analysis of HIV/AIDS surveillance systems in Mozambique leads to the following key recommendations: (1) a strengthening and standardisation of both the case-detection and case-reporting systems at all levels; (2) the regular training of staff at peripheral facilities, to allow for better testing and improved local data analysis, validation and interpretation; (3) the redesign of reporting systems for blood banks, including integration of the AIDS case-reporting subsystems into one; and (4) the use of baseline data as a foundation for more comprehensive analysis across the country, in response to UNAIDS advice regarding second-generation HIV surveillance.