AIDS surveillance in Africa

Abstract

Surveillance of the AIDS pandemic in Africa has always posed formidable problems for epidemiologists. Diagnostic accuracy-according to the case definitions for AIDS used in industrialised countries-is impossible to achieve in all but a few places with the right diagnostic facilities. Responding to the urgent need for surveillance, the World Health Organisation drew up a clinical case definition (the WHO/Bangui definition), which depended on clinical criteria without the need for serological verification.'2 Judged by its use, the WHO/Bangui definition has been successful-52 African countries have reported cases ofAIDS using mainly this definition.3 Some countries have modified it to fit local circumstances, removing a defining symptom here, adding the need for an extra sign there, and many now accept or encourage a positive result of an HIV test as supportive evidence. (At least one, COte d'Ivoire, requires such a result.2)