Effective responses to infectious disease epidemics depend on timely information. Data collection, data management, data analysis and data use all play crucial roles in public health responses to infectious diseases. Information systems configured to provide timely data can provide essential support for disease detection, management and control efforts.1
One major challenge facing national HIV programs is the need to coordinate and harmonize data collection efforts. In the case of complex conditions, such as HIV/AIDS, the demand for data is enormous. Government agencies need data to assess the magnitude of disease, to guide policy decisions, and to shape disease prevention, treatment and control efforts. External donors need data specific to the programs that they support. Numerous other stakeholders also need data, including non-governmental organizations (NGOs) and academic researchers. In many countries, this plurality of data needs has given rise to multiple data collection systems for disease surveillance and program monitoring and evaluation (M&E). These multiple systems most often generate data that are not standardized, making comparisons over time, across geographic areas or between programmatic areas difficult or impossible.
In China, numerous HIV/AIDS data collection systems arose to meet different data collection needs, including those of Chinese government programs and donor-funded AIDS programs and research projects. Eight national routine reporting subsystems emerged, covering:
- HIV/AIDS case reporting;
- HIV testing and counselling;
- HIV sentinel surveillance;
- HIV behavioural surveillance surveys (BSSs);
- antiretroviral treatment (ART) for adults;
- aRT for children;
- behavioural interventions for high-risk groups; and
- methadone maintenance treatment (MMT).
These subsystems were managed by different technical divisions within the National Centre for AIDS/STD Control and Prevention (NCAIDS) at Chinese Centers for Disease Control and Prevention (China CDC).
Besides these national subsystems with coverage cross the country, other major AIDS projects, such as China CARES, the Global Fund China AIDS Project, China–UK AIDS Project and the World Bank 9th Health Loan Project, also collect and manage their projects’ information, which created project-based AIDS information subsystems that also overlapped with the above eight subsystems.
While these subsystems provided a wealth of data across the spectrum of HIV/AIDS programs and focus areas, the diversity of data collection sources and methodologies created many problems. With regard to data collection, duplicative requests from different subsystems generated a heavy workload for public health field staff. Inconsistent data collection methods within and across subsystems led to problems in comparing data.2
In addition, substantial amounts of data were collected but seldom analysed and rarely shared. Over time, China’s need for an integrated information system for HIV/AIDS surveillance and response became clear, and the creation of a unified, web-based, national HIV/AIDS information system was identified as a top priority.
The first major step in this direction occurred in 2005, when the China CDC instituted a web-based case-reporting system across a number of different disease areas, including HIV/AIDS.3
This system allows end users to enter case report data directly into an online system using automated forms, and it allows authorities to examine case report data in real time. In addition, the system allows users to generate automated reports that make it easier for public health staff and officials at every level to make use of data within their area of jurisdiction.
The second major step in this direction began in 2006, when the NCAIDS launched an initiative to develop a comprehensive, national, web-based HIV/AIDS information system. This system aimed to streamline data collection, data management, data analysis and data use by standardizing data collection methodologies, automating data management functions, and generating standardized statistical reports that can be readily used to guide public health efforts. The new system was launched in 2008, and has been in operation for >2 years. Here, we describe China’s new HIV/AIDS Comprehensive Response Information Management System (CRIMS) and provide a preliminary assessment of the new system.