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Linking Surveillance to Prevention through Data 2002 Perinatal Prevention Grantees Meeting February 12-14, 2002 Facilitators: Norma Harris and Joann Schulte, CDC Invited Speakers: Linda DiMasi and Daniel Lauricelli, New Jersey Dept of Health HIV/AIDS Surveillance 101 Session Outline

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Linking Surveillance to Prevention through Data

2002 Perinatal Prevention Grantees Meeting

February 12-14, 2002

Facilitators: Norma Harris and Joann Schulte, CDC

Invited Speakers: Linda DiMasi and Daniel Lauricelli, New Jersey Dept of Health


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HIV/AIDS Surveillance 101

Session Outline

  • Introduction

  • Framework for integrated HIV/AIDS surveillance

  • Critical concepts: confidentiality, dissemination, and evaluation

  • Technical assistance

  • Relevant resources

  • Pediatric/perinatal surveillance


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HIV/AIDS Surveillance

Definition

The systematic collection, analysis, interpretation, dissemination, and evaluation of population-based information about persons with diagnosed HIV and AIDS.


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Public Health Surveillance

  • Ongoing, systematic

    collection, analysis, and interpretation of data essential to the

    planning, implementation, and evaluation

    of public health practice

  • Closely integrated with the timelydissemination

    tothose responsible for

    prevention and control


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HIV/AIDS Surveillance

How Data are Used

  • Monitor incidence and prevalence of diagnosed HIV infection and AIDS

  • Track HIV-related morbidity and mortality

  • Detect trends in HIV transmission

  • Follow the characteristics of those affected

  • Identify populations at risk

  • Estimate incidence and prevalence of HIV infection

  • Target prevention activities and evaluate their effectiveness

  • Allocate funds for health care and social services


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AZT shown to reduce risk

of perinatal transmission

Protease inhibitors

licensed for use in US

Use of HAART becomes

widespread.

AIDS case definition

expanded

500,000 AIDS cases

reported to CDC as

of October 1995

AZT monotherapy

becomes available

HIV identified

100,000 AIDS cases reported

to CDC as of July 1989.

Serologic assay for HIV

antibody available

An estimated 798,500

AIDS cases diagnosed

through 2000

AIDS case definition modified

First AIDS case definition published

Evolution of an Epidemic

Estimated AIDS incidence* through 2000, United States

*Estimated from data reported to CDC through June 2001, adjusted for reporting delays.


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HIV Infection

HIV exposure (children)

HIV

infection

1st positive confidential HIV test

1st CD4+ T-cell count

1st viral load test

1st CD4+

T-cell count <200 cells per FL

AIDS-OI

Death

HIV/AIDS Surveillance

Monitoring the Spectrum of Infection


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Local Health Dept

Sources of Reports

HIV/AIDS

-Hospital Practitioners

9,999

Reports

-Private Practitioners

-Public Clinics

-Laboratories

Passive Reporting

Active

Case Finding

CDC

Dissemination

State Health Dept

-Local Bulletins

-HIV/AIDS Surveillance Reports

HIV/AIDS

-Supplemental Reports

-CDC HIV/AIDS Web Sites

-Public Information Data Set

-Surveillance Slide Sets

HIV/AIDS Surveillance

How HIV/AIDS Surveillance Works

People with HIV/AIDS


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HIV/AIDS Surveillance

How Data are Collected

  • Passive reporting

    • Health care practitioners, hospitals, clinics, and laboratories report cases of HIV/AIDS to state and local health departments

  • Active reporting

    • Health department surveillance staff find cases by contacting health care practitioners and reviewing medical records in hospitals and clinics


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HIV/AIDS Surveillance

What Data are Collected?

  • Demographic characteristics

    • Sex, race/ethnicity, age, residence

  • Risk information

    • Potential modes of exposure to HIV

  • Laboratory and clinical information

    • Virologic and immunologic status

    • Opportunistic illnesses diagnosed

  • Supplemental information

    • Prescription of antiretroviral and prophylactic therapies

    • Use of medical and substance abuse treatment services

    • Health insurance coverage


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Behavioral Surveys of High Risk Groups

e.g., HITS

Performance Evaluations e.g., completeness, timeliness, accuracy

Assays to Estimate HIV Incidence

Representative Samples

Database Matches

e.g., NDI, SSDI

Supplemental Interviews

e.g., SHAS, RECENT, Risk Sampling

Medical Record Abstractions

e.g., EPS, ASD, SDC

HIV/AIDS Surveillance

Building a Better System

Methods Research and Supplemental Data Collection

HIV Infection


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Name-based

Name-based

(Pediatric only)

Name-to-code

Code-based

Other non-name

Reporting not

required or not

yet implemented

Progress Toward a National Integrated HIV/AIDS Surveillance System

Status of HIV Infection Reporting as of December 2001

Washington, D.C.


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HIV/AIDS Surveillance

Confidentiality of Data

  • State and territorial laws for protection of public health data apply to HIV/AIDS data

  • CDC requires that

    • HIV/AIDS case data be maintained in physically secure environments with limited access by authorized personnel

    • State surveillance programs certify that

      • Program requirements have been met

      • Overall Responsible Party (ORP) has been identified

      • Confidentiality policies have been written

  • Patient’s and physician’s names and other personal identifiers are not sent to CDC


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HIV/AIDS Surveillance

  • HIV/AIDS surveillance programs are responsive to data needs for planning prevention and care.


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Epi

Profile

RWCA

Data

HIV Prevention

Indicators

Quarterly

Surveillance

Reports

HIV/AIDS Surveillance Data

Data Requests

HIV Prevention

Community Planning Groups

RWCA Title I

Planning Councils

Surveillance

Staff

RWCA Title II

Planning Consortia

Program Staff, Media,

Legislators, Ad Hoc Requests


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HIV/AIDS Surveillance

Dissemination of Data

  • Surveillance Reports

  • Epi Profiles

  • Ryan White CARE Act Applications

  • Grant Applications

  • Responses to:

    • Ad hoc Requests

    • Media Requests

    • Congressional/Political Inquiries


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HIV/AIDS Surveillance

National Data Dissemination

  • HIV/AIDS Surveillance Reports

    www.cdc.gov/hiv/surveillance.htm

  • MMWRswww.cdc.gov/hiv/pubs/mmwr.htm

  • Slide setswww.cdc.gov/hiv/graphics.htm

  • Prevention and treatment guidelines

    www.cdc.gov/hiv/pubs/guidelines.htm

  • Public information data set (PIDS)

    www.cdc.gov/software/apids.htm

  • CDC fact sheetswww.cdc.gov/nchstp/od/nchstp.html

  • Presentations at meetings and conferences

  • Peer-reviewed journal articles

  • AIDS hotline 1-800-342-AIDS www.ashastd.org/nah.org


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HIV/AIDS Surveillance

Evaluation of System Performance

  • HIV/AIDS surveillance systems evaluated for:

    • Accuracy

    • Completeness of case reporting

    • Timeliness of reporting (time between diagnosis and report)

    • Completeness and accuracy of data collected

  • Evaluation provides information needed to:

    • Improve the system

    • Interpret analyses of data collected

    • Promote the best use of public health resources


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HIV/AIDS Surveillance

Evaluation of System Performance (cont’d)

Minimum Performance Standards

  • Timeliness

    66% reported in 6 months

  • Completeness

    85%

  • Accuracy

    5% duplication and 5% incorrect matching

  • Completeness of risk ascertainment

    >85%

As outlined in: Centers for Disease Control and Prevention. CDC guidelines for national HIV case surveillance, including monitoring for HIV infection and AIDS. MMWR 1999;48 (No. RR-13).



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Perinatal Exposure/Infection Surveillance

  • Routine perinatal surveillance

    • Population-based

    • Active case ascertainment

    • Follow-up of exposed infants every 6 months to obtain HIV infection status, AIDS and death

    • Match to death registry


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Pediatric/Perinatal Surveillance

  • A subset of HIV/AIDS Surveillance

  • Identify HIV infected women who are pregnant

    • Identify children born exposed to HIV

    • Not all children born to HIV-infected mothers will be infected

  • Additional information collected on mothers and children

  • Enhanced surveillance methods (EPS) used in 25 sites


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Pediatric/Perinatal Methods

  • AIDS Surveillance data – all states

  • HIV reporting in 37 States and Territories

    • Conduct active case finding and monitor perinatally exposed children for HIV status, receipt of ARV, maternal HIV testing, PNC

  • Enhanced Perinatal surveillance

    • STEP

    • EPS


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Enhanced Perinatal HIV Surveillance

  • STEP

    • 7 states previously funded

      • to collect data on mother-child pairs for 1993, 1995, 1996 and 1997

      • Pilot project that expanded to EPS


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EPS Methods

  • 25 sites currently funded

  • Match HIV/AIDS and birth registries for birth years 1999, 2000, 2001

  • Review maternal HIV, prenatal, labor/delivery, newborn and pediatric records

  • Includes states with named HIV reporting and states with non-named reporting, using facility based, IRB-approved protocols


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Project Sites: Enhanced Perinatal HIV Surveillance and Perinatal HIV Prevention

Chicago

DC

Enhanced Perinatal

Surveillance (EPS) only

Perinatal Prevention Project

(PPP) only

BOTH EPS and PPP sites

Puerto Rico


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HIV/AIDS Surveillance Perinatal HIV Prevention

Know Thy Data

Additional resources

  • Recent HIV/AIDS Surveillance Reports and Supplemental Reports

    www.cdc.gov/hiv/surveillance.htm

  • Recent HIV/AIDS-related MMWRs

    www.cdc.gov/hiv/pubs/mmwr.htm

  • Fleming PL, Wortley PM, Karon JM, De Cock KM, Janssen RS. Tracking the HIV epidemic: current issues, future challenges.Am J Pub Health 2000;90:1037-41.

  • Karon JM, Fleming PL, Steketee RW, De Cock KM. HIV in the United States at the turn of the century: an epidemic in transition.Am J Pub Health 2001;91:1060-8.


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