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NIR Update January 2002 - June 2002

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NIR Update January 2002 - June 2002

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    2. NIR NIR – Cases with no identified risk represent: Persons who do not wish to reveal their risk for HIV Persons who truly do not know how they became infected Persons for whom risk could not be assessed Persons for whom risk was not reported

    3. Why Collect Risk Information? To monitor changing patterns of transmission; To effectively counsel the client regarding the spread of HIV; Community Planning: To assist in targeting resources for populations at increased risk; To detect any unusual transmission.

    4. The NIR Problem The proportion of AIDS & HIV cases reported without risk continues to increase due to: Increased volume following revised AIDS case definition in 1993 Decreases in surveillance staff to conduct investigations Increases in heterosexual transmission of HIV to persons without known risk factors Cases noting sex with the opposite sex, but lacking a risk on the partner(s) will remain as NIR.

    5. Acronyms MSM – Men who have sex with men (includes homosexual and bisexual). IDU – Injecting drug user. This category assumes that needle-sharing has taken place. Hetero – Persons known to be infected by a partner of the opposite sex and/or that partner has a known HIV/AIDS risk. NIR – No identified risk. Information regarding risk for HIV was unknown, not determined or denied. This information is updated when determined.

    6. Percent of Adult AIDS and HIV Cases Reported with No Identified Risk (NIR) by Sex, U.S. and Florida, 2001

    11. Demographics of NIRs in Florida By Sex: Females have a higher NIR rate than males By Race/Ethnicity: Blacks have a higher NIR rate than white or Hispanic cases By Age: Persons 60+ have the highest NIR rate

    19. In Summary HIV – NIRS 1,058 have been re-classified (10% of total) 52% were adult males Of these: 49% were reclassed as MSM 13% as IDU 38% as heterosexual 48% were adult females Of these: 11% were reclassed as IDU 89% as heterosexual

    20. HIV – NIRs (continued) By source of report, the majority of risks were found from: 14% private MDs 12% medical record 43% STD One-fourth of these risks were identified within 3 months HIV NIRs dropped from 43% to 39% during this six month period ending on July 1, 2002 In Summary (cont’d)

    21. AIDS – NIRs 1,063 AIDS NIRs have been re-classified (7% of total) 65% were adult males of which 49% reclassed as MSM 13% as IDU 38% as heterosexual 35% were adult females 11% reclassed as IDU 89% as heterosexual In Summary (cont’d)

    22. AIDS – NIRs (continued) By source of report, the majority of these risks were found: 21% private MDs 27% medical record reviews 17% STD One-fourth of these risks were identified within 3 months of report AIDS NIRs dropped from 19% to 18% during the six month period ending July 1, 2002. In Summary (cont’d)

    23. Florida Initiatives to Reduce NIRs Routine database matches with ADAP, STD, TB, etc. Place educational articles relating to NIR issues in publications that reach out to numerous providers (AETC, Dept. of Corrections, etc.) Educate private providers at every opportunity on how to identify and report risks, especially for partners of heterosexual cases. Remind providers that they can notify surveillance of risk information at any time, even if they did not initially report the case. Dear Colleague letter to providers

    24. National Strategies for Dealing with Increased Numbers of NIR Cases Redistribution fraction applied to AIDS cases based on historical patterns of NIR re-classification Estimating HIV case risks based on patterns of risk redistribution using SHAS data

    25. Expanded HIV Risk Assessment Project (EHRAP) – Captures HIV risk information on a sample of persons with HIV/AIDS Sampling by State health departments for cases reported within a particular period of time. NIR protocol used to validate or identify risk. Sample estimates used to describe distribution in all cases. National Strategies for Dealing with Increased Numbers of NIR Cases (cont’d)

    26. How can Providers Help to Reduce NIRs? Explain to your client that in the vast majority of AIDS cases, HIV was acquired through identified transmission routes. Review the different risk exposures with your client, including the need for details on heterosexual transmission.

    27. More Ways That Providers Can Help to Reduce NIRs If you identify a risk on a HIV/AIDS client, notify your local HIV/AIDS surveillance staff, no matter how long ago you reported the case, or even if you were not the provider who initially reported the case. If a new or unusual transmission route is suspected, notify your local HIV/AIDS surveillance contact as soon as possible.

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