Enhancing HIV/AIDS Surveillance in Enhancing HIV/AIDS Surveillance in CaliforniaCalifornia

California Department of Public California Department of Public HealthHealth

Office of AIDSOffice of AIDS

Guide for Health Care ProvidersGuide for Health Care Providers

Enhancing HIV/AIDS Surveillance in Enhancing HIV/AIDS Surveillance in CaliforniaCalifornia

Primary Target Audience

Providers of HIV testing and Providers of HIV testing and treatment services in California.treatment services in California.

Training Goal

Provide a general overview of the Provide a general overview of the surveillance model used to surveillance model used to estimate HIV incidence. estimate HIV incidence.

Describe the information needed Describe the information needed to estimate HIV incidence.to estimate HIV incidence.

What is HIV Incidence Surveillance (HIS)?What is HIV Incidence Surveillance (HIS)?

HIV incidence measures the number of new HIV infections in a population over a period of time.

HIS estimates are based on data collected through routine case reporting and a newly developed biomarker.

HIS is part of a national effort supported by the Centers for Disease Control and Prevention (CDC) to fully integrate incidence as a component of the HIV/AIDS surveillance system and will help target HIV treatment and prevention efforts.

Why track NEW infections?Why track NEW infections?

Routine HIV and AIDS case reporting does not generate information on the timing of HIV infection.

An estimate of the annual number of new infections, rather than new diagnoses, more accurately describes the current HIV epidemic.

The more accurate description of the HIV epidemic will help local health agencies target prevention programs to the populations at greatest risk.

Core Surveillance HIS

Measures New diagnosesHIV Prevalence Existing cases

New infectionsHIV Incidence New cases

Data collected

Demographic information HIV risk HIV test result AIDS Indicators

Also: Past HIV testing history Medications to treat or

prevent HIV (ARV) STARHS test result from

remnant blood specimen

Uses of data Both important to guiding prevention and care; resource allocation.

Changes in burden of disease.

Where infection is spreading

Comparing Core & HIV Incidence Surveillance (HIS)

Remnant HIV+ SerumSTARHS Testing

Patient Testing and Treatment History

HIV Incidence Estimation

Core demographic& clinical data from

HIV/AIDS case reports

Requirements for HIV Incidence Surveillance

Remnant HIV+ SerumSTARHS Testing

Patient testing and Treatment History

HIV Incidence Estimation

Core demographic& clinical data from

HIV/AIDS case reports

Requirements for HIV Incidence Surveillance

Antibody-based laboratory testing method that allows CDC to identify, with reasonable probability, how many newly reported HIV diagnoses represent recent infections.

STARHSSTARHS

Serologic Testing Algorithm for Recent HIV Seroconversion

Combination of two HIV antibody tests can detect recent HIV infection

– Standard HIV antibody test (EIA)– STARHS test (HIV-1 BED Capture EIA)

Average window period of 5 months to detect recent HIV-1 seroconversion.

STARHSSTARHS

Serologic Testing Algorithm for Recent HIV Seroconversion

Only approved for public health Only approved for public health surveillance purposes.surveillance purposes. Test results are not returned to Test results are not returned to the patient.the patient.

STARHSSTARHS

Serologic Testing Algorithm for Recent HIV Seroconversion

STARHS Window Period

HIV IgG / Total IgG

INFECTION

Incident case

Standard EIA

Prevalent case

BED HIV-1 Capture EIA

Ave. Window Period = 153 days (~5 months); 95% CI 146 – 168 days

TIMETIME

RECENT SEROCONVERSION

(STARHS reactive)

NOT RECENT

Remnant HIV+ SerumSTARHS Testing

Patient Testing and Treatment History

HIV Incidence Estimation

Core demographic& clinical data from

HIV/AIDS case reports

Requirements for HIV Incidence Surveillance

Testing and Treatment History Testing and Treatment History (TTH) Collection in California(TTH) Collection in California

Counseling and Counseling and Testing Sites Testing Sites (CTS)(CTS)

Private and other Private and other non-CTS settingsnon-CTS settings

Data entry Data entry module module

LEO/PEMSLEO/PEMS eHARSeHARS

ImplementedImplemented 20052005 20092009

Collection Collection instrumentinstrument Testing and Treatment History Form [CDPH 8681

(08/11]

What general information is What general information is needed?needed?

Collect and chart the following information from all patients newly diagnosed with HIV

– Date of the patient’s first positive HIV test result

– Date of the patient’s last negative HIV test result

– # of HIV negative tests received by the patient in the two years preceding their first positive test

– Any history of antiretroviral therapy (ART)

How can HIS How can HIS information be information be

collected?collected?

The Testing and Treatment History Form (TTH)

What information is needed on the

TTH?

Stateno assigned by surveillance

staff for the clients

Note the data source. “PEMS” refers to our LEO database

This date can be when the patient answered the TTH (in a patient interview) or when the information was obtained from either a: Provider Report, PEMS, Medical Record Review or Other.

If interviewing a patient, this is a self-reported date. Laboratory documented previous HIV tests should be recorded in the Laboratory Data section of the HIV/AIDS Case Report Form.

-Last known date of negative test even if not certain that this is the most recent negative test-An approximate date is better than no date-Enter date of test, not date of provider note-Leave blank if no evidence of previous test-If the date if from a lab test with a specified test type, enter the information on the “Lab Tab” section as well

Answer this portion of the TTH as it is asked. DO NOT count the first positive test. Only count the negative tests patient had in the 24 months (2 years) prior to having the first positive test.

-Record ‘Yes’ if patient used any ARV at any point in time

-Record the dates ARVs began and last use, if known

-Record ‘No’ if the patient has never used ARVs

-Record ‘Don’t know’, if ARV use is unknown

-Absence of ARV use information is NOT the same as never used ARVs

-Enter the name of earliest known ARV taken

-Select ‘Unspecified’ if ARV name is unknown

-Variable not being used to monitor treatment.

-Record the earliest date of any ARV use, even if this is after the date of HIV diagnosis

-Record the last known date of any ARV use

-Record month and year

-Leave blank if unknown date of first use

Thank You!

For more information please visit our websites:

HIV/AIDS Surveillance in Californiahttp://www.cdph.ca.gov/programs/aids/Pages/OAHISHome.aspx

HIV Incidence Surveillance in the U.S.www.cdc.gov/hiv/topics/surveillance/incidence.htm