Background

CDC’s HIV/AIDS surveillance system is the nation’s key source of information used to track the epidemic. CDC funds HIV/AIDS surveillance in 65 areas to monitor the number and characteristics of persons who have been diagnosed with HIV and trends in the incidence of HIV-related morbidity and mortality.

In July 2005, CDC formally recommended that all states and territories adopt confidential name-based surveillance systems to report HIV infections. CDC policy is to accept HIV infection and AIDS case surveillance data only from areas conducting confidential name-based HIV reporting because this reporting has been shown to routinely achieve high levels of accuracy and reliability. As of April 2006, 43 states and 5 territories have adopted confidential, name-based HIV reporting.

Summary Analysis of Performance Indicators

For Goal 4, CDC has one performance indicator (Indicator 11): the number of states and territories with integrated, confidential, name-based HIV/AIDS case surveillance systems for adults and adolescents. Prior to the advent of highly effective HIV therapies, data on AIDS (which has been reported through name-based systems since the beginning of the epidemic) was reasonably adequate to monitor the epidemic; however, as the proportion of HIV-infected persons progressing to AIDS has declined, it is increasingly important to have information on the larger population of HIV-infected persons who have not yet developed AIDS. Data from the HIV/AIDS case surveillance system are used as the basis for the fair allocation of both prevention and care resources by multiple federal agencies. In states with confidential, name-based HIV reporting, the state and local health departments retain the names of persons in their case registries to assist them in follow-up of epidemiologically important cases and de-duplication of cases from multiple jurisdictions; names are not sent to the federal government. This is the same method as that used for AIDS cases. In 2000, there were 32 states and 2 territories with name-based HIV/AIDS case surveillance systems. By 2006, these numbers increased to 43 states and 5 territories. The remaining states use non-name-based systems with coded identifiers. These have not been shown to allow adequate de-duplication of cases, and they are much more costly because of the extensive follow-up needed to confirm codes. At all levels of government where name-based data are held, elaborate security and confidentiality procedures have been put into place to protect the confidentiality of individuals. It is hoped that a uniform national HIV/AIDS case surveillance system will be implemented by the end of the decade. An important impetus for states to move to name-based reporting has been the Ryan White CARE Act, which requires the use of HIV data to make resource allocations for HIV/AIDS care and treatment.

Selected Activities

CDC currently funds a total of 34 areas to conduct a population-based incidence surveillance system using the Serologic Testing Algorithm for Recent HIV Seroconversion (STARHS). STARHS is a way of analyzing HIV-positive blood samples to determine whether an HIV infection is recent or has been long-standing. The system is expected to provide the clearest picture yet of the magnitude of the domestic HIV epidemic, as well as aid CDC in more effectively targeting HIV prevention efforts to promote decreases in the incidence of new HIV infections. Date on estimates of incidence are expected in mid-2006.

In addition to assessing infection and disease trends, CDC conducts the ongoing National HIV Behavioral Surveillance (NHBS) system to monitor risk behaviors, testing, and use of prevention services among three groups of persons at risk for HIV infection: MSM, IDUs, and high-risk heterosexual adults. Data are collected from one group per year in 25 metropolitan statistical areas across the United States. Data collection began for MSM in 2004; for IDUs in 2005; and for high-risk heterosexuals in 2006. The information collected in NHBS will be used to develop and implement effective HIV prevention programs for these high-risk groups.

In conjunction with tracking disease trends and monitoring risk behaviors, the provision of locally relevant data for community planning is an integral component of this goal. In 2004, CDC funded four organizations under the new CBA program to provide assistance and training to state and local health departments and HIV prevention community planning groups to assure high-quality incidence, prevalence and behavioral profile reporting. Through this program, organizations are required to provide CBA to help community planning groups understand surveillance data, particularly how to apply locally relevant information to community planning activities.

The DEBI project is CDC’s primary means of disseminating scientifically proven, evidence-based interventions to funded grantees. Over the past 3 years, CDC has diffused 11 of the 14 interventions to CBOs and health departments, and provided 274 DEBI trainings to 1,525 CBOs; 400 county, city, state, and territorial health departments; and 5,362 individuals.

In 2004, CDC responded to the need for more accurate and timely data for monitoring HIV prevention programs by designing and implementing the Program Evaluation and Monitoring System (PEMS). PEMS is a national data reporting system that aims to strengthen the capacity to monitor and evaluate CDC-funded HIV prevention programs supported or delivered by health departments and CBOs. PEMS is being rolled out and developed in phases. It was first released in late 2004 to 42 health departments and 27 CBOs with the goal of improving reporting capabilities between the CDC, health departments, and CBOs. The system includes a standardized set of HIV prevention data variables to measure and track prevention processes and outcomes, such as HIV counseling and testing results, client risk factors for HIV transmission, service utilization, and detailed risk behaviors. Also to monitor the implementation of quality evidence-based behavioral programs and interventions, data from PEMS will include detailed information on the program services as intended and actually delivered to clients. This information will enable CDC and funded-grantees to demonstrate successful programs as well as modify program activities to improve service delivery and achieve programmatic goals.

⁶ The funding amounts presented here represent amounts spent in 2004 by CDC's National Centers on goals 1 - 4 of CDC's HIV Strategic Plan. They exclude amounts spent on Goal 5 (to assist in reducing HIV transmission and improving HIV/AIDS care and support in partnership with resource-constrained countries) and amounts for centralized rent, utilities, and program support at CDC. They include funding transferred to CDC from HHS for the Minority AIDS Initiative.

Go to next section