Core HIV/AIDS Surveillance
AIDS Surveillance
Overview: AIDS is a reportable condition in all states and
territories. Since 1993, all states and territories base their reporting
practices on the 1993 CDC case definition for AIDS surveillance. The
AIDS Surveillance system was established to monitor incidence of the
disease and the demographic profile of AIDS cases; describe the modes of
HIV transmission among persons with AIDS; guide the development and
implementation of public health intervention and prevention programs;
and to assist in the evaluation of the efficacy of public health
interventions. AIDS surveillance data are also used to allocate
resources for Titles I and II of the Ryan White CARE Act.
State and local health departments actively solicit disease reports
from health care providers and laboratories. Standardized case report
forms are used to collect sociodemographic information, mode of
exposure, laboratory and clinical information, vital status, and
referrals for treatment or services
Population: All persons who meet the 1993 CDC AIDS surveillance
case definition
Strengths: This is the only source of AIDS information that is
available in all areas (states). The data reflect the effect of AIDS on
communities and trends of the epidemic in communities. AIDS surveillance
has been determined to be >85% complete. The data include all
demographic groups (age, race/ethnicity, sex).
Limitations: Because of the prolonged and variable period from
infection to the development of AIDS, trends in AIDS surveillance do not
represent recent HIV infections. Asymptomatic HIV-infected persons are
also not represented by AIDS case data. In addition, incomplete HIV or
CD4+ T-cell testing may interfere with the completeness of reporting.
Further, the widespread use of HAART complicates the interpretation of
AIDS case surveillance data and the estimation of the HIV/AIDS epidemic
in an area. Newly reported AIDS cases may reflect treatment failures or
the failure of the health care system to halt the progression of HIV
infection to AIDS. AIDS cases represent late-stage HIV infections.
HIV Surveillance
Overview: Since the human immunodeficiency virus was identified
and a test for HIV was licensed, CDC and other professional
organizations have recommended the reporting of HIV infections to local
health authorities as an integral part of AIDS surveillance activities.
As part of ongoing, active HIV surveillance, state and local health
departments educate providers on their reporting responsibilities,
establish active surveillance sites, and establish liaisons with
laboratories that perform HIV testing of samples. Moreover, HIV/AIDS
surveillance programs routinely evaluate the completeness of HIV
reporting and conduct follow-up on HIV cases that are of epidemiologic
importance.
Population: All persons who test positive for the human
immunodeficiency virus (HIV)
Strengths: HIV surveillance data represent more recent
infections, compared with AIDS surveillance data. Previous evaluations
have estimated that HIV infection reporting in Louisiana is >85%
complete for persons who have tested positive for HIV. Consequently, HIV
surveillance provides a minimum estimate of the number of persons known
to be HIV infected and reported to the health department, identifies
emerging patterns of transmission, and can be used to detect trends in
HIV infections among populations of particular interest (e.g., children,
adolescents, or women) that may not be evident from AIDS surveillance.
Additionally, HIV surveillance provides a basis for establishing and
evaluating linkages to the provision of prevention and early
intervention services and can be used to anticipate unmet needs for HIV
care.
Limitations: HIV surveillance data may underestimate the level of
recently infected persons because some infected persons either do not
know they are infected or have not sought testing. Persons who have
tested positive at an anonymous test site and have not sought medical
care, where they would be confidentially tested, are not included in HIV
surveillance statistics. HIV surveillance data represent infections in
jurisdictions where reporting laws for HIV are in place. HIV reporting
laws differ by jurisdiction; therefore, consultation with local
surveillance staff is advised on how to interpret local HIV surveillance
data. Furthermore, reporting of behavioral risk information may not be
complete.
Enhanced Perinatal Surveillance
Overview: Perinatal HIV/AIDS surveillance is the ongoing and
systematic collection of information on HIV-infected pregnant mothers
and perinatally exposed and HIV-infected children. Extensive medical
record abstractions are conducted for all HIV-exposed children and their
mothers, and the children are followed up until their infection status
is determined. These data address the prevention of perinatal
transmission, including prenatal care, HIV counseling and testing during
pregnancy, and the use of zidovudine or other antiretroviral medications
for pregnant mothers and neonates. The data also address questions
regarding treatment issues for HIV-infected women and their children.
Population: All HIV-exposed children and their mothers
Strengths: Enhanced perinatal surveillance data provide perinatal-specific
information that can be used to examine patterns in HIV testing and in
the use of zidovudine in clinical practice, as well as to identify
barriers to the implementation of Public Health Services guidelines.
Perinatal surveillance data may also be used to help ascertain
mother-infant pairs by matching data in the HIV/AIDS registry to the
state birth registry each year.
Limitations: Perinatal data may underestimate the number of
mother-infant pairs because some pregnant women may not know they are
HIV infected and others may not have been tested for HIV. Perinatal data
includes only those women who have had a positive confidential HIV test
result. HIV-exposed infants must be followed up until sufficient
laboratory information is available, so infants who are lost to
follow-up cannot be classified as infected or not infected.
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