Evaluation of the National Human Immunodeficiency Virus Surveillance System for the 2011 diagnosis year.

CONTEXT: In 2009, the Centers for Disease Control and Prevention completed migration of all 59 surveillance project areas (PAs) from the case-based HIV/AIDS Reporting System to the document-based Enhanced HIV/AIDS Reporting System. OBJECTIVES: We conducted a PA-level assessment of Enhanced HIV/AIDS Reporting System process and outcome standards for HIV infection cases. DESIGN: Process standards were reported by PAs and outcome standards were calculated using standardized Centers for Disease Control and Prevention SAS code. SETTING: A total of 59 PAs including 50 US states, the District of Columbia, 6 separately funded cities (Chicago, Houston, Los Angeles County, New York City, Philadelphia, and San Francisco), and 2 territories (Puerto Rico and the Virgin Islands). PARTICIPANTS: Cases diagnosed or reported to the PA surveillance system between January 1, 2011, and December 31, 2011, using data collected through December 2012. MAIN OUTCOME MEASURES: Process standards for death ascertainment and intra- and interstate case de-duplication; outcome standards for completeness and timeliness of case reporting, data quality, intrastate duplication rate, risk factor ascertainment, and completeness of initial CD4 and viral load reporting. RESULTS: Fifty-five of 59 PAs (93%) reported linking cases to state vital records death certificates during 2012, 76% to the Social Security Death Master File, and 59% to the National Death Index. Seventy percent completed monthly intrastate, and 63% completed semiannual interstate de-duplication. Eighty-three percent met the 85% or more case ascertainment standard, and 92% met the 66% or more timeliness standard; 75% met the 97% or more data quality standard; all PAs met the 5% or less intrastate duplication rate; 41% met the 85% or more risk factor ascertainment standard; 90% met the 50% or more standard for initial CD4; and 93% met the same standard for viral load reporting. Overall, 7% of PAs met all 11 process and outcome standards. CONCLUSIONS: Findings support the need for continued improvement in HIV surveillance activities and monitoring of system outcomes.

Prevalence of undiagnosed HIV infection among persons aged ≥13 years--National HIV Surveillance System, United States, 2005-2008.

In the United States, approximately 1.1 million adults and adolescents are living with human immunodeficiency virus (HIV) infection and, each year, another 50,000 become infected. At the end of 2008, approximately 20% of the persons living with HIV had an undiagnosed infection. Of those living with HIV at the end of 2008, nearly two thirds were racial/ethnic minorities and half were men who have sex with men (MSM). In 2007, HIV ranked fifth as a leading cause of death among persons aged 35-44 years in the United States but third among blacks or African Americans in this age group. In 40 states with longstanding confidential name-based HIV surveillance systems, 33% of the estimated 41,768 adults and adolescents diagnosed with HIV infection in 2008 developed acquired immunodeficiency syndrome (AIDS) within 1 year and, of these, 44% received their initial diagnosis in an acute care setting, suggesting that they received HIV testing late in the course of the infection. HIV-infected persons who are unaware of their infection or who receive a late diagnosis cannot benefit fully from timely initiation of therapy and are more likely to experience HIV-related morbidity and premature mortality. In addition, persons unaware of their infection are more likely to transmit HIV to others because of a higher prevalence of high-risk sexual behaviors and higher levels of viral RNA that continue to replicate without appropriate antiretroviral treatment.

Assessing receipt of medical care and disparity among persons with HIV/AIDS in San Francisco, 2006-2007.

We used data from HIV/AIDS surveillance case registry to assess the timing of entry into medical care, level of care received after HIV diagnosis, and to identify characteristics associated with delayed and insufficient care among persons diagnosed with HIV/AIDS between 2006 and 2007 in San Francisco. Laboratory reports of HIV viral load and CD4 test results were used as a marker for receipt of medical care. The time from HIV diagnosis to entry into care was estimated using Kaplan-Meier product limit method and independent predictors of delayed entry into care were determined using the proportional hazards model. Insufficient care was defined as less than an average of two viral load/CD4 tests per person-year of follow-up. Predictors of insufficient care were evaluated using a logistic regression model. An estimated 85% of persons diagnosed with HIV/AIDS entered care within three months after HIV diagnosis; the proportion increased to 95% within 12 months after diagnosis. Persons who were born outside of the USA and those tested at the public counseling and testing sites were more likely to delay care. Nineteen percent of persons were determined to have received insufficient care. Younger persons and those diagnosed at a hospital were more likely to receive insufficient care. A high proportion of persons diagnosed with HIV/AIDS in San Francisco established timely and adequate care after HIV diagnosis. However, delays for some individuals in entry into care and markers of insufficient care suggest that there remains a need to improve access to and sustainability of HIV-specific medical care.