First comprehensive HIV data several years away
First comprehensive HIV data several years away
All but three areas are collecting HIV info
Since the Centers for Disease Control and Prevention (CDC) in Atlanta asked that each state and territory add HIV surveillance to their AIDS surveillance, all but three have complied. "California is supposed to implement HIV surveillance on July 1 this year, and Pennsylvania is still going through the process to implement this year," says Robert Janssen, MD, director of the division of HIV/AIDS Prevention — Intervention, Research, and Support. "And Georgia has not announced any plans to implement surveillance," he adds.
The fact that some of the biggest states have been the longest holdouts on HIV data collecting is one of the reasons the CDC does not anticipate having any additional information about HIV prevalence and incidence for several more years, Janssen says. In recent CDC surveillance reports, the HIV data are from 25 states that have been collecting the information for quite a while and, therefore, their data are very stable systems, he says.
"So the people being diagnosed in 2001 with HIV are reported in 2001," Janssen explains. "While in new states that are just beginning to conduct HIV surveillance, some states are asking for reports on everyone who is diagnosed with HIV, but not AIDS, so that means in 2001 they might be getting people who were diagnosed with HIV in 1997." This backlog of HIV-infected people who need to be reported will create less-than-perfect data for at least the first two or three years of a state’s new HIV surveillance.
Then there is the problem that while the majority of states and territories were collecting HIV data by Jan. 1, 2001, there were some major gaps. For instance, New York had problems when the reporting began, and, of course, any national HIV surveillance report that is missing data from Pennsylvania and California will be far from complete. "We can tell whether a system is stable because some problem has occurred, or you will look at the data and they don’t make sense," Janssen says.
Meantime, Congress has directed the Department of Health and Human Services to do a review of HIV reporting and the quality of HIV reporting in each state, and that report is due to be released next year, he says. "We’re doing an evaluation in 10 states of HIV reporting, including those where it’s reported by name and those where it’s reported by coded identifier," Janssen says. "We’ll do the evaluation from July through December 2002, and if everything goes OK, we’ll have data early next year."
The report will evaluate the quality of the data-collecting systems, the completeness of reporting, the timeliness of reporting, whether people are reported multiple times, and other issues. "What we’re beginning to do in states with HIV reporting is we are beginning to move to a national HIV incidence surveillance, and we have funded five states to pilot the approach, which is the Detuned Assay," he says.
The Detuned Assay, developed in 1998, is an enzyme immunoassay that is less sensitive than the more commonly used EIA and Western Bloc assays. Since a newly-infected person’s antibodies generally peak and stabilize about six months after the infection date, the Detuned Assay only is sensitive after the stabilization. "So if you have blood from someone that is positive in the other tests but nonreactive on the Detuned Assay, then you know you’re within that six-month time period and the person has an early infection," Janssen explains.
"No what we want to do is use that method for when a specimen from an individual goes to the diagnostic lab for the HIV test and the specimen tests positive on the EIA and Western Bloc, we want it tested with the less-sensitive test, so we can identify when they are reporting that this person is in early infection," he says. "We will identify people who were just infected and use it to make estimates of incidence rates," he says.
In all, 32 health departments will receive funding to conduct this surveillance in Alabama, Michigan, Colorado, New Jersey, and Washington state.
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