Update on Comprehensive HIV Surveillance in the United States

1
Update on Comprehensive HIV Surveillance in the
United States
CAPT Michael Campsmith, DDS, MPH 2 June
2009 Centers for Disease Control and
Prevention HIV Incidence and Case Surveillance
Branch
The findings and conclusions in this presentation
have not been formally disseminated by the
Centers for Disease Control and Prevention and
should not be construed to represent any agency
determination or policy.
2
Definitions

• HIV
• HIV infection, not progressed to AIDS
• AIDS
• end-stage disease syndrome (all persons with AIDS
  are infected with HIV)
• HIV/AIDS
• HIV alone, or
• HIV and later AIDS, or
• HIV and AIDS at same time

3
Basic Tenets of National Disease Surveillance
Programs

• Statutory and regulatory authority for disease
  reporting and data protection reside with State
  governments
• CDC provides funding, technical assistance, and
  coordinates activities with States for
  aggregation of data for the national surveillance
  system
• All reportable diseases (AIDS, anthrax, breast
  cancer, etc.)now including HIV
  infectionreported to health departments using
  patient name as identifier
• names are not sent to CDC

4
HIV/AIDS Surveillance

• the systematic collection, analysis,
  interpretation, dissemination, and evaluation of
  population-based information about persons
  diagnosed with HIV infection or AIDS

5
Initial MMWR - 1981
6

• CDC staff budget for HIV/AIDS Surveillance
• 1981 Kaposis Sarcoma and Opportunistic
  Infections Task Force
• About a dozen part-time volunteers
• Zero dedicated budget
• 2008 HIV Incidence and Case Surveillance Branch
• 50 FTEs and contractors
• 36 million for core surveillance (extramural)
• Part of Division of HIV/AIDS Prevention550
  staff,
• 653 million budget (65 million intramural and
  586 million extramural)

7

• AIDS surveillance complicated because
• In the beginning the cause of AIDS was unknown
• - there was no lab test for it
• It was defined as a syndrome
• - a disease consisting of multiple other
  diseases
• - with a case definition consisting of multiple
  
• case definitions for the other diseases
• After HIV (human immunodeficiency virus) was
  discovered, AIDS case definition expanded several
  times by taking into account results of lab tests
  for HIV and immunodeficiency (CD4 T-lymphocyte
  count)

8
Reportable Events in the Spectrum of HIV/AIDS
Morbidity and Mortality
HIV infection diagnosis (or 1st positive
confidential HIV test) may occur at any point
along this spectrum.
CORE HIV/AIDS SURVEILLANCE
Incident HIV infection
Birth to an HIV-infected mother (children only)
HIV Test
CD4 Counts, including lt200 (Immuno-AIDS)
Viral Load Tests
AIDS-OI
Death
9
Reportable Events in the Spectrum of HIV/AIDS
Morbidity and Mortality
HIV infection diagnosis (or 1st positive
confidential HIV test) may occur at any point
along this spectrum.
CORE HIV/AIDS SURVEILLANCE
Incident HIV infection
Birth to an HIV-infected mother (children only)
HIV Test
CD4 Counts, including lt200 (Immuno-AIDS)
Viral Load Tests
AIDS-OI
Death
10
(No Transcript)
11
Reportable Events in the Spectrum of HIV/AIDS
Morbidity and Mortality
HIV infection diagnosis (or 1st positive
confidential HIV test) may occur at any point
along this spectrum.
CORE HIV/AIDS SURVEILLANCE
Incident HIV infection
Birth to an HIV-infected mother (children)
HIV Test
CD4 Counts, including lt200 (Immuno-AIDS)
Viral Load Tests
AIDS-OI
Death
12
Staggered Implementation of HIV Infection
Surveillance
Washington, D.C.
Through 1994
1995 - 1998
1999 - 2000
2001- 2004
13
Current Status of HIV Infection
SurveillanceApril 2008
Washington, D.C.
Name-based HIV reporting
14
Old-Fashioned HIV/AIDS Surveillance
State Health Dept
Passive
CDC
15
How HIV/AIDS Surveillance Should Work
with routine electronic reporting
People with HIV/AIDS
State Health Dept
Passive
16
Needs for Modern Surveillance Practices

• Ability to
• Use electronic data (directly import match)
• Monitor what/when data changes were made
• Identify sources of information (where to focus
  efforts)
• Link together all surveillance information
  (currently in ancillary systems)
• Easily, consistently conduct evaluation

17
Lessons Learned

• Integrated surveillance system necessary to meet
  public health needs
• System needs to be flexible
• Change is almost always harder than you first
  think

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Status of the HIV Epidemic in the United
States2007

• CAPT Michael Campsmith, DDS, MPH
• 2 June 2009
• Centers for Disease Control and Prevention
• HIV Incidence and Case Surveillance Branch

The findings and conclusions in this presentation
have not been formally disseminated by the
Centers for Disease Control and Prevention and
should not be construed to represent any agency
determination or policy.
19
Oral Manifestations of HIVoral candidiasis
Source Veterans Affairs website. Photo by
Paul Volberding, UCSF
20
Oral Manifestations of HIV oral candidiasis
Source Veterans Affairs website. Photo by
Paul Volberding, UCSF
21
Oral Manifestations of HIVKaposis sarcoma
Source Veterans Affairs website. Photo by
Paul Volberding, UCSF
22
Oral Manifestations of HIV Kaposis sarcoma
Source Veterans Affairs website. Photo by
Paul Volberding, UCSF
23
Estimated Numbers of AIDS Cases, Deaths, and
Persons Living with AIDS,19852007United States
and Dependent Areas
Note. Data have been adjusted for reporting
delays.
24
Estimated Numbers of Male Adults and Adolescents
Living with AIDS, by Transmission
Category19852007United States and Dependent
Areas
Note. Data have been adjusted for reporting
delays and missing risk-factor information.
Heterosexual contact with a person known to have,
or to be at high risk for, HIV infection.
25
Estimated Numbers of Female Adults and
Adolescents Living with AIDS, by Transmission
Category,19852007United States and Dependent
Areas
Note. Data have been adjusted for reporting
delays and missing risk-factor information.
Heterosexual contact with a person known to have,
or to be at high risk for, HIV infection.
26
Estimated Numbers of Perinatally Acquired AIDS
Cases, by Year of Diagnosis, 19852007United
States and Dependent Areas
Note. Data have been adjusted for reporting
delays and missing risk-factor information.
27
Estimated Numbers of Adults and Adolescents
Living with AIDS by Sex,19932007United States
and Dependent Areas
Note. Data have been adjusted for reporting
delays.
28
Estimated Numbers of Persons Living with AIDS by
Race/Ethnicity 19932007United States and
Dependent Areas
Note. Data have been adjusted for reporting
delays. Hispanics/Latinos can be of any
race. Includes Asian and Pacific Islander legacy
cases.
29
Estimated Number of AIDS Cases and Rates for
Adults and Adolescents, by Race/Ethnicity
200750 States and DC
Rate
(cases per 100,000
population)
Cases
Race/Ethnicity
American Indian/ Alaska Native
8.6
158
Asiana
4.3
475
59.2
Black/African American
17,486
Hispanic/Latino
20.4
6,918
Native Hawaiian/ other Pacific Islander
76
22.3
10,402
6.1
White
14.4
35,934
Total
Note. Data have been adjusted for reporting
delays. aIncludes Asian/Pacific Islander legacy
cases.
Includes adults and adolescents of unknown race
or multiple races.
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Percentages of AIDS Cases among Adults and
Adolescents by Transmission Category and Year of
Diagnosis19852007United States and Dependent
Areas
Note. Data have been adjusted for reporting
delays and missing risk-factor information. Heter
osexual contact with a person known to have, or
to be at high risk for, HIV infection.
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Activities of Research and Dissemination (RAD)
Team

• Produce/publish surveillance products
• Surveillance report
• Slide series
• Supplemental reports
• Recurring/ad hoc analyses for Ryan White, HP2010,
  manuscripts, presentations, etc.
• Technical assistance to grantees
• GIS pilot project
• Epi capacity building project

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Uses of HIV/AIDS Surveillance Data

• Monitor the incidence and prevalence of HIV
  infection and AIDS, and HIV-related morbidity and
  mortality in the population
• Identify changes in trends of HIV transmission
  and identify populations at risk

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Uses of HIV/AIDS Surveillance Data (cont)

• Target prevention interventions and evaluate
  their effectiveness
• Allocate funds for health and social services

34
Information on Epidemiology of HIV and AIDS in
the United States

• http//www.cdc.gov/hiv/resources/index.htm
• Thanks!!
• Questions??
• Michael Campsmith
• Centers for Disease Control and Prevention
• 1600 Clifton Road NE
• Mailstop E-47
• Atlanta, GA 30333
• mcampsmith_at_cdc.gov
• 404-639-2050