1. An Introduction to HIV Incidence Surveillance (HIS) in California California Department of Public Health Office of AIDS

2. An Introduction to HIV Incidence Surveillance (HIS) in California Primary Target Audience HIV/AIDS Surveillance Coordinators and other health department staff working in HIV surveillance programs in California. Training Goal Provide a general overview of the surveillance model used to estimate HIV incidence. Provide a general overview of the surveillance model used to estimate HIV incidence. Provide an overview of data requirements for estimating HIV incidence. Provide an overview of data requirements for estimating HIV incidence.

3. Timeline of HIV Surveillance in California

4. Comparing Core & HIV Incidence Surveillance (HIS) Core Surveillance HIS Measures New diagnoses HIV Prevalence Existing cases Existing cases New infections HIV Incidence New cases New cases Data collected Demographic information Demographic information HIV risk HIV risk HIV test result HIV test result AIDS Indicators AIDS IndicatorsAlso: Past HIV testing history Past HIV testing history Medications to treat or prevent HIV (ARV) Medications to treat or prevent HIV (ARV) STARHS test result from remnant blood specimen STARHS test result from remnant blood specimen Uses of data Both important to guiding prevention and care; resource allocation. Changes in burden of disease. Where infection is spreading

5. Requirements for HIV Incidence Surveillance Remnant HIV+ Serum STARHS Testing Patient Testing and Treatment History HIV Incidence Estimation Core demographic & clinical data from HIV/AIDS case reports

6. Remnant HIV+ Serum STARHS Testing Patient testing and Treatment History HIV Incidence Estimation Core demographic & clinical data from HIV/AIDS case reports Requirements for HIV Incidence Surveillance

7. Antibody-based laboratory testing method that allows CDC to identify, with reasonable probability, how many newly reported HIV diagnoses represent recent infections. Antibody-based laboratory testing method that allows CDC to identify, with reasonable probability, how many newly reported HIV diagnoses represent recent infections. STARHS STARHS Serologic Testing Algorithm for Recent HIV Seroconversion

8. Combination of two HIV antibody tests can detect recent HIV infection Combination of two HIV antibody tests can detect recent HIV infection – Standard HIV antibody test (EIA) – STARHS test (HIV-1 BED Capture EIA) Average window period of 5 months to detect recent HIV-1 seroconversion. Average window period of 5 months to detect recent HIV-1 seroconversion. STARHS STARHS Serologic Testing Algorithm for Recent HIV Seroconversion

9. Only approved for public health surveillance purposes. Only approved for public health surveillance purposes. Test results are not returned to the patient. Test results are not returned to the patient. STARHS STARHS Serologic Testing Algorithm for Recent HIV Seroconversion

10. STARHS Window Period HIV IgG / Total IgG INFECTION Incident case Standard EIA Prevalent case BED HIV-1 Capture EIA Ave. Window Period = 153 days (~5 months); 95% CI 146 – 168 days TIME RECENT SEROCONVERSION (STARHS reactive) NOT RECENT

11. Remnant HIV+ Serum STARHS Testing Patient Testing and Treatment History HIV Incidence Estimation Core demographic & clinical data from HIV/AIDS case reports Requirements for HIV Incidence Surveillance

12. Patient Testing and Treatment History Calculate appropriate statistical weights to ensure incidence estimates can be generalized to the California population. Calculate appropriate statistical weights to ensure incidence estimates can be generalized to the California population. Identify people with previous positive HIV test results and those already being treated for HIV infection. Identify people with previous positive HIV test results and those already being treated for HIV infection. Distinguish between repeat HIV testers and new HIV testers; and measure HIV testing frequency. Distinguish between repeat HIV testers and new HIV testers; and measure HIV testing frequency. Allows us to:

13. Key Non-Health Department Partners Providers: Providers: – Ensure records for newly diagnosed HIV cases include testing and treatment history. – First positive HIV Test – Last negative HIV test, if any – Exposure to antiretroviral medication(s) – Facilitate completion of HIV/AIDS case report form when new HIV case is diagnosed.

14. Key Non-Health Department Partners Laboratories: Laboratories: – Ship remnant serum samples to central facility for STARHS testing

15. Key Health Department Partners Local Health Departments Local Health Departments –Collect core surveillance variables and TTH data from providers and active surveillance Office of AIDS Office of AIDS –Raise awareness and interest –Guidance, technical support and monitoring –Data management and transfer to CDC –Complete California incidence estimation

16. Thank You! For more information please visit our websites: HIV/AIDS Surveillance in California www.cdph.ca.gov/programs/OAHIS HIV Incidence Surveillance in the U.S. www.cdc.gov/hiv/topics/surveillance/incidence.htm