1. Enhancing HIV/AIDS Surveillance in California California Department of Public Health Office of AIDS Guide for Health Care Providers

2. Enhancing HIV/AIDS Surveillance in California Primary Target Audience Providers of HIV testing and treatment services 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. Describe the information needed to estimate HIV incidence. Describe the information needed to estimate HIV incidence.

3. What is HIV Incidence Surveillance (HIS)? HIV incidence measures the number of new HIV infections in a population over a period of time. HIS estimates are based on data collected through routine case reporting and a newly developed biomarker. HIS is part of a national effort supported by the Centers for Disease Control and Prevention (CDC) to fully integrate incidence as a component of the HIV/AIDS surveillance system and will help target HIV treatment and prevention efforts.

4. Why track NEW infections? Routine HIV and AIDS case reporting does not generate information on the timing of HIV infection. An estimate of the annual number of new infections, rather than new diagnoses, more accurately describes the current HIV epidemic. The more accurate description of the HIV epidemic will help local health agencies target prevention programs to the populations at greatest risk.

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

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. 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

8. 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

9. 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. STARHS STARHS Serologic Testing Algorithm for Recent HIV Seroconversion

10. 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

11. 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

12. 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

13. Testing and Treatment History (TTH) Collection in California Counseling and Testing Sites (CTS) Private and other non- CTS settings Data entry module LEO/PEMSeHARS Implemented20052009 Collection instrument Testing and Treatment History Form [CDPH 8681 (08/11]

14. What general information is needed? Collect and chart the following information from all patients newly diagnosed with HIV – – Date of the patient ’ s first positive HIV test result – – Date of the patient ’ s last negative HIV test result – – # of HIV negative tests received by the patient in the two years preceding their first positive test – – Any history of antiretroviral therapy (ART)

15. How can HIS information be collected?

16. The Testing and Treatment History Form (TTH)

17. What information is needed on the TTH?

18. Stateno assigned by surveillance staff for the clients Note the data source. “PEMS” refers to our LEO database

19. This date can be when the patient answered the TTH (in a patient interview) or when the information was obtained from either a: Provider Report, PEMS, Medical Record Review or Other.

20. If interviewing a patient, this is a self- reported date. Laboratory documented previous HIV tests should be recorded in the Laboratory Data section of the HIV/AIDS Case Report Form.

21. -Last known date of negative test even if not certain that this is the most recent negative test -An approximate date is better than no date -Enter date of test, not date of provider note -Leave blank if no evidence of previous test -If the date if from a lab test with a specified test type, enter the information on the “Lab Tab” section as well

22. Answer this portion of the TTH as it is asked. DO NOT count the first positive test. Only count the negative tests patient had in the 24 months (2 years) prior to having the first positive test.

23. -Record ‘Yes’ if patient used any ARV at any point in time -Record the dates ARVs began and last use, if known -Record ‘No’ if the patient has never used ARVs -Record ‘Don’t know’, if ARV use is unknown -Absence of ARV use information is NOT the same as never used ARVs

24. -Enter the name of earliest known ARV taken -Select ‘Unspecified’ if ARV name is unknown -Variable not being used to monitor treatment.

25. -Record the earliest date of any ARV use, even if this is after the date of HIV diagnosis -Record the last known date of any ARV use -Record month and year -Leave blank if unknown date of first use

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