1. Monitoring Indicators of the National HIV/AIDS Strategy Using Data for Public Health Action Irene Hall, PhD, FACE HIV Incidence and Case Surveillance Branch 2012 CSTE Annual Conference HIV Surveillance Pre-conference Workshop Omaha, NE June 3, 2012 National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of HIV/AIDS Prevention

2. National HIV/AIDS Strategy (NHAS) Indicator Program  CDC developed a SAS program to assist local and state HIV surveillance programs to assess: — Linkage to care within 3, 6, and 12 months following HIV infection diagnosis, and — Retention in care and viral load suppression among persons living with diagnosed HIV infection  The fully automated SAS program was made available on HICSB’s SiteScape (now SharePoint) on January 12, 2012

3. NHAS Indicator Program - Definitions  Linkage to care: ― There is at least one result of a CD4 or viral load test based on a specimen collected within the specified time period following diagnosis  Retention in HIV care — Had at least two CD4 and/or viral load tests (two care visits) at least three months apart during the specified year  Viral suppression ― The most recent viral load measured during the specified year was less than or equal (≤) 200 copies per milliliter

4. NHAS Indicator Program – Reporting Delays  Recommendation: — Linkage to care: allow at least 3 months delay for reporting and data entry of laboratory test results (after observation period) — Retention in care and viral suppression: allow at least 18 months delay in death reporting  Table footnotes will indicate if insufficient length of time has been given to account for reporting delays

5. NHAS Indicator Program – Case Inclusion Criteria  Meet the surveillance case definition of HIV infection  Resided in the area when diagnosed with HIV  Person View status is ‘A – Active’, ‘R – Required field missing’, or ‘W – Warning’  Linkage to care: ― Year and month of HIV diagnosis are known ― At least 13 years old at the time of diagnosis ― Irrespective of vital status after diagnosis  Retention in care and viral suppression: ― Year of HIV diagnosis is known ― At least 13 years old at the end of the specified time period ― Presumed alive at the end of the specified time period

6. NHAS Indicator Program – Test Inclusion Criteria  CD4 (count or percent)  HIV viral load  Linkage to care: specimen collected in or after the month of HIV diagnosis  Viral suppression: result or result interpretation is not blank

7. NHAS Indicator Program – Output (1) Link 1. Number and percentage of persons linked to care within 3, 6, and 12 months after diagnosis of HIV infection among persons who were residing in and diagnosed with HIV infection in 2010 - based on HIV surveillance data reported through 06/30/2012 Persons diagnosed with HIV infection in 2010 Persons linked to care within 3 months following diagnosis Persons linked to care within 6 months following diagnosis Persons linked to care within 12 months following diagnosis No. % % %

8. NHAS Indicator Program – Output (2) Link 2. Number and percentage of persons linked to care within 3, 6, and 12 months after diagnosis of HIV infection among persons who were residing in and diagnosed with HIV infection in 2010, by selected characteristics - based on HIV surveillance data reported through 06/30/2012 Characteristics Persons diagnosed with HIV infection in 2010 Persons linked to care within 3 months following diagnosis Persons linked to care within 6 months following diagnosis Persons linked to care within 12 months following diagnosis No. % % % Sex Age group at diagnosis Race/ethnicity Transmission category MSM x Race/ethnicity Sex x IDU x Race/ethnicity Sex x Heterosexual contact x Race/ethnicity Total

9. NHAS Indicator Program – Output (3) Care 1. Number and percentage receiving HIV care in 2010 among persons who were residing in, diagnosed with HIV infection through 12/31/2009 and living at the end of 2010, by selected characteristics - based on HIV surveillance data reported through 06/30/2012 Characteristics No. of persons diagnosed through 12/31/2009 and living at the end of 2010 (Overall population) No. who had ≥1 care visit in 2010 No. who had >=2 care visits in 2010, at least 3 months apart % who had >=2 care visits in 2010, at least 3 months apart among the overall population % who had >=2 care visits in 2010, at least 3 months apart among persons who had >=1 care visit in 2010 Sex Age at the end of 2009 Race/ethnicity Transmission category MSM x Race/ethnicity Sex x IDU x Race/ethnicity Sex x Heterosexual contact x Race/ethnicity Total

10. NHAS Indicator Program – Output (4) VL1. Number and percentage with suppressed HIV viral load among persons who were residing in, diagnosed with HIV infection through 12/31/2009 and living at the end of 2010, by selected characteristics - based on HIV surveillance data reported through 06/30/2012 Characteristics No. of persons diagnosed through 12/31/2009 and living at the end of 2010 (Overall population) No. of persons had ≥1 VL test in 2010 No. with HIV viral suppression in 2010 % with HIV viral suppression in 2010 among the overall population % with HIV viral suppression in 2010 among persons had >=1 VL test in 2010 Sex Age at the end of 2009 Race/ethnicity Transmission category MSM x Race/ethnicity Sex x IDU x Race/ethnicity Sex x Heterosexual contact x Race/ethnicity Total

11. National HIV/AIDS Strategy (NHAS) Line-listing Program  CDC is developing a SAS program to assist local and state HIV surveillance programs to list persons: — Not linked to care within 3, 6, and 12 months following HIV infection diagnosis (no CD4 or VL test within time period) — Not in care during specified time period (no CD4 or VL test in time period)  The SAS program is currently being revised after preliminary testing  Output to list facility of latest document

12. Line-listing Program  Specifications — Case inclusion criteria: see NHAS program — HIV infected people who are alive at the time of the data run — 2 sets of outputs: (1) no cd4/VL and (2) no lab within the time period — Reporting delays: see NHAS program  Note: laws/regulations, completeness of lab reporting, and data entry will affect results

13. Line Listing Variables  Care: No CD4/VL, No lab  Diagnosis: date, status, PV status  ID: STATENO, eHARS unique identifier, Document ID  Personal identifiers: name, address at dx, current  RIDR duplicate status  Vital status

14. Line-listing Program: Output—Not in Care Variable nameDescription Sample_dtSpecimen collection date Name1Name of the facility Name2 Facility_uid Facility_type_cdFacility type City_nameCity of facility State_cdState of Facility Street_address1Street address Street_address2 Loinc_cd … and results Facility information from most recent lab report available; or, if no lab report available, facility of diagnosis.

15. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of HIV/AIDS Prevention Acknowledgements Tian Tang Aruna Surendera Babu Mi Chen State and local surveillance program staff