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Monitoring Indicators of the National HIV/AIDS Strategy
Using Data for Public Health ActionIrene 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 PreventionDivision of HIV/AIDS Prevention
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
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
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
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
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
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 <X> and
diagnosed with HIV infection in 2010 - based on HIV surveillance data reported through 06/30/2012
Persons diagnosedwith HIV
infection in 2010
Persons linked tocare within 3
months following diagnosis
Persons linked tocare within 6
months following diagnosis
Persons linked tocare within 12
months following diagnosis
No. No. % No. % No. %
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 <X> 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 tocare within 3
months following diagnosis
Persons linked tocare within 6
months following diagnosis
Persons linked tocare within 12
months following diagnosis
No. No. % No. % No. %Sex
Age group at diagnosis
Race/ethnicity
Transmission category
MSM x Race/ethnicity
Sex x IDU x Race/ethnicitySex x Heterosexual contact x Race/ethnicity
Total
NHAS Indicator Program – Output (3)Care 1. Number and percentage receiving HIV care in 2010 among persons who were
residing in <X>, 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
NHAS Indicator Program – Output (4)VL1. Number and percentage with suppressed HIV viral load among persons who
were residing in <X>, 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
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
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
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
Line-listing Program: Output—Not in Care
Variable name DescriptionSample_dt Specimen collection dateName1 Name of the facilityName2Facility_uidFacility_type_cd Facility typeCity_name City of facilityState_cd State of FacilityStreet_address1 Street addressStreet_address2Loinc_cd… and results
Facility information from most recent lab report available; or, if no lab report available, facility of diagnosis.
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 PreventionDivision of HIV/AIDS Prevention
Acknowledgements
Tian TangAruna Surendera BabuMi ChenState and local surveillance program staff