an introduction to hiv incidence surveillance (his) in california california department of public...
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An Introduction to An Introduction to HIV Incidence HIV Incidence
Surveillance (HIS) in Surveillance (HIS) in CaliforniaCalifornia
California Department of Public California Department of Public HealthHealthOffice of AIDSOffice of AIDS
An Introduction to HIV Incidence Surveillance An Introduction to HIV Incidence Surveillance (HIS) in California(HIS) in California
Primary Primary Target Target AudienceAudience
HIV/AIDS Surveillance Coordinators HIV/AIDS Surveillance Coordinators and other health department staff and other health department staff working in HIV surveillance working in HIV surveillance programs in California.programs in California.
Training Training GoalGoal
Provide a general overview of the Provide a general overview of the surveillance model used to surveillance model used to estimate HIV incidence. estimate HIV incidence. Provide an overview of data Provide an overview of data requirements for estimating HIV requirements for estimating HIV incidence.incidence.
Timeline of HIV Surveillance in Timeline of HIV Surveillance in CaliforniaCalifornia
Comparing Core & HIV Incidence Comparing Core & HIV Incidence Surveillance (HIS)Surveillance (HIS)
Core SurveillanceCore Surveillance HISHIS
Measures New New diagnosesdiagnoses
HIV PrevalenceHIV Prevalence Existing cases Existing cases
New New infectionsinfections
HIV IncidenceHIV Incidence New casesNew cases
Data collected
Demographic Demographic informationinformation HIV risk HIV risk HIV test resultHIV test result AIDS Indicators AIDS Indicators
Also:Also: Past HIV testing historyPast HIV testing history Medications to treat or Medications to treat or
prevent HIV (ARV) prevent HIV (ARV) STARHS test result from STARHS test result from
remnant blood specimenremnant blood specimen
Uses of data Both important to guiding prevention and care; Both important to guiding prevention and care;
resource allocation. resource allocation.
Changes in burden of Changes in burden of disease.disease.
Where infection is Where infection is spreadingspreading
Requirements for HIV Incidence Requirements for HIV Incidence SurveillanceSurveillance
Remnant HIV+ SerumSTARHS Testing
Patient Testing and Treatment History
HIV Incidence Estimation
Core demographic& clinical data from
HIV/AIDS case reports
Remnant HIV+ SerumSTARHS Testing
Patient testing and Treatment History
HIV Incidence Estimation
Core demographic& clinical data from
HIV/AIDS case reports
Requirements for HIV Incidence Requirements for HIV Incidence SurveillanceSurveillance
Antibody-based laboratory testing Antibody-based laboratory testing method that allows CDC to identify, method that allows CDC to identify, with reasonable probability, how with reasonable probability, how many newly reported HIV diagnoses many newly reported HIV diagnoses represent recent infections.represent recent infections.
STARHSSTARHS
Serologic Testing Algorithm for Recent HIV Seroconversion
Combination of two HIV antibody tests Combination of two HIV antibody tests can detect recent HIV infectioncan detect recent HIV infection
– Standard HIV antibody test (EIA)Standard HIV antibody test (EIA)– STARHS test (HIV-1 BED Capture STARHS test (HIV-1 BED Capture
EIA)EIA)
Average window period of 5 months to Average window period of 5 months to detect recent HIV-1 seroconversion.detect recent HIV-1 seroconversion.
STARHSSTARHS
Serologic Testing Algorithm for Recent HIV Seroconversion
Only approved for public health Only approved for public health surveillance purposes.surveillance purposes.
Test results are not returned to the Test results are not returned to the patient.patient.
STARHSSTARHS
Serologic Testing Algorithm for Recent HIV Seroconversion
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
TIMETIME
RECENT SEROCONVERSION
(STARHS reactive)
NOT RECENT
Remnant HIV+ SerumSTARHS Testing
Patient Testing and Treatment History
HIV Incidence Estimation
Core demographic& clinical data from
HIV/AIDS case reports
Requirements for HIV Incidence Requirements for HIV Incidence SurveillanceSurveillance
Patient Testing Patient Testing and Treatment Historyand Treatment History
Calculate appropriate statistical weights to Calculate appropriate statistical weights to ensure incidence estimates can be ensure incidence estimates can be generalized to the California population. generalized to the California population.
Identify people with previous positive HIV Identify people with previous positive HIV test results and those already being treated test results and those already being treated for HIV infection.for HIV infection.
Distinguish between repeat HIV testers and Distinguish between repeat HIV testers and new HIV testers; and measure HIV testing new HIV testers; and measure HIV testing frequency.frequency.
Allows us to:Allows us to:
Key Non-Health Key Non-Health Department PartnersDepartment Partners
Providers: Providers: – Ensure records for newly diagnosed HIV Ensure records for newly diagnosed HIV
cases include testing and treatment history.cases include testing and treatment history.– First positive HIV TestFirst positive HIV Test– Last negative HIV test, if anyLast negative HIV test, if any– Exposure to antiretroviral medication(s)Exposure to antiretroviral medication(s)
– Facilitate completion of HIV/AIDS case Facilitate completion of HIV/AIDS case report form when new HIV case is report form when new HIV case is diagnosed.diagnosed.
Key Non-Health Key Non-Health Department PartnersDepartment Partners
Laboratories:Laboratories:– Ship remnant serum samples to central Ship remnant serum samples to central
facility for STARHS testingfacility for STARHS testing
Key Health Key Health Department PartnersDepartment Partners
Local Health DepartmentsLocal Health Departments– Collect core surveillance variables and TTH Collect core surveillance variables and TTH
data from providers and active surveillance data from providers and active surveillance
Office of AIDSOffice of AIDS– Raise awareness and interestRaise awareness and interest– Guidance, technical support and monitoringGuidance, technical support and monitoring– Data management and transfer to CDCData management and transfer to CDC– Complete California incidence estimationComplete California incidence estimation
Thank You!Thank You!
For more information please visit our For more information please visit our websites: websites:
HIV/AIDS Surveillance in CaliforniaHIV/AIDS Surveillance in Californiawww.cdph.ca.gov/programs/OAHISwww.cdph.ca.gov/programs/OAHIS
HIV Incidence Surveillance in the U.S.HIV Incidence Surveillance in the U.S.www.cdc.gov/hiv/topics/surveillance/incidence.htmwww.cdc.gov/hiv/topics/surveillance/incidence.htm