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Surveillance is the ongoing,
systematic collection, analysis,
interpretation, and dissemination of data
regarding a health-related event.
HIV/AIDS surveillance observes records and
disseminates reports about new cases of HIV
and AIDS.
CDC’S HIV/AIDS
surveillance system is the nation’s source
for timely information used to track the
epidemic. CDC funds and assists state and
local health departments to collect the
information. Health departments report their
data to CDC so that information from around
the country can be analyzed to determine who
is being affected and why.
The ultimate surveillance goal is a
nationwide system that combines information
on AIDS cases, new HIV infections, and
behaviors and characteristics of people at
high risk. By meeting this goal, CDC can
track the epidemic and direct HIV prevention
funding to where it is needed the most.
Tracking AIDS Trends
During the 1980s, AIDS cases alone provided
an adequate picture of HIV trends because
the time between infection with HIV and
progression to AIDS was predictable. This
predictability, however, has diminished
since 1996, when highly active
antiretroviral therapy (HAART) became
available. Access, adherence, and response
to HAART affect whether or when HIV
progresses to AIDS. Thus, trends in AIDS
cases alone no longer accurately reflect
trends in HIV infection. AIDS trends do,
however, continue to provide important
information about where care and treatment
resources are most needed.
Tracking HIV Trends
By April 2004, all states had
adopted some system for reporting HIV diagnoses to CDC. Tracking HIV trends is challenging and depends
on several factors, such as how often people are tested, when during the course
of their infection they are tested, whether and how test results are reported to
health departments, and how case reports (with personal identifiers removed) are
shared with CDC.
Read
 CDC director, Dr. Julie
Gerberding's "Dear Colleague" letter
recommending that all states and territories
adopt confidential name-based surveillance
systems to report HIV infections.
A major advance has been the development of
the serologic testing algorithm for recent
HIV seroconversion (STARHS). STARHS is a way
of analyzing HIV-positive blood samples to
determine whether an HIV infection is recent
or has been ongoing. In 2001, an expert
panel agreed that STARHS is the best method
available for measuring new HIV infections.
After funding 5 areas to pilot test this
method, CDC now funds 34 areas to include
STARHS in their HIV incidence surveillance
activities.
Monitoring HIV Risk Behavior
Behaviors are
monitored with regard to risk taking, HIV
testing,
care seeking,
and adhering to treatment for HIV in
different populations.
Several
federally supported surveys collect
information about HIV-related behaviors of
the general population. They are conducted
periodically so that trends can be
evaluated. A few examples are:
- MMP (Morbidity Monitoring Project,
sometimes called the Medical Monitoring
Project) is a new surveillance system
designed to collect information from
HIV/AIDS patients who received care from
randomly selected HIV care providers.
- The NHBS (National HIV Behavioral
Surveillance System), for populations
at high risk, began in 2003. NHBS conducts
surveys in cities with high levels of AIDS
among MSM, IDUs, and heterosexuals at high
risk to determine their risk behavior,
testing behavior, and use of prevention
services.
- HITS (HIV Testing Survey)
primarily interviewed adults who were not
HIV-infected but were at high risk for HIV
infection. HITS collected information
about what motivates people to get tested
for HIV and what behaviors place people at
risk for HIV.
Monitoring HIV Counseling and Testing
Behavior
The HIV Counseling and Testing System (CTS) has been used since 1989 to monitor
CDC-funded HIV counseling and testing services. Through this system, each
CDC-funded HIV counseling and testing episode was reported to CDC and included
information about demographics, self-reported behavior, and HIV test results.
Data from this system have been used to guide the development of HIV prevention
programs in response to the needs of the community. Beginning in 2005, CTS will
be replaced by Counseling, Testing, and Referral (CTR) system. Data parameters
collected by CTR have been updated to include information on new testing
technologies and client referrals to medical care and other services and to be
consistent with other data collection and reporting requirements.
Through cooperative agreements, CDC has funded
59 health departments and six US trust territories to provide CTR. |
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