WHAT IS HIV INCIDENCE SURVEILLANCE
HIV Incidence Surveillance (HIS) is a supplemental HIV surveillance activity funded by the Centers for Disease Control and Prevention (CDC) in 25 areas across the country, including Virginia.
HIV incidence: In general, incidence is expressed as the estimated number of persons newly infected with HIV during a specified time period (e.g., a year), or as a rate calculated by dividing the estimated number of persons newly infected with HIV during a specified time period by the number of persons at risk for HIV infection.
It is important to understand the difference between HIV incidence and a new diagnosis of HIV infection. HIV incidence refers to persons newly infected with HIV, whereas a person newly diagnosed with HIV may have been infected years before being diagnosed.
Process: HIV incidence surveillance consists of two key components; the collection of testing and treatment history (TTH) information as part of routine surveillance working closely with local health departments to get this information. Case reports are then sent to CDC after the removal of all identifying information. The second component is the acquisition of leftover diagnostic blood specimens to test for recent HIV infection.
The TTH form is completed by local health department Disease Intervention Specialists (DIS), contracted HIV testing site staff from Community Based Organizations (CBOs), and the HIV Incidence Epidemiology Consultant. Completion of this form is critical to capture elements required for an accurate incidence estimate calculation. The TTH form captures dates of the last known negative HIV test and first positive test, as well as antiretroviral treatment history. For the collection of remnant sera from confirmed HIV-1 blood samples from individuals “new” to the HIV surveillance system, program staff at the state health department level, work closely with commercial/private, public, and hospital-based laboratories to acquire leftover diagnostic blood specimens to test for recent infection at a population level. The specimens are sent for testing at the CDC-designated laboratory and by applying new technology to the leftover blood specimens from persons newly diagnosed with HIV infection, the laboratory is able to determine if the infection is recent (occurring within the past six months) or long-term (older than six months). These two components are integral to HIV incidence surveillance as they provide the data that CDC and the state health department use to estimate the number of new HIV infections in a given year.
Virginia’s Incidence Surveillance program was launched in June 2004 and piloted in three health department sites through mid-2005. By December 2005, the program had expanded to all 35 health districts. As of January 2006, all public health department laboratories began submitting samples for incidence testing through the Division’s partnership with the state public health laboratory, the Division of Consolidated Laboratory Services (DCLS). In 2007, VDH developed key relationships with the national commercial reference laboratories and with both the University of Virginia and Virginia Commonwealth University Health Systems laboratories to submit remnant sera to the CDC-designated laboratory for incidence testing.
PROGRAM OBJECTIVES
The purpose of HIV incidence surveillance is to provide national and local estimates of the number of new HIV infections per year.
PROGRAM IMPORTANCE
While HIV case reporting allows for the measurement of the number of people newly diagnosed with HIV, it does not provide information about people who are newly infected. The new technology used in HIS allows for the estimation of HIV incidence at a population level both nationally and locally. The ability to do this is important for prevention evaluation and planning, public health policy development, resource allocation and to identify disease trends.
KEY CONTACT
Celestine A. Buyu, MPH, MHSA
Assistant Director, HIV Surveillance
HIV Incidence Program Coordinator
Phone: (804) 864-8043,
Email: Celestine.Buyu@vdh.virginia.gov
LINKS TO RELATED SITES AND RESOURCES
Additional information regarding Virginia’s HIV Surveillance program may be viewed at:
http://www.vdh.state.va.us/Epidemiology/DiseasePrevention. [Fact sheet from 6/2009 release located here-leave place card for newer version to be released with next estimate?]
Information regarding the CDC national HIV Incidence Surveillance program may be viewed at:
http://www.cdc.gov/hiv/topics/surveillance/incidence.htm and
http://www.cdc.gov/hiv/resources/guidelines/index.htm#surveillance
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