Data gathered through surveillance:
- provides current information on the status of the epidemic and the development of trends;
- indicates the magnitude and extent of medical, economic and social impact and need;
- identifies levels and trends of HIV infection that are necessary for developing, targeting, and evaluating both prevention and care and treatment programs; and
- provides information on which to base decisions about policy development and resource allocation.
History of AIDS/HIV surveillance in Wisconsin
In the early to mid-1980's, AIDS surveillance was strictly passive. It was conducted by one individual on a case-by-case basis from reports submitted by physicians, many who were seeing their first AIDS case. Because there was no approved test for HIV in the early 1980's, cases were confirmed using clinical criteria based on a crude CDC case definition.
In March 1985, the FDA approved the HIV enzyme immunoassay (EIA) and Western blot test for screening blood products to ensure safety of the blood supply. The test was quickly adapted in clinical settings and the Wisconsin legislature enacted legislation in the fall of 1985 requiring all positive confidential HIV tests be reported to the state epidemiologist. Wisconsin was one of the first three states in the nation to enact such legislation. Simultaneously, the Wisconsin Alternate Counseling and Testing Site (CTS) Program was established to defer persons at risk of HIV infection from seeking testing at blood/plasma centers.
By the spring of 1986, the AIDS/HIV Program initiated active surveillance with hospitals statewide and passive laboratory-based reporting. Over time, surveillance data collection methods have been streamlined and automated. Sentinel physicians and hospitals/clinics were identified and visited by surveillance staff to strengthen the surveillance network and enhance reporting.
Confidential, name-associated reporting of confirmed HIV infection and AIDS to the State Epidemiologist is required by Wisconsin statute (s. 252.15). Case reports are submitted to the Wisconsin AIDS/HIV Program from private physicians, hospitals, clinics, ambulatory care facilities, sexually transmitted disease clinics, the Wisconsin correctional system, family planning clinics, perinatal clinics, Indian health clinics, blood and plasma centers, military entrance processing stations, and laboratories performing HIV testing.
Other sources of AIDS/HIV surveillance data include state entitlement programs (AIDS/HIV Drug Assistance Program and AIDS/HIV Health Insurance Premium Subsidy Program), tumor registry reports, ICD-9 discharge code reviews conducted by the Bureau of Health Information and Policy, vital records death certificate registry, and the tuberculosis (TB) registry.
AIDS and HIV reports are reported directly to the state epidemiologist rather than local health departments. Case reports are usually received by the Division of Public Health within one to two months of a physicians diagnosis.
Laboratory-based reporting is required by law. Laboratories performing confidential name-associated HIV confirmatory testing (Western blot, viral load, DNA PCR, CD4) report to the AIDS/HIV Program the name of the subject of all positive samples and the name of the physician who ordered the test. This is useful in identifying newly infected persons. The surveillance team uses these lists to ensure that all case reports are received from clinicians.
Once collected, surveillance data is analyzed to define the demographics of the epidemic in Wisconsin. This information can be used by prevention staff to focus interventions, identify objectives for the HIV Prevention Planning Council, identify trends, and provide essential data for program planning and resource allocation. The numbers of cases of AIDS and HIV are also used to determine program funding from the federal and state government.
Security of surveillance records has always been a priority for the Wisconsin AIDS/HIV Program. Physical security measures have become increasingly sophisticated through the use of automated technology that is integrated with the security services of state law enforcement personnel. Written policies and procedures ensuring security include annual in servicing of staff, locating staff who handle patient/client data in a restricted area, and signed confidentiality assurances by individual Program staff.
Surveillance staff continue to look for ways to improve case-finding methods, increase onsite visits at clinical settings (especially outpatient clinics), and investigate new technologies for efficiently managing highly confidential information.
For additional information regarding the surveillance activities of the Wisconsin AIDS/HIV Program, contact Katarina Grande at 608-266-2664.