1. Evaluating the National HIV/AIDS Strategy
with Surveillance Data
H. Irene Hall, PhD, FACE
Chief, HIV Incidence and Case Surveillance Branch
2011 National HIV Prevention Conference
August 15, 2011
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of HIV/AIDS Prevention

2. Outline
 Outcome measures of the National HIV/AIDS
Strategy
 Surveillance data collection
 Preliminary data
 Conclusion

3. National HIV/AIDS Strategy
 Reducing New HIV Infections
 Increasing Access to Care and Improving Health
Outcomes for People Living with HIV
 Reducing HIV-Related Health Disparities

4. Reducing New HIV Infections
 Lower the annual number of new infections by 25
percent
 Reduce the HIV transmission rate, which is a
measure of annual transmissions in relation to the
number of people living with HIV, by 30 percent
 Increase from 79 percent to 90 percent the
percentage of people living with HIV who know
their serostatus

5. Increasing Access to Care and
Improving Health
 Increase the proportion of newly diagnosed patients
linked to clinical care within three months of their
HIV diagnosis from 65 percent to 85 percent
 Increase the proportion of Ryan White HIV/AIDS
Program clients who are in continuous care (at least
2 visits for routine HIV medical care in 12 months at
least 3 months apart) from 73 percent to 80 percent
 A benchmark for surveillance?

6. Reducing HIV-Related Health Disparities
 Increase the proportion of HIV diagnosed gay and
bisexual men with undetectable viral load by 20
percent
 Increase the proportion of HIV diagnosed Blacks
with undetectable viral load by 20 percent
 Increase the proportion of HIV diagnosed Latinos
with undetectable viral load by 20 percent

7. HIV Surveillance
Measures of HIV morbidity and mortality
HIV Infection
HIV diagnosis
(1st positive
confidential test) 1st CD4 Count
1st Viral Load
Test 1st CD4
Count <200
1st Drug (IMM-AIDS)
Resistance test AIDS-OI
Death
Entry to care Retention in care and viral suppression

8. HIV Case Surveillance Information Flow
People with HIV
Sources of Reports
Local Health Dept Dissemination
HIV Local Bulletins
Hospital Practitioners Report CDC Semiannual Report
Private Practitioners HIV Web Sites
2001
Public Clinics Region X
Public Information Data Set
Laboratories Surveillance Slide Set
Active
Case Finding
State Health Dept CDC
7,738 74,353

9. National HIV Surveillance
Data Year
2008: confidential, name-
based HIV reporting in all
states
2011: all states included in
estimates of HIV diagnoses

10. National HIV Incidence Surveillance
WA
CHI
MA
NYS CT
MI
NYC
SF
CO IN NJPhil
CA VA DC
NC
LA AZ SC
Cty
MS AL
TX LA
FL
HOU

11. Areas with Laws and Regulations for
Reporting all CD4 and Viral Load Values
VT
NH
MA
RI
CT
NJ
DE
MD
DC
Laboratory reporting
(laws and regulations)
Not all values
All values, specified
All values, not
specified
Puerto Rico
Virgin Islands, U.S.

12. National HIV/AIDS Strategy
Implementation Plan
 VA, CMS, HRSA, CDC, SAMHSA and NIH will jointly consider and issue
a report of strategies to encourage providers to collect and report
standardized viral load and CD4 data from infected individuals within
populations at greatest risk for HIV infection.
 CDC will identify which States and localities collect CD4 and viral load data
 HRSA and CDC will convene a consultation with clinical providers and
community-based organizations to develop recommendations for
gathering and reporting necessary data to calculate community viral load
 CDC, in consultation with States, will provide technical assistance to
localities, particularly those with a heavy disease burden, to collect
necessary data to calculate community viral load

13. National HIV/AIDS Strategy
Implementation Plan
 CDC will release a report on suggestions for border states to help
improve HIV surveillance and prevention interventions among
migrant communities
 CDC will provide State health departments with greater
concentrations of AAPI or AI/AN populations with recommendations
on effective HIV surveillance activities for these small populations
 HHS OS will coordinate among HHS agencies to mine existing
databases to explore associations between HIV infection and social
determinants of health

14. PRELIMINARY DATA

15. HIV Incidence 2006-2009,
United States
60,000
50,000
56,000
(49,100-69,200)
40,000 48,600 47,800 48,100
(42,400-54,700) (41,800-53,800) (42,200-54,000)
30,000
20,000
10,000
0
2006 2007 2008 2009
Prejean (2011) Estimated HIV Incidence in the United States, 2006–2009. PLoS ONE 6(8): e17502.
doi:10.1371/journal.pone.0017502

16. Estimated AIDS Diagnoses, Deaths, Persons Living with an AIDS
Diagnosis and Persons Living with HIV Infection (Diagnosed and
Undiagnosed) Among Adults and Adolescents – United States,
1981 - 2008
80 1,200
AIDS Diagnoses
1,100
70 Deaths
1,000
No. of Diagnoses and Deaths
Living with an AIDS Diagnosis
60 900
Living with HIV infection
800
50
(thousands)
(thousands)
Prevalence
700
40 600
500
30
400
20 300
200
10
100
0 0
1984
1988
1993
2002
1981
1982
1983
1985
1986
1987
1989
1990
1991
1992
1994
1995
1996
1997
1998
1999
2000
2001
2003
2004
2005
2006
2007
2008
Year
MMWR 2011;60:689-693.

17. Annual Transmission Rates per 100 Persons
Living with HIV, 1977–2006
Holtgrave . Updated Annual HIV Transmission Rates in the United States, 1978-2006. JAIDS 2009;50(2):236-38.

18. Estimated Number of Adults and Adolescents Living with HIV
Infection (Diagnosed and Undiagnosed) and Percent Undiagnosed
– United States, 1985 - 2008
1,200,000 No. living with undiagnosed HIV infection 100.0
No. living with diagnosed HIV infection
Percent undiagnosed
1,000,000
80.0
800,000
60.0
Number
Percent
600,000
40.0
400,000
20.0
200,000
0 0.0
2002
2003
2004
2005
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2006
2007
2008
Year

19. Linkage to Care and Continuous Care
 Data from 13 areas with mandatory laboratory
reporting of HIV-related tests and reporting to
national HIV surveillance
 82% of persons diagnosed in 2009 linked to care within 3
months -- NHAS 85 percent
Poster No. 083M. Mahle et al. Using HIV Surveillance-based Indicators to Monitor the National HIV/AIDS
Strategy, 13 U.S. Jurisdictions
 Persons living with HIV in 2009 in continuous care – NHAS 80%
Track B Session B04 . Hall et al. Retention in Care of HIV-Infected Adults and Adolescents in 13 U.S.
Areas

20. Reducing HIV-Related Health Disparities
 Data from 13 areas with mandatory laboratory reporting of HIV-
related tests and reporting to national HIV surveillance
 Persons living with HIV in 2009
 Viral suppression (≤400 copies/mL) among those in care, vs.
NHAS undetectable viral load
 77% among MSM
 65% among blacks/African Americans
 74% among Hispanics/Latinos
• vs. 81% among whites
 NHAS – increase by 20 percent
Poster No. 083M. Mahle et al. Using HIV Surveillance-based Indicators to Monitor the National HIV/AIDS
Strategy, 13 U.S. Jurisdictions

21. Conclusion
 Of 9 outcome measures in the National HIV/AIDS
Strategy, 8 can be measured with surveillance data
 However, there is a need to
 Support and strengthen HIV … surveillance activities: There
is a need to support existing surveillance methods to
identify populations at greatest risk that need to be targeted
for HIV prevention services.

22. Thank you
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position o f
the Centers for Disease Control and Prevention.
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of HIV/AIDS Prevention