New Reporting Rules for HIV Infection

As of January 1, 1999, the Texas State Board of Health has altered the reporting requirements for HIV infection. From 1983 to the present, all AIDS cases have been reportable to the local health authorities by name. Other variables collected are address, date of birth, sex, race, risk factors for transmission of disease, laboratory data, AIDS defining diagnoses and death data. In 1994, the rules were amended to include reporting by name of all pediatric HIV exposures and infections, and reporting of adult HIV infection by a unique identifier.

The unique identifier system failed as a surveillance mechanism. Laboratories handle the majority of reporting of all communicable diseases. These providers, while very good at reporting the information they have, cannot report information not received by them from the health care providers who submit the specimens. The majority of HIV testing submitted by individual physician offices and practices is not followed up with a report to the health department. The unique identifier system failed to meet two critical criteria of a surveillance system: the majority of positive test results could not be reported in this way, and among those reported, duplicates could not be ruled out.

The new rules mandate all diagnosed HIV infections from January 1, 1999 to be reported by name to the local health authority. Other variables to be reported include demographic information, locating information and laboratory data. In an effort to further impact the spread of disease, the Texas Department of Health also now requires follow up on all HIV infection reports. This follow up is conducted to ensure that the patient has been notified of his/her HIV positive status, that the patient has been referred for appropriate treatment for the disease and that partners of the patient will be informed of the exposure they may have received. Notification can be undertaken by the patient or by the physician, or the physician may request that the health department assist in this process. If assistance is required, the disease intervention specialists of the local health authority (in Houston, HDHHS) will be given the information needed to meet with the patient and assist with partner notification.

The change in the reporting rules was prompted by the tremendous advances that have been made in the treatment of AIDS. In the early days of the epidemic, almost everyone who became infected with HIV gradually progressed through loss of immune competency until a severe illness developed; one that was considered AIDS defining.

At that point in the illness, patients would have to encounter the health care system for medical care and so a report to the health department was made. Since those early days, a test for HIV infection has been developed and treatment advances have greatly delayed the onset of severe illness, and for some patients may have eliminated it entirely. While the number of patients with AIDS is declining, the number with HIV infection is increasing, partly due to delay of severe, life-threatening illness and partly due to additional new infections.

In order to accurately monitor the extent and demographic mix of the epidemic for prevention planning and service resource allocation, surveillance for the disease needed to move back to the point of diagnosis with HIV infection. Reporting by name is considered the only effective system for this surveillance effort.

All reports of communicable disease are kept strictly confidential and may not be used for any purpose other than disease surveillance.

For more information on HIV, AIDS or the new reporting policy, call the HDHHS Bureau of HIV Prevention at 713-794-9092.

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Advisory Council Newsnotes is published quarterly by the Houston Department of Health and Human Services

8000 N. Stadium Dr., Houston, Texas 77054

· M. desVignes-Kendrick, MD, MPH, Director

· Kathy Barton, Chief, Office of Public Affairs

· Rita Rodriguez, Senior Community Liaison