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BACKGROUND: Implementation of the National HIV/AIDS Strategy (NHAS) is focused on the HIV Care Continuum Initiative. An essential element of the HIV care continuum (also termed the “HIV treatment cascade” or “HIV care cascade”) is the proportion of persons who have been diagnosed with HIV who are in care. To more accurately evaluate this element of the continuum, the Iowa Department of Public Health (IDPH) HIV Surveillance Program sought to ascertain the status of HIV-infected persons in IDPH’s enhanced HIV/AIDS reporting system (eHARS) database that appeared to be out of care and living in Iowa. The goal of the project was to determine if they were deceased, living in another state, living in Iowa and receiving care out of state, or living in Iowa and apparently out of care.
METHODS: Analysis of the eHARS dataset revealed 751 persons who appeared not to have been in care in the 12 month period ending May 31, 2013. The IDPH surveillance team compiled a list of last name Soundex, date of birth, and sex for the 751 persons. From that list, the HIV Incidence and Case Surveillance Branch (HICSB), Division of HIV AIDS Prevention (DHAP), of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) generated a spreadsheet of potential matches to persons that had been reported in other states. Reducing the original list by 215 persons that had been reported only in Iowa, a public health student intern spent five weeks contacting HIV surveillance programs in other states to determine the status of the 536 HIV-infected individuals potentially living outside of Iowa.
RESULTS: As mentioned above, 215 of the 751 persons appearing to be out of care had been reported only in Iowa. Of the 536 persons potentially living in other states, 28 were found to be deceased; 377 were found to have been in care and living in another state; and 131 matched with other states but were most recently in Iowa and seemingly out of care. Results of the project decreased Iowa’s estimated HIV prevalence by 405 and contributed in large measure to increasing Iowa’s in-care calculation from 62% in 2012 to 74% in 2013.
CONCLUSIONS: Increasing Iowa’s in-care calculation not only demonstrates the value of good disease reporting information and investigation, but will also allow re-engagement and follow-up programs to focus their efforts where they are most needed.