Integrating HIV/AIDS Surveillance into a Web-Based System That Includes Electronic Laboratory Reporting to Improve Case Reporting and Monitoring of HIV Care and Treatment Status

BACKGROUND: The evidence that effective treatment of known HIV cases is important for preventing new HIV cases has drastically changed the public health interventions for controlling the epidemic. Metrics (e.g., retention-in-care) obtained from HIV/AIDs case surveillance data will be increasingly important for monitoring treatment-as-prevention programmatic activity. To accomplish this, follow-up laboratory information on cases (e.g., viral loads, CD4 counts) will be needed. Recent enhancements to surveillance, such as integrated surveillance systems, implementation of electronic laboratory reporting (ELR) and methods to improve data quality will make this task easier. In 2009, the Utah Department of Health (UDOH) implemented TriSano (a NEDSS-compatible system) for all reportable diseases except HIV. TriSano is a web-based application that is shared among all public health departments (state and local) throughout Utah.  In 2013, UDOH began implementation of ELR, which allows rapid posting of laboratory information to cases in TriSano. The objective of this study is to describe the integration of HIV/AIDS case surveillance into the TriSano system and the benefits of ELR in obtaining laboratory information on cases. 

METHODS: Data exports from TriSano were obtained for the evaluation of HIV and ELR. The initial evaluation included all reported laboratory results entered into TriSano during 2013, tabulated by disease and included whether the lab was entered manually or via ELR. Due to ELR being implemented in August 2013, another dataset containing only the last third of 2013 laboratory results was obtained. Analysis included cross-tabulation of the lab results entered and also the number of events created either manually or by ELR.  

RESULTS: From September 1 to December 31, 2013, two major laboratories began reporting through ELR. During this period, a total of 18,380 laboratory results were entered into the TriSano system. Of these, 3,941 (21.4%) were various HIV tests (including HIV diagnostic tests, viral loads and CD4 counts). Of the HIV tests, 2,811 (71.3%) were posted to HIV/AIDS cases in TriSano by ELR. During the same time period, TriSano had 8,638 new disease events created. Of those, 97 (1.1%) were HIV events, which resulted in 40 new HIV events (41.2%) being initiated by a laboratory test. Among those 40 events, 22 (55.0%) were initiated by ELR. 

CONCLUSIONS: These data support the benefits of integrating HIV/AIDs case surveillance into the TriSano system and the resulting improvements in completeness and timeliness of HIV/AIDS data because of ELR. These changes in the HIV/AIDS surveillance will improve our ability to monitor retention-in-care.