Evaluation of Laboratory Reporting Completeness Using HIV Surveillance and Medical Monitoring Project Data, Washington State, 2010-2012

BACKGROUND:  In Washington State (WA), state regulations mandate all HIV-related laboratory results (viral load and CD4+ lymphocyte) be reported to the WA Department of Health (DOH) directly or via Public Health Seattle-King County, if the lab is in King County. Complete and timely reporting of HIV laboratory results are important to identify new HIV cases and assure cases are in medical care and virally suppressed. However, completeness of laboratory reporting has not been thoroughly evaluated in WA. The Medical Monitoring Project (MMP) is a supplemental surveillance project that includes a medical record abstraction (MRA) of laboratory data. The purpose of this analysis was to evaluate the completeness of laboratory reporting to DOH by comparing reported lab results to those collected through MMP.

METHODS:  During each MMP cycle, participants are matched with the HIV surveillance database (eHARS) and assigned a unique identifier (stateno). MMP CD4+ and viral load results with specimen collection dates in 2010-2012 were compared to the DOH comprehensive laboratory reporting database. Laboratory results were matched on stateno, type of laboratory test performed, result value and laboratory specimen collection date (+/- seven days). Results not matched automatically were manually reviewed to control for data entry errors.

RESULTS:  Over 90 percent of MMP participants (n=716) matched with eHARS and were included in analysis. A total of 4,861 lab results from 26 facilities were collected through the MRA. Of those, 85.6% (n=4,162) of results were reported to DOH. Overall reporting completeness did not vary greatly by test type: 87.3% CD4+ count, 85.1% CD4+ percent, 84.5% viral load. Completeness did improve over time, going from 74.6% of labs collected in 2009 to 92.3% in 2012. Viral load reporting improved the most, from 67.3% complete in 2009 to 95.2% in 2012. Approximately 2% of reported labs did not match on all four criteria, but were matched through manual review.

CONCLUSIONS:  While high percentages of laboratory results have been reported since 2010, a substantial increase in completeness was seen from 2010 to 2012. This is particularly encouraging for viral load results since there is an ongoing focus to monitor viral suppression. Currently there is no penalty for not reporting lab results, so DOH relies on constant communication and good relationships with labs. Along with working with labs to report electronically, these efforts can be incorporated into a comprehensive quality assurance program to ensure laboratory reporting completeness to the WA HIV Surveillance program.