This January marks the end of the first year of HIV names reporting here in the State of Georgia. For each person that tests positive for HIV, his or her name and other demographic information, such as age, race and sex, is collected by the Department of Human Resources. According to the Department of Human Resources, names reporting was a necessary policy change, as it would produce more representative data about the epidemic in Georgia. This improved data would allow for better prevention services, as well as increased funding. Given that the need for HIV names reporting was stressed by policy makers, we asked Dr. Luke Shouse, Department of Human Resources, HIV/AIDS Surveillance Unit, how successful the new policy has been in its first year of implementation.
NF: What have you learned from the new statistics in the past year? Have there been any surprises in terms of demographics of people who are testing positive? Have you seen any surprises in regards to people who are over the age of 50?
LS: Although I expect to see differences in the demographics of the HIV data as compared to AIDS data, I have not compared the HIV and AIDS data by demographic variables. Until the surveillance system matures more, I hesitate to analyze the HIV data for trends such as new infections among those greater than 50 years of age or shifts in racial categories. When initiating any new surveillance system, time is required to educate providers and labs of the change and to get a majority of them reporting. The new HIV surveillance system is no different. The danger in analyzing the data too soon is that the data may not be representative of the entire epidemic, and thus be misleading.
NF: Has there been a decrease in testing since the names reporting requirement was implemented?
LS: We have seen no indication of a decrease in HIV testing since implementing the new system in December 2003. Preliminary 2004 data suggest an increase in the total number of HIV tests performed in Georgia during 2004 from the previous four years.
NF: Have there been any complications in this new process? Has the data collection become more reliable since this method was implemented?
LS: As before, with any new system there are challenges, but we haven't experienced any insurmountable problems. One of our toughest challenges is getting the word out to the hundreds of labs and providers throughout the state with our limited resources.
AIDS surveillance relied almost wholly on provider-initiated reports. HIV surveillance relies on reports received from labs that require follow-up with providers. The addition of lab reporting makes both HIV and AIDS surveillance a more reliable and systematic system.
NF: Have you been receiving reliable information from private doctors? Are their results coming from confirmatory tests, as opposed to first tests?
LS: Many private medical providers acknowledge the importance of HIV data for guiding prevention and for helping bring resources to Georgia for their patients, and they began reporting immediately. Others began reporting later, and some haven't started yet. However, since state law requires all physicians to report, all providers will ultimately be reporting.
Public Health understands that complying with notifiable disease reporting requirements is challenging for physicians in the current environment of HMOs, shorter and shorter time for patient interactions, and confusion over HIPAA. In order to make reporting less burdensome for providers, we developed a shorter, more user-friendly form for private physicians. A Physician Resource Manual has also been created that explains reporting requirements, why HIPAA does not interfere with reporting, and how to make a report. Physicians may contact my office at (404) 657-2624 to request a manual or assistance from one of the surveillance technicians.
NF: Has this new method data produced recommendations for the development of education programs? If so, how and what programs are benefiting from this data? How do you see the new data being integrated into education programs? Will it produce more directed education or testing?
LS: The surveillance system and HIV data aren't mature enough yet to be used for developing education, care or prevention programs. In the future, HIV data will replace AIDS data in directing decisions for primary HIV prevention programs, HIV counseling and testing programs, outreach efforts, early intervention programs and many other programs that affect at-risk populations or those newly infected with HIV. HIV data will be more useful and accurate than AIDS data in informing these programs, since it is more reflective of those most recently infected with HIV.
HIV names reporting has been a controversial issue, with many opponents expressing concern about privacy. Now that the policy has been implemented, we will continue to follow up with the Department of Human Resources to keep you informed of ways in which this new method of data collection affects services for our community.