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Descriptive Epidemiology of HIV/AIDS: Counting & Surveillance

This module explores the distribution of HIV/AIDS and the importance of surveillance. Topics include case definition, surveillance methods, and ethical considerations. Students learn to interpret surveillance data for changes in incidence, prevalence, and subgroup differences.

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Descriptive Epidemiology of HIV/AIDS: Counting & Surveillance

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  1. Module 1 Overview Context Content Area: Descriptive Epidemiology & Surveillance Essential Question (Generic): How are health-related states or events distributed? Essential Question (Drug Abuse Specific): How is drug abuse distributed? Enduring Epidemiological Understanding: The frequency and distribution of health-related states or events in a population can be determined by systematically collecting, analyzing, and interpreting data. Synopsis In Module 1, students explore how to describe the distribution of health-related states or events. Students begin to uncover and develop the following epidemiological concepts and skills: observing groups of people, counting, the value of a denominator, a case definition, a representative sample, and creating circumstances that encourage truthful responses and protect confidentiality. Lesson 1-1: Counting and Rates Lesson 1-2: Introduction to Surveillance Lesson 1-3: Counting/Describing HIV / AIDS Lesson 1-4: Counting High School Marijuana Use Lesson 1-5: National Survey on Drug Use and Health Lesson 1-6: Other Drug Abuse Surveillance Systems

  2. Module 1 - Descriptive Epidemiology and Surveillance • Lesson 1-3 Counting and Describing HIV/AIDS • Content • Justification for surveillance of HIV/AIDS • Sampler of HIV/AIDS surveillance information • Consideration of HIV/AIDS surveillance in light of case definition, the • surveillance population, surveillance methods, strengths and limitations of • HIV/AIDS surveillance information, HIV/AIDS incidence versus prevalence, • ethical issues in the collection and use of HIV/AIDS data • Uses of HIV/AIDS surveillance data • Big Ideas • HIV/AIDS surveillance in the U.S. is justified, extensive and useful • Surveillance data tell us about changes in HIV/AIDS incidence and prevalence over time, differences in occurrence within subgroups of the population, and differences by geographic location This project is supported by a Science Education Drug Abuse Partnership Award, Grant Number 1R24DA016357-01, from the National Institute on Drug Abuse, National Institutes of Health.

  3. Where are we? Essential Questions Enduring Understandings

  4. E. Europe & Central Asia 1.7 million Western & Central Europe 740,000 North America 1.4 million East Asia 750,000 North Africa & Middle East 460,000 Caribbean 250,000 South & S.E. Asia 7.8 million Sub-Saharan Africa 24.7 million Latin America 1.7 million Oceania 81,000 Adults and Children Living with HIV - 2006 Estimates The number of people living with HIV has increased from approximately 8 million in 1990 to nearly 40 million today, and continues to increase

  5. Western & Central Europe 740,000 E. Europe & Central Asia 1.7 million North America 1.4 million East Asia 750,000 North Africa & Middle East 460,000 South & S.E. Asia 7.8 million Caribbean 250,000 Sub-Saharan Africa 24.7 million Latin America 1.7 million Oceania 81,000 Significance of Health Problem: - Justifying Surveillance • Criteria • Frequency • Severity • Cost • Preventability • Communicability • Public Interest

  6. Counts • In 2003, the estimated number of diagnoses of AIDS in the United States was 43,171 • Adult and adolescent AIDS cases totaled 43,112 with 31,614 cases in males and 11,498 cases in females • Also in 2003, there were 59 AIDS cases estimated in children under age 13.

  7. http://www.cdc.gov/hiv/

  8. HIV / AIDS Descriptive Epidemiology - Adolescents

  9. HIV / AIDS Descriptive Epidemiology Adolescents

  10. HIV / AIDS - Children Infected at Birth

  11. HIV / AIDS - By Race / Ethnicity

  12. HIV / AIDS - By Race / Ethnicity and Heterosexual Contact

  13. Five Considerations in HIV / AIDS Surveillance • Case Definition - What exactly is being counted)? • Surveillance Population: Who is being monitored to obtain counts? • Surveillance Methods - How are these counts determined? • Quality of Surveillance Information - Are the data accurate, complete, representative of the population, unbiased • Ethics - Are the data collected and used in an ethical manner?

  14. HIV / AIDS Case Definition What exactly is being counted?

  15. Case Definition Case definition: A set of standard criteria for deciding whether a person has a particular disease or other health-related condition • Characteristics of a case definition (depending on the condition, this may include signs, symptoms, time frame, location) • Why needed?

  16. HIV / AIDS Case Definition Definitions of AIDS have changed over the years as more specific virus testing was developed. • Surveillance definitions were revised again in Jan 2000 • CDC now recommends HIV surveillance as an extension of AIDS surveillance (as more HIV+ people are treated and do not progress to AIDS)

  17. HIV / ADIS Surveillance Population Who is being monitored to obtain counts?

  18. Surveillance Population Who will be surveyed? Sample population – who to study (and where, when) Sampling issues – Should everyone be studied, or a sample? If using a sample, need to do it in a valid way (e.g., a random sample) HIV / AIDS: Survey entire population - reporting from all 50 states, District of Columbia, and territories and possessions

  19. HIV/AIDS Surveillance Methods How are these counts determined?

  20. HIV / AIDS Surveillance Flow Chart

  21. HIV / AIDS Surveillance Methods • HIV / AIDS surveillance in the U.S. has a combination of: • Passive Reporting - combination of health care practitioners, hospitals, clinics and laboratories report cases of HIV/AIDS to state and local health departments • Active Reporting – state and local health department personnel collect information by contacting health care practitioners and reviewing medical records in hospitals and and clinics

  22. Types of Information Collected on HIV / AIDS What frequencies and distributions are being collected? • Frequencies (how many cases) • - New cases of HIV / AIDS – Incidence • - Number presently living with HIV / AIDS – Prevalence • Distributions • - Person characteristics such as gender, ethnicity • - Place, such as by state • - Trends over time from 1981 to the present • CDC also monitors: • - Mode of exposure to HIV • - Opportunistic illnesses and virologic and immunoligic status • - Supplemental information such as prescription of antiretroviral and prophylactic therapies

  23. Review: Incidence and Prevalence

  24. HIV / AIDS - New Cases, Deaths, and Prevalence

  25. Quality of HIV / AIDS Surveillance Data Are the data accurate, complete, representative of the population, unbiased? What are the strengths and limitations of the HIV/AIDS information?

  26. HIV / AIDS Data: Strengths and Limitations • Strength: Based on entire population rather than on a sampling strategy • Strength: Cases that are reported are accurate, based on lab test • Limitation: CDC acknowledges that HIV / AIDS data are underestimates of the true incidence and prevalence of HIV / AIDS • - only “confidential, identified” cases are recorded • - not all states report with same degree of • completeness

  27. Ethics in HIV / AIDS Surveillance • Data protection is crucial for this disease - associated with stigma for many • CDC goes to great lengths to enforce data protection rules • - Checked privacy practices in 1994 • - Ongoing activities to enhance privacy • protection

  28. Uses of HIV / AIDS Surveillance Data • Assessment of the status of a health condition • Establishment of priorities • Evaluation of programs • Conduct of research

  29. Uses of HIV / AIDS Surveillance Data • Assessment of the status of a health outcome Tracking new cases over time provides a measure of the speed of an epidemic (uses “Time” information) • Establishment of priorities Early cases of HIV / AIDS among IV drug use helped determine the early public health programs in the U.S. (“Person”) • Evaluation of programs Can evaluate clean-needle programs by comparing change in disease rates in cities with and without such programs (“Place”) • Conduct of research Increases in HIV+ newborns AIDS provided impetus to develop and test drugs for pregnant women with AIDS (“Person”)

  30. Re-Cap • Big Ideas in this Lesson (1-3) • HIV/AIDS surveillance in the U.S. is justified, extensive, and useful • Surveillance data tell us about changes in HIV/AIDS incidence and prevalence over time, differences in occurrence within subgroups of the population, and differences by geographic location This project is supported by a Science Education Drug Abuse Partnership Award, Grant Number 1R24DA016357-01, from the National Institute on Drug Abuse, National Institutes of Health.

  31. How This Relates to the Next Lesson (1-4) Counting High School Marijuana Use • What question would you ask to be able to determine marijuana use? (Case Definition, Methods) • Who would you include in your survey? (Population) • How would you conduct the survey (telephone, mail, personal interview, internet, or group)? (Methods) • How would you assure that the survey answers are accurate? (Methods, Quality) • What would the limitations of your plan be? (Quality, Ethics)

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