Using HIV Surveillance Registry Data to Re-Link Persons to Care: The RSVP Project in San Francisco
March
Using HIV Surveillance Registry Data to Re- Link Persons to Care: The RSVP Project in San Francisco
Kate Buchacz 0 1
Miao-Jung Chen 0 1
Maree Kay Parisi 0 1
Maya Yoshida-Cervantes 0 1
Erin Antunez 0 1
Viva Delgado 0 1
Nicholas J. Moss 0 1
Susan Scheer 0 1
0 1 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America, 2 San Francisco Department of Public Health , San Francisco , California, United States of America, 3 Alameda County Public Health Department , Oakland, California , United States of America
1 Academic Editor: Patrick S Sullivan, Rollins School of Public Health, Emory University , UNITED STATES
-
Data Availability Statement: Because of legal
restrictions and the confidential nature of HIV
surveillance data, public health authorities cannot
release individual-level data on reported HIV cases.
However, results presented in the manuscript tables
and text are available to others for use. The SFDPH
staff are also available to assist external researchers
who may have further specific data questions or
uses. Please contact Dr. Susan Scheer at Susan.
with requests for additional
information. A minimal de-identified dataset needed
to replicate manuscript findings can be made
Persons with unsuppressed HIV viral load (VL) who disengage from care may experience
poor clinical outcomes and potentially transmit HIV. We assessed the feasibility and yield of
using the San Francisco Department of Public Health (SFDPH) enhanced HIV surveillance
system (eHARS) to identify and re-engage such persons in care.
Using SFDPH eHARS data as of 4/20/2012 (index date), we selected HIV-infected adults
who were alive, had no reported VL or CD4 cell count results in the past nine months (proxy
for out-of-care) and a VL >200 copies/mL drawn nine to 15 months earlier. We prioritized
cases residing locally for investigation, and used information from eHARS and medical and
public health databases to contact them for interview and referral to the SFDPH linkage
services (LINCS). Twelve months later, we matched-back to eHARS data to assess how HIV
laboratory reporting delays affected original eligibility, and if persons had any HIV laboratory
results performed and reported within 12 months after index date (new labs).
Among 434 eligible persons, 282 were prioritized for investigation, of whom 75 (27%) were
interviewed, 79 (28%) could not be located, and 48 (17%) were located out of the area.
Among the interviewed, 54 (72%) persons accepted referral to LINCS. Upon match-back to
eHARS data, 324 (75%) in total were confirmed as eligible, including 221 (78%) of the
investigated; most had new labs.
Among the investigated persons presumed out-of-care, we interviewed and offered LINCS
referral to about one-quarter, demonstrating the feasibility but limited yield of our project.
Funding: The Centers for Disease Control and
Prevention (CDC) provides funding to the San
Francisco Department of Public Health and to other
state and local health departments in the United
States to conduct surveillance of HIV disease in
accordance with their own disease reporting
regulations. CDC provides technical guidance for the
collection of data by the state and local health
departments and data are sent to CDC for
nationallevel analyses. Aside from CDC's support to
surveillance of HIV disease, the authors received no
specific funding for this work. Role of the Sponsors:
The CDC reviewed and approved final submission
but the findings and conclusions in this report are
those of the authors and do not necessarily represent
the views of the CDC. The funders had no role in
study design, data collection and analysis, decision to
publish, or preparation of the manuscript.
Competing Interests: The authors have declared
that no competing interests exist.
Matching to updated surveillance data revealed that a substantial minority did not
disengage from care and that most re-engaged in HIV care. Verifying persons HIV care status
with medical providers and improving timeliness of transfer and cross-jurisdictional sharing
of HIV laboratory data may aid future efforts.
The benefits of combination antiretroviral therapy (ART), both for preserving the health of
infected persons and for preventing further HIV transmission, have been well established [13]
and support high-impact combination prevention strategies [47] to reduce the burden of
HIV/AIDS in the United States (US). As such, the Department of Health and Human Services
released revised recommendations in 2012 that all HIV-infected persons initiate ART
regardless of immunologic status [8]. Realizing individual- and population-level benefits of ART
depends on timely diagnosis of HIV infection followed by linkage to and continuous engagement
in care.
National analyses of the continuum of HIV care indicate that substantial proportions of
HIV-infected persons are either unaware of their infection or, if aware, fail to stay engaged in
care. Nati (...truncated)