1. California Department of Public Health Office of AIDS Guide for Health Department Surveillance Staff Collecting Data on the new Testing and Treatment History form for HIV Incidence Surveillance

2. Collecting Testing and Treatment History for HIV Incidence Surveillance Primary Target = Audience HIV/AIDS Surveillance Coordinators and other health department staff working in HIV surveillance programs in California. Training = Goal Participants will know what Testing and Treatment History (TTH) information is needed for HIV Incidence estimation.

3. Testing and Treatment History (TTH) Definition: Definition: –Form that documents the testing and treatment history of the client. Its elements include: Ever tested positive – date; Ever tested negative – date; Number of HIV tests in the past 24 months before first positive test; Ever taken any antiretrovirals – types; Date of antiretroviral use – date of first use – date of last use Link to form: http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdph86 81.pdf http://www.cdph.ca.gov/pubsforms/forms/CtrldForms/cdph86 81.pdf

4. Testing and Treatment History - Purpose Data must be collected on all newly reported HIV/AIDS cases Data must be collected on all newly reported HIV/AIDS cases Used in calculation of HIV incidence estimates. Used in calculation of HIV incidence estimates. Needed to differentiate between new testers and repeat testers. Needed to differentiate between new testers and repeat testers. Used to identify patients receiving ARV meds within six months of first positive HIV test. Used to identify patients receiving ARV meds within six months of first positive HIV test.

5. “New” Variables  Main Source of TTH Information  Date Patient Reported Information  Ever Have a Previous Positive HIV Test

6. Main Source of TTH Information Purpose: To identify main method of obtaining TTH information to inform program improvement Purpose: To identify main method of obtaining TTH information to inform program improvement Choices: Patient Interview, Medical Record Review, Provider Report, PEMS, Other, or leave blank Choices: Patient Interview, Medical Record Review, Provider Report, PEMS, Other, or leave blank

7. Date Patient Reported Information Purpose: To capture the date when the patient reported TTH information Purpose: To capture the date when the patient reported TTH information –Represents the latest information for a given TTH form –Date of medical record review may be much later than the last contact with the patient

8. Previous Positive HIV Test Previous Positive HIV Test Purpose: To ascertain if an earlier positive test exists that was not reported to HIV surveillance Purpose: To ascertain if an earlier positive test exists that was not reported to HIV surveillance Old: “Have you ever had a positive HIV test result?” Old: “Have you ever had a positive HIV test result?” New: “Ever had previous positive HIV test?” : ‘Yes’, ‘No’, ‘Don’t know’, ‘Refused’ New: “Ever had previous positive HIV test?” : ‘Yes’, ‘No’, ‘Don’t know’, ‘Refused’

9. Date of First Positive HIV Test Purpose: To identify cases that are not new diagnoses Purpose: To identify cases that are not new diagnoses Record the earliest reported date even if no lab slip documentation of test: Record the earliest reported date even if no lab slip documentation of test: –Positive HIV test found in another database –Date of first positive provided in a doctor’s note –Anonymous test date given by patient history –Date of test done in another country For all dates, ideally record mm/dd/yyyy For all dates, ideally record mm/dd/yyyy –If date unknown, record as mm/--/yyyy

10. Date of Last Negative HIV Test Purpose: To identify the point in time when the person was known not to be HIV infected Purpose: To identify the point in time when the person was known not to be HIV infected One of the 3 variables used to classify as ‘new’ or ‘repeat’ tester One of the 3 variables used to classify as ‘new’ or ‘repeat’ tester Record : Record : –Last known date of negative test even if not certain that this is the most recent negative test –An approximate date is better than no date –Enter date of test, not date of provider note –Leave blank if no evidence of previous test –If the date if from a documented lab test with a specified test type, enter the information on the “Lab Tab” section as well

11. Indeterminate and Unknown Results Do not record ‘indeterminate’ or ‘unknown’ results Do not record ‘indeterminate’ or ‘unknown’ results These are neither positive nor negative HIV tests These are neither positive nor negative HIV tests If the only previous test was ‘indeterminate’, record ‘no’ for “Ever Tested Negative” If the only previous test was ‘indeterminate’, record ‘no’ for “Ever Tested Negative” Do not record dates Do not record dates

12. Number of Negative HIV Tests Within 24 Months Before First Positive Purpose: To indicate testing frequency in order to calculate the inter-test interval Purpose: To indicate testing frequency in order to calculate the inter-test interval One of 3 variables used to classify cases as ‘repeat’ testers One of 3 variables used to classify cases as ‘repeat’ testers Record the number of negative tests in the 24 months prior to first positive Record the number of negative tests in the 24 months prior to first positive If no previous negative HIV test, enter 0 If no previous negative HIV test, enter 0

13. Ever Taken Any Antiretroviral Medications (ARVs)? Two purposes: 1. Determine if the patient was taking ARVS which might affect the BED result 2. Determine eligibility for VARHS

14. Ever taken any antiretroviral medications (ARVs)? Record ‘Yes’ if patient used any ARV at any point in time Record ‘Yes’ if patient used any ARV at any point in time –Record the dates ARVs began and last use, if known Record ‘No’ if the patient has never used ARVs Record ‘No’ if the patient has never used ARVs Record ‘Don’t know’, if ARV use is unknown Record ‘Don’t know’, if ARV use is unknown Absence of ARV use information is NOT the same as never used ARVs Absence of ARV use information is NOT the same as never used ARVs

15. Date ARVs First Began Date of Last ARV Use Purpose: To identify ARV use before STARHS specimen was collected Purpose: To identify ARV use before STARHS specimen was collected Record the earliest date of any ARV use, even if this is after the date of HIV diagnosis Record the earliest date of any ARV use, even if this is after the date of HIV diagnosis Record the last known date of any ARV use Record the last known date of any ARV use Record month and year Record month and year Leave blank if unknown date of first use Leave blank if unknown date of first use

16. Name of ARV Medication Taken Purpose: To verify ARV use Purpose: To verify ARV use Enter the name of earliest known ARV taken Enter the name of earliest known ARV taken Select ‘Unspecified’ if ARV name is unknown Select ‘Unspecified’ if ARV name is unknown Variable not being used to monitor treatment. Variable not being used to monitor treatment.

17. How to complete the form…visualized The following slides point to and explain different elements of the TTH form… Most information for the TTH form may be found in the patient chart. Some information is also found in the AIDS case report form.

18. Stateno assigned by surveillance staff for the clients Note the data source. “PEMS” refers to our LEO database

19. This date can be when the patient answered the TTH (in a patient interview) or when the information was obtained from either a: Provider Report, PEMS, Medical Record Review or Other.

20. If interviewing a patient, this is a self- reported date. Laboratory documented previous HIV tests should be recorded in the Laboratory Data section of the HIV/AIDS Case Report Form.

21. -Last known date of negative test even if not certain that this is the most recent negative test -An approximate date is better than no date -Enter date of test, not date of provider note -Leave blank if no evidence of previous test -If the date if from a lab test with a specified test type, enter the information on the “Lab Tab” section as well

22. Answer this portion of the TTH as it is asked. DO NOT count the first positive test. Only count the negative tests patient had in the 24 months (2 years) prior to having the first positive test.

23. -Record ‘Yes’ if patient used any ARV at any point in time -Record the dates ARVs began and last use, if known -Record ‘No’ if the patient has never used ARVs -Record ‘Don’t know’, if ARV use is unknown -Absence of ARV use information is NOT the same as never used ARVs

24. -Enter the name of earliest known ARV taken -Select ‘Unspecified’ if ARV name is unknown -Variable not being used to monitor treatment.

25. -Record the earliest date of any ARV use, even if this is after the date of HIV diagnosis -Record the last known date of any ARV use -Record month and year -Leave blank if unknown date of first use

26. Can the date of the first positive HIV test result be based only on a patient’s preliminary positive rapid test result? No. A positive HIV test refers to a reactive screening test that is confirmed using supplemental testing, either Western Blot or Immunofluorescent assay (IFA). If a patient did not return for his or her confirmatory result disclosure, then this test cannot be considered their first positive HIV test. No. A positive HIV test refers to a reactive screening test that is confirmed using supplemental testing, either Western Blot or Immunofluorescent assay (IFA). If a patient did not return for his or her confirmatory result disclosure, then this test cannot be considered their first positive HIV test. –Here it is important to define the term, “positive HIV test.” For the purposes of this field, the term, “positive HIV test” refers to a reactive screening test (like the OraQuick Rapid test) that is confirmed using supplemental testing, either Western Blot or Immunofluorescent assay (IFA). –If a patient did not return for his or her confirmatory test disclosure, then this test cannot be considered their first positive HIV test

27. Sending TTH’s to CDPH/OA Step 1 of 3  Identifiers and Frequency –No anonymous testers. –Make sure there are no personal identifiers visible such as name or social security number on any forms. –Send along with the related Adult Case Report Form

28. Sending TTH’s to CDPH/OA Step 2 of 3 Shipment should be double enveloped and sent via traceable overnight courier Shipment should be double enveloped and sent via traceable overnight courier – Inner envelope: Seal TTH’s (and ACRF’s) in the inner envelope and mark it confidential. – Outer envelope: Address to: Chief HIV/AIDS Surveillance Section Steven Starr California Department of Public Health 1616 Capitol Avenue, Suite 616, MS 7700 Sacramento, CA 95814

29. Sending TTH’s to CDPH/OA Step 3 of 3 Notify the HIS project of shipment Notify the HIS project of shipment Arvin Magusara HIS Project Coordinator email: arvin.magusara@cdph.ca.gov arvin.magusara@cdph.ca.gov phone: 916-449-5867

30. OA HIS Website OA HIS Website –http://www.cdph.ca.gov/pubsforms/forms/CtrldFor ms/cdph8681.pdf http://www.cdph.ca.gov/pubsforms/forms/CtrldFor ms/cdph8681.pdfhttp://www.cdph.ca.gov/pubsforms/forms/CtrldFor ms/cdph8681.pdf –The Forms are located under “Resources for Local Heath Departments or Providers” –Download and Print as needed How do I get more TTH forms?

31. Thank You! For more information please visit our websites: HIV/AIDS Surveillance in California http://www.cdph.ca.gov/programs/aids/Pages/OAHIS Home.aspx http://www.cdph.ca.gov/programs/aids/Pages/OAHIS Home.aspx HIV Incidence Surveillance in the U.S. www.cdc.gov/hiv/topics/surveillance/incidence.htm