California Department of Public HealthCalifornia Department of Public HealthOffice of AIDSOffice of AIDS

Guide for Health Department Surveillance StaffGuide for Health Department Surveillance Staff

Collecting Data Collecting Data on the new Testing and Treatment on the new Testing and Treatment

History History form for HIV Incidence Surveillanceform for HIV Incidence Surveillance

Collecting Testing and Treatment History Collecting Testing and Treatment History for HIV Incidence Surveillancefor HIV Incidence Surveillance

Primary Primary Target Target = Audience= Audience

HIV/AIDS Surveillance Coordinators and HIV/AIDS Surveillance Coordinators and other health department staff working in other health department staff working in HIV surveillance programs in California.HIV surveillance programs in California.

Training Training = Goal = Goal

Participants will know what Testing Participants will know what Testing and Treatment History (TTH) and Treatment History (TTH) information is needed for HIV information is needed for HIV Incidence estimation. Incidence estimation.

Testing and Treatment HistoryTesting and Treatment History(TTH)(TTH)

Definition:Definition:– Form that documents the testing and treatment Form that documents the testing and treatment

history of the client. Its elements include: 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/cdph8681.pdf

Testing and Treatment History - Testing and Treatment History - PurposePurpose

Data must be collected on all newly reported Data must be collected on all newly reported HIV/AIDS casesHIV/AIDS cases

Used in calculation of HIV incidence Used in calculation of HIV incidence estimates.estimates.

Needed to differentiate between new testers Needed to differentiate between new testers and repeat testers.and repeat testers.

Used to identify patients receiving ARV Used to identify patients receiving ARV meds within six months of first positive HIV meds within six months of first positive HIV testtest..

““New” VariablesNew” Variables

Main Source of TTH InformationMain Source of TTH Information

Date Patient Reported InformationDate Patient Reported Information

Ever Have a Previous Positive HIV Test Ever Have a Previous Positive HIV Test

Main Source of TTH Main Source of TTH InformationInformation

Purpose: To identify main method of Purpose: To identify main method of obtaining TTH information to inform obtaining TTH information to inform program improvementprogram improvement

Choices: Patient Interview, Medical Choices: Patient Interview, Medical Record Review, Provider Report, PEMS, Record Review, Provider Report, PEMS, Other, or leave blankOther, or leave blank

Date Patient Reported Date Patient Reported InformationInformation

Purpose: To capture the date when the Purpose: To capture the date when the patient reported TTH informationpatient reported TTH information– Represents the Represents the latestlatest information for a information for a

given TTH formgiven TTH form– Date of medical record review may be Date of medical record review may be

much later than the last contact with the much later than the last contact with the patientpatient

Previous Positive HIV Previous Positive HIV Test Test

Purpose: To ascertain if an earlier positive Purpose: To ascertain if an earlier positive test exists that was not reported to HIV test exists that was not reported to HIV surveillancesurveillance

OldOld: “: “Have you ever had a positive HIV test Have you ever had a positive HIV test result?result?””

NewNew: “: “Ever had previous positive HIV Ever had previous positive HIV test?” : test?” : ‘Yes’, ‘No’, ‘Don’t know’, ‘Refused’‘Yes’, ‘No’, ‘Don’t know’, ‘Refused’

Date of First Positive HIV Date of First Positive HIV TestTest

Purpose: To identify cases that are not new diagnosesPurpose: To identify cases that are not new diagnoses Record the earliest reported date even if no lab slip Record the earliest reported date even if no lab slip

documentation of test:documentation of test:– Positive HIV test found in another databasePositive HIV test found in another database– Date of first positive provided in a doctor’s noteDate of first positive provided in a doctor’s note– Anonymous test date given by patient historyAnonymous test date given by patient history– Date of test done in another countryDate of test done in another country

For all dates, ideally record mm/dd/yyyyFor all dates, ideally record mm/dd/yyyy– If date unknown, record as mm/--/yyyyIf date unknown, record as mm/--/yyyy

Date of Last Negative HIV Date of Last Negative HIV TestTest

Purpose: To identify the point in time when the person Purpose: To identify the point in time when the person was known not to be HIV infected was known not to be HIV infected

One of the 3 variables used to classify as ‘new’ or One of the 3 variables used to classify as ‘new’ or ‘repeat’ tester‘repeat’ tester

Record :Record :– Last known date of negative test even if not certain that this Last known date of negative test even if not certain that this

is the most recent negative testis the most recent negative test– An approximate date is better than no dateAn approximate date is better than no date– Enter date of test, not date of provider noteEnter date of test, not date of provider note– Leave blank if no evidence of previous testLeave blank if no evidence of previous test– If the date if from a documented lab test with a specified 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 type, enter the information on the “Lab Tab” section as well

Indeterminate and Indeterminate and Unknown ResultsUnknown Results

Do not record Do not record ‘indeterminate’ or ‘indeterminate’ or ‘unknown’ results‘unknown’ results

These are neither These are neither positive nor negative positive nor negative HIV testsHIV tests

If the only previous test was If the only previous test was ‘indeterminate’, record ‘no’ ‘indeterminate’, record ‘no’ for “Ever Tested Negative”for “Ever Tested Negative”

Do not record dates Do not record dates

Number of Negative HIV Tests Number of Negative HIV Tests Within 24 Months Before First Within 24 Months Before First

PositivePositive Purpose: To indicate testing frequency in Purpose: To indicate testing frequency in

order to calculate the inter-test interval order to calculate the inter-test interval One of 3 variables used to classify cases One of 3 variables used to classify cases

as ‘repeat’ testersas ‘repeat’ testers Record the number of negative tests in the Record the number of negative tests in the

24 months prior to first positive24 months prior to first positive If no previous negative HIV test, enter 0If no previous negative HIV test, enter 0

Ever Taken Any Ever Taken Any Antiretroviral Antiretroviral

Medications (ARVs)? Medications (ARVs)? Two purposes: Two purposes:

1. Determine if the patient was taking 1. Determine if the patient was taking ARVS which might affect the BED result ARVS which might affect the BED result

2. Determine eligibility for VARHS2. Determine eligibility for VARHS

Ever taken any Ever taken any antiretroviral antiretroviral

medications (ARVs)?medications (ARVs)? Record ‘Yes’ if patient used any ARV at any Record ‘Yes’ if patient used any ARV at any

point in timepoint in time– Record the dates ARVs began and last Record the dates ARVs began and last

use, if knownuse, if known Record ‘No’ if the patient has never used Record ‘No’ if the patient has never used

ARVsARVs Record ‘Don’t know’, if ARV use is unknownRecord ‘Don’t know’, if ARV use is unknown Absence of ARV use information is NOT the Absence of ARV use information is NOT the

same as never used ARVssame as never used ARVs

Date ARVs First BeganDate ARVs First BeganDate of Last ARV UseDate of Last ARV Use

Purpose: To identify ARV use before STARHS Purpose: To identify ARV use before STARHS specimen was collectedspecimen was collected

Record the earliest date of Record the earliest date of anyany ARV use, even ARV use, even if this is after the date of HIV diagnosisif this is after the date of HIV diagnosis

Record the last known date of any ARV useRecord the last known date of any ARV use Record month and yearRecord month and year Leave blank if unknown date of first useLeave blank if unknown date of first use

Name of ARV Medication Name of ARV Medication TakenTaken

Purpose: To verify ARV use Purpose: To verify ARV use

Enter the name of earliest known ARV takenEnter the name of earliest known ARV taken

Select ‘Unspecified’ if ARV name is unknownSelect ‘Unspecified’ if ARV name is unknown

Variable not being used to monitor Variable not being used to monitor treatment.treatment.

How to complete the How to complete the form…visualizedform…visualized

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

Stateno assigned by surveillance

staff for the clients

Note the data source. “PEMS” refers to our LEO database

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.

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.

-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

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.

-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

-Enter the name of earliest known ARV taken

-Select ‘Unspecified’ if ARV name is unknown

-Variable not being used to monitor treatment.

-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

Can the date of the first positive HIV test result be Can the date of the first positive HIV test result be based only on a patient’s preliminary based only on a patient’s preliminary

positive rapid test result?positive rapid test result?

No. No. A positive HIV test refers to a reactive screening test that is confirmed using supplemental testing, 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 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.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 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) test” refers to a reactive screening test (like the OraQuick Rapid test) that is confirmed using supplemental that is confirmed using supplemental testingtesting, either Western Blot or Immunofluorescent assay (IFA). , 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 If a patient did not return for his or her confirmatory test disclosure, then this test cannot be considered their first positive HIV testpositive HIV test

Sending TTH’s to CDPH/OASending TTH’s to CDPH/OAStep 1 of 3Step 1 of 3

Identifiers and Frequency Identifiers and Frequency – No anonymous testers.No anonymous testers.– Make sure there are no personal identifiers Make sure there are no personal identifiers

visible such as name or social security visible such as name or social security number on any forms.number on any forms.

– Send along with the related Adult Case Send along with the related Adult Case Report FormReport Form

Sending TTH’s to CDPH/OASending TTH’s to CDPH/OAStep 2 of 3Step 2 of 3

Shipment should be double enveloped Shipment should be double enveloped and sent via traceable overnight courier and sent via traceable overnight courier – Inner envelope: Seal TTH’s (and ACRF’s) in Inner envelope: Seal TTH’s (and ACRF’s) in the inner envelope and mark it confidential.the inner envelope and mark it confidential.

– Outer envelope: Address to:Outer envelope: Address to:Chief HIV/AIDS Surveillance SectionChief HIV/AIDS Surveillance SectionSteven StarrSteven StarrCalifornia Department of Public HealthCalifornia Department of Public Health1616 Capitol Avenue, Suite 616, MS 77001616 Capitol Avenue, Suite 616, MS 7700Sacramento, CA 95814Sacramento, CA 95814

Sending TTH’s to CDPH/OASending TTH’s to CDPH/OAStep 3 of 3Step 3 of 3

Notify the HIS project of shipment Notify the HIS project of shipment Arvin MagusaraArvin MagusaraHIS Project CoordinatorHIS Project Coordinatoremail: email:

arvin.magusara@cdph.ca.gov phone: 916-449-5867phone: 916-449-5867

OA HIS Website OA HIS Website – http://www.cdph.ca.gov/pubsforms/forms/http://www.cdph.ca.gov/pubsforms/forms/

CtrldForms/cdph8681.pdfCtrldForms/cdph8681.pdf– The Forms are located under “Resources for The Forms are located under “Resources for

Local Heath Departments or Providers” Local Heath Departments or Providers” – Download and Print as neededDownload and Print as needed

How do I get more TTH forms?How do I get more TTH forms?

Thank You!Thank You!For more information please visit our For more information please visit our websites: websites:

HIV/AIDS Surveillance in CaliforniaHIV/AIDS Surveillance in Californiahttp://www.cdph.ca.gov/programs/aids/Pages/http://www.cdph.ca.gov/programs/aids/Pages/

OAHISHome.aspxOAHISHome.aspx

HIV Incidence Surveillance in the U.S.HIV Incidence Surveillance in the U.S.www.cdc.gov/hiv/topics/surveillance/www.cdc.gov/hiv/topics/surveillance/

incidence.htmincidence.htm