ABSTRACT
OBJECTIVE: To evaluate laboratory-initiated CD4 reporting (LICR) for AIDS surveillance and for differences in cases found by LICR and traditional surveillance methods (i.e., health care provider or death certificate reports and medical record searches). METHODS: We compared the characteristics of persons reported with AIDS between May 1993 and April 1994 by traditional methods or by LICR reports <200/microl. RESULTS: We received 643 LICR reports and 278 AIDS case reports. HIV status was available on 94% of LICR reports; 96% of these persons were HIV-infected. LICR reports were received on 250 (90%) AIDS cases. Cases found by LICR were less likely to be persons of color and to have opportunistic illnesses and more likely to live in rural areas. Cost of LICR to the health department was less than the salary of one research analyst. CONCLUSIONS: LICR, with a high positive predictive value, is a highly sensitive, timely, and relatively inexpensive method of surveillance and its use should be considered in other jurisdictions.
Subject(s)
Acquired Immunodeficiency Syndrome/diagnosis , CD4 Lymphocyte Count , Adult , Aged , Costs and Cost Analysis , Female , Humans , Male , Middle AgedABSTRACT
Using AIDS surveillance data, we analyzed trends and correlates of outpatients AIDS diagnosis in Oregon and Washington. The proportion of outpatient diagnoses rose from 24% of cases in 1987 to 51% in 1990. Case characteristics associated with outpatient diagnosis included white race, urban residence, and the exposure category of male homosexual/bisexual contact. AIDS-defining conditions associated with outpatient diagnosis included Kaposi's sarcoma, HIV wasting syndrome, and esophageal candidiasis. Completeness and timeliness of reporting was poorer for cases diagnosed as outpatients compared with inpatients. As outpatient diagnosis becomes more common, modified surveillance methods may be needed to ensure complete case finding and consequent reliability of AIDS surveillance information.
Subject(s)
Acquired Immunodeficiency Syndrome/diagnosis , Outpatients , Acquired Immunodeficiency Syndrome/epidemiology , Adult , Female , Humans , Inpatients , Male , Oregon/epidemiology , Population Surveillance/methods , Washington/epidemiologyABSTRACT
We searched for unreported AIDS cases in Oregon through death certificate and medical record review, and enhanced infection control practitioner and physician surveillance. Fifty-six AIDS cases diagnosed between February 1, 1986 and January 31, 1987 were reported passively. Twenty-nine additional cases diagnosed during this time were retrospectively identified by active methods. Ninety percent of those 29 cases were diagnosed by physicians and cared for in hospitals that had previously reported cases. Completeness of reporting under the passive system was 64 percent.
