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HIV/AIDS Surveillance in Michigan
Michigan HIV/AIDS Surveillance Statistics with latest reports attached
Special
PowerPoint Presentations/
Epi Profiles Where to
send HIV serum tests / Reporting HIV/AIDS Cases / HIV/AIDS
Reporting Contacts for Michigan 5/21/09
- Counties assigned to various surveillance staff have been updated /Resources
for Reporting HIV/AIDS Cases in Michigan / Special Reports Back to HIV &
STD Statistics
Special PowerPoint Presentations
Getting the
picture: HIV/AIDS and Latinos -
PowerPoint Presentation presented at the National Latino AIDS
Awareness Day kick-off on September 15, 2009.
2008 EPI Profiles
2008 Epidemiologic Profiles of HIV in Michigan
These have been posted on the MDCH HIV website
http://www.michigan.gov/mdch/0,1607,7-132-2940_2955_2982_46000_46003-36307--,00.html
There are three separate profiles- Michigan as a whole, SE Michigan and Outstate
Michigan.
These profiles represent the most comprehensive picture of HIV in our state and
are a great source of information. I encourage you to read the Forward so you
will know more about what is in them.
Michigan HIV/AIDS Surveillance Statistics
Note:
You can subscribe and unsubscribe to the electronic
e-mailing list at:
http://www.localhealth.net/hivstats/subscribe.aspx
January 1, 2010 Michigan HIV/AIDS Statistics
The October 2009 HIV/AIDS statistics for the State of Michigan have been posted
on the MDCH website and can be accessed at the address directly by
clicking on this link:http://www.michigan.gov/documents/mdch/JAN_2010_307661_7.pdf
- Updated Prevalence Estimate for Michigan
Every January NDCH updates the estimated HIV prevalence in the
state; that is, the number of people we estimate to be currently
living with HIV in Michigan. This number includes reported cases and
is increased to account for people who have been diagnosed but not
reported (estimated at 10%) and the number infected but not yet
diagnosed (estimated at 21%). Because the number of people reported
and living with HIV continues to increase the estimated prevalence
also increases every year; this year it is 18,800. To give you
perspective on this, below are the estimates for the last four
years:
Jan 2007: 17,000
Jan 2008: 18,000
Jan 2009: 18,200
Jan 2010: 18,800
More information on how MDCH calculates these can be found in the
Quarterly Report in the Front Matter, page iii.
- PowerPoint Presentation with latest MI Stats to be
available in February
Power point slides summarizing this Quarter's report will be
released next month. We invite and encourage you to use these
slides for presentations and discussions on the state of the
epidemic in Michigan.
-
Items to
Look for in 2010:
An improved
Michigan Adult/Adolescent HIV/AIDS case report form that:
- Expands
categories for current gender so we can quantify the HIV
epidemic among transgendered persons
- Adds a place
for providers to let us know that the person being reported
represents a suspect case of acute HIV infection.
Acute or primary HIV infection is associated with high viral
load levels in blood plasma with potentially conflicting
antibody results (e.g., ELISA could be negative and/or
confirmatory Western blot antibody may be indeterminate).
P24 antigen blood test is often positive. The infection is
highly transmissible during this stage and an early
diagnosis provides the first opportunity to appropriately
counsel patients in regard to preventing the spread of the
infection. See more information pertinent to Reporting.
Initial analysis
from the Medical Monitoring Project (MMP).
This project consists of patient interviews and extensive chart
reviews in order to collect information from a representative
sample of HIV infected persons in care in the state that is not
available from routine HIV surveillance. We look forward to
sharing data such as time between diagnosis and entry into care,
antiretroviral use, non-injecting drug use, unprotected sex and
unmet need for ancillary services.
October 1, 2009 Michigan HIV/AIDS Statistics
The October 2009 HIV/AIDS statistics for the State of Michigan have been posted
on the MDCH website and can be accessed directly by
clicking on this link:
http://www.michigan.gov/mdch/0,1607,7-132-2940_2955_2982_46000_46003-35962--,00.html
- Injecting Drug Users (IDU) - Behavioral Surveillance Report
Available
This report can be accessed by going to the Behavioral
Surveillance page of the state website and clicking on the report
link:
http://www.michigan.gov/mdch/0,1607,7-132-2940_2955_2982_46000_46002-165551--,00.html
The data for this report were collected during 2005 as part of the
National HIV Behavioral Surveillance IDU1 cycle to identify
characteristics and risk behaviors of Detroit Metro's injecting drug
user population. The data for the IDU1 cycle were collected using a
sampling method called Respondent Driven Sampling (RDS). The first
stage of an RDS study entails ethnographic assessment of the
population of interest in order to evaluate the status of the
population, to assess behavioral trends in the population, and to
identify sampling initiators, known as seeds. Each seed is given
three coupons to distribute to potentially eligible participants and
each of those eligible participants is, in turn, given three coupons
to recruit additional eligible participants (Figure 1.2). This chain
of recruitment, which is also called "snowball sampling," continues
until the desired sample size is reached.
Key findings presented in this report:
Demographics
Almost all (99%) living in Detroit at time of interview
Mostly black non-Hispanic (89%) and male (65%)
Older than the city of Detroit's population (median 51 versus 32
years)
Very low income (60% with an annual household income <$10,000)
Drug Use
Heroin was the most commonly injected drug (99% of
participants)
Heroin was injected more frequently (75% use once or multiple times
daily) than other injection drugs (18% use once or multiple times
daily)
Alcohol and other non-injection drugs were commonly reported (83%
and 81%, respectively)
Injection Safety
35% of participants reported using a sterile needle for
all injections
77% of participants never share needles
46% of participants shared some drug equipment in the prior 12
months
HIV Testing
92% were tested at least once in the past, 45% of those
tested were tested in the prior 6 months and 70% within the last 12
months
88% of those tested obtained all results of HIV tests
Drug Treatment
77% have been in drug treatment at some point, 33% within
the last year
93% learned to protect themselves from HIV in drug treatment
programs
Sexual Behaviors
96% describe themselves as heterosexual
85% had one or more sexual partners in the last year
80% of those having sex had unprotected sex in the prior 12 months
Health
64% had health insurance at the time of the survey
82% had a health care visit in the prior 12 months
32% have been diagnosed with Hepatitis C
- STARHS Data Analysis
Indicates ART may be needed in an Substantial Subgroup of Recently
Infected People
A collaboration between Dr. Norman Markowitz of Henry Ford
Health System and our incidence surveillance staff utilizing STARHS
(Serologic Testing Algorithm for Recent HIV Seroconversion)
incidence data suggests the need to consider initiating
antiretroviral therapy (ART) in a substantial subgroup of recently
HIV-infected individuals. Current Department of Health and Human
Services treatment guidelines recommend the initiation of ART at <
350 CD4 cells/mm³. Recently published studies suggest that earlier
initiation of ART at 500 CD4 cells/mm³ may provide better long-term
outcomes to patients. CD4 counts measured during the approximate
first year following infection among Michigan residents indicate 17%
of persons would require ART soon after infection at <350 cells/mm³
and 42% at <500 cells/mm³. Dr Markowitz presented the results of
this analysis as a poster at the IAS (International AIDS Society)
Conference in South Africa in July 2009.
1Timing of initiation of antiretroviral therapy in AIDS-free
HIV-1-infected patients: a collaborative analysis of 18 HIV cohort
studies. Lancet . 2009 Apr 18;373(9672):1352-63. Epub 2009 Apr 8
- Newly Release Communicable Disease Rules
By Law, Michigan Department of Community Health (MDCH) is
required to periodically review and update the Communicable Disease
Rules. This process usually takes well over a year and we are
pleased to share with you the changes in the rules that went into
effect on October 2, 2009. They can be accessed at:
http://www.michigan.gov/documents/Communicable_Final_Rule_-_Signed_120104_110923_7.pdf
Regarding HIV reporting, ethnicity and country of birth were added
as required information to be included in case reports, when known.
Previously the law only required race to be reported. Regarding HIV
specimen submission, the law now codifies what most labs in Michigan
and across the nation have been doing voluntarily: providing
specimens for incidence testing when available. Michigan is one of
25 sites participating in the effort to generate HIV incidence rates
nationally and at the state level.
- CDC External Peer Review of CDC's Division of HIV/AIDS
Prevention Surveillance, Research and HIV Prevention Programs
See the summary of CDC's External Peer Review that was conducted in
April 2009.
http://www.champnetwork.org/files/HIVPJA/EPRsummary.pdf
July 1, 2009 Michigan HIV/AIDS Statistics
The July 2009 HIV/AIDS statistics for the State of Michigan have been posted on
the MDCH website and can be accessed by clicking on this link:
http://www.michigan.gov/documents/mdch/Jul_2009_286299_7.pdf
- Trend Documents
Every year we analyze data over a recent five-year period of time in the
State of Michigan and Southeast Michigan to describe trends over time by
age, race, sex and risk. The 2009 analyses are now available and can be
accessed at:
http://www.michigan.gov/mdch/0,1607,7-132-2940_2955_2982_46000_46003-36304--,00.html
Key findings in the Michigan report include:
* Increases among 13-17 year olds - this is the fourth consecutive
trend report with this finding
* Among these teens, 85% are black, compared with 59% of
those age 20+
* 62% are MSM, compared with 22% of HIV-infected persons
age 20+
* Increases among black and other race/ethnicity MSM of all ages and
decreases among white MSM
* Decreases among IDUs - this is the fourth consecutive trend report
with this finding
Key findings in the Southeast Michigan report include:
* Increases among 13-17 year olds and those age 60 and older at
diagnosis
* Fourth consecutive trend report with this finding among teens
* Second consecutive trend report with this finding among 60+ year
olds
* Decreases among IDUs - this is the fourth consecutive trend report
with this finding
* For the first time we are seeing shifts in the geographic
distribution of cases with residence in SE MI at the time of diagnosis
* Decreases in the City of Detroit
* Increases in Macomb County
* Stable rates in Oakland County
The geographic shifts in persons living with HIV mirror shifts in general
population changes in these jurisdictions but the relationship between the
two is not definitive. We will need to watch this in future years to better
understand the relationship between general population shifts and changes in
where people are living at the time of HIV diagnosis.
- Partner Services - What does it offer HIV-infected persons?
Requests for assistance with notifying sex/needle sharing partners
of HIV infected persons are usually made to the local health
departments by checking that option on the case report form.
Michigan law imposes an affirmative duty upon physicians to notify
known partners of their potential exposure unless they discharge
that duty to the local health department (See MCL 333.51315(b) for
specific language). Partner Services (PS AKA Partner Notification or
Partner Counseling and Referral Services) include assisting the
infected person with either telling their partners themselves or
obtaining assistance with such notification from the local health
department. PS is an important disease prevention tool to assist
physicians and patients by providing additional HIV education, risk
reduction information, and referral into appropriate support
services. PS can also assist with the identification and location
of at-risk sex or needle-sharing partners of infected individuals,
so they can be confidentially informed of their potential exposure
to HIV, offered testing, and referral information.
- Staff Changes
Elizabeth Hamilton has taken on the Coordinator position for our
Data Management and Analysis Team (DMAT). In this role she is
coordinating our Section's response to data requests. Liz has
been a national leader in analyzing incidence data and providing
support to surveillance programs in other states. She has been
the primary author of the last three Epidemiologic Profiles of
HIV in Michigan. We welcome her taking on this responsibility
and appreciate her leadership both in Michigan and nationally.
Please contact Liz directly for data requests
HamiltonE2@michigan.gov.
April 1, 2009
Michigan HIV/AIDS Statistics
The April 2009 HIV/AIDS statistics for the State of Michigan have been posted on
the MDCH website
http://www.michigan.gov/documents/mdch/Apr_2009_27585lass="MsoBodyText" =:0in;margin-bottom:.0001pt">
- Changes Mode of Transmission
Last quarter we introduced Table 2- Risk Transmission and Exposure
Categories for HIV on Prevalent HIV/AIDS Cases by Sex. The purpose of this
table is to display more of the information on risk factors that is reported
on the case report form. The goal is to provide more detailed information to
inform prevention programs. For those collecting data, please see the
instructions in this quarterly report.
- Behavioral Surveillance Date for IDUs
Detroit participated in the National HIV Behavioral Surveillance (NHBS) for the
IDU cycle during 2005-2006. Data from the national database were recently
released in the April 10, 2009 MMWR (http://cdc.gov/mmwr/preview/mmwrhtml/mm5813a1.htm).
We anticipate releasing data about the IDUs interviewed in the Detroit area by
the time the Summer Quarterly Statistical Report is published. An initial
presentation of these data will take place next month and you are invited to
attend. Melissa Reznar, our past Data Manager, is continuing to work with us to
analyze the behavioral data. She will be presenting the Detroit IDU data on Thursday May 14, 2009 in Lansing at the
Capitol View
Building,201 Townsend in the first floor Conference Room A from 11:30 am to 1:00 pm.
- Michigan Behavioral Risk Factor Survey
Preliminary HIV testing data from the Michigan
Behavioral Risk Factor Survey. The Michigan Behavioral Risk Factor Survey (BRFS) is an annual, statewide
telephone survey of Michigan adults aged 18 years and older that is conducted
through a collaborative effort among the Behavioral Surveillance Branch (BSB) of
the Centers for Disease Control and Prevention, the Michigan State University
Institute for Public Policy and Social Research (IPPSR), and the Michigan
Department of Community Health. Michigan BRFS data contribute to the national
Behavioral Risk Factor Surveillance System that is managed by BSB. The entire
report can be viewed on the State of Michigan website --
www.michigan.gov/brfs,
and click on Annual Tables. Black
respondents were almost twice as likely to have been tested for HIV compared to
White respondents.
-
Staff Changes
Some surveillance responsibilities
are shifting among staff. Michael Kucab will be coordinating the implementation
of the Hepatitis Body Art Legislation, and thus Dr. Kim Kirkey (who currently
manages Hepatitis C Surveillance) will be the contact for Out-State Pediatric
HIV Surveillance. Michael will be retaining his Adult HIV Surveillance sites.
Congratulations to Michael and welcome to Kim.
As we announced last quarter, our
Section Manager Garry Goza retired late last year. Karen MacMaster has been
hired to take this position and she starts in late May.
Karen started
her career with MDCH as a microbiologist with the Bureau of Laboratories. She
also worked with Epi Lab Capacity and then with Bioterrorism Surveillance as a
Section Manager. She then went to Office of Public Health Preparedness as a
Section Manager and is currently a Departmental Manager with the Michigan State
Police. She has a Master of Public Administration - Healthcare and we look
forward to her leadership in our Section.
We have a new Coordinator for our
Medical Monitoring Project (MMP). After working for the program as an
interviewer/abstractor we welcome Meosia Lee Turner in her new position of MMP
Coordinator. You can contact her at
turnerm@michigan.gov or 313 876 0072.
January 2009 HIV/AIDS statistics for the State of
Michigan
http://www.michigan.gov/documents/mdch/Jan_2009_265353_7.pdf
- Changes to this Quarter's Report
1) CDC lowered their estimate of the percent of HIV-infected persons
who are not diagnosed from 25% to 21% (MMWR, October 3,
2008/57(39);1073-1076; HIV Prevalence Estimates -- United States, 2006).
Following their lead, we made the same change when calculating the Michigan
HIV prevalence estimates. Consequently the number of persons estimated to be
living with HIV in Michigan is currently 18,200.
2) Table 2 and the accompanying notes on Page ii of the January 2009
quarterly statistics display and explain the mode of transmission categories
in a different way than we have used since the 1980s. In the past we
have displayed the modes of transmission as primarily single modes in a
hierarchy that assumes that modes higher up in the hierarchy are more
efficient modes of transmission than those lower down. This month we added a
table with mutually exclusive categories that include virtually all of the
information reported to us in Section VII of the current Michigan Adult Case
Report Form (DCH Form #1355). We hope this additional information will make
the data more useful for you in planning services and prevention programs.
- PowerPoint Slides
This PowerPoint presentation
uses year-end data. We want to make these data
as useful as possible for you and this has been well received in the
past. We are open to other suggestions of data products that you would
find useful.
- Signed Consent and Viral Load Testing
Is signed legal consent required when ordering HIV RNA viral
load tests?
-
Clarification
of the conditions under which such consent is required
(This was added by Eve Mokotoff in a follow-up to the report)
Section 333.5133 of the Michigan Compiled Laws describes the
consent requirements for HIV testing in Michigan. I recommend you
look there for specific language. This Section can be found at:
http://www.legislature.mi.gov/(S(tux4iuuhfghzbmz2lo55hz45))/mileg.aspx?page=getObject&objectName=mcl-333-5133
Briefly, 5133 only applies to DIAGNOSTIC
testing of HIV (unless one of the subsections of 333.5133 applies)
and not routine VL monitoring of a person already diagnosed as
HIV-infected.
- Appropriate Use of HIV Viral Load Tests
Viral loads may not be reliable for diagnosing HIV since
viral levels can be undetectable in an HIV-infected person. HIV
Viral load tests are usually used for 1) monitoring drug therapy
effectiveness and 2) diagnosing HIV if Acute Retroviral
Infection is suspected. In this situation, HIV antibody tests
are typically negative.
The National Institutes of Health publishes Guidelines for the
Use of Antiretroviral
Agents in HIV-1-Infected Adults and Adolescents, which can be
found at:
http://aidsinfo.nih.gov/contentfiles/AdultandAdolescentGL.pdf
There is a table on page 6 of these guidelines entitled: Laboratory Monitoring for Patients Prior to and After Initiation
of Antiretroviral Therapy that you may find useful in
determining when viral load tests and other lab tests should be
run for the HIV-infected patient.
- Staff Changes
Garald Goza, our Section Manager, has retired from the
State of Michigan. He provided vital guidance for us since
the early 1990s and presided over the Section as it grew
from HIV/AIDS surveillance to include Hepatitis, TB and
STDs. We are grateful for his mentoring and leadership. His
position will be posted. In the interim, Elizabeth Hamilton,
Nilsa Mack or Eve Mokotoff may be contacted for questions
previously sent to him.
See Archived
Surveillance Reports
Where to send
HIV serum tests
Effective Jan 1, 2010, all serum HIV testing previously performed at
Kent County and the Detroit Department of Health and Wellness Promotion
Laboratories will be performed at the MDCH Bureau of Laboratories in Lansing.
After Monday, December 14 you can download the new test request (DCH-0583 Dec 4,
2009), with new shipping address located at:
www.michigan.gov/mdchlab -click on "What's New" and utilize these materials
for all specimens shipped after January 1, 2010.
(1.12.10)
Following the transfer of HIV-1 serum testing from City of Detroit and Kent
County Laboratories to the MDCH Bureau of Laboratories in Lansing, we have
prepared a FAQ document for your convenience in order to make the transfer
easier.
Answers to Frequent Questions
1. Question: We send HIV serum specimens to Detroit City HD (or Kent Co. HD) for
testing and receive automatic FAX reports via our secure FAX machine. Will we
need to complete new auto FAX agreements to keep receiving HIV reports via FAX?
Answer: HIV serum reports will continue to arrive via your designated secure
FAX.
Lansing is cross-referencing Detroit City HD and Kent Co HD agency d-bases to
verify correct secure automatic FAX numbers.
In the event Lansing finds a discrepancy your agency will receive an Automatic
FAX Agreement to update and return per included instructions.
2. Question: Do we continue to use the same agency code when completing the
Microbiology/Virology Test Requisition (DCH-0583 December 4, 2009) form, for
sending HIV serum specimens to Lansing?
Answer: Continue to use the current agency code. Lansing is cross-referencing
Detroit City HD and Kent Co HD agency d-bases to verify correct agency codes.
In the event Lansing finds a discrepancy your agency will receive a notice, of
the correct agency code to use when completing the Microbiology/Virology Test
Requisition (DCH-0583).
3. Question: How do we access the MDCH Laboratories Services Guide on line?
Answer:
Web address: www.michigan.gov/mdchlab SAVE this web address as an
*internet favorite* for future reference. To access the Laboratory
Services Guide: Find the section titled Laboratory Services Guide. It
is located in the middle of the screen. Click on it.1. To order test kits
(clinical components) click on Specimen Collection & Shipping Containers then
DCH-0568.
To find information regarding a specific test click on A * Z Test Listing. To
find specimen collection, submission and shipping guidelines and a breakdown of
BOL Lab tests, click on Bureau of Laboratories - Laboratory Services Guide.
4. Question: Can we request multiple testing such as HepB, Syphilis and HIV
serum testing using one serum sample and one requisition form?
Answer: Yes, however the minimum volume of serum, for multiple tests
ordered is 3 ml. NOTE: Whole blood is spun resulting in 3ml serum.
5. Question: Where can we obtain Unit 49 collection kit?
Answer: This kit can be obtained by either -Faxing a DCH-0568 *Clinical Specimen
Shipping Units Requisition* to
517-335-9039
-Mailing a DCH-0568 to Michigan Department of Community Health
Laboratory Support Unit
927 Terminal Road
Lansing, MI 48906
6. Question: Who can we contact with additional questions?
Answer: For HIV testing questions, please contact Bruce Robeson @
517-335-8099 or email your questions to
RobesonB@michigan.gov
For general HIV questions please contact Dr Anthony Muyombwe @
517-335-8099 or email your questions to
muyombwea@michigan.gov
With shipping unit questions please contact Dr Jeff Massey
@517-335-8074 or email questions to
masseyj@michigan.gov
Reporting HIV/AIDS Cases
Why we ask for Race and Ethnicity
CDC requires the completion of the race/ethnicity variable for a case
of HIV/AIDS to be counted in the national statistics as well as for a case to
count as a Michigan case. This has a direct impact on federal funding for care
of HIV infected persons in the state.
Additional rationale is related to the disparate rate that HIV affects persons
by race/ethnicity. Among some racial/ethnic minorities, the rate at which people
acquire HIV is disproportionate. The epidemic disproportionately impacts black
and Latino/Hispanic populations in Michigan. For example, blacks comprise 14% of
the state's population and 59% of the state's HIV/AIDS cases with a rate of 607
per 100,000, 9.5 times higher than the rate among non-Hispanic whites (64 per
100,000). Hispanics comprise 4% of HIV/AIDS cases and 4% of the population and
have a rate of 141 per 100,000 (over two times higher than non-Hispanic whites).
Findings such as these are based largely on data collected from public health
surveillance.
An important priority for CDC and MDCH is to eliminate health disparities by
improving the health of racial and ethnic minority populations through the
development of health policies and programs.. To accomplish this goal,
high-quality data on race and ethnicity are necessary to identify and eliminate
health disparities. Accurate and complete data on race and ethnicity provide
important information regarding who is impacted by various health issues and
guides resource allocation and decision-making.
DOCUMENTATION OF MODE OF HIV TRANSMISSION
Information on how persons living with HIV/AIDS became infected continues to be
vital to prevention planning efforts. In addition, national surveillance data on
HIV/AIDS transmission category, as well as demographic risk factors (geographic
location of residence, age, sex, race/ethnicity) are used to allocate funds for
HIV prevention programs and services and target and evaluate interventions and
programs, among other uses. Therefore it is crucial to have complete and
accurate data for these variables. MDCH appreciates your
documentation of modes of HIV transmission in the patient's medical record
and/or your documentation of this information on the HIV/AIDS case report form.
In addition, please call your contact on their staff (see
list below) if you have a patient with a suspected unusual mode of
transmission. Examples of these include an HIV-infected child whose biological
mother is not HIV-infected, a person who has reported no sexual contact in the
previous years, patient report of exposure to possible HIV-infected blood or
body fluids or of transfusions in countries outside of the USA.
Implementation of Michigan's HIV Reporting Law
PA 514, which went became law on April1, 2005, changed the way HIV is reported in
Michigan. Now, physicians and testing sites will share the responsibility with
clinical labs to report confirmed positive HIV tests. (See Lab Based Reporting of HIV). It is important to note that this does not
affect the ability of individuals in our state to obtain anonymous testing at
MDCH designated testing sites.
This law helps to provide a more accurate picture of the epidemic in
Michigan. And it will paved the way for a more equitable assessment of need for
Ryan White CARE Act funding. As more states provide accounting of HIV cases, the
federal government will change its criteria for CARE funding from numbers of
AIDS cases to the numbers of those living with HIV.
For more information on the ramifications of
this new law, see the PowerPoint Presentation made by Eve Mokotoff at the March 2005
MHAC meeting Also, see the letter
sent to clinicians by MDCH regarding the implementation of this new law at
http://www.mihivnews.com/stats/PA514.Clinicianinfo.Memo.pdf.
Lab-Based Reporting of HIV
PA 514 the
e and add to the completeness of reporting of both HIV and AIDS.
Licensed clinical labs are now required to report positive HIV tests, and also
“test results ordered for the management and surveillance of the infection” (CD4
test results under 200 and viral load test results) which would indicate an AIDS
diagnosis. Underblicesting sites for testing that is not requested to be done anonymously.
Medical providers are also required by law to report AIDS diagnosis.
Michigan was actually ahead of the national game for requiring HIV name-based
reporting. It was written into the public health code as part of a package of
HIV laws passed back in 1988. Prior to the Governor signing PA 514 in December,
Michigan was the only name-based HIV reporting state that did not require the clinical laboratory to report HIV according to
Eve Mokotoff, HIV/AIDS Epidemiology Manager for MDCH.
“An integrated, clinically-based HIV/AIDS surveillance system worked well in the
late 1980’s and early 1990’s,” stated Mokotoff in a presentation to
MHAC. (However), as
medical care became more decentralized, the system’s dependence on conducting
surveillance with a manageable number of key physicians became less reliable.”
This new law will not affect a person’s ability to be
tested anonymously in Michigan, which has been unique in allowing anonymous
reporting from the non-anonymous care setting (i.e., physician’s offices)
according to Mokotoff. “We are not interested in, and have no plans for,
changing the availability of anonymous reporting in Michigan.”
See the PowerPoint presentation by Eve Mokotoff, which explains the
ramifications of the bill on surveillance and the possible impact on future Ryan
White funding at
http://www.mihivnews.com/stats/labreportingSB1129.pdf
See the other Michigan HIV Laws
How They Affect Physicians and Other Health Care Providers
Revised
September 2002.
Resources for Reporting HIV/AIDS Cases in Michigan
Many of the forms and information often requested are available on line. The
following summarizes the location of: 1) the booklet, Michigan HIV Laws: How
They Affect Physicians and Other Health Care Providers, 2) adult and pediatric
case report forms and instructions for completion, 3) Form DCH-1221 Confidential
Request for Local Health Department Assistance for Partner Counseling & Referral
Services (PCRS) and 4) the Michigan Communicable Disease rules 5)
PCRS fact sheet
Risk Ascertainment
A reminder from MDCH Surveillance: Ascertainment of mode of transmission of
HIV continues to be important information for planning and evaluating HIV
prevention and care services. Although we know how HIV is transmitted,
obtaining information on how HIV-infected persons were most likely to have
acquired their infection allows us to target persons at highest risk. Please
continue to provide this information in medical records and on any case report
forms you complete.
Risk
Assessment Form
Finding Michigan HIV/AIDS Laws booklet online:
http://www.michigan.gov/documents/mihivlaws_49845_7.pdf
Or navigate through the MDCH website:
www.michigan.gov/mdch
>Physical Health and Prevention
>Prevention
>HIV/STD: Under “HIV” click: HIV/AIDS
>Click here to open a copy of the booklet, Michigan HIV Laws: How They Affect
Physicians and Other Health Care Providers
Finding Adult HIV/AIDS Case Report form or instructions
online:
Form:
http://www.michigan.gov/documents/Frm5042A_6861_7.pdf
Instructions:
http://www.michigan.gov/documents/CRFINST9-02_41194_7.pdf
Or navigate through the MDCH website:
www.michigan.gov/mdch
>Providers
>Departmental Forms
>Communicable Disease Case Definitions and History Forms:
Click on Form # “CDC 50.42A Adult HIV/AIDS” or “Instructions”
Finding Pediatric HIV/AIDS Case Report form or
instructions online:
Form:
http://www.michigan.gov/documents/frm5042b_6862_7.pdf
Instructions:
http://www.michigan.gov/documents/PEDCRF9-02_41195_7.pdf
Or navigate through the MDCH website:
www.michigan.gov/mdch
>Providers
>Departmental Forms
>Communicable Disease Case Definitions and History Forms:
Click on Form # “CDC 50.42B Pediatric HIV/AIDS” or “Instructions”
Finding DCH-1221 Confidential Request for Local Health
Department Assistance for Partner Counseling & Referral Services online:
https://www.hapis.org/dc/PublicPages/DCH1121.pdf
Or navigate through the HAPIS website:
www.hapis.org
Scroll down beyond the username and password boxes.
Under “Partner Counseling & Referral Services Material, click:
“Confidential Request for LHD Assistance for PCRS (Obsoletes Form HP-139)”
Finding the Michigan Communicable Disease Rules online:
http://www.state.mi.us/orr/emi/admincode.asp?AdminCode=Single&Admin_Num=32500171&Dpt=CH&RngHigh=
Or navigate through the MDCH website:
www.michigan.gov/mdch
>Providers
>Communicable and Chronic Diseases
>Communicable Disease Reporting in Michigan
Click on “Michigan Communicable Disease Rules”
MDCH HIV/AIDS Surveillance Section Special Reports/Projects
MDCH Staff Co-authored Research
Quality of Care for
HIV Infection Provided by Ryan White Program-Supported versus Non-Ryan White
Program- Supported Facilities
Patrick S. Sullivan1,2*, Maxine Denniston1,
Eve Mokotoff3, Susan Buskin4,
Stephanie Broyles5, A. D.
McNaghten1
Special Reports and Publications
Estimate of Recent HIV
Infections
A new method of estimating new HIV infections released by the Centers
for Disease Control and Prevention (CDC) in August revealed that an estimated
56,300 people were infected with HIV in the United States in 2006. Michigan was
among the 22 states and cities that contributed data for the estimate, and our
rate was the lowest at 10 per 100,000 Michiganians newly infected in 2006 – less
than half the national rate of 23 per 100,000. The sex, race, age and risk
breakdowns of the national estimate are being released this week in the Sept.
12, 2008 CDC publication, Morbidity and Mortality Weekly Report. See the entire
MDCH Press Release (9/11/08)
Annual Review of HIV Trends in the Detroit Metro Area
At the end of May, MDCH sent out the Annual Review of HIV Trends in
Michigan*. The companion document, Annual Review of HIV Trends in the Detroit
Metro Area, is now complete and both are available on the web at:
http://www.michigan.gov/mdch/0,1607,7-132-2940_2955_2982_46000_46003-36304--,00.html
*NOTE: The version of the Statewide review sent out in May had an error in Table
2, New HIV Diagnoses by Race/Sex as well as a typo on the final summary page. If
you saved and/or printed that document please replace it with the one found at
the link above.
Find both the latest Metro Detroit Trends and the Updated Michigan Trends
reports at the MDCH website
Annual Review of HIV Trends
in Michigan 2002-2006
Key findings are:
-
Adolescent
and young adult diagnoses (13-24 year olds) have increased for the third
consecutive year.
-
Three
quarters of newly diagnosed adolescents and young adults are black compared
with 59% of persons diagnosed at older ages.
-
13-24 year
olds are much more likely to be black MSM compared with those diagnosed at
older ages - 48% vs 19%.
-
New
diagnoses among MSM increased by an average of 4% per year 2002-2006.
-
New
diagnoses among IDUs decreased by an average 7% per year 2002-2006.
-
An average
of 890 persons were diagnosed with HIV each year from 2002-2006.
-
New HIV
diagnoses are highest among MSM, black men, 25 -44 year olds and residents
of SE Michigan.
The Adult
and Adolescent Spectrum of Disease (ASD) project
was a supplemental
surveillance project sponsored by the Centers for Disease Control and Prevention
(CDC) to learn more about the disease status of HIV-infected persons. Health
departments in eleven U.S. cities, including Detroit, collected data for a
period of 14 years, 1990-2003. The data from ASD formed the basis for the
revision of the AIDS surveillance case definition in 1993 to include CD4+
T-cell count <200 cells/mm3 as an AIDS-defining event. In the
following years, 1994-2003, ASD continued to track developments in the natural
history of HIV infection, such as the improved health status of HIV-infected
persons following introduction of more effective therapies for HIV and for
opportunistic illnesses, the side-effects of these therapies, and the rise of
liver disease in persons co-infected with HIV and hepatitis. The
report summarizes the
Detroit ASD data. It will also be posted on
www.michigan.gov/hivstd in the near future.
Mokotoff ED, Glynn MK. Surveillance
for HIV/AIDS in the United States.
Chapter 16 in Infectious Disease
Surveillance. Editors: Mikanatha N,
Lynfi eld R, Van Beneden CA, deValk H.
Blackwell Publishers 2007.
McNaghten, A, Wolfe, M, Onorato, I
Nakashima, A, Valdiserri, R, Mokotoff,
E, Romaguera, R, Kroliczak, A
Janssen, R, and Sullivan, P.
Improving
the Representativeness of Behavioral
and Clinical Surveillance for Persons
with HIV in the United States: The
Rationale for Developing a Population-
Based Approach. PLoS ONE. 2007 July
6(e550).
http://www.plosone.org/article/fetchArticle.action?articleURI=info%3Adoi%2F10.1371%2Fjournal.pone.0000550
Characteristics of Persons With Recently Acquired HIV Infection:
Application of the Serologic Testing Algorithm for Recent HIV Seroconversion in
10 US Cities
J Acquir Immune Defic Syndr. 2007;44(1):112-115. ©2007 Lippincott Williams &
Wilkins
Posted 03/14/2007
http://www.medscape.com/viewarticle/551828_print
This reported research on the
serologic testing algorithm for recent HIV
seroconversion (STARHS) project. STARHS is a relatively
new testing strategy that can distinguish persons whose
HIV infection was acquired, on average, in the past 6
months from those who have been HIV infected longer.
Using data collected as part of a multisite (including
Detroit) study of primary HIV drug resistance, the researchers compared the
characteristics of persons whose HIV diagnosis was made within 6 months of
acquiring HIV infection with characteristics of persons whose HIV diagnosis was
made more than 6 months after infection.
Authors of the study included Garald Goza, MS, Manager, HIV/STD & Bloodborne
Infections Surveillance Section, Michigan Department of Community, Health.
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