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What do you do with a patient with stable HIV but presents with a new STD? The CDC is offering suggestions to providers fro handling this and other situations.
The CDC has unveiled data showing that new HIV diagnoses have increased 5% between 1999 and 2002, and says the statistics likely reflect an increase in HIV cases and not simply increased HIV testing. The recent report offers the strongest evidence to date that the nation's prevention efforts are beginning to fail.
Q & A with Sevgi O. Aral, from the Division of STD Prevention with the CDC.
St. Paul-Ramsey Medical Center is a member of the Centers for Disease Control (CDC) Sentinel Hospital Surveillance Group. The authors have modified the surveillance group's protocol in order to calculate what percentage of the human immunodeficiency virus (HIV)-infected samples identified came from persons known by them to be HIV infected. All identifiers are still unlinked from the sample before testing for HIV. After 24 months, the HIV seroprevalence was 0.96 percent and the estimated cost of identifying a "new" seropositive at this site is $4,530 to $9,060. This range is a cost estimate; a typical laboratory charge for the HIV ELISA screen, if applied to such a testing program, would considerably increase this estimate. Modifications to the protocol design that would target patients in certain demographic groups (for example, men ages 15 to 44 years) or HIV-associated diseases might improve efficiency but could miss a significant number of HIV-infected patients. The efficiency of hospital-based HIV testing would likely decline after several years of practice. Although there are significant ethical problems with programs attempting routine hospital-based HIV testing, pilot testing may merit consideration in areas where the HIV-1 seroprevalence is greater than 1 percent.
Officials with the CDC expect to see some results from the HIV Prevention Initiative in 2004, although the data remain to be analyzed and the data from the 2003 HIV Prevention Initiative in 2003 showed it was having no impact, but officials are hopeful 2004 data will be different.
Since the mid-1990s, public health laboratories have improved tuberculosis (TB) test performance, which has contributed to the resumption of the decline in TB incidence in the United States. However, to eliminate TB in the United States, further improvements are needed in laboratory services to support TB treatment, prevention, and control. A critical step is the development of an integrated system that ensures prompt and reliable laboratory testing and flow of information among laboratorians, clinicians, and TB-control officials. Challenges to developing such a system include 1) establishing lines of communication among laboratorians, clinicians, and TB-control officials; 2) expediting reporting of laboratory results, which can avoid delayed or inappropriate treatment and missed opportunities to prevent transmission; 3) developing evidence-based recommendations for use of new laboratory technologies; 4) maintaining staff proficiency in light of declining numbers of specimens to test, workforce shortages, and loss of laboratory expertise; and 5) upgrading laboratory information systems and connecting all partners. The report of the Association of Public Health Laboratories Task Force presents a framework to improve the future of TB laboratory services and describes the role of the laboratory in TB treatment and control, Task Force processes, general principles and benchmarks, and steps for the dissemination of the Task Force recommendations. This MMWR expands on the Task Force report by describing specific actions and performance measures to guide development and implementation of an integrated system for providing TB laboratory services. CDC and the Association of Public Health Laboratories have developed these guidelines so that laboratorians, clinicians, public health officials, administrators, and funding entities can work together to ensure that health-care providers and TB-control officials have the information needed to treat TB patients, prevent TB transmission, and ultimately eliminate TB in the United States.
While post-exposure prophylaxis has been available to medical employees and first responders for years, public health officials routinely have dismissed the possibility of extending PEP to the general public, citing the inefficiency of its use. That philosophy has changed. For the first time, the CDC has provided a detailed blueprint for how clinicians might recommend nPEP among patients who might have been exposed to HIV within the previous 72 hours.
In this panel discussion, three health leaders provide information on techniques and approaches used to effectively implement the CDC's Racial and Ethnic Adult Disparities Immunization Initiative (READII) Programs. Part 1 offers an overview of READII and information on early results and program accomplishments. In Part 2, the Mississippi READII initiative is explored, with insights on how this program has served 10,000 African Americans in inner-city Jackson, Mississippi as well 23,000 elderly African Americans in 18 rural Delta counties, said to be the poorest counties in the nation. The third segment of this presentation explains challenges and successes found in San Antonio, Texas where READII efforts focused on immunizing the city's elderly Hispanics. Readers will find lessons learned and plans for future expansion to use as models when considering implementation of immunization programs in local communities.
Although the CDC has reached the year when its strategic plan for HIV prevention was supposed to be realized, little has changed since the plan was published in January 2001, experts say. For example, the HIV new infection rate has not changed at all, according to official estimates, and about the same proportion of HIV-infected individuals do not know their HIV status. Some experts claim the fault has been a lack of federal funding to back up the ambitious goals.
In this Q & A, AIDS Alert interviews Ronald Valdiserri, MD, MPH, deputy director of the National Center for HIV, STD, and TB Prevention at the CDC. Valdiserri discusses what has been achieved by the HIV Prevention Strategic Plan Through 2005, and what more needs to be accomplished.
OBJECTIVES: We investigated the within-group and between-group variation in prenatal HIV testing in a sample of low-income pregnant and recently postpartum women. METHODS: Multivariable linear regression was used to estimate proportional differences in prenatal HIV testing for the total sample and stratified by race. RESULTS: In bivariate analyses, race and site of care jointly affected the probability of being tested. Hispanic women had the highest probability of being tested in public practice settings but relative to white women, black women had a higher probability of being tested in public and private practice settings. Predictors of prenatal HIV testing differed by race. Receiving prenatal care in a community health center or hospital outpatient clinic increased the probability of testing for Hispanics. Being a recent victim of intimate partner violence was associated with less frequent testing for blacks. Positive beliefs about HIV screening, while significant for blacks and Hispanics, was the only factor associated with testing for whites. CONCLUSION: Our data suggest that racial biases may be influencing providers' approach to testing, rather than CDC's 2001 guidelines for HIV screening of pregnant women. Study findings are being used to modify social marketing campaigns and improve provider trainings regarding prenatal HIV testing.
State and federal funding already was tight, and now it has become tighter for prevention work since most funding sources are requiring HIV organizations to follow strict guidelines regarding the use of evidence-based HIV prevention interventions. So far, the CDC has a list of 12 evidence-based interventions that include training materials for sites that desire to replicate them, but this limited list does not meet all of the target population needs. So behavior scientists say the interventions often need extensive adaptation, which is both expensive and difficult.
Due to the fact that complications from infections are more frequent and serious related to intravenous therapy it is necessary to implement multidisciplinary measures which reduce their incidence. The recommendations made by the CDC help to guarantee the quality of the services which nursing professionals provides to patients when applying this procedure.
The most interesting piece of the new HIV epidemic data coming from the Centers for Disease Control and Prevention (CDC) of Atlanta, GA, is that it includes statistics from New York state for the first time, which means that it finally provides a more comprehensive national picture.
People readily associate the role of veterinarians with private veterinary practice focused on pets and farm animals, but the true dimensions and contributions of veterinary medicine are much broader and reflect expanding societal needs and contemporary challenges to animal and human health and to the environment. Veterinary medicine has responsibilities in biomedical research; ecosystem management; public health; food and agricultural systems; and care of companion animals, wildlife, exotic animals, and food animals. The expanding role of veterinarians at CDC reflects an appreciation for this variety of contributions. Veterinarians' educational background in basic biomedical and clinical sciences compare with that of physicians. However, unlike their counterparts in human medicine, veterinarians must be familiar with multiple species, and their training emphasizes comparative medicine. Veterinarians are competent in preventive medicine, population health, parasitology, zoonoses, and epidemiology, which serve them well for careers in public health. The history and tradition of the profession always have focused on protecting and improving both animal health and human health.
Since CDC's inception, an important function of the agency has been the compilation, analysis, and interpretation of statistical information to guide actions and policies to improve health. Sources of data include vital statistics records, medical records, personal interviews, telephone and mail surveys, physical examinations, and laboratory testing. Public health surveillance data have been used to characterize the magnitude and distribution of illness and injury; to track health trends; and to develop standard curves, such as growth charts. Beyond the development of appropriate program study designs and analytic methodologies, statisticians have played roles in the development of public health data-collection systems and software to analyze collected data. CDC/ATSDR employs approximately 330 mathematical and health statisticians. They work in each of the four coordinating centers, two coordinating offices, and the National Institute for Occupational Safety and Health.
Since CDC acquired its first mainframe computer in 1964, the use of information technology in public health practice has grown steadily and, during the past 2 decades, dramatically. Public health informatics (PHI) arrived on the scene during the 1990s after medical informatics (intersecting information technology, medicine, and health care) and bioinformatics (intersecting mathematics, statistics, computer science, and molecular biology). Similarly, PHI merged the disciplines of information science and computer science to public health practice, research, and learning. Using strategies and standards, practitioners employ PHI tools and training to maximize health impacts at local, state, and national levels. They develop and deploy information technology solutions that provide accurate, timely, and secure information to guide public health action.
Economics is the study of decisions--the incentives that lead to them and the consequences that result from them--as they relate to present and future production, distribution, and consumption of goods and services when resources are limited and have alternative uses. At CDC, economics is used to systematically identify, measure, value, and compare the costs and consequences of alternative prevention strategies. Costs and consequences in public health can be measured in various ways, including incidence or prevalence of disease; numbers of adverse events; utility measures, such as quality-adjusted life years; and monetary values. Because it deals with behavior, economics is not really about money at all. Money is just a convenient way to measure incentives and consequences.