Washington state adopts unique identifiers for reporting, tracking of HIV infec
September 1, 1999 4 minutes read
Washington state adopts unique identifiers for reporting, tracking of HIV infection
Rules for HIV reporting that both activists and public health officials at least can live with go into effect in Washington state Sept. 1. Washington’s plan for using both names and coded identifiers to track HIV-positive individuals is modeled after one developed during the past year in Seattle’s King County, home to about two-thirds of the state’s AIDS cases.
"Everything that I think was insurmountable, we have surmounted," says Jack Jourdan, director of infectious disease and reproductive health within the state’s Department of Health. "Does it get everything I think public health ought to have? No. Does it get the things I think we need to have? Yes."
Under the rules, laboratories will send test results to the state Department of Health, where the results will be sorted and distributed to the appropriate county health departments. Identifying information on asymptomatic HIV-positive individuals must be destroyed after 90 days.
The new rules leave in place Washington’s anonymous HIV-testing services and in fact increase the requirements for public health officials to notify clients about its availability. (See details of new rules, p. 4.)
Public health officials will continue to pursue rule revisions that give public health a more "proactive" role in notifying contacts of HIV-positive individuals, says Mr. Jourdan, who took a lead role in developing the unique identifier system while holding a similar position in King County. Current mechanisms shift too much responsibility for that task to HIV-positive individuals or their health care providers, he says.
AIDS activists are concerned about expanding the role of public health in contact tracing, but acknowledge the current system is unlikely to remain in place.
"We’d be happy with that, but it’s not going to happen," says Karl Swenson, policy research analyst for the Northwest AIDS Foundation in Seattle.
The 90-day limit for retaining the names of HIV-positive asymptomatic individuals makes it difficult to describe the longevity of persons with HIV infection or to trace HIV-positive individuals across state lines, says Mr. Jourdan. To address the latter problem, state officials are discussing with local governments and other states how to forward the names of persons who move before the 90-day window expires, he says.
Officials in at least one Washington county believe the new state rules give them the latitude to maintain the names of HIV-positive individuals for an indefinite period of time. Under name-based HIV reporting guidelines adopted by Tacoma’s Pierce County in January, public health officials use clients’ names for ongoing "risk reduction case management" targeted to persons believed to need services or to be at risk of spreading the infection. Retaining the names for such use is allowed under the new rules, explains Dian Sharma, manager of communicable disease for the Tacoma-Pierce County Health Department.
Protracted contact’ our job
The initiative maintains and builds upon an existing partnership under which the local AIDS network provides psychosocial services and the health department assumes responsibilities for contact tracing, Ms. Sharma says.
"The difference is that we’re going to make a concerted effort now to have protracted contact with clients who have indicated to us that they are not going to reduce their risky behavior. That is really our job," she explains.
While several states are considering the use of unique identifiers, Maryland is apparently the only other state using a coding system to track HIV. Texas public health officials on Jan. 1 returned to name-based HIV reporting after four years of using a unique identifier system.
"The data were not complete enough; they weren’t reliable," says Sharon Melville, MD, director of HIV/STD epidemiology within the Texas Department of Health. For example, public health officials expected all new AIDS diagnoses also to show up in the HIV tracking system, but found in the first year only 26% of AIDS patients also had a unique HIV identifier.
"It improved over time, but even after three years it still was not at an acceptable level," Ms. Melville says.
The use of anonymous HIV testing in Texas since eliminating unique identifiers has remained within the typical 15% to 20% of all tests, says Ms. Melville, alleviating fears that the use of name-based reporting would deter people from getting tested.
Texas is still investigating changes in the system, including the possibility of destroying the names of HIV-positive individuals at the state level. At the same time, local health departments must be able to retain the names of HIV-positive individuals in order to carry out surveillance and contact tracing, Ms. Melville says.
Contact Mr. Swenson at (206) 860-6247, Mr. Jourdan (360) 236-3466, Ms. Sharma at (253) 798-6500, and Ms. Melville at (512) 490-2545.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content