Purpose Of The Database And Study Design: The CDC supports anonymous and confidential HIV counseling and testing services in each State, the District of Columbia, Puerto Rico, and US territories. The objectives of the HIV counseling and testing service program are to: provide a convenient opportunity for persons to learn their current HIV serostatus; allow those individuals to receive prevention counseling to help initiate behavior change to avoid infection or, if already infected, to prevent transmission to others; assist individuals to obtain referrals to receive additional prevention, health care, and other needed services; and provide prevention services and referrals for sex and needle-sharing partners of HIV positive persons. In 39 states, testing can be obtained anonymously (i.e., individuals do not have to give their names to get tested). All States provide confidential testing by name and have confidentiality laws and regulations to protect this information.
Nature Of The Data Collected: Cross-sectional interview and laboratory specimen data
Unit Of Analysis: Individual HIV tests
Data Collection Methods: HIV counseling and testing services are offered in about 11,000 sites, including dedicated HIV counseling and testing sites, sexually transmitted disease clinics, drug-treatment centers, hospitals, and prisons. Data is collected from each individual client encounter at a site. Site staff complete a survey instrument (i.e., HIV Counseling and Testing Report Form; a State-based form; or a summary record report) during or after a pre-test counseling session. Information from each individual client encounter can be determined from the HIV Counseling and Testing Report Form and most State-based forms. Information from aggregate client encounters is available from eleven States and six territories. Completed survey instruments are batched and transmitted to the State health department for processing. Electronic data are transmitted to CDC for analysis and report generation.
General Attributes: About 2.5 million forms are completed annually. Of the 9.7 million federally-funded HIV tests performed in 1995 through 1998, individual client encounter information on 8.3 million tests was available for analysis. The database is maintained in a mainframe environment at CDC.
Major Data Constructs And Key Data Elements: Site type and location, counseling date, source of referral, client demographic characteristics, risk behaviors, reason for visit, type of testing (anonymous or confidential), reasons if the test was not conducted, test results, and outcome of counseling.
Strengths And Weaknesses Of The Study Design And Database: The data collected include information from all HIV counseling and testing service client encounters, including information from clients with positive or negative HIV serostatus, in 65 reporting areas, including each State, the District of Columbia, Puerto Rico, and US territories. The data collection methods vary by reporting area. It is unclear what impact this variability has on the data recorded in the HIV Counseling and Testing System. Data submitted to the HIV Counseling and Testing System represents HIV tests and not unique counts of individuals. As a result, the number of persons returning for testing over time cannot be computed. These data represent HIV counseling and testing services conducted at federally funded counseling and testing sites. Some unknown number of HIV tests are also conducted by health care providers and funded by health insurance, out-of-pocket payments, and other mechanisms. Home test kits are also available. Therefore, the number of total HIV tests conducted in the US and their results are not available.
Gaps In The Data Collected And Factors Leading To The Gaps: Individual encounter data are not available from eleven States and six territories. These areas report data on the total number of tests in a summary record format, not on each individual client encounter.
Feasibility Of Linking With Other Databases: It is unclear how feasible it is to link data from confidential test sites to other databases. Data from confidential test sites have been linked with the HIV/AIDS Reporting System (HARS) database. In anonymous test sites, the test subject does not provide unique identifiers. Therefore, linkage to other databases is not feasible. Public use data tapes can be made available upon request.
Process To Access The Database And Contact Person: For more information contact: Chief, Prevention Services Research Branch, Division of HIV/AIDS Prevention, Surveillance, and Epidemiology, CDC, Mailstop E-46, 1600 Clifton Road, NE, Atlanta GA 30333: (404) 639-2080.
HIV counseling and testing in publicly funded sites: 1997-1998 summary report. DHHS. Atlanta: CDC, (in preparation).
Nakashima AK, Horsley R, Frey RL, Sweeney PA, Weber JT, Fleming PL. Effect of HIV reporting by name on use of HIV testing in publicly funded counseling and testing programs. JAMA. 280(16): 1421-1426, 1998.
HIV counseling and testing in publicly funded sites: 1996 summary report. DHHS. Atlanta: CDC, May 1998.
Valdiserri RO, Weber JT, Frey RL. Trends in HIV seropositivity among clients attending publicly funded HIV counseling and testing sites across the USA:1990-1994. American Journal of Prevention. 14(1): 31-42, 1998.
HIV counseling and testing in publicly funded sites: 1995 summary report. DHHS. Atlanta: CDC, September 1997.
Weber JT, Frey RL, Horsley R, Gwinn ML. Publicly funded HIV counseling and testing in the United States, 1992-1995. AIDS Education and Prevention. 9, Supplement B, 79-91, 1996.
HIV counseling and testing in publicly funded sites: 1993-1994 summary report. DHHS. Atlanta: CDC, March 1996.
Valdiserri RO, Gerber AR, Dillon BA, Campbell CH. Clients without health insurance and publicly funded HIV counseling and testing sites: implication for early intervention. Public Health Reports. 110(1): 47-52, 1995.
HIV counseling, testing, and referral: standards and guidelines. DHHS. Atlanta: CDC, 1994.
CDC. Differences between anonymous and confidential registrants for HIV testing- Seattle, 1986-1993. MMWR. 42(3): 53-56, 1993.
Holtgrave DR, Valdiserri RO, Gerber AR, Hinman AR. Human immunodeficiency virus counseling, testing, referral, and partner notification services: a cost-benefit analysis. Archives of Internal Medicine. 153(10): 1225-1230, 1993.
Valdiserri RO, Jones TS, West GR, Campbell CH, Thompson PI. Where injecting drug users receive HIV counseling and testing. Public Health Reports. 108(3): 294-298, 1993.
Valdiserri RO, Moore M, Gerber AR, Campbell CH, Dillon BA, West GR. A study of clients returning for counseling after HIV testing: implications for improving rates of return. Public Health Reports. 108(1): 12-18, 1993.
CDC. Testing for HIV in the public and private sectors- Oregon, 1998-1991. MMWR. 41(32): 581-584, 1992.
CDC. Publicly funded HIV counseling and testing- US, 1991. MMWR. 41(34): 613-617, 1992.