Purpose Of The Database And Study Design: The objective of SHAS is to obtain additional descriptive information on persons newly reported to State/local health departments with HIV infection and AIDS. This information supplements data that are routinely collected by the HARS. The information obtained from this project is useful in improving understanding of a variety of epidemiologic and policy issues (e.g., minority issues related to the HIV epidemic); how to best target educational efforts and interventions (e.g., condom distribution) to prevent HIV transmission, and how to improve health care for HIV positive persons (e.g., assessing access to and utilization of health care). SHAS sites include Arizona, Colorado, Connecticut, Delaware, Florida, Georgia, Los Angeles County, Maryland (new in 2000), Michigan, Minnesota (new in 2000) New Jersey, New Mexico, South Carolina, Texas (new in 2000) and Washington.
Nature Of The Data Collected: Cross-sectional interviews
Unit Of Analysis: Newly reported adults with HIV or AIDS
Data Collection Methods: Persons at least 18 years of age and reported as having HIV or AIDS to collaborating health departments are eligible for inclusion in the study. The study protocol and questionnaire are routinely reviewed by the CDC Institutional Review Board (IRB) and State/local IRBs. Depending on the caseload in each participating jurisdiction, data are collected for patients at selected facilities, in specific metropolitan areas or counties, or statewide. Sampling is necessary in some jurisdictions. When feasible, personal physicians are consulted before a patient is contacted. Patients whose medical and/or psychiatric status is unstable are excluded from the study. Family members or other proxies for deceased patients are not contacted. Verbal or written consent is sought before interviews are conducted. A standardized interview form is administered by trained interviewers either during a routine medical visit or by interview at home or other mutually acceptable location; rarely, interviews may be conducted by telephone. As part of the interview process, patients are counseled about practices to avoid HIV transmission and are referred, as needed, to appropriate medical care, substance abuse treatment, or social service agencies. Because the database is an extension of routine surveillance, the representativeness of the interviewed sample compared to all cases reported in the jurisdiction conducting the study can be assessed. Data are routinely analyzed at the State/local level for HIV prevention community planning and publication. Data are also transmitted to CDC after identifiers have been removed. At the national level, data are analyzed for program purposes and scientific publications.
General Attributes: Data collection was begun in 1990 and is ongoing. To date, more than 22,000 SHAS interviews have been completed.
Major Data Constructs And Key Data Elements: Demographic and socioeconomic characteristics, drug use history (both injected and non-injected), sexual behavior history (including sexually transmitted diseases), access to and utilization of health care services, reasons and location for HIV testing; reproductive history of HIV positive women, disabilities, migration patterns, antiretroviral therapy and therapies to prevent AIDS opportunistic infections (OIs), and adherence to therapies. These data supplement the information gathered by routine case investigations and reported to the HARS.
Strengths And Weaknesses Of The Study Design And Database: SHAS gathers useful data that supplements the information routinely collected through HARS. The study establishes infrastructure at the State/local level to collect these data on a routine basis for local use, as well as at the national level. The sampling methods used to identify subjects may not derive a generalizable sample of newly reported cases within a jurisdiction or across the US. However, representativeness of the sample can be assessed because of the direct link to surveillance data. Therefore, the generalizability can be improved by adjusting the sample interviewed in each participating site. The large number of cases interviewed and the multi-site aspect of the study also contribute to its generalizability.
Gaps In The Data Collected And Factors Leading To The Gaps: None identified
Feasibility Of Linking With Other Databases: SHAS data are routinely linked to HIV/AIDS surveillance data. The data may also be linked at the local level to other databases (e.g., the Adult/Adolescent Spectrum of Diseases study). However, this may require additional informed consent procedures.
Process To Access The Database And Contact Person: For more information contact: Chief, Surveillance Branch, Division of HIV/AIDS Prevention, Surveillance, and Epidemiology, CDC, Mailstop E-47, 1600 Clifton Road, NE, Atlanta GA 30333; (404) 639-2050.
Denning P, Nakashima AK Wortley P, the SHAS Project Group. High risk sexual behaviors among HIV positive adolescents and young adults. Conference on Retroviruses and Opportunistic Infections. 1999.
Campsmith ML, Nakashima AK, Jones JL, Ward JW, the SHAS Project Group. Crack use after HIV diagnosis and impact on condom use.American Public Health Association. 1999.
Sullivan PS, Nakashima AK, Purcell D. Geographic differences in non-injection and injection substance use among HIV-seropositive men who have sex with men (MSM): western United States versus other regions. Journal of AIDS and Human Retrovirology. 19: 266-273, 1998.
Wohl AR, Lu S, Odem S. Sorvillo F, Pegues CF, Kerndt PR. Sociodemographic and behavioral characteristics of African-American women with HIV and AIDS in Los Angeles, 1990-1997. Journal of AIDS and Human Retrovirology. 19(4): 413-420, 1998.
CDC. Risks for HIV infection among persons residing in rural areas and small cities, 1995-1996. MMWR. 47: 974-978, 1998.
Davidson AJ, Bertram SL, Lezotte DC, Marine WN, Rietmeijer CA, Haggland BB, Cohn DL. Comparison of health status, socioeconomic characteristics, and knowledge and use of HIV-related resources between HIV positive men and women. Medical Care. 36: 1676-1684, 1998.
Nakashima AK, Jones JL, Burgess DA, Ward JW, the SHAS Project Group. Predictors of not currently receiving protease inhibitors.International Conference on AIDS. 1998.
Nakashima AK, Jones JL, Burgess DA, Ward JW, the SHAS Project Group. Adherence to currently prescribed antiretroviral therapies: results from a multi-site interview project. American Public Health Association. 1998.
Boyd DK, Brown C. Demographics and needle-sharing of injecting drug users in Arizona. International Conference on AIDS. 11(1): 127 (Abstract No. Mo.C.1418), 1996.
Diaz T, Chu SY, Conti L, Nahlen BL. Health insurance coverage among persons with AIDS: results from a multistate surveillance project.AJPH. 84(6): 1015-1018, 1994.
Fann SA, Conti L, Smith, D, et al. Risks for HIV infection among persons residing in rural areas and small cities- selected sites, Southern United States, 1995-1996. MMWR. 47(45): 974-978, 1998.
Chu SY, Diaz T, Schable B. Risk behaviors among women with HIV/AIDS who report sex with women. International Conference on AIDS. 10(1): 311 (Abstract No. PC0173), 1994.
Diaz T, Chu S. Bisexual men with AIDS: supplement to HIV/AIDS surveillance. International Conference on AIDS. 10(1): 699 (Abstract No. PO-C13-2890), 1993.