# 13 {#section .Chapter-# .unnumbered}

# HIV

13-1 New AIDS cases

13-2 AIDS among men who have sex with men

13-3 AIDS among persons who inject drugs

13-4 AIDS among men who have sex with men and who inject drugs

13-5 New HIV cases

13-6 Condom use

13-6a Females aged 18 to 44 years

13-6b Males aged 18 to 49 years

13-7 Knowledge of serostatus

13-8 HIV/AIDS counseling and education for persons in substance abuse
treatment

13-9 HIV/AIDS, STD, and TB education in State prisons

13-10 HIV counseling and testing in State prisons

13-11 HIV testing in TB patients

13-12 Screening for STDs and immunization for hepatitis B

13-13 Treatment according to guidelines

Testing

13-13a Viral load testing

13-13b Tuberculin skin testing

Treatment

13-13c Any antiretroviral therapy

13-13d Highly active antiretroviral therapy

Prophylaxis

13-13e *Pneumocystis carinii* pneumonia prophylaxis

13-13f *Mycobacterium avium* complex prophylaxis

13-14 HIV-infection deaths

13-15 Interval between HIV infection and AIDS diagnosis

13-16 Interval between AIDS diagnosis and death from AIDS

13-17 Perinatally acquired HIV infection

  ---------------------- ------------------------------------------------
  13-1. Reduce AIDS      
  among adolescents and  
  adults.                

  **National Data        HIV/AIDS Surveillance System, CDC, NCHSTP.
  Source**               

  **State Data Source**  State HIV/AIDS Surveillance Programs.

  **Healthy People 2000  18.2 (HIV infection).
  Objective**            

  **Measure**            Rate per 100,000 population.

  **Baseline**           19.5 (1998).

  **Numerator**          Number of reported AIDS cases among adolescents
                         and adults aged 13 years and older.

  **Denominator**        Number of adolescents and adults aged 13 years
                         and older.

  **Population           U.S. resident population.
  Targeted**             

  **Questions Used To    CDC Adult HIV/AIDS Confidential Case Report,
  Obtain the National    Form 50.42A, Rev. 7/93.
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           The AIDS case definition used by the HIV/AIDS
                         Surveillance system for an AIDS case is provided
                         by the CDC.**^1,\ 2,\ 3,\ 4,\ 5,\ 6,\ 7^** Data
                         are adjusted for reporting delay.**^1^**

                         See Part C for a description of the HIV/AIDS
                         Surveillance System and Appendix A for focus
                         area contact information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  13-2. Reduce the       
  number of new AIDS     
  cases among adolescent 
  and adult men who have 
  sex with men.          

  **National Data        HIV/AIDS Surveillance System, CDC, NCHSTP.
  Source**               

  **State Data Source**  State HIV/AIDS Surveillance Programs.

  **Healthy People 2000  18.2a (HIV infection).
  Objective**            

  **Measure**            Number of cases.

  **Baseline**           17,847 (1998).

  **Numerator**          Number of AIDS cases among males 13 years and
                         older who report having sex with males after
                         1977 and preceding the first positive HIV
                         antibody test or AIDS diagnosis.

  **Denominator**        Not applicable.

  **Population           U.S. resident population.
  Targeted**             

  **Questions Used To    CDC Adult HIV/AIDS Confidential Case Report,
  Obtain the National    Form 50.42A, Rev. 7/93.
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           The AIDS case definition used by the HIV/AIDS
                         Surveillance System for an AIDS case is provided
                         by the CDC.**^1,\ 2,\ 3,\ 4,\ 5,\ 6,\ 7^** Data
                         are adjusted for reporting delay.**^1^**

                         Case counts by date of diagnosis by exposure
                         category have not been redistributed to adjust
                         for cases with risk not reported or identified.

                         See Part C for a description of the HIV/AIDS
                         Surveillance System and Appendix A for focus
                         area contact information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  13-3. Reduce the       
  number of new AIDS     
  cases among females    
  and males who inject   
  drugs.                 

  **National Data        HIV/AIDS Surveillance System, CDC, NCHSTP.
  Source**               

  **State Data Source**  State HIV/AIDS Surveillance Programs.

  **Healthy People 2000  18.2b (HIV infection).
  Objective**            

  **Measure**            Number of cases.

  **Baseline**           12,099 (1998).

  **Numerator**          Number of AIDS cases among persons aged 13 years
                         and older who inject drugs.

  **Denominator**        Not applicable.

  **Population           U.S. resident population.
  Targeted**             

  **Questions Used To    CDC Adult HIV/AIDS Confidential Case Report,
  Obtain the National    Form 50.42A, Rev. 7/93.
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           See Comments provided in objective 13-2 for more
                         information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  13-4. Reduce the       
  number of new AIDS     
  cases among adolescent 
  and adult men who have 
  sex with men and       
  inject drugs.          

  **National Data        HIV/AIDS Surveillance System, CDC, NCHSTP.
  Source**               

  **State Data Source**  State HIV/AIDS Surveillance Programs.

  **Healthy People 2000  Adapted from 18.2 (HIV Infection).
  Objective**            

  **Measure**            Number of cases.

  **Baseline**           2,122 (1998).

  **Numerator**          Number of AIDS cases among males aged 13 years
                         and older who inject drugs and report having sex
                         with males after 1977, preceding the first HIV
                         antibody test or AIDS diagnosis.

  **Denominator**        Not applicable.

  **Population           U.S. resident population.
  Targeted**             

  **Questions Used To    CDC Adult HIV/AIDS Confidential Case Report,
  Obtain the National    Form 50.42A, Rev. 7/93.
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           The AIDS case definition used by the HIV/AIDS
                         Surveillance system for an AIDS case is provided
                         by the CDC.**^1,\ 2,\ 3,\ 4,\ 5,\ 6,\ 7^** Data
                         are adjusted for reporting delay.**^1^**

                         Case counts by date of diagnosis by exposure
                         category have not been redistributed to adjust
                         for cases with risk not reported or identified.

                         This measure is a modification of Healthy People
                         2000 objective 18.2, which tracked HIV
                         prevalence among men who have sex with men and
                         injecting drug users separately. This measure
                         tracks HIV prevalence among men who have sex
                         with men and inject drugs.

                         See Part C for a description of the HIV/AIDS
                         Surveillance System and Appendix A for focus
                         area contact information.
  ---------------------- ------------------------------------------------

  

+---------------------+------------------------------------------------+
| 13-5.               |                                                |
| (Developmental)     |                                                |
| Reduce the number   |                                                |
| of cases of HIV     |                                                |
| infection among     |                                                |
| adolescents and     |                                                |
| adults.             |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | An operational definition could not be         |
|                     | specified at the time of publication.          |
+---------------------+------------------------------------------------+
|                     | The proposed national data source is the       |
|                     | HIV/AIDS Surveillance System, CDC, NCHSTP.     |
+---------------------+------------------------------------------------+
|                     | As of November 1, 1999, a total of 34 States   |
|                     | and the U.S. Virgin Islands participate in HIV |
|                     | case surveillance with CDC. Combined, these    |
|                     | areas represent approximately 42 percent of    |
|                     | AIDS cases reported. It is expected that       |
|                     | additional States will move to HIV case        |
|                     | surveillance and release the data to CDC.      |
+---------------------+------------------------------------------------+
|                     | This objective is a modification of Healthy    |
|                     | People 2000 objective 18.2, which tracked HIV  |
|                     | prevalence using estimates based on data from  |
|                     | a number of sources to derive estimates on HIV |
|                     | prevalence, including data from the National   |
|                     | Health and Nutrition Examination Survey        |
|                     | (NHANES), CDC, NCHS (for the total             |
|                     | population), anonymous surveys conducted in    |
|                     | STD clinics (for men who have sex with men),   |
|                     | seroprevalence studies (for injecting drug     |
|                     | users), and the Survey on Childbearing Women   |
|                     | (for females giving birth).**^8,\ 9^** This    |
|                     | measure will provide data based on HIV case    |
|                     | surveillance reports from the HIV/AIDS         |
|                     | Surveillance System.                           |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of the HIV/AIDS   |
|                     | Surveillance System and Appendix A for focus   |
|                     | area contact information.                      |
+---------------------+------------------------------------------------+
| 13-6. Increase the  |                                                |
| proportion of       |                                                |
| sexually active     |                                                |
| persons who use     |                                                |
| condoms.            |                                                |
+---------------------+------------------------------------------------+
| 13-6a. Females aged |                                                |
| 18 to 44 years.     |                                                |
+---------------------+------------------------------------------------+
| **National Data     | National Survey of Family Growth (NSFG), CDC,  |
| Source**            | NCHS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 19.10 (Sexually Transmitted       |
| 2000 Objective**    | Diseases) (also 18.4).                         |
+---------------------+------------------------------------------------+
| **Leading Health    | Responsible Sexual Behavior.                   |
| Indicator**         |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 23 (1995).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of sexually active, unmarried females   |
|                     | aged 18 to 44 years who reported using a       |
|                     | condom at last sexual intercourse.             |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of sexually active, unmarried females   |
|                     | aged 18 to 44 years.                           |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1995 National Survey of Family        |
| Obtain the National | Growth:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   What is your current marital status? Are   |
|                     |     you...                                     |
|                     |                                                |
|                     |     1\) Married\                               |
|                     |     2) Widowed\                                |
|                     |     3) Divorced\                               |
|                     |     4) Separated, because you and your husband |
|                     |     are not getting along\                     |
|                     |     5) Have you never been married?            |
+---------------------+------------------------------------------------+
|                     | -   The last time you had intercourse, did you |
|                     |     or your partner use any method?            |
+---------------------+------------------------------------------------+
|                     | \[If yes:\]                                    |
|                     |                                                |
|                     | -   Which methods?                             |
|                     |                                                |
|                     |     1\) Birth control pills\                   |
|                     |     2) Condom\                                 |
|                     |     3) Partner's vasectomy\                    |
|                     |     4) Diaphragm\                              |
|                     |     5) Foam\                                   |
|                     |     6) Jelly or cream\                         |
|                     |     7) Cervical cap\                           |
|                     |     8) Suppository, insert\                    |
|                     |     9) Today sponge\                           |
|                     |     10) Female condom, vaginal pouch\          |
|                     |     11) IUD, Coil, Loop\                       |
|                     |     12) Norplant\                              |
|                     |     13) Depo-provera, Injectables\             |
|                     |     14) Morning after pill\                    |
|                     |     15) Rhythm or safe period by calendar\     |
|                     |     16) Safe period by temperature, or         |
|                     |     cervical mucus test, natural family        |
|                     |     planning\                                  |
|                     |     17) Withdrawal, pulling out\               |
|                     |     18) Respondent sterile\                    |
|                     |     19) Partner sterile\                       |
|                     |     20) Other method (specify)                 |
+---------------------+------------------------------------------------+
| **Expected          | Periodic.                                      |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Unmarried females are considered to have used  |
|                     | a condom at last intercourse if they reported  |
|                     | they had never been married, were sexually     |
|                     | active, and either used a female condom        |
|                     | (vaginal pouch) or partner used a condom       |
|                     | (rubber) at their last intercourse.            |
+---------------------+------------------------------------------------+
|                     | Sexually active refers to females who have had |
|                     | intercourse in the 3 months prior to           |
|                     | interview.                                     |
+---------------------+------------------------------------------------+
|                     | This objective is adapted from a measure in    |
|                     | Healthy People 2000 objective 19.10, which     |
|                     | tracked the proportion of sexually active,     |
|                     | unmarried people aged 15 to 44 years who       |
|                     | report their partner used a condom at last     |
|                     | intercourse. This measure tracks the           |
|                     | proportion of females aged 18 to 44 years who  |
|                     | used a condom (male or female) at last         |
|                     | intercourse.                                   |
+---------------------+------------------------------------------------+
|                     | This objective is one of the measures used to  |
|                     | track the Responsible Sexual Behavior Leading  |
|                     | Health Indicator. See Appendix H for a         |
|                     | complete list.                                 |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NSFG and       |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+
|                     |                                                |
+---------------------+------------------------------------------------+
| 13-6b.              |                                                |
| (Developmental)     |                                                |
| Males aged 18 to 49 |                                                |
| years.              |                                                |
+---------------------+------------------------------------------------+
| ##                  | An operational definition could not be         |
| #### Comments {#com | specified at the time of publication.          |
| ments .Heading6THP} |                                                |
+---------------------+------------------------------------------------+
|                     | The proposed national data source is the       |
|                     | National Survey of Family Growth (NSFG), CDC,  |
|                     | NCHS.                                          |
+---------------------+------------------------------------------------+
|                     | The current NSFG does not collect data on      |
|                     | males. Starting in 2001, data for males aged   |
|                     | 18 to 49 years will be collected and can track |
|                     | this objective.                                |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NSFG and       |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

  

  ---------------------- ------------------------------------------------
  13-7. (Developmental)  
  Increase the number of 
  HIV-positive persons   
  who know their         
  serostatus.            

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         The proposed national data source is the
                         HIV/AIDS Surveillance System, CDC, NCHSTP.

                         This measure is a modification of Healthy People
                         2000 objective 18.8, which tracked the percent
                         of positive HIV tests for which people returned
                         for counseling. This measure will track the
                         number of HIV positive persons who know their
                         serostatus.

                         See Part C for a description of the HIV/AIDS
                         Surveillance System and Appendix A for focus
                         area contact information.
  ---------------------- ------------------------------------------------

  

+---------------------+------------------------------------------------+
| 13-8. Increase the  |                                                |
| proportion of       |                                                |
| substance abuse     |                                                |
| treatment           |                                                |
| facilities that     |                                                |
| offer HIV/AIDS      |                                                |
| education,          |                                                |
| counseling, and     |                                                |
| support.            |                                                |
+---------------------+------------------------------------------------+
| **National Data     | Uniform Facility Data Set (UFDS), SAMHSA.      |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **State Data        | Uniform Facility Data Set (UFDS), SAMHSA.      |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 18.5 (HIV Infection).             |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 58 (1997).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of publicly and privately funded        |
|                     | treatment facilities known to SAMHSA that      |
|                     | report that they offer HIV testing; HIV/AIDS   |
|                     | education, counseling, and support; or have    |
|                     | special substance abuse treatment programs for |
|                     | persons with HIV/AIDS.                         |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of publicly and privately funded        |
|                     | treatment facilities known to SAMHSA.          |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1997 Uniform Facility Data Set:       |
| Obtain the National |                                                |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   As of October 1, 1997, which of these      |
|                     |     services were being provided at this       |
|                     |     substance abuse facility?                  |
|                     |                                                |
|                     |     \[List of options provided in three        |
|                     |     categories. Relevant responses for         |
|                     |     objective are listed below:\]              |
|                     |                                                |
|                     |     A\) Testing \[option 24: HIV/AIDS\]\       |
|                     |     B) Health Services \[option:               |
|                     |     education/counseling/support\]\            |
|                     |     C) Programs for special groups \[option    |
|                     |     32: persons with AIDS\]                    |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | A treatment facility is considered to offer    |
|                     | HIV/STD education, counseling, and support if  |
|                     | the facility reports it provides               |
|                     | [either]{.underline} HIV/AIDS testing,         |
|                     | education/counseling/support health services,  |
|                     | or programs for persons with AIDS.             |
+---------------------+------------------------------------------------+
|                     | Data collection years 1998, 2000, and          |
|                     | subsequent years will include questions that   |
|                     | ask about HIV testing; HIV/AIDS education,     |
|                     | counseling, and support; or special substance  |
|                     | abuse treatment programs for persons with      |
|                     | HIV/AIDS. The 1999 UFDS only included          |
|                     | questions on special programs for persons with |
|                     | HIV.                                           |
+---------------------+------------------------------------------------+
|                     | This objective is a modification of Healthy    |
|                     | People 2000 objective 18.5, which tracked the  |
|                     | proportion of injecting drug users enrolled in |
|                     | substance abuse treatment programs. This       |
|                     | measure tracks the number of substance abuse   |
|                     | treatment facilities that report offering HIV  |
|                     | testing; HIV/AIDS education, counseling, and   |
|                     | support; or have special substance abuse       |
|                     | treatment programs for persons with HIV/AIDS.  |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

  

  ---------------------- ------------------------------------------------
  13-9. (Developmental)  
  Increase the number of 
  State prison systems   
  that provide           
  comprehensive          
  HIV/AIDS, sexually     
  transmitted diseases,  
  and tuberculosis (TB)  
  education.             

  **Comments**           An operational definition could not be specified
                         at time of publication.

                         The proposed national data source is the
                         Biennial Survey of HIV, STD, and TB Prevention
                         in Correctional Facilities, CDC, and NIJ.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  13-10. (Developmental) 
  Increase the           
  proportion of inmates  
  in State prison        
  systems who receive    
  voluntary HIV          
  counseling and testing 
  during incarceration.  

  **Comments**           See Comments provided with objective 13-9 for
                         more information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  13-11. Increase the    
  proportion of adults   
  with tuberculosis (TB) 
  who have been tested   
  for HIV.               

  **National Data        National TB Surveillance System, CDC, NCHSTP.
  Source**               

  **State Data Source**  State TB Surveillance Systems.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Percent.

  **Baseline**           55 (1998).

  **Numerator**          Number of reported TB cases among adults aged 25
                         to 44 years with a negative, positive or
                         indeterminate HIV test result.

  **Denominator**        Number of reported TB cases (based on TB case
                         report forms) among adults aged 25 to 44 years.

  **Population           U.S. resident population.
  Targeted**             

  **Questions Used To    CDC Report of Verified Case of Tuberculosis,
  Obtain the National    Form 72.9A, Rev. 5/93.
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           Numerator includes only those cases with
                         negative, positive, and indeterminate HIV test
                         results.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  13-12. (Developmental) 
  Increase the           
  proportion of adults   
  in publicly funded HIV 
  counseling and testing 
  sites who are screened 
  for common bacterial   
  sexually transmitted   
  diseases (STDs)        
  (chlamydia, gonorrhea, 
  and syphilis) and are  
  immunized against      
  hepatitis B virus.     

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         A proposed national and State data source is the
                         HIV Counseling and Testing System (CTS), CDC,
                         NCHSTP.

                         For STD screening, the proposed numerator is the
                         number of HIV tests among persons aged 18 years
                         and older visiting an STD, family planning, or
                         prenatal/obstetric HIV counseling and testing
                         site who also receive screening for common
                         bacterial STDs.

                         For hepatitis B immunization, the proposed
                         numerator is the number of HIV tests among
                         persons aged 18 years and older visiting an STD,
                         family planning, or prenatal/obstetric HIV
                         counseling and testing site who receive a
                         hepatitis B vaccination, according to Advisory
                         Committee on Immunization Practices (ACIP)
                         recommendations.

                         Screening for common bacterial STDs and
                         immunizations against hepatitis B is not
                         feasible in all publicly funded CTS sites, which
                         may include sites without a primary care
                         provider on the premises. HIV counseling and
                         testing sites providing STD, family planning, or
                         prenatal/obstetric care will be able to offer
                         appropriate services to populations at risk.

                         CTS data are from publicly funded HIV counseling
                         and testing sites provided in a variety of
                         settings, including freestanding HIV counseling
                         and testing sites (which offer anonymous tests,
                         confidential tests, or both), STD clinics,
                         family planning clinics, prenatal clinics, drug
                         treatment centers, and correctional facilities
                         (including long-term and short-term detention
                         facilities).

                         Data are collected and analyzed at the level of
                         an individual test encounter, without the
                         identity of the client. A single client can have
                         multiple tests recorded during 1 year. Sites
                         that only report test encounters in summary
                         records and not individual test encounters will
                         not be included in the analysis.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

13-13. Increase the proportion of HIV-infected adolescents and adults
who receive testing, treatment, and prophylaxis consistent with current
Public Health Service treatment guidelines.

###### Testing {#testing .Heading6THP}

+---------------------+------------------------------------------------+
| 13-13a.             |                                                |
| (Developmental)     |                                                |
| Viral load testing. |                                                |
+---------------------+------------------------------------------------+
| ####                | An operational definition could not be         |
| ## Comments {#comme | specified at the time of publication.          |
| nts-1 .Heading6THP} |                                                |
+---------------------+------------------------------------------------+
|                     | The proposed national data source is the Adult |
|                     | Spectrum of Disease (ASD) surveillance         |
|                     | project, CDC, NCHSTP. ASD data represent more  |
|                     | than 100 sites in 11 U.S. cities. ASD collects |
|                     | demographic, clinical, laboratory,             |
|                     | surveillance, and other related data on        |
|                     | HIV-infected persons aged 13 years and older.  |
|                     | Data currently are being analyzed to measure   |
|                     | this objective.                                |
+---------------------+------------------------------------------------+
|                     | The proposed numerator is the number who ever  |
|                     | received a viral load test in the past year.   |
|                     | The proposed denominator is the number of      |
|                     | persons who had at least one visit to a clinic |
|                     | participating in the ASD surveillance project. |
+---------------------+------------------------------------------------+
|                     | Viral load testing is defined as the methods   |
|                     | used to monitor HIV replication in a given     |
|                     | sample of body fluid (usually blood).          |
|                     | Measurements are necessary to determine risk   |
|                     | for disease progression in an HIV-infected     |
|                     | person and to determine when to initiate or    |
|                     | modify antiretroviral treatment regimens.      |
+---------------------+------------------------------------------------+
|                     | ASD data were standardized to national AIDS    |
|                     | surveillance data by age, race, sex, country   |
|                     | of birth, year of AIDS diagnosis, and HIV      |
|                     | exposure mode. Exposure modes in AIDS          |
|                     | surveillance were redistributed to adjust for  |
|                     | cases with risk that were not reported or      |
|                     | identified.                                    |
+---------------------+------------------------------------------------+
|                     | ASD collects demographic, clinical,            |
|                     | laboratory, surveillance, and other related    |
|                     | data on HIV-infected persons aged 13 years and |
|                     | older.                                         |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

  

  ---------------------- ------------------------------------------------
  13-13b.                
  (Developmental)        
  Tuberculin skin        
  testing (TST).         

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         The proposed national data source is the Adult
                         Spectrum of Disease (ASD) surveillance project,
                         CDC, NCHSTP. ASD data represent more than 100
                         sites in 11 U.S. cities. ASD collects
                         demographic, clinical, laboratory, surveillance,
                         and other related data on HIV-infected persons
                         aged 13 years and older. Data currently are
                         being analyzed to measure this objective.

                         The proposed numerator is the number of persons
                         who ever received a tuberculin skin test. The
                         proposed denominator is the number of persons
                         with no history of tuberculosis who had at least
                         one visit to a clinic participating in the ASD
                         surveillance project.

                         TST is defined as the standard method for
                         screening asymptomatic populations for infection
                         with *M. tuberculosis*.

                         ASD data were standardized to national AIDS
                         surveillance data by age, race, sex, country of
                         birth, year of AIDS diagnosis, and HIV exposure
                         mode. Exposure modes in AIDS surveillance were
                         redistributed to adjust for cases with risk that
                         were not reported or identified.

                         ASD collects demographic, clinical, laboratory,
                         surveillance, and other related data on
                         HIV-infected persons aged 13 years and older.

                         Data from ASD represent only persons with HIV
                         who are in care at participating ASD facilities.
                         Treatment interventions include viral load
                         testing, TB skin testing, highly active
                         antiretroviral therapy (HAART), Pneumocystis
                         carinii pneumonia (PCP) prophylaxis,
                         Mycobacterium avium complex (MAC) prophylaxis,
                         and pneumococcal vaccination.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

###### Treatment {#treatment .Heading6THP}

  ---------------------- ------------------------------------------------
  13-13c. Any            
  antiretroviral         
  therapy.               

  **National Data        Adult Spectrum of Disease (ASD) surveillance
  Source**               project, CDC, NCHSTP (11 U.S. cities---see
                         Comments).

  **State Data Source**  Not identified.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Percent.

  **Baseline**           80 (1997) (selected sites---Comments).

  **Numerator**          Number of persons enrolled in the ASD
                         surveillance project with at least one clinic
                         visit, had a minimum cd4 cell count of less than
                         500, and received any antiretroviral therapy,
                         all in the past year.

  **Denominator**        Number of persons enrolled in the ASD
                         surveillance project with at least one clinic
                         visit and had a minimum cd4 cell count of less
                         than 500 in the past year.

  **Population           Residents of selected sites---see Comments.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           Any antiretroviral therapy is defined as any
                         drug that inhibits the replication of HIV or
                         destroys or brings about the destruction of a
                         retrovirus.

                         ASD data were standardized to national AIDS
                         surveillance data by age, race, sex, country of
                         birth, year of AIDS diagnosis, and HIV exposure
                         mode. Exposure modes in AIDS surveillance were
                         redistributed to adjust for cases with risk that
                         were not reported or identified.

                         ASD data represent more than 100 sites in 11
                         U.S. cities. ASD collects demographic, clinical,
                         laboratory, surveillance, and other related data
                         on HIV-infected persons aged 13 years and older.

                         Data from ASD represent only persons with HIV
                         who are in care at participating ASD facilities.
                         Treatment interventions include viral load
                         testing, TB skin testing, HAART, PCP
                         prophylaxis, MAC prophylaxis, and pneumococcal
                         vaccination.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

  -----------------------------------------------------------------------
  13-13d. Highly active  
  antiretroviral therapy 
  (HAART).               
  ---------------------- ------------------------------------------------
  **National Data        Adult Spectrum of Disease (ASD) surveillance
  Source**               project, CDC, NCHSTP (11 U.S. cities---see
                         Comments).

  **State Data Source**  Not identified.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Percent.

  **Baseline**           40 (1997) (selected sites---see Comments).

  **Numerator**          Number of persons enrolled in the ASD
                         surveillance project with at least one clinic
                         visit, had a minimum cd4 cell count of less than
                         500, and received any highly active
                         antiretroviral therapy, all in the past year.

  **Denominator**        Number of persons enrolled in the ASD
                         surveillance project with at least one clinic
                         visit and had a minimum cd4 cell count of less
                         than 500 in the past year.

  **Population           Residents of selected sites---see Comments.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           HAART is defined as a treatment regimen for HIV
                         infection that consists of three drugs,
                         including two nucleoside analogue reverse
                         transcriptase inhibitors combined with either a
                         nonnucleoside reverse transcriptase inhibitor or
                         a protease inhibitor.

                         ASD data were standardized to national AIDS
                         surveillance data by age, race, sex, country of
                         birth, year of AIDS diagnosis, and HIV exposure
                         mode. Exposure modes in AIDS surveillance were
                         redistributed to adjust for cases with risk that
                         were not reported or identified.

                         ASD data represent more than 100 sites in 11
                         U.S. cities. ASD collects demographic, clinical,
                         laboratory, surveillance, and other related data
                         on HIV-infected persons aged 13 years and older.

                         Data from ASD represent only persons with HIV
                         who are in care at participating ASD facilities.
                         Treatment interventions include viral load
                         testing, TB skin testing, HAART, PCP
                         prophylaxis, MAC prophylaxis, and pneumococcal
                         vaccination.

                         See Appendix A for focus area contact
                         information.
  -----------------------------------------------------------------------

  

###### Prophylaxis {#prophylaxis .Heading6THP}

  ---------------------- ------------------------------------------------
  13-13e. Pneumocystis   
  carinii pneumonia      
  (PCP) prophylaxis.     

  **National Data        Adult Spectrum of Disease (ASD) surveillance
  Source**               project, CDC, NCHSTP (11 U.S. cities---see
                         Comments).

  **State Data Source**  Not identified.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Percent.

  **Baseline**           80 (1997) (selected sites---see Comments).

  **Numerator**          Number of persons enrolled in the ASD
                         surveillance project with at least one clinic
                         visit, had no history of PCP, had a minimum cd4
                         cell count of less than 200, and received any
                         appropriate PCP prophylaxis, all in the past
                         year.

  **Denominator**        Number of persons enrolled in the ASD
                         surveillance project with at least one clinic
                         visit, had no history of PCP, and had a minimum
                         cd4 cell count of less than 200 in the past
                         year.

  **Population           Residents of selected sites---see Comments.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           PCP prophylaxis is defined as medications
                         (trimethoprim-sulfamethoxazole, dapsone, or
                         aerosolized pentamidine) given to prevent the
                         occurrence of PCP. The case definition of PCP is
                         provided by CDC.**^4^**

                         ASD data were standardized to national AIDS
                         surveillance data for 1997 by age, race, sex,
                         country of birth, year of AIDS diagnosis, and
                         HIV exposure mode. Exposure modes in AIDS
                         surveillance were redistributed to adjust for
                         cases with risk that were not reported or
                         identified.

                         ASD data represent more than 100 sites in 11
                         U.S. cities. ASD collects demographic, clinical,
                         laboratory, surveillance, and other related data
                         on HIV-infected persons aged 13 years and older.

                         Data from ASD represent only persons with HIV
                         who are in care at participating ASD facilities.
                         Treatment interventions include viral load
                         testing, TB skin testing, HAART, PCP
                         prophylaxis, MAC prophylaxis, and pneumococcal
                         vaccination.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  13-13f. Mycobacterium  
  avium complex (MAC)    
  prophylaxis            

  **National Data        Adult Spectrum of Disease (ASD) surveillance
  Source**               project, CDC, NCHSTP (11 U.S. cities---see
                         Comments).

  **State Data Source**  Not identified.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Percent.

  **Baseline**           44 (1997) (selected sites---see Comments).

  **Numerator**          Number of persons enrolled in the ASD
                         surveillance project with at least one clinic
                         visit, had a minimum cd4 cell count of less than
                         50, had no history of MAC, and received any
                         appropriate MAC prophylaxis, all in the past
                         year.

  **Denominator**        Number of persons enrolled in the ASD
                         surveillance project with at least one clinic
                         visit, who had a minimum cd4 cell count of less
                         than 50, and no history of MAC in the past year.

  **Population           Residents of selected sites---see Comments.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           MAC prophylaxis is defined as medications
                         (rifabutin, clarithromycin, or azithromycin)
                         given to prevent the occurrence of MAC. The case
                         definition of MAC is provided by CDC.**^4^**

                         ASD data were standardized to national AIDS
                         surveillance data by age, race, sex, country of
                         birth, year of AIDS diagnosis, and HIV exposure
                         mode. Exposure modes in AIDS surveillance were
                         redistributed to adjust for cases with risk that
                         were not reported or identified.

                         ASD data represent more than 100 sites in 11
                         U.S. cities. ASD collects demographic, clinical,
                         laboratory, surveillance, and other related data
                         on HIV-infected persons aged 13 years and older.

                         Data from ASD represent only persons with HIV
                         who are in care at participating ASD facilities.
                         Treatment interventions include viral load
                         testing, TB skin testing, HAART, PCP
                         prophylaxis, MAC prophylaxis, and pneumococcal
                         vaccination.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  13-14. Reduce deaths   
  from HIV infection.    

  **National Data        National Vital Statistics System (NVSS), CDC,
  Source**               NCHS.

  **State Data Source**  State Vital Statistics.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Rate per 100,000 (age adjusted---see Comments).

  **Baseline**           4.9 (1998).

  **Numerator**          Number of deaths due to HIV infection (ICD-9
                         codes \*042-\*044).

  **Denominator**        Number of persons.

  **Population           U.S. resident population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           Data are age adjusted to the 2000 standard
                         population. Age-adjusted rates are weighted sums
                         of age-specific rates. For a discussion on age
                         adjustment, see Part A, section 5.

                         Resident death data are based on information
                         from death certificates filed in the 50 States
                         and the District of Columbia.

                         See Part C for a description of NVSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  13-15. (Developmental) 
  Extend the interval of 
  time between an        
  initial diagnosis of   
  HIV infection and AIDS 
  diagnosis in order to  
  increase years of life 
  of an individual       
  infected with HIV.     

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         The proposed national data source is the
                         HIV/AIDS Surveillance System, CDC, NCHSTP.

                         See Part C for a description of the HIV/AIDS
                         Surveillance System and Appendix A for focus
                         area contact information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  13-16. (Developmental) 
  Increase years of life 
  of an HIV-infected     
  person by extending    
  the interval of time   
  between an AIDS        
  diagnosis and death.   

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         The proposed national data source is the
                         HIV/AIDS Surveillance System, CDC, NCHSTP.

                         See Part C for a description of the HIV/AIDS
                         Surveillance System and Appendix A for focus
                         area contact information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  13-17. (Developmental) 
  Reduce new cases of    
  perinatally acquired   
  HIV infection.         

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         The proposed national data source is the
                         HIV/AIDS Surveillance System, CDC, NCHSTP.

                         See Part C for a description of the HIV/AIDS
                         Surveillance System and Appendix A for focus
                         area contact information.
  ---------------------- ------------------------------------------------

  

## References

1\. Centers for Disease Control and Prevention (CDC). *HIV/AIDS
Surveillance Report* 10(2), 1998.

2\. CDC. *Morbidity and Mortality Weekly Report* 34:373-75, 1985.

3\. CDC. *Morbidity and Mortality Weekly Report* 36 (Suppl. 15):1S-15S,
1987.

4\. CDC. *Morbidity and Mortality Weekly Report* 41(RR-17):1-19, 1992.

5\. CDC. *Morbidity and Mortality Weekly Report* 44:64-67, 1995.

6\. CDC. *Morbidity and Mortality Weekly Report* 36:225-30,35, 1987.

7\. CDC. *Morbidity and Mortality Weekly Report* 43 (RR-12):1-19, 1994.

8\. Karon, J.M. *Methods for Estimating HIV Prevalence in the United
States.* Technical Report No. D821. Atlanta, GA: CDC, National Center
for HIV, STD, and TB Prevention. 1996.

9\. Karon, J.M.; Rosenberg, P.S.; McQuillan, G.; et al. Prevalence of
HIV infection in the United States, 1984--1992. *Journal of the American
Medical Association* 274:952-5, 1996.