Differences among U.S. states in estimating the number of people living with HIV/AIDS: Impact on allocation of federal Ryan White funding

Denis Nash, Evie Andreopoulos, Deborah Horowitz, Nancy Sohler, David Vlahov

    Research output: Contribution to journalArticlepeer-review

    Abstract

    Objective. We assessed the impact of differing laboratory reporting scenarios on the completeness of estimates of people living with human immunodefi-ciency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (PLWHA) in the U.S., which are used to guide allocation of federal Ryan White funds. Methods. We conducted a four-year simulation study using clinical and laboratory data on 1,337 HIV-positive women, including 477 (36%) who did not have AIDS at baseline. We estimated the completeness of HIV (non-AIDS) case ascertainment for three laboratory reporting scenarios: CD4<200 cells/μL and detectable viral load (Scenario A); CD4<500 cells/μL and no viral load reporting (Scenario B); and CD4<500 cells/μL and detectable viral load (Scenario C). Results. Each scenario resulted in an increasing proportion of HIV (non-AIDS) cases being ascertained over time, with Scenario C yielding the highest by Year 4 (Year 1: 69.0%, Year 4: 88.1%), followed by Scenario A (Year 1: 63.3%, Year 4: 84.5%), and Scenario B (Year 1: 43.0%, Year 4: 67.7%). Overall completeness of PLWHA ascertainment after four years was highest for Scenario C (95.8%), followed by Scenario A (94.5%), and Scenario B (88.5%). Conclusions. Differences in laboratory reporting regulations lead to substantial variations in the completeness of PLWHA estimates, and may penalize jurisdictions that are most successful at treating HIV/AIDS patients or those with weak or incomplete HIV/AIDS surveillance systems.

    Original languageEnglish (US)
    Pages (from-to)644-656
    Number of pages13
    JournalPublic health reports
    Volume122
    Issue number5
    DOIs
    StatePublished - 2007

    ASJC Scopus subject areas

    • Public Health, Environmental and Occupational Health

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