Prior to 2009, HIV and AIDS case information was entered into and maintained in 13 individual HIV/AIDS reporting systems (HARS) located in local and regional health departments throughout the state. In 2009, the Centers for Disease Control and Prevention (CDC) deployed the new enhanced electronic HIV/AIDS reporting system (eHARS) in Texas. This new system is a centralized document-based reporting system that enables exponentially greater capabilities for managing and monitoring HIV/AIDS surveillance data. The implementation of this new system required thorough cleaning of the 13 databases, including intensive de-duplication of the data, before the data was uploaded into the new system in May 2009.
These comprehensive cleaning efforts resulted in the removal of approximately 1,500 cases across all years of data collection, primarily due to case duplication within the state of Texas and with other states. Additionally during this cleaning process, many cases had information updated that may affect the analysis of HIV/AIDS data, such as death status. Overall, the cleaning of the HIV/AIDS surveillance data has resulted in much more accurate and complete HIV/AIDS data.
In order to best meet the needs of HIV/AIDS data users, the TB/HIV/STD Epidemiology and Surveillance Branch and HIV/STD Prevention and Care Branch changed the way HIV/AIDS data analyses are produced and reported. Starting with 2009 HIV/STD data, data reported is based on the date a case was diagnosed with HIV, not the date the case was reported with HIV. Date of report is the date in which the HIV/AIDS case was first entered into the HIV/AIDS surveillance system and date of diagnosis is the date when a case was first diagnosed by health professional. Because the report date of a case can be affected many factors, such as when a provider notifies the state of a new case or staff completion and entry of a case report form, and may be months after the date the case was first diagnosed with HIV, the TB/HIV/STD Epidemiology and Surveillance Branch and HIV/STD Prevention and Care Branch use diagnosis date in HIV/AIDS analysis to most accurately reflect the HIV epidemic in Texas. However, because diagnosed cases may not be reported to the system in a timely manner the TB/HIV/STD Epidemiology and Surveillance Branch and HIV/STD Prevention and Care Branch will not be producing any data analysis until at least 6 months after the close of a year.
In addition, while the TB/HIV/STD Epidemiology and Surveillance Branch and HIV/STD Prevention and Care Branch attempt to attain information on risk behaviors used to determine the mode of exposure, there are circumstances that prevent or delay the collection of this information. To compensate for this, risk data are imputed using cases with similar characteristics to adjust for unknown mode of exposure.
The TB/HIV/STD Epidemiology and Surveillance Branch and HIV/STD Prevention and Care Branch acknowledge the need for timely HIV/AIDS data but have to balance that need with the need for data that is complete and accurate. The year of diagnoses is used for surveillance reports, data requests and the Epidemiologic Profiles providing consistency in data reporting format for all of these data dissemination activities.