Differences among U.S. states in estimating the number of people living with HIV/AIDS: impact on allocation of federal Ryan White funding.
OBJECTIVE
We assessed the impact of differing laboratory reporting scenarios on the completeness of estimates of people living with human immunodeficiency 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/microL and detectable viral load (Scenario A); CD4 < 500 cells/microL and no viral load reporting (Scenario B); and CD4 < 500 cells/microL 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.
Nash
Denis
D
Center for Urban Epidemiologic Studies, The New York Academy of Medicine, New York, NY, USA. dn2145@columbia.edu
Andreopoulos
Evie
E
Horowitz
Deborah
D
Sohler
Nancy
N
Vlahov
David
D
D000328:Adult; D005260:Female; D005380:Financing, Government; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology*; D006801:Humans; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D013219:State Government; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology