Illinois’ Code-Based Reporting System is Working, Study Finds

Illinois' HIV surveillance system, which tracks HIV cases by codes instead of names, is a "model system" of HIV surveillance, and the state should work to improve both the operation of the system and the criteria by which it is evaluated, according to a new study released yesterday by the AIDS Foundation of Chicago. The Illinois Department of Public Health is employing the coding system on a trial basis, and will decide next July whether to keep it or switch to names-based reporting of HIV cases ( AFC release, 11/2). In March, IDPH released a report stating that while providers assigned a patient code to 99.1% of Illinois residents diagnosed with HIV between July 1 and Dec. 31, 1999, only 74% of the reports included data on the behavior that led to HIV infection and only 9% of the reports included all of the required information, including treatment, high-risk behavior and demographic information ( Kaiser Daily HIV/AIDS Report, 3/20). Still, the AFC noted that the 74% rate of collecting the risk information of all reported cases is "markedly higher than the national average of 59%" and is "most impressive" considering Illinois is using a code-based reporting system (AFC release, 11/2). The study, titled " Promising Results: HIV Tracking By Unique Identifier in Illinois," reports that several areas of the system and the health department's method of evaluating the system could be improved. The following are flaws in the system as identified by AFC and recommendations AFC makes for solving these problems:

• Epidemiological follow-up activities are conducted either irregularly or not at all, in violation of state regulation. AFC recommends the development of systematic procedures for following up on HIV case reports with missing information.
• Greater education and technical assistance is needed for providers. AFC recommends that an independent contractor be hired "to give providers statewide education and technical assistance" to facilitate better compliance with state reporting requirements.
• More "staff support and expertise" is needed for implementation of the system. In addition, local health departments are inadequately funded.

• Generally, AFC believes that "IDPH's evaluation plans are biased against non-name-reporting methods." The performance criteria are "inconsistent with standards recommended by the federal government" and "unrealistically high." AFC recommends that the performance criteria mirror those recommended by the CDC.
• The health department is evaluating forms for "completeness of reporting" that contain questions not required by state regulation. The AFC recommends that this practice be revised.
• Given this criticism, the AFC suggests that the health department "[r]econvene its advisory HIV Case Surveillance Working Group to receive community input" into the evaluation of the program. It recommends that an "independent, impartial, process evaluation of the system" should be conducted for one year beginning next July.
• Finally, AFC recommends that IDPH convene with health professionals, HIV-positive individuals and community representatives to "implement a rigorous outcome evaluation plan (to commence January 2003 and end by January 2004) to measure the ability of the system to track trends in the HIV epidemic" (AFC release, 11/2).