Improved AIDS Surveillance Through Laboratory-Initiated CD4 Cell Count Reporting

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Abstract
To evaluate laboratory-initiated CD4 reporting (LICR) for AIDS surveillance and for differences in cases found by LICR and traditional surveillance methods (i.e., health care provider or death certificate reports and medical record searches). We compared the characteristics of persons reported with AIDS between May 1993 and April 1994 by traditional methods or by LICR reports We received 643 LICR reports and 278 AIDS case reports. HIV status was available on 94% of LICR reports; 96% of these persons were HIV-infected. LICR reports were received on 250 (90%) AIDS cases. Cases found by LICR were less likely to be persons of color and to have opportunistic illnesses and more likely to live in rural areas. Cost of LICR to the health department was less than the salary of one research analyst. LICR, with a high positive predictive value, is a highly sensitive, timely, and relatively inexpensive method of surveillance and its use should be considered in other jurisdictions.