In the decade since the human immunodeficiency virus (HIV) was discovered, the epidemic has grown steadily each year. According to the Global Health Council (2006) by 2005, the number of those infected has grown to more than 40 million, double the number in 1995. By the end of 2005, 40.3 million people were living with HIV/AIDS world wide, including 17.5 million women and 2.3 million children under the age of 15. Without prevention efforts, 35% of children born to an HIV positive mother will become infected with HIV.
At least a quarter of newborns infected with HIV die before age one, and up to 60% will die before reaching their second birthdays. World-wide, only one in ten persons infected with HIV has been tested and knows his/her HIV status (Global Health Council, 2006).
As the HIV/AIDS epidemic in the United States has progressed, strategies that are associated with the prevention, treatment and monitoring of the disease are important in controlling the spread of the epidemic. Epidemiology plays an important role in decision making strategies by monitoring data which can give insights into the infection rates of HIV in various segments of the population.
The uses of epidemiologic data is crucial in the surveillance of the decrease in overall HIV incidence, the substantial increase in survival after AIDS diagnosis and the continued disparities among racial/ethnic minority populations. This paper will discuss the role and uses of epidemiologic data relating to HIV evolution, definition and refinement of a disease management programs.
Disease management of HIV
According to Wright (2005) the number of Americans living with HIV who are over 45 years old grew by 60 percent between 1999and 2002. The epidemic aging is a sign of success: "We have learned how to keep people alive with HIV. As individuals grow old with HIV, the treatment for the virus will begin to collide with treatment for a host of other health concerns that plague aging individuals.
There are about 20 antiretroviral drugs available in the U.S. to stop the loss of natural defenses in HIV infection. What is so troubling for individuals with HIV/AIDS is that protease inhibitors are associated with diabetes, heart disease liver and kidney disorders (Wright, 2005). Epidemiologic analyses/data in a hospital setting can be use to identifying these disorders in the population that are a result of the treatment of HIV/AIDS. The use of epidemiologic data can lead to a more effective care planning for individuals that will be effected by the prolong uses of antiretroviral medication.
HIV/AIDS surveillance
According to Fos and Fine (2005) most healthcare organizations have in place surveillance programs charged with the responsibility to monitor key indictors, such as infection rates. The focus of these surveillances is to target infections that are frequent and preventable, and that generate high treatment cost or serious effects on either morbidity or mortality (Fos and Fine, 2005 p.167). Organizations that seek to prevent HIV infection must utilize HIV surveillance to provide timely and accurate data that is relevant to the ever changing demographic, cultural and social economic spectrum of HIV/AIDS disease.
The Centers for Disease Control and Prevention (2006) indicate the HIV epidemic has continued to expand in the United States; at the end of 2003, approximately 1,039,000--1,185,000 persons in the United States were living with HIV/AIDS, an estimated 24%--27% of whom were unaware of their infection. In the United States there are an estimated 252,000--312,000 persons unaware that they are infected with HIV and, therefore, are unaware of their risk for HIV transmission. Analysis of data collected by the National HIV Behavioral Surveillance System, which surveys populations at high risk for HIV to assess prevalence and trends in risk behavior, HIV testing, and use of prevention services, revealed that of at risk population surveyed in five U.S. cities, 25% were infected with HIV and of those, 48% were unaware of their infection (Center for Disease Control and Prevention, 2006). These results underscore the need to increase HIV testing and prevention efforts among populations at high risk.
With in a hospital or community-based health care setting primary prevention is vital in the efforts to stop the spread of HIV/AIDS. The Center for Disease Control and Prevention (2006) indicates early studies of HIV counseling and testing observed considerable reductions in risk among persons who learned that they were HIV seropositive. A shift in client-centered counseling that emphasized increasing the client's perception of risk and developing a personalized risk-reduction plan substantially increased condom use and decreased new sexually transmitted diseases (STDs) among HIV-seronegative patients at STD clinics (Center for Disease Control and Prevention, 2006).
Since the HIV/AIDS epidemic was first recognized, there has been geographic clustering of AIDS cases with the United States. Morse, Lessner, Medvesky, Glebatis and Novick (1991) suggest clustering is related to pools of HIV infected individuals and to risk behavior activities which occur most frequently in metropolitan areas and states with large populations at risk. Identification of geographic clusters of cases can be useful in focusing preventive efforts and allocation of health care resources (Morse et. al, 1991).
Epidemiologic surveys
Surveys often provide reliable, in-depth, population based data on specific groups. According to Whitmore, Zaidi, and Dean (2005) epidemiologic surveys may be cohort, case control, longitudinal, or cross sectional studies. These studies are not considered a part of routine public health surveillance but help health care decision-makers identify populations at greater risk for HIV infection (Whitmore, Zaidi, Dean, 2005). The unique feature about an epidemiologic survey is the collection of data comes directly for the population. This information can be compared to other collected epidemiological data such demographic or geographic indicators to provide a descriptive evaluation of morbidity and risk in the community. The inclusion of multiple data sources using epidemiologic information enables planners in hospitals to know the strengths and limitations of the services provided.
Prevention planning
Fos and Fine (2005) suggest rational efforts to prevent disease and disability are rooted solidly in clinical epidemiology. In fact, preventive practices not supported by clinical epidemiologic evidence may be dangerous or costly, or both. Epidemiology is critical to our understanding of the prevalence of any disease and its natural history (Fos Fine, 2005 p. 244). Preventing and treating HIV/AIDS over a long period of time can be problematic in an era of limited health care resources. According to Whitmore, Zaidi, and Dean (2005) effective HIV prevention planning should be an evidence-based process.
Epidemiologic profiles and assessments of community services are primary sources of that evidence. In the past, epidemiologic profiles have emphasized HIV/AIDS surveillance data because of its universal availability and high quality. An ideal intergraded epidemiologic profile describes the effect of the HIV/AIDS epidemic in terms of social demographic, geographic, behavioral, and clinical characteristics for decision-makers to make informed decisions (Whitmore, Zaidi, and Dean, 2005). Epidemiologic data can aid in the decision-making processes in a hospital or community-based health care setting by developing a comprehensive picture of the HIV/AIDS epidemic in the community.
Data that describes the sociodemographic characteristics of the general population can provide a baseline for comparing educational status, poverty level, and insurance coverage of individuals infected with HIV. Epidemiologic data can also identify populations for whom HIV risk behavior or HIV/AIDS prevalence information is needed. Community-base organizations can use epidemiologic data to identify which racial/ethnic groups are at risk and to focus interventions appropriately. The use of epidemiologic data in a health care setting allows health care decisions-makers to identify which populations are receiving HIV primary medical care.
Conclusion
HIV prevention and care involves planning between health departments and HIV-affected communities. The inclusion of multiple data sources in the decision making process enables decision makers to optimize the strength and validity of finding presented in epidemiologic analyses/data. HIV/AIDS surveillance data along with social demographic, geographic, behavioral, and clinical characteristics must all be included in the decision making process to paint a three dimensional picture of HIV/AIDS epidemic.
Epidemiologic data has refine disease management by further describing the socialdemographic characteristics of persons infected with HIV and comorbid conditions, such as tuberculosis, hepatitis and other STDs. The application of epidemiologic analyzes/ data must continuously be developed and used to lead health care providers to more effective prevention and care planning for individuals infected with HIV. Fos and Fine (2005) suggest epidemiological data can help health care decision makers to identify, evaluate and select alternatives. Epidemiology can help decision makers set criteria on which solution in an epidemic will be the most cost effective utilization of health care resources (Fos Fine, 2005). A health care decision maker can use epidemiological data to prioritize and focus prevention and care services to specific subpopulations. Data on STD morbidity, HIV and tuberculosis comorbidity, mortality data, seroprevalence studies may provide a more comprehensive picture of the HIV epidemic.
At present there is little known about the long-term effects of any of the anti-HIV medications now on the market. Even more alarming are the effectives that risk behaviors have on the transmission of HIV. In the future hospitals and community -based health care setting may one day use epidemiological data to answer some of these questions in the search for preventing and treating HIV/AIDS epidemic.
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