of birth, race, and sex. There is also guidance and sufficient staffing to be able to investigate cases of public-health importance, including clusters of unusual clinical, laboratory, or geographic occurrences; cases with unusual modes of transmission; cases without detectable antibody response; and cases with unusual strains of HIV, such as HIV-2 and non-B subtypes.

Another aspect of the HIV surveillance model is that all jurisdictions use standardized HIV/AIDS case-report forms. Specific information must be completed before the software system will classify an entry as a case; this information includes laboratory or provider diagnosis confirmation, and patient’s date of birth, race, ethnicity, and sex. The case-report form includes the collection of behavioral-risk information, measures of immunologic function (CD4+ cell count and percentage), and viral load.

Most important, the HIV model includes process and outcome standards that all jurisdictions must strive to achieve (CDC, 1999). The outcome standards include completeness, timeliness, accuracy, risk ascertainment, and collection of first CD4+ cell count. Because the new software system is document-based, it will enable evaluation of the completeness of national case ascertainment with a capture-recapture method (Hall et al., 2006). The resulting information can be used to determine weaknesses in the reporting system and to help interpret data appropriately.

Finally, the process and outcome standards have been incorporated into CDC’s updated framework for evaluating public-health surveillance systems (Hall and Mokotoff, 2007). CDC assesses national HIV surveillance data against the required outcome standards annually. The HIV/AIDS surveillance evaluation framework promotes continuous improvement in the quality of data through technical guidance, measurement of performance, reporting of assessment results to state and local health departments, and adjustments in guidance, training, or technical assistance according to assessment results.

The cooperative agreement and the associated funding have allowed the development of the national HIV surveillance system. Both are imperative for the development of an accurate, timely, and complete hepatitis surveillance system that will provide accurate incidence and prevalence data to inform proper resource allocation, program development and evaluation, and policy-making.

The following section details the committee’s recommended model for structuring surveillance for hepatitis B and hepatitis C.

MODEL FOR SURVEILLANCE

The committee recommends that a two-tiered model be developed: core surveillance and targeted surveillance. The initial focus of the program should be the development and implementation of standardized systems



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