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Texas Incidence Surveillance   Tracking the Leading Edge of the HIV Epidemic

What is TIS? Texas Incidence Surveillance (TIS) is an exiting new activity that will assist the Centers for Disease Control and Prevention (CDC) and the Texas Department of Health (TDH) to gain a more complete picture of the HIV epidemic. Texas has been conducting AIDS case reporting since the 1980s and began monitoring HIV infection in 1999. However, HIV surveillance has been limited to monitoring prevelance, the proportion of individuals with HIV regardless of how long they have been infected. TIS will allow us to estimate HIV incidence, or the number of individuals newly infected with HIV over a period of time.

Until now, testing technology has not allowed us to learn anything about how long a positive individual has had HIV.  As a result, the incidence of HIV infection in the United States has not been accurately measured.  The purpose of HIV Incidence Surveillance is to provide estimates of the number of newly acquired infections at the local, State, territorial, and national level.  Texas Incidence Surveillance (TIS) will use new testing methods to incorporate incidence into the current HIV reporting system and then utilize incidence estimates to more effectively allocate resources in the fight against HIV/AIDS. 

What is STARHS? The standard HIV antibody test tells whether or not a person is infected with HIV, not when they were infected. The CDC has developed the Serologic Testing Algorithm for Recent HIV Seroconversion (STARHS) to determine whether people with HIV may have been infected recently (within the past year). STARHS uses two enzyme immunoassays (EIAs): a standard HIV EIA that is sensitive to low levels of HIV  antibodies and a modified, less sensitive (LS) HIV EIA that is less sensitive to low levels of HIV antibodies. Specimens that react to the more sensitive (standard) EIA, but not on the less sensitive EIA, indicate a lower level of HIV antibodies and therefore likely to represent a newer infection. 

STARHS was developed to look at HIV infection in groups of people, not individuals.   Group results will tell us the number of people in the group that may have been recently infected with HIV.  STARHS is not approved by the Food and Drug Administration (FDA).

Who can participate in TIS?

Participants can include male, female or transgendered persons who are:

1. 18 years of age or older
2. Testing in the state of Texas
3. Able to provide informed consent
4. Not previously documented as HIV positive
5. Testing confidentially

How will Texas Incidence Surveillance (TIS) affect your HIV testing experience?

TIS procedures will not:

• Require an additional blood draw
• Affect the quality of your counseling sessions

TIS procedures will:

• Require your consent to perform STARHS on your left over blood if your HIV diagnostic test is positive

What are the benefits of TIS? 

Information gained through Incidence Surveillance will enable Texas public health officials to more accurately identify which populations are being newly infected. These data can be used to:

• Provide insight into HIV infection trends in your area
• Assist local agencies and planning groups in planning, implementing, and evaluating prevention programs that better target HIV prevention efforts
• Guide HIV-related counseling and better direct referrals
• More effectively allocate resources in the fight against HIV/AIDS

What are the risk of TIS?

There is a very rare chance that someone other than STARHS staff might learn your STARHS result. In order to prevent this we will:

• Store results in locked file cabinets in locked file rooms.
• Make sure that only STARHS staff will have access to the locked file rooms.
• Protect all computer records with password known only to STARHS staff.

What do my STARHS results mean?

You do not have to receive your STARHS results, since STARHS is more accurate at the population level and less accurate at the individual level.

If you decide to request STARHS results, your counselor will give you one of two results*:

• STARHS Recent -  means that you probably seroconverted within the last year.  
• Time Period Unkown - means that STARHS has not been able to determine whether or not you were infected recently.

*Results will not be available to those testing in Houston.

Who do I contact to get my STARHS results?

If you want to receive your STARHS results, you can make an appointment with your HIV testing provider to get your STARHS result.

Where do I get more information about STARHS?

The University of Texas Southwestern Medical Center at Dallas is the subcontractor who will be working closely with you and your agency to determine the best way to implement TIS within your current procedures. Each Public Health Region has a Region Leader from UT Southwestern. Areas will be phased in based on morbidity and eventually will include all sites. If you have any questions about the progress of TIS, please feel free to contact your Region Leader:

• State of Texas Public Health Regions & HIV Incidence Surveillance Region Leaders

Community Prevention & Intervention Unit

HIV Epidemiology Research & Behavioral Studies (H.E.R.B.S.)

400 S. Zang Blvd. Suite 520 Dallas, Texas 75208

(214) 645-7300 Office (214) 645-7303 Fax