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Name-Based Surveillance for HIV-Infected Persons
- Dennis H. Osmond, PhD;
- Karen Vranizan, MA; and
- Andrew Bindman, MD
- University of California, San Francisco; San Francisco, CA 94143 (Osmond) San Francisco General Hospital; San Francisco, CA 94110 (Vranizan) San Francisco General Hospital; San Francisco, CA 94110 (Bindman)
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IN RESPONSE:
Brewer and Potterat maintain that self-reported data invalidate our finding that the number of partners of HIV-infected persons notified of risk was not increased by a confidential rather than an anonymous HIV test in states with name-based HIV surveillance. Although we agree that self-report is likely to be inaccurate, the question is not the validity of a particular number but whether the lack of difference between the two groups is valid.
In calculating the mean number of partners notified, we probably inflated the number of partners notified in the confidential test group by assuming that all names given to the health department were notified partners and by not ruling out double-counting of partners self-notified and those given to the health department to inform. Landis and colleagues (1) found that under likely optimal conditions, only 50% of names given to the health department were notified.
To change our finding, virtually all self-notified partners (58% in the confidential test group) and none of the health department referrals would have to be invalid. If we assume that 1 in 3 self-notified partners and 1 in 2 partners notified by the health department are valid, the difference between the means is still nonsignificant: 1.3 in the anonymous group and 1.5 in the confidential group.
Despite the randomized design of Landis and colleagues' study, there are difficulties in generalizing the results. Only 46% of eligible persons participated, and eligibility requirements may have excluded many tacit refusals, reducing participation to as low as 26%. The partners in the self-referral group were given only 1 month to come to the health department before they were contacted by health department personnel. Because of awareness of this limit, participants assigned to self-notification may have left notification up to the health department.
The other studies Brewer and Potterat cite used self-report and therefore have no superior claim to validity (2-4). The average number of partners informed in our study may have been higher because we asked about partners retrospectively from the time of AIDS diagnosis and thus had a longer study period than other studies.
Our study examined partner notification in a random sample of all AIDS cases from several states. We do not think that using self-reported data introduced a bias that can explain the lack of effect of partner notification by health departments.
Dennis H. Osmond, PhD
University of California, San Francisco; San Francisco, CA 94143
Karen Vranizan, MA
San Francisco General Hospital; San Francisco, CA 94110
Andrew Bindman, MD
San Francisco General Hospital; San Francisco, CA 94110
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
