Normal Limits

"Chance is the very guide of life"

"In practical medicine the facts are far too few for them to enter into the calculus of probabilities... in applied medicine we are always concerned with the individual" -- S. D. Poisson

December 07, 2005

Applying public health measures to HIV infection

Dr. Thomas R. Frieden, the Commissioner of the New York City Department of Health and Mental Hygiene, et al in the New England Journal of Medicine.

25 years into the epidemic, progress is stalled. The number of deaths among people with AIDS has not declined since 1998, and the number of newly diagnosed cases is rising slightly... Late diagnosis of infection is common... Notification of the partners of infected persons is rare.

...given the availability of drugs that can effectively treat HIV infection and progress on antidiscrimination initiatives, perhaps society is ready to adopt traditional disease-control principles and proven interventions that can identify infected persons, interrupt transmission, ensure treatment and case management, and monitor infection and control efforts throughout the population.

I do not know much about applied epidemiology myself, but this is how Dr. Frieden breaks it down:

  1. Case finding and surveillance:

    • Named reporting of all found with a reportable condition (e.g., Salmonella infections and Reye's syndrome). This is now true for patients found to be HIV positive in Michigan.

    • Availability of routine testing in health care settings. Dr. Frieden states that this is often not available.

    • Notification and testing of partners

  2. Interruption of transmission: promotion of condom use, perinatal veritcal transmission prevention, blood product screening, development of vaccine.

  3. Systematic treatment and case management:

    • Case management of the infected individual and his/her contacts, with the case managers accountable for patient outcome. In Ann Arbor, the non-profit HIV/AIDS Resource Center (HARC) provides this service.

    • Linkage of social services to medical care compliance

  4. Population-based monitoring:

    • Contact of treating physician by public health agencies if patient shows inadequate response. This is generally not done for HIV/AIDS.

    • Monitoring viral resistance. Not done outside of research studies.

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