The impact of the 1993 AIDS case definition on the completeness and timeliness of AIDS surveillance

Objective: To assess the impact of the 1993 change in the AIDS case definition on the completeness and timeframe of AIDS case reporting in San Francisco. Design: Retrospective review of records: billing records, list of selected diagnostic codes, radiology logs, ophthalmology clinic records, and patient registries at a selection of hospitals, clinics, and physician offices. Setting: Hospitals, public/community health clinics, and physician offices. Main outcome measures: The completeness of reporting and the median reporting delay was calculated for hospitals, clinics, and physician offices. Results: Reporting was 97% complete. Reporting from physician offices was less complete (75%) than from other facilities. The median reporting delay was 1 month and was shorter for persons who met the 1993 AIDS case definition (1 month) than for persons who met the 1987 case definition (3 months). Conclusions: AIDS case reporting in San Francisco is highly complete but less so for persons diagnosed at physician offices. The 1993 AIDS case definition has resulted in more timely reporting. Health departments should consider efforts to improve reporting from private physician offices and should evaluate the use of laboratory-initiated CD4 reporting. (C) 1999 Lippincott Williams & Wilkins.