Ending a process that began nearly two years before, the Washington State Board of Health voted unanimously to implement HIV case reporting in Washington State. Reporting will start September 1, 1999 and applies to both adult/adolescent and pediatric HIV cases. The final HIV reporting plan as adopted at the July 14th meeting is a unique system among the 33 states which now require named HIV reporting.

In Washington, reporting of HIV and AIDS cases will be by name from providers and laboratories. Providers will report to local health departments and, for cases of asymptomatic HIV infection, patient name will be coded within 90 days after receipt of a complete case report and the name eliminated from case records. For smaller local health jurisdictions without the capacity to gather case reports, WA Administrative Code (WAC) allows state health department personnel to act as an agent of the local health department for the purpose of collecting reports, however, patient names will not be retained by state staff.

Only the encoded identifier, plus other standard report data such as demographic and risk exposure information, will be forwarded from local health jurisdictions to the WA State Department of Health. Thus, the State will never have a list of the names of persons with HIV infection and local public health officials will have names only temporarily while processing the case report. While previously diagnosed HIV cases are required to be reported, providers will report only patients currently under their care. This will give providers the opportunity to inform patients and answer any questions or concerns about reporting that the patient may have. Over the next several months, state and local health department staff will work with HIV/AIDS care providers to explain the reporting requirements and supply revised case report forms and informational brochures that can be given to patients.

Anonymous testing for HIV must continue to be available. The WAC stipulates that health care providers and others conducting HIV pretest counseling must inform individuals presenting for HIV testing, either orally or in writing, that anonymous HIV testing is available through the local health department, home testing kits, or may be available through other community sources, and explain the differences between 'anonymous' and 'confidential HIV testing'. Anonymous testing is not restricted to health department sites. The WAC states that 'any person authorized to order or prescribe an HIV test for another may offer anonymous HIV testing without restriction'. Another provision of the revised WAC exempts providers conducting clinical HIV research from reporting HIV+ individuals participating in the research if the project has institutional (human subjects) review board approval and if the project has a system in place to remind referring health care providers of their HIV/AIDS reporting obligations.

As with AIDS, confidential laboratory reporting of HIV-indicative test results will play an important role in assuring the completeness of case reporting. Incoming lab reports will be matched against the public health registry containing the name (for AIDS) or code (for asymptomatic HIV) of persons already reported. The patient code, while not identifying, contains enough information based on date of birth and the Soundex of the name, to allow reasonably accurate matching to named lab reports. Non-matching reports are likely to represent unreported cases of HIV or AIDS and these are investigated by authorized public health staff through contact with the provider ordering the test. Names of persons matching the HIV/AIDS registry will be immediately destroyed upon completion of the match process. The new WAC eliminates lab reporting of CD4 test results by patient code; such reporting will now be done by name. This provision will make follow-up on unreported cases much simpler for both health department staff and health care providers.