On July 14, 1999 the State Board of Health unanimously approved implementation of a "Washington Model" for HIV case reporting in the state.

The model contains the following elements which begin 9/1/99:

• Providers will be required to report names and other important data (date of birth, zip code, risk factors, etc.) to their local public health surveillance staff in the course of seeing patients, unless those patients are only known anonymously. (Providers are not required to report all past cases, but only as they see patients for care, refills, tests, etc..)
  
• Labs must also report the names of persons and their providers when viral load tests show virus or CD4+ (T4+) cell tests are less than 200 or 14% for patients age 13 and older.
  
• HIV surveillance staff will follow-up on unrecognized cases by calling providers to complete the needed case data.
  
• After 1 year the State Health Officer will report to the State Board of Health on the success of this new reporting system, including impacts on disease control efforts.

Extra Protections in the Washington Model, over a standard name-based disease reporting system:

Once a case record is complete, local public health may keep patient names for only 90 days. By the end of that period of time, a computer program will convert the name to a unique “Soundex-plus” code, and the name will be expunged from the record. It is not possible to convert codes back into names.

Although the state department of health (DOH) epidemiology staff may briefly have case names from laboratories for some local health jurisdictions which do not have the capacity to do HIV/AIDS surveillance, the state will not keep names, and will only have a listing of patients by their coded identifiers. (The CDC has never been given patient names of cases of AIDS or HIV by states.)

Earlier this year, Governor Locke signed HB 1080 into law, substantially increasing the penalties for inappropriate disclosure of medical and public health information and requiring local health officers to follow-up on breeches of confidentiality.

The HIV reporting regulations also prohibit the use of HIV surveillance data for comparison with state license registries (e.g., licensed care providers, teachers, etc.)

Partner notification will only be provided by Public Health if the patient’s provider and the patient consent to this service.

Anonymous HIV counseling & testing:

Persons considering testing will be informed by providers that they may test confidentially (using their names, protected by the usual medical records safeguards), or anonymously. Public sites for anonymous testing will continue to be available in every public health region and will not result in an HIV case report. Persons may also be tested anonymously at Planned Parenthood clinics, in some private doctors’ offices, and by using mail-in test kits available at about $40 in most pharmacies. There is no public health effort or desire to eliminate anonymous HIV counseling & testing, and the CDC strongly advocates that this service remain in all jurisdictions.

Efforts to inform health care providers:

The following steps have been taken or are planned to inform practitioners of HIV reporting requirements: Providers who have reported cases of AIDS ("Sentinel Providers") have regularly received updates on the progress of the HIV reporting debate, and earlier this summer received a "Sentinel Providers Newsletter" explaining the details of the State Board of Health-approved regulations. The DOH is preparing brochures to explain providers’ obligations in implementing these new regulations. A new HIV report form has been developed and will be distributed. A "Q & A" document is being prepared and will be distributed and published in provider bulletins. This document will also be useful for clients and any other interested persons. Especially in clinics that see high-volumes of persons with HIV (e.g., the Madison Clinic at Harborview), Public Health staff will conduct provider trainings.

Efforts to inform clients and the public:

There has been considerable news coverage of the HIV reporting debate; however, many clients calling HIV/AIDS Hotlines, and being seen in clinic settings have voiced concerns and confusion about HIV reporting. DOH is preparing a brochure to help patients understand HIV reporting requirements, protections, and testing options. DOH will be reviewing drafts of provider and client brochures with persons who have HIV and with AIDS service organizations. Consumer materials are being developed by a task force including leaders of the NW AIDS Foundation, POCAAN, HIV C/T researchers, and local and state Public Health staff with the aim of: Insuring understanding of HIV testing options, including how to locate anonymous testing sites. Clarifying that treatment for HIV is available to all persons. State and local Hotline and Public Health clinic staff are being trained to understand new regulations, to reassure clients, and to make helpful referrals.

Efforts to inform clinical labs and their staff:

DOH has sent a letter to all labs informing them of new HIV reporting requirements. DOH conducted a lab survey to inquire about their computer capabilities and whether they collect variables which might enable them to create Soundex codes. DOH will be doing site visits and educational sessions for labs.