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HIV/AIDS risk factor ascertainment: A critical challenge.

Ascertainment of risk factors for HIV transmission is critical to monitoring the HIV epidemic. Since 1993, there has been an increase in the proportion of HIV/AIDS cases that are reported to the Centers for Disease Control and Prevention (CDC) without an identified risk factor for HIV. About this time many areas implemented laboratory reporting, which generates an initial report with little to no HIV risk factor information. In 2001, the CDC convened a group of experts who recommended changes to the presentation of HIV risk factor data. The CDC subsequently funded two projects to improve the collection of HIV risk factors by surveillance staff. Since 2004, the CDC and state surveillance coordinators revised surveillance guidance to recommend prioritization of follow-up and provider training, and to monitor key variables while providing feedback to reporters. The CDC also began an evaluation of provider-targeted educational materials. The CDC has also been working with professional associations to incorporate methods for documenting HIV risk factors into existing training modules. CDC and state surveillance coordinators will need to continue efforts to educate, train, and identify barriers for providers in order to improve the completeness of HIV risk factor documentation and reporting.