Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention.
Milbank Q. 2013 Sep;91(3):558-603. doi: 10.1111/milq.12018. Epub 2013 Jul 8.
Reducing HIV incidence in the United States and improving health outcomes for people living with HIV hinge on improving access to highly effective treatment and overcoming barriers to continuous treatment. Using laboratory tests routinely reported for HIV surveillance to monitor individuals' receipt of HIV care and contacting them to facilitate optimal care could help achieve these objectives. Historically, surveillance-based public health intervention with individuals for HIV control has been controversial because of concerns that risks to privacy and autonomy could outweigh benefits. But with the availability of lifesaving, transmission-interrupting treatment for HIV infection, some health departments have begun surveillance-based outreach to facilitate HIV medical care.
Guided by ethics frameworks, we explored the ethical arguments for changing the uses of HIV surveillance data. To identify ethical, procedural, and strategic considerations, we reviewed the activities of health departments that are using HIV surveillance data to contact persons identified as needing assistance with initiating or returning to care.
Although privacy concerns surrounding the uses of HIV surveillance data still exist, there are ethical concerns associated with not using HIV surveillance to maximize the benefits from HIV medical care and treatment. Early efforts to use surveillance data to facilitate optimal HIV medical care illustrate how the ethical burdens may vary depending on the local context and the specifics of implementation. Health departments laid the foundation for these activities by engaging stakeholders to gain their trust in sharing sensitive information; establishing or strengthening legal, policy and governance infrastructure; and developing communication and follow-up protocols that protect privacy.
We describe a shift toward using HIV surveillance to facilitate optimal HIV care. Health departments should review the considerations outlined before implementing new uses of HIV surveillance data, and they should commit to an ongoing review of activities with the objective of balancing beneficence, respect for persons, and justice.
减少美国的艾滋病毒发病率和改善艾滋病毒感染者的健康结果取决于改善获得高效治疗的机会并克服持续治疗的障碍。利用常规报告的艾滋病毒监测实验室检测来监测个人接受艾滋病毒护理的情况，并与他们联系以促进最佳护理，可能有助于实现这些目标。从历史上看，基于监测的针对个人的艾滋病毒控制公共卫生干预措施一直存在争议，因为人们担心隐私和自主权受到的威胁可能超过收益。但是，随着具有挽救生命、阻断艾滋病毒感染传播作用的治疗方法的出现，一些卫生部门已开始基于监测的外展活动，以促进艾滋病毒医疗服务。
我们在伦理框架的指导下，探讨了改变艾滋病毒监测数据用途的伦理论点。为了确定伦理、程序和战略方面的考虑因素，我们审查了正在利用艾滋病毒监测数据联系被确定需要帮助启动或重新接受护理的人员的卫生部门的活动。
尽管围绕艾滋病毒监测数据使用的隐私问题仍然存在，但不利用艾滋病毒监测来最大程度地提高艾滋病毒医疗和治疗收益也存在伦理问题。早期利用监测数据促进最佳艾滋病毒医疗保健的努力说明了伦理负担如何根据当地情况和实施的具体情况而有所不同。卫生部门通过让利益攸关方参与，以获得他们对共享敏感信息的信任，为这些活动奠定了基础；建立或加强法律、政策和治理基础设施；并制定保护隐私的沟通和后续协议。
我们描述了一种利用艾滋病毒监测来促进最佳艾滋病毒护理的转变。卫生部门在实施艾滋病毒监测数据的新用途之前，应审查所概述的考虑因素，并承诺对活动进行持续审查，以平衡善行、尊重个人和公正。
