8.1 General Information for All Health Care Professionals8.1.1 DefinitionsSexually transmitted disease (STD): any disease, with or without symptoms, that is transmitted primarily through sexual activities. The STDs that are required by Texas law to be reported include: Show
STDs that are voluntarily reportable include:
Surveillance case definitions are consistent with those set by the Centers for Disease Control and Prevention (CDC) and are listed in the CDC Case Definitions. Violation: Failure to report a reportable disease is a Class B misdemeanor under Health and Safety Code, §81.049. 8.2 HIV Infection ReportingBeginning January 1, 1999, HIV infection in adults (clients 13 years of age or older) became reportable by name. All HIV positive test results from HIV testing are being reported to the local surveillance authority. HIV infection reports that have a test date prior to the implementation of named HIV infection reporting will not be accepted into the DSHS database as morbidity. There was no change in the procedure for CD4 test result reporting - all CD4 T lymphocyte counts of <200 cells/microliter or <14% remain reportable to local surveillance authorities. Pediatric reporting of HIV infection has been reportable by name for children <13 years of age since 1994. Effective January 1, 2000, the CDC made a change in the case definition for HIV disease. The CDC case definition considers a single viral load test (HIV RNA with detectable viral load) to be a reportable event. Beginning January 1, 2000, all individuals meeting the case definition of HIV infection (positive HIV test after January 1, 1999, OR any detectable viral load test performed after January 1, 2000) should be reported by name to the local surveillance authorities. The implementation of HIV reporting by name did not affect the availability of anonymous HIV testing in Texas. 8.2.1 Enhanced Pediatric HIV Infection SurveillancePediatric HIV infection surveillance is currently conducted comprehensively with the HIV/AIDS case surveillance program, due in part to the named pediatric HIV infection provision included in the revision to the rules and regulations on March 16, 1994. These rules were revised in 1999 to include named reporting for adult/adolescent HIV infection cases. This revision allowed for more comprehensive reporting with regard to mother/baby pairs on HIV exposed pediatric cases. With additional data collected about perinatally exposed infants, the ability to characterize and target the utilization of available pediatric medical and social support services in Texas will be strengthened. Infants born in Texas to mothers who have test results indicative of HIV infection are to be reported to the local surveillance authority as “exposed” pediatric cases. Infants born in Texas since January 1, 1999, to an HIV infected mother will be required to have an Enhanced HIV/AIDS Surveillance to Maximally Reduce Perinatal HIV Transmission, form CDC 50.132 completed as an expansion of the standard pediatric HIV/AIDS morbidity report form. 8.2.2 Reason for ReportingCase statistics are used in planning for HIV/STD prevention, education, counseling, testing, medical and social services. Accurate and reliable information about the diseases can be used in defining the broad range of clinical conditions and manifestations associated with HIV infection and other STDs. Additionally, funding for HIV/STD services is tied to the number of cases reported. The accurate identification and timely reporting of STDs, including HIV infection, is an integral part of successful disease control that enables the health department to provide epidemiological follow-up or disease intervention without delay. 8.2.3 Who Should Report
8.2.4 How Cases Should be ReportedDisease reports can be reported on either the DSHS STD-27, Confidential Report of Sexually Transmitted Disease, by telephone, through a laboratory report or on any other mechanism that provides the information necessary to begin a case investigation. Laboratories should report on the DSHS for STD-28, Notification of Laboratory Test Findings Indicating Presence of Chlamydia Trachomatis, Gonorrhea, Syphilis, Chancroid, HIV Infections or Suppressed CD4 Counts, or its equivalent. The existing CDC 50.42A, Adult HIV/AIDS Confidential Case Report form should be used as the official case report form for HIV infections by the surveillance personnel for adult infections and the existing CDC 50.42B, Pediatric HIV/AIDS Confidential Case Report form should be used for reporting infections in individuals <13 years old. The following information is required when completing the report: patient’s name, address, city, county of residence, date of birth, sex, race/ethnicity, stage of diagnosis (syphilis only), type of test(s) performed, result of the test(s), date test(s) were performed, treatment provided, physician’s name, physician’s/clinic’s address, and telephone number. The STD-28, STD-27, CDC 50.42A, and CDC 50.42B forms are available from local health departments and DSHS Regional offices. Disease reports can also be made by calling 1-800-705-8868. 8.2.5 Where To ReportReporting forms and/or information from all entities required to report diseases should be sent to the local health department serving the area where the physician's office, hospital, laboratory, or medical facility is located. To locate a local reporting authority, use the HARS-STD Maps included in the forms section. If there is no local health department, the reports should be sent to the regional office of the Texas Department of State Health Services (DSHS) in the region where the physician's office, hospital, laboratory, or medical facility is located. 8.2.6 ConfidentialityState law protects STD case report information, including HIV infection and AIDS case report information. No names are ever released to the public. Individual morbidity case reports received by the DSHS are confidential records and not public records. More detailed legal information on the reporting of STDs, including HIV infection, may be found in Title 25, Texas Administrative Code, Part I, Chapter 97, Communicable Diseases, Subchapter F, Sexually Transmitted Diseases Including Acquired Immunodeficiency Syndrome (AIDS) And Human Immunodeficiency Virus (HIV), §§97.132, 97.134, and 97.135. Copies may be obtained online at: texreg.sos.state.tx.us/public/readtac$ext.viewtac. 8.3 Specific Information for Surveillance Authorities8.3.1 Record Searching a Disease ReportOnce received by either the local or regional health department, the disease report should be handled in the following manner:
The designated personnel will record search the STD disease report, AIDS case report, HIV infection report or the viral load test result to determine if this is a previously known infection report.
The report should be entered into either the STD*MIS or HARS system as morbidity. In addition, the appropriate portions of the STD*MIS system need to be completed. This should include the morbidity section, the patient information section, laboratory information, treatment information and the field record and/or interview record, as appropriate. Disease reports and follow-up information should be entered in either the STD*MIS or the HARS system on a daily basis. The electronic data should be cleaned and checked for completeness before it is transmitted electronically to the HIV/STD Epi & Surveillance Branch. The electronic data transmission to Central Office Surveillance Branch should be performed no less than once each week. 8.3.2 Case Report Follow-upAdditional follow-up to the initial disease report may be needed to:
Follow-up required to inform the patient of a positive test result for STDs, including HIV infection, to offer partner services and referral services must be done by public health staff who have completed the full course of DIS training. Follow-up of newly reported infections for HIV and syphilis should be started within 24 hours of the receipt of the report. All follow-up of HIV/STD infection reports should be done in accordance with Chapter 9, Performance Standards for Disease Intervention Specialists. In the follow-up of case reports and positive laboratory findings for HIV/STD infection reports, the public health staff member must contact the responsible health provider in order to inform the provider that the client will be contacted or to assist the provider in obtaining public health services for their client.
The staff performing the HIV/STD follow-up should elicit from the health provider or their designee the information required to provide services to the client and to complete the appropriate DSHS morbidity report (either the STD-27 or the appropriate CDC case report form). The information should also be entered into the STD*MIS or HARS databases, as appropriate. Staff should determine through discussion with the health provider whether or not:
The health provider should be informed of the need to provide disease intervention and referral services to the client if they have not already been provided. If the health provider denies permission for an interview with their client, staff will tactfully conclude the discussion with the health provider, document the refusal and consult with her/his supervisor. The supervisor will determine if additional follow-up with the provider is needed (e.g., an in-service on health department services that are available). For viral load tests that lead to newly discovered AIDS cases, follow-up should be done to locate and record the viral load test result that occurred nearest the date of diagnosis of AIDS. 8.3.3 Confidentiality in Surveillance SituationsIn order to protect the security and confidentiality of HIV/STD case reports, the contents of registries and potentially identifying surveillance data, the Surveillance Branch of the HIV/STD Epidemiology Division has taken specific proactive actions at the central office and require specific security and confidentiality measures of its contractors and all local surveillance authorities. Local and regional health departments are required by law to maintain strict confidentiality and security measures. Additionally, they are bound by their surveillance contracts with the DSHS to uphold the following standards of security:
8.3.4 Medical and Laboratory InformationCustody and management of medical and laboratory records is the legal responsibility of the local health officer/authority (or of the individual health provider). When accessing these records in the course of daily activities, it will be done in a manner that serves to protect the confidentiality of the records.
8.4 Client ConfidentialityThe HIV/STD staff safeguards the privacy of all persons served by the health department and of those who become involved in the disease intervention process by observing strict confidentiality of information. The HIV/STD staff shares information only with authorized persons on a need-to-know basis. In this case, authorized persons are health professionals who are bound by medical/professional rules of confidentiality and who are involved in providing health services to the individual in question. Attempts by any others to obtain records or information will be reported by the HIV/STD staff person to the supervisor.
8.4.1 Electronic Data SecurityElectronic data will be managed in accordance with the DSHS policy on confidentiality, including the following specifics:
8.4.2 Policy for Release of InformationData on individuals with STDs, including HIV infection, can be released only in aggregate statistical format. Only staff directly involved with HIV/STD surveillance, disease intervention or case management activities should have access to complete patient registries. Statistical data can be released to such entities as local health agencies, community planning partners, health care providers and the general public in aggregate format. 8.5 Congenital Syphilis SurveillanceThe Infant Syphilis Reactor Control Record (ISRCR) is a dual-purpose form for field-based case investigation and surveillance unit morbidity reporting of congenital syphilis. It is intended to provide:
8.5.1 Direct Service Provider InstructionsThe investigator uses the ISRCR form to provide follow-up for all mothers and infants who test positive for syphilis. The investigator completes the ISRCR form and makes a case determination supported by the information from the worksheet. The investigator’s supervisor or program manager reviews the ISRCR form and closes the investigation by signing the completed form in the Supervisor’s Approval block. All completed forms, regardless of closure, are provided to and maintained by central office surveillance (filed by month reported) for a minimum of one year. They will serve to provide a method of quality control by providing the information used in making a case determination. The total ISRCR form count will provide DSHS with a better “picture” of the amount of effort committed to investigating reactive mothers and infants. All babies with evidence of syphilis or born to mothers who show any evidence of syphilis during pregnancy are to be written up on the ISRCR form and entered into STD*MIS (this includes those infants determined to be “no case”). Each program should maintain a copy of each ISRCR form completed and submitted. Forms should be mailed to: 8.5.2 Central Office Surveillance Branch ISRCR ProcessISRCR forms received in the Central Office Surveillance Branch will be reviewed for completeness and accuracy. Any questions or concerns will be addressed by contacting the originating program manager or point of contact by phone. Significant concerns not addressed satisfactorily in a phone call will be referred to the Field Operations Branch for follow-up. Significant concerns would include incomplete, or inadequate treatment regimens for infants, and partial investigations. After reviewing all ISRCR forms received, final case determinations will be reviewed and confirmed. All “No Case,” “Confirmed,” and “Presumptive” cases will be checked to see if they have been entered into STD*MIS by the investigating agency. (“No Case” reports do not export out of STD*MIS. They are entered in order for the Central Office Surveillance Branch to be able to determine the amount of effort being devoted to congenital syphilis investigation.) Names are stripped and sent via the NETSS export in STD*MIS. They are then transmitted electronically to CDC weekly. The CDC reviews the information they receive and contacts the Central Office Surveillance Branch with corrections or questions about the data. CDC gathers and generates reports using the infant’s date of birth. Therefore, the Central Office Surveillance Branch number of reported cases, done by date of report, and the CDC number of reported cases may not match. 8.5.3 Enhanced Pediatric HIV Infection SurveillanceInfants born in Texas to mothers who have test results indicative of HIV infection are to be reported to the local surveillance authority as “exposed” pediatric cases. The Pediatric HIV/AIDS Confidential Case Report, CDC 50.42B is to be completed at the time of birth and updated regularly as additional laboratory tests on the infant are completed. Once a final determination of infection status is made for the infant, the case report form and the HARS database should be updated to reflect the final infection status. Infants born in Texas since January 1, 1999, to an HIV infected mother will be required to have a CDC 50.132 form completed as an expansion of the standard pediatric HIV/AIDS morbidity report form. The following recommendations should be followed:
Although data abstraction will primarily require review of medical records, contact staff at the central office surveillance program if a review of the following ancillary data sets could assist with enhanced surveillance form completion for each pediatric HIV exposed case reported:
The surveillance report form of record for pediatric HIV/AIDS case reporting will continue to be form CDC 50.42B. 8.6 Completing and Routing HIV Infection or AIDS Case Report FormsEvery HIV infection or AIDS case must have a case report form completed (Adult, CDC 50.42A or Pediatric, CDC 50.42B). The case report form is the mechanism used to enter the case into the HARS system (the official surveillance database for HIV/AIDS cases).
The reporting system is most efficient and timely when the reporting providers (whether it is an STD clinic site, private physician, hospital infection control personnel) complete the case report and submit it to the local surveillance authority. DSHS encourages all local and regional health departments to establish working relationships with local providers and reporting sources to facilitate the form completion by a reporting provider. The reporting rules and regulations do not REQUIRE anyone reporting an HIV infection or AIDS case to submit anything more than the basic morbidity information. There is no legal method to require infection control nurses or any other reporting source to complete the case report form. These arrangements are made strictly through negotiations at the local level and require cooperation to ensure the form submission gets accomplished. 8.6.1 HIV/AIDS Case ReportingIn areas with local HARS installations:
The surveillance person notifies the STD program that there is an HIV/AIDS case that needs follow-up for either test result notification, partner elicitation or referral for other public health services. The surveillance person then enters the case into the local HARS installation and forwards the electronic copy of the data and a copy of the case report form to central office during the weekly data submissions. In areas WITHOUT a local HARS installation:
At the Central Office, HIV/AIDS cases reported through STD*MIS are handled by the surveillance staff as outlined below:
In summary:
8.6.2 Completed HIV Infection Case ReportsAfter all information is gathered to complete the HIV infection case report, the HARS and/or STD*MIS systems should be updated and the case report forwarded to the Central Office Surveillance Branch. In order to be considered a complete case report (and not just a morbidity report) the case report information must include all items required for morbidity:
as well as:
Case reports received at the Central Office Surveillance Branch without the above information documented will be returned to the local surveillance authority to complete the follow-up. Once the Central Office Surveillance Branch receives a completed case report form, the statewide HARS database will be reviewed to determine if the case report is a “duplicate” of an already known case.
Monthly, the contents of the statewide database is stripped of client identifiers (name, address) and sent to the CDC. The HARS system will continue to be the database of record for HIV/AIDS morbidity. 8.6.3 Anonymous HIV Positive Test ResultsThe implementation of HIV reporting by name did not affect the availability of anonymous HIV testing in Texas. When a positive HIV test result is received at the local surveillance authority, the surveillance personnel will contact the provider for follow-up information. If the determination is made at that time that the positive HIV test was performed anonymously, the local surveillance personnel should retain the anonymous test result information in a separate, secure file and in accordance with the record retention policies for retaining positive laboratory reports. 8.6.4 Communication with Reporting SourcesAll reporting sources need to be provided information about the HIV/STD reporting rules. Reporting materials need to be distributed to local health clinics, public and private hospitals, private physicians, laboratories and other reporting sources in the local surveillance areas. Annual site visits to the major reporting sources to personally inform them of the reporting requirements, provide reporting materials, review the spousal notification rules and reinforce the need to report STDs, including HIV, are also recommended. 8.6.5 Laboratory VisitsNon-health department laboratories comprise a crucial component in HIV/STD surveillance, both through their reporting practices and through their influence on the levels of testing throughout the medical community. Laboratories should be visited in order to:
These visits should be documented on the forms provided in the HIV and STD Program Operating Procedures and Standards manual. 8.7 Non-HIV/STD Clinic Health ProvidersNon-HIV/STD clinic health providers who offer HIV/STD services can make critical contributions to the public health system in the areas of surveillance, treatment services, and client education. All PCPE contractors are required to have a memorandum of understanding with their local or regional STD Program regarding reporting, contact elicitation and notification. Providers should be visited in order to:
These visits should be documented on the forms provided in the HIV and STD Program Operating Procedures and Standards manual. 8.8 Community Based OrganizationsCommunity-based organizations (CBOs) are extremely important to a well-functioning HIV/STD reporting system. It is crucial that the local surveillance personnel establish a good working relationship with the CBOs in their areas. Surveillance staff should be encouraged to work with personnel in the CBOs to establish a trusting professional relationship. The following suggestions can improve communication between the local surveillance program and the CBOs.
8.9 Prioritization for Case Follow-UpIt is crucial that each local program reviews its existing interview and follow-up priorities and adjusts them accordingly to ensure that:
Priorities for interview should follow the hierarchy below:
Field follow-up activities will also be impacted by changes in morbidity. Program priorities for field follow up may also need to be adjusted to deal with additional follow-up activities. The following field follow-up priorities should be used:
Other adjustments in field activities can include:
8.10 Interstate Communication Control Record (ICCR) ProcessWhen notification of a client contact is received from out-of-state, the Field Record, CDC form 73.2936S, is to be filled out as completely as possible by the Interstate Communication Control Record (ICCR) Clerk within the Central Office Surveillance Branch. For diseases with high priority for follow-up (new HIV infections, new syphilis infections, pregnant client):
8.10.1 Disposition Due Dates
8.10.2 Interstate InformationAll information on positive test results or contact follow-up for patients residing outside the state of Texas must be communicated through the ICCR desk. Local arrangements for communicating to a “border” state (i.e., Oklahoma, Louisiana, or New Mexico) can be made to hasten patient notification, treatment or contact notification. These local arrangements do not negate the requirement to report the information through the DSHS ICCR desk for communication through official channels to the other state health departments.
8.10.3 Intrastate InformationLocal and regional health departments should communicate information on Texas residents across jurisdictions without reporting them through the DSHS ICCR desk using the steps outlined in section 9.10 Interstate Communication Control Record (ICCR) Process. NOTE: The DSHS ICCR Clerk is NOT involved in Intrastate sharing of information except when information needs to be communicated to the Texas Department of Criminal Justice (TDCJ) contacts. Any type of contact information for TDCJ must come through the Central Office ICCR desk. This process is requested by TDCJ in Huntsville so that they have only one public health entity to deal with in the state regarding HIV/STD infections. 8.10.4 ICCR Process for Low-Priority Disease ReportsDiseases that have low priority for follow-up are gonorrhea, chlamydia, and chancroid. These do not need a disposition and are mailed to the central office ICCR clerk unless the client is pregnant, a minor, or the DIS worker made a special request to expedite the process by telephoning the information. 8.11 Investigations Involving Texas Department of Criminal JusticeLocal and regional public health department surveillance programs are to follow-up on case reports on individuals residing in a TDCJ facility. In order to accomplish the communication of information between the local surveillance programs and the TDCJ medical units, the following process has been established:
See Forms Chapter of the HIV and STD Program Operating Procedures and Standards manual for a copy of the Department of Criminal Justice - Letter encouraging the local TDCJ facilities to cooperate and work with the local health department in their area. 8.12 Data Management, Review, Quality and AnalysisGood data management is crucial to a well-functioning surveillance system. All local and regional health departments should maintain the following standards to ensure that their surveillance data is useful and accurate.
Data analysis and interpretation are necessary to ensure accurate case reporting and to provide insight into needed disease intervention activities. State and local surveillance programs should perform the following analyses of surveillance data to monitor disease trends. 8.12.1 Weekly Analysis
8.12.2 Monthly Analysis
8.12.3 Quarterly Analysis
8.12.4 Annual Analysis
Central office surveillance and epidemiology staff are available to assist local areas with the various analyses recommended. 8.12.5 Syphilis Decision TreeEach local surveillance area is expected to utilize the decision tree listed below in order to prioritize interview and follow-up efforts. Local areas may redefine the syphilis decision tree to reflect their local morbidity trends. The local decision trees must be no more restrictive than the Central Office Surveillance Branch recommended reactor grid.
Syphilis Reactor Criteria Syphilis Reactor Criteria
8.12.6 Investigate
8.12.7 Administrative Closure
Administrative closures should be used as a tool to prioritize investigative efforts. Unless local morbidity dictates and after performing a record search, administrative closures should be used for:
8.12.8 Supervisory ApprovalItems marked “Supervisory approval” should be discussed with the DIS supervisor. The supervisor will be responsible for making the follow-up decisions based on items such as who the provider is, the reason for exam, known morbidity occurring in that demographic population and other items that indicate a need for disease intervention. 8.12.9 HIV Decision Tree(HIV Positive refers to laboratory tests that meet the reporting definition e.g., a positive ELISA/Western Blot positive or detectable viral load.) HIV Positive Report Received HIV Positive Report Received
8.12.10 CD4 Test ResultsCD4 T-lymphocyte test results of <200 cells/microliter should be referred to the appropriate surveillance personnel for further investigation before applying the HIV decision tree. CD4 T-lymphocyte test results without any HIV test information are not to be considered an HIV infection. CD4 T-lymphocyte test results of >200 cells/microliter are not reportable under current Texas law. They do not warrant investigation. 8.12.11 Handling High Priority Follow-up
8.12.12 Handling Low Priority Follow-upLow priority cases should be investigated and prioritized for investigative efforts as local morbidity dictates. Low Priority cases include:
8.13 Surveillance Program Leadership and Management GuidelinesEach local and regional health department should have in place written guidelines or procedures that address the questions below. The following questions, as well as other measures, will frame the requirements for contract monitoring visits. 8.13.1 System Organization
8.13.2 Case Reporting
8.13.3 Community Organization Participation
8.13.4 Rapid Response
8.13.5 Security
8.14 Minimum Standards for HIV/STD SurveillanceAll local surveillance authorities will have written procedures for performing registry matching and record searching. These procedures will specify the processes and timeframes used. No less than 90% of all new disease reports received by the local surveillance authority will be entered as morbidity into either the STD*MIS or HARS systems (as appropriate) within 24 hours of the receipt of the disease report. Each local surveillance authority should meet the weekly electronic data transmission. Within any 6-month time frame, 85% of the weekly transmissions will be transmitted on time. Each local area should have no less than 90% of the HIV/AIDS case reports with legitimate answers to the three questions: 1) was patient informed of HIV status or other STD diagnosis; 2) were partner services needed; and, 3) are additional referral services needed. If the percentage of case reports with these three questions complete drops below 80%, the local surveillance authority must prepare and submit a plan to the central office addressing how the completion percentage will be improved. STD Programs must have an appropriate written security policy that addresses access to areas where confidential information is used or stored. All computers that contain confidential patient information should be equipped with password protection and each employee who must access the information should have an individual password. All file cabinets used for storage of confidential patient information is equipped with a working lock that is use during non-working hours, when files are not in use or left unattended. All employees handling confidential patient information must sign statements of confidentiality within seven days of their date of employment and all employees must renew these annually. No less than 95% of all infants born to mothers with reactive syphilis serologies will have the congenital syphilis case report and worksheet forms completed (or an approved electronic substitute) and submitted to Central Office Surveillance Branch within one month of the report of the reactive serology. No less than 85% of all pediatric HIV/AIDS cases born after 1999 will have the CDC 50.132 form completed. A determination of the need for public health follow up will be made on 95% of all HIV positive test results within three business days of the receipt of the test result. If no clear determination can be made within the three business days, the HIV test result should be sent to a DIS for investigation. Once it has been determined that HIV/AIDS cases need DIS follow-up for either test result notification, partner elicitation or referral to other public health services, no less than 95% of these cases will be forwarded to the STD program within 72 hours. No less than 95% of HIV/AIDS case report forms received by a local surveillance authority without a HARS installation will be copied and forwarded within seven days of the receipt of the case report to Central Office Surveillance Branch for entry into the statewide system. Each area (either with or without a HARS installation) must have a written procedure on handling HIV/AIDS cases reported to them, including the process for ensuring case reports are entered into the statewide database and the process for ensuring DIS follow-up for test result notification, partner elicitation or referral to other public health services. No less than 85% of case reports returned to the local surveillance authority for completion of case report data elements will be returned, completed, to Central Office Surveillance Branch within 30 days. Each local surveillance authority must prepare and maintain an annual proposed schedule for provider and laboratory visits. All local surveillance authorities will have written procedures documenting how ICCR reports are tracked and maintained. No more than 15% of ICCR dispositions will be considered “overdue” (i.e., returned more than two weeks after the original due date) in any six-month period. Copies of quarterly analyses reports will be maintained on file for the past two-year time frames. Local program managers will review and monitor the use of the syphilis decision tree no less than quarterly. Each local and regional surveillance authority should have written procedures in place that address system organization, case reporting, community organization participation, rapid response plans and security, as defined in this chapter. Subchapters8.1 General Information for All Health Care Professionals 8.2 HIV Infection Reporting 8.3 Specific Information for Surveillance Authorities 8.4 Client Confidentiality 8.5 Congenital Syphilis Surveillance 8.6 Completing and Routing HIV Infection or AIDS Case Report Forms 8.7 Non-HIV/STD Clinic Health Providers 8.8 Community Based Organizations 8.9 Prioritization for Case Follow-Up 8.10 Interstate Communication Control Record (ICCR) Process 8.11 Investigations Involving Texas Department of Criminal Justice 8.12 Data Management, Review, Quality and Analysis 8.13 Surveillance Program Leadership and Management Guidelines 8.14 Minimum Standards for HIV/STD Surveillance |