Attachment 3 (e)
Adult and Pediatric HIV/AIDS Confidential Case Reports
for National HIV/AIDS Surveillance OMB No. 0920-0573
Supplemental Surveillance Activity 2:
Variant, Atypical, and Resistant HIV Surveillance (VARHS) – Data Elements
Form Approved
OMB No. 0920-0573
Expiration Date XX/XX/20XX
Adult and Pediatric HIV/AIDS Confidential Case Reports
for National HIV/AIDS Surveillance
Variant, Atypical, and Resistant HIV Surveillance (VARHS) Data Elements
Public reporting burden of this collection of information is estimated to average 5 minutes per response including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a persons is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-0573)
Name |
Type |
Length |
Valid Value |
Label |
Required Variable Code* |
PrimaryIDType |
Text |
50 |
Text |
Primary ID Type |
1† |
PrimaryID |
Text |
14 |
Text |
Primary ID |
1† |
AlternateIDType |
Text |
50 |
PEMS_ClientID |
AlternateID Type |
4† |
|
|
PEMS_FormID |
|
||
|
|
PCN |
|
||
|
|
HARS_CityNo |
|
||
|
|
Code-base Stateno |
|
||
|
|
Other Local ID |
|
||
AlternateID |
Text |
50 |
Text |
AlternateID |
4† |
INELIG |
Text |
1 |
0 = Eligible (default) |
Eligibility of Case |
2† |
|
|
1 = Confirmatory tests non-reactive or negative |
|
||
|
|
2 = Diagnosed before specified time period |
|
||
|
|
3 = ARV drugs |
|
||
|
|
4 = Other |
|
||
ANONYM |
Text |
1 |
1=yes; 0=no |
Anonymous Tester? |
5† |
SITENUM |
Text |
50 |
Text; list of valid site numbers will be provided by each project area |
Site Number |
1‡ |
SITEEXT |
Text |
50 |
Text; for areas that have extensions, otherwise blank |
Site Extention |
4 |
YEAR |
Text |
50 |
YY |
Year of Blood Draw |
1‡ |
SEQNUM |
Text |
50 |
Text |
Sequence Number |
1‡ |
SPECIMENID |
Text |
50 |
Text |
SpecimenTracking ID |
1 |
|
|
14 character field, left zero filled |
|
||
|
|
positions 1-4 = area number |
|
||
|
|
positions 5-8 = site number |
|
||
|
|
positions 9-10 = last 2 digits of year of draw date |
|
||
|
|
positions 11-14 = consecutive numbers for each |
|
||
|
|
participant enrolled, zero filled on left |
|
||
|
|
The last four digits need to be in ascending order |
|
||
|
|
for a given year, but not necessarily consecutive. |
|
||
ACCESNUM |
Text |
15 |
Text |
Laboratory Accession Number |
4 |
DRAWDTTM |
Text |
50 |
YYYYMMDDHHMM |
Date and Time of Draw Date |
1 |
TUBETYPE |
Text |
1 |
1 = Clot tube (Red top tube - for serum) |
Type of Tube Used for Blood Collection |
2 |
|
|
2 = SST tube (Red and gray tiger top tube - for serum) |
|
||
|
|
3 = EDTA tube (Purple top tube - for plasma) |
|
||
|
|
4 = ACD tube (Yellow top tube - for plasma) |
|
||
|
|
5 = PPT tube (White top tube - for plasma) |
|
||
|
|
6 = CPT tube (Blue and black tiger top tube - for cells or plasma) |
|
||
|
|
7 = Finger stick - no tube |
|
||
|
|
9 = Other |
|
||
|
|
0 = No information provided |
|
||
BLDCOMP |
Text |
1 |
1= Serum |
Type of Specimen Sent from Collection Site |
2 |
|
|
2= Plasma |
|
||
|
|
3= Whole anticoagulated blood |
|
||
|
|
4= Dried Blood Spot |
|
||
|
|
5= Cells |
|
||
|
|
6= Dried Serum Spot |
|
||
|
|
7= Dried Plasma Spot |
|
||
|
|
8= Clotted blood |
|
||
BLDLAB |
Text |
1 |
0= No information provided |
Type of Specimen Sent for Resistance Testing |
2 |
|
|
1= Serum |
|
||
|
|
2= Plasma |
|
||
|
|
3= Whole anticoagulated blood |
|
||
|
|
4= Dried Blood Spot |
|
||
|
|
5= Cells |
|
||
|
|
6= Dried Serum Spot |
|
||
|
|
7= Dried Plasma Spot |
|
||
|
|
8= Clotted blood |
|
||
COURDTTM |
Text |
50 |
YYYYMMDDHHMM |
Date and Time of Courier Pick-up From Collection Site |
3 |
DRECDTTM |
Text |
50 |
YYYYMMDDHHMM |
Date and Time of Receipt in Diagnostic Lab |
3 |
CENTDTTM |
Text |
50 |
YYYYMMDDHHMM |
Date and Time of Centrifugation |
3 |
SEPDTTM |
Text |
50 |
YYYYMMDDHHMM |
Date and Time of Separation |
3 |
VOLUME |
Text |
3 |
Text |
Volume of Serum/Plasma After Separation |
3 |
COND |
Text |
1 |
Enter highest relevent number |
Condition of the Serum/Plasma |
3 |
|
|
0= no hemolysis |
|
||
|
|
1= low hemolysis |
|
||
|
|
2= moderate hemolysis |
|
||
|
|
3= high hemolysis |
|
||
|
|
4= lipemic |
|
||
|
|
5= contaminated |
|
||
SpecimenFrozen |
Text |
50 |
1=yes; 0=no |
Was the Specimen Frozen Before Aliquoting? |
3§ |
FREZ1DTM |
Text |
50 |
YYYYMMDDHHMM |
Date and Time of First Freeze of Specimen before Aliquoting |
3 |
THAW1DTM |
Text |
50 |
YYYYMMDDHHMM |
Date and Time of First Thaw of Specimen before Aliquoting |
3 |
FREZ2DTM |
Text |
50 |
YYYYMMDDHHMM |
Date and Time of Second Freeze of Specimen before Aliquoting |
3 |
THAW2YN |
Text |
1 |
1=yes; 0=no |
Were There Two or More Thaws of Specimen before Aliquoting? |
3§ |
EIADTTM |
Text |
50 |
YYYYMMDDHHMM |
Date and Time of First Reactive EIA |
5 |
ALIQDTTM |
Text |
50 |
YYYYMMDDHHMM |
Date and Time of Aliquoting |
3 |
VOLGENO |
Text |
3 |
Text |
Volume Aliquoted for Genotyping |
2 |
GFRZ1DTM |
Text |
50 |
YYYYMMDDHHMM |
Date and Time of First Freeze of Genotyping Aliquot |
2 |
GTHW1DTM |
Text |
50 |
YYYYMMDDHHMM |
Date and Time of First Thaw of Genotyping Aliquot |
3 |
GFRZ2DTM |
Text |
50 |
YYYYMMDDHHMM |
Date and Time of Second Freeze of Genotyping Aliquot |
3 |
GTHAW2YN |
Text |
1 |
1=yes; 0=no |
Were there 2 or More Thaws of Specimen Before Aliquoting? (Specimen for Genotyping) |
3§ |
VOLBACK |
Text |
3 |
Text |
Volume Aliquoted for Back-up Specimen |
4 |
BFRZ1DTM |
Text |
50 |
YYYYMMDDHHMM |
Date and Time of First Freeze of Back-up Specimen |
4 |
BTHW1DTM |
Text |
50 |
YYYYMMDDHHMM |
Date and Time of First Thaw of Back-up Specimen |
4 |
BFRZ2DTM |
Text |
50 |
YYYYMMDDHHMM |
Date and Time of Second Freeze of Back-up Specimen |
4 |
BTHAW2YN |
Text |
1 |
1=yes; 0=no |
Were there 2 or More Thaws Before Aliquoting? (Back-up Specimen) |
4 |
CNPOSDAT |
Text |
50 |
YYYYMMDDHHMM |
Date of Western Blot or Other Confirmatory Positive Test |
5 |
GSHPDATE |
Text |
50 |
YYYYMMDD |
Date of Shipment to Geno Lab |
3 |
GRESDATE |
Text |
50 |
YYYYMMDDHHMM |
Date and Time Genotyping Results Received at DOH |
4 |
NOTSENT |
Text |
1 |
0= Specimen was sent (default) |
If Specimen was not sent for genotyping, what was the reason for this? |
2 |
|
|
|
1= QNS |
|
|
|
|
|
2= Viral Load Not detectable |
|
|
|
|
|
3= Low Viral Load |
|
|
|
|
|
4= Lost |
|
|
|
|
|
5= Other |
|
|
AMPLIFY |
Text |
50 |
0= Yes (default) |
Did the Specimen Amplify? |
1 |
|
|
|
1= No |
|
|
|
|
|
8= Not attempted or unavailable for attempt |
|
|
|
|
|
9 = Unknown |
|
|
|
|
|
11=private/commercial lab |
|
|
SPOTDTTM |
Text |
50 |
YYYYMMDDHHMM |
Date and Time of Spotting |
6 |
DRYTIME |
Text |
4 |
Text |
Length of Drying Time (Hours) |
6 |
DRYLOC |
Text |
50 |
1 = Standard Laboratory |
Drying Location: |
6 |
|
|
|
2 = Mobile Laboratory |
|
|
|
|
|
3 = Field |
|
|
|
|
|
4 = Clinic |
|
|
|
|
|
5 = Other |
|
|
SPECIFYLOC |
Text |
50 |
Text |
Specify the drying location if DRYLOC = Other |
6 |
DIAGDFS |
Text |
4 |
1 = HIV Diagnostic Lab |
Where was dried fluid spot made? |
6 |
|
|
|
0 = Site other than HIV Diagnostic Lab |
|
|
RNALATER |
Text |
50 |
1 = Yes |
Was Specimen Collection Card Pretreated with RNALater? |
6 |
|
|
|
2 = No |
|
|
|
|
|
9 = Unknown |
|
|
LocationType |
Long Integer |
4 |
1 = DFS Collection Site |
Type of Site Where Specimen Was Handled |
6 |
|
|
|
2 = Public Health Laboratory |
|
|
|
|
|
3 = Other Laboratory |
|
|
|
|
|
4 =Storage Facility |
|
|
|
|
|
5 = Hospital |
|
|
|
|
|
6 = Other |
|
|
|
|
|
9 = Unknown |
|
|
StoreTemp |
Long Integer |
4 |
1 = Room Temperature |
Storage Temperature at Site |
6 |
|
|
|
2 = 4ºC |
|
|
|
|
|
3 = -20ºC |
|
|
|
|
|
4 = -70ºC |
|
|
StoreDTM |
Text |
50 |
YYYYMMDDHHMM |
Date and Time of Refrigeration or Freeze and Desiccant Addition at Site |
6 |
StoreDes |
Long Integer |
4 |
1=yes; 0=no |
Was Desiccant Changed Before or After Transport from This Site to Next Site? |
6 |
TransMeth |
Long Integer |
4 |
1 = US Mail |
Method of Transport from This Site to Next Site |
6 |
|
|
|
2 = FedEx/UPS/DHL |
|
|
|
|
|
3 = Local Courier |
|
|
|
|
|
4 = Lab/Health Department Staff |
|
|
|
|
|
5 = Other |
|
|
TransDTM |
Text |
50 |
YYYYMMDDHHMM |
Date and Time of Removal from Refrigeration or Freeze at Site |
6 |
TransCool |
Long Integer |
4 |
1=yes; 0=no |
Was cooler or dry ice used for transport? |
6 |
Nucleic Acid Sequence |
Text |
3000 |
Text |
Nucleic Acid Sequence |
1 |
* Required Variable Codes: 1=required for sequence reporting from any source (VARHS contract laboratory or private/commercial laboratory); 2=required if specimen was sequenced by the VARHS contract laboratory; 3=required if project area specimens are sequenced by the VARHS contract laboratory and the rate of amplification is less than 85%; 4=optional ; 5=no longer collected; 6=required for dried fluid spot specimens only.
† Variables were not included in the technical guidance because they are variables used to link VARHS data to HARS or are associated with surveillance processes.
‡ Variables were not included in the technical guidance because they are used to create the variable SpecimenID and so are implicitly required.
§ Variables were not included in the technical guidance but are associated with the variable GFRZ2+YN
File Type | application/msword |
File Title | Name |
Author | pas3 |
Last Modified By | pas3 |
File Modified | 2009-11-03 |
File Created | 2009-06-23 |