Transmittal of Surveilance Variables

Form Approved

OMB No. 0920-New

Expiration Date: XX/XX/XXXX

Cooperative Re-Engagement Controlled Trial (CoRECT)

Attachment #3

Electronic CoRECT clinic data variables

Public reporting burden of this collection of information is estimated to average 1 hour 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 person 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-NEW)

Attachment 3: Electronic surveillance variables

Data element #	Data element
	Variables collected from surveillance data or assigned by health department
	Collected at enrollment:
1	Unique patient study ID (not clinic ID)
2	State no (eHARS)
3	Month and year of birth
4	Biological sex of patient
5	Ethnicity of patient (OMB categories)
6	Race (OMB categories)
7	HIV exposure risk category
8	Date first tested HIV-positive
9	Lowest known CD4
10	Earliest known CD4 date
11	Trial classification (intervention vs. SOC)
	Collected at each visit:
12	Unique patient study ID
13	eHARS ID
14	Date of laboratory test (CD4 count or viral load)
15	CD4 count
16	Type of HIV-1 viral load assay
17	HIV-1 viral load result
18	Out of range indicator for viral load