Form 0920-0696 NHME Data Variables and Values

National HIV Prevention Program Monitoring and Evaluation (NHM&E)

Attachment D. Proposed 2018 NHME Data Variable Set (DVS) 0902-0696 May 2018

Community-Based Organization Report - NHME

OMB: 0920-0696

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0920-0696 can be found here:

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Attachment D: Proposed 2018 NHM&E Variables

NHM&E DATA
VARIABLES &
VALUES

National HIV
Prevention Program
Monitoring and
Evaluation (NHM&E)

NHM&E Data Variables and Values
Agency Level
Table A: General Agency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 1
Table S: Site Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 14

Client Level
Table CDC: CDC Use Variables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 21
Table G1: Client Characteristics-Demographic . . . . . . . . . . . . . . . . . . . . . . . . . Page 23
Table G2: Client Characteristics- Risk Profile . . . . . . . . . . . . . . . . . . . . . . . . . . Page 30
Table G4: Client Characteristics – Priority Populations . . . . . . . . . . . . . . . . . . . Page 41
Table H: Client Intervention Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 43
Table PCRS-1: Partner Services Case . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 46
Table PRCS-2: Partner Services Partner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 48
Table X-1: HIV Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 49
Table X-2: HIV Test History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 67
Table X-3: Attempt to Locate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 68
Table X-5: Elicit Partners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 70
Table X-6: Notification of Exposure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 72
Table X-7: Referral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 74

Aggregate Level Requirements
Table ME: Aggregate Level Variables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 107

XML Specific Fields
Table Z1: XML Specific Fields . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 109

Budget
Table BT: Budget Table . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 114

CBO
Table CBOTEST: Additional CBO Variables . . . . . . . . . . . . . . . . . . . . . . . . . . Page 135
Table CBOCL: CBO Client Summary Variables . . . . . . . . . . . . . . . . . . . . . . . . Page 142

Version Date: 14-May-2018

Data Variable Set (DVS)
Agency Level
Table: A

General Agency Information

This table is required to be completed by all directly funded grantees. It is also required for all agencies that indirectly receive CDC funds
for HIV prevention AND: 1) Provide HIV prevention services and/or 2) Provide contracts using CDC funds to support the provision of HIV
prevention services.

A01

Agency Name

Value Option: N/A

XSD (Schema) Name: agencyName

Format Type: Alpha-Numeric

Min Length: 1

Max Length: 100

Definition:

The official legal name of the agency or organization.

Instructions:

Enter the official legal name of the agency funded by CDC to provide HIV prevention programs.
Please note: for jurisdictions that upload CT data, there is currently no way to enter the actual name of the agency via
XML upload. The system substitutes the Agency ID for the name. System administrators can log into
EvaluationWeb® and update this field to their actual name.

Business rules:

HIV Testing: Required
Partner Services: Allowed, but not reported to CDC

A01a

Agency ID

Value Option: N/A

XSD (Schema) Name: agencyId
Format Type: Alpha-Numeric

Min Length: 1

Max Length: 32

Definition:

An alpha-numeric identification used to uniquely identify an agency.

Instructions:

Enter the unique agency ID generated by the CDC-funded agency. If using EvaluationWeb for direct key entry, this
number may be automatically generated by that system.

Business rules:

HIV Testing: Mandatory
Partner Services: Mandatory

A02

Jurisdiction
XSD (Schema) Name: populatedAreaValueCode

Value Option: Choose only one

Format Type: Number

Min Length: 2

Max Length: 3

Definition:

The CDC-directly funded state, territory, city area, or region where a state or city health department receives funding
to monitor HIV prevention activities. Each jurisdiction has a corresponding Federal Information Processing
Standards (FIPS) code.

Instructions:

Select the code of state, city or territory in which your agency is located. If uploading data to EvaluationWeb, submit
the two number FIPS code for your state or territory, not the value description or the name of the jurisdiction. FIPS
codes contain leading zeros when applicable.

Business rules:

HIV Testing: Mandatory
Partner Services: Required

Code

Value Description

Value Definition

Alabama

Alaska

Arizona

Arkansas

California

Colorado

Connecticut

Delaware

District of Columbia

Florida

Georgia

Hawaii

Idaho

Illinois

Indiana

Iowa

Kansas

Kentucky

Louisiana

Maine

Maryland

Massachusetts

Michigan

Minnesota

Mississippi

Missouri

Montana

Nebraska

Nevada

New Hampshire

New Jersey

New Mexico

New York

North Carolina

North Dakota

Ohio

Oklahoma

Oregon

Pennsylvania

Rhode Island

South Carolina

South Dakota

Tennessee

Texas

Utah

Vermont

Virginia

Washington

West Virginia

Wisconsin

Wyoming

American Samoa

Federated States of Micronesia

Guam

Marshall Islands

Northern Mariana Islands

Palau

Puerto Rico

Virgin Islands of the U.S.

San Francisco, CA

San Francisco Health Department

Los Angeles, CA

Los Angeles Health Department

New York City, NY

New York City Health Department

Houston, TX

Houston Health Department

Chicago, IL

City of Chicago Health Department

Philadelphia, PA

City of Philadelphia Health Department

Baltimore, MD

Baltimore City Health Department

A27
Value Option: N/A

CBO Agency Name

XSD (Schema) Name: CBOAgencyName
Format Type: Alpha-Numeric

Min Length: 1

Max Length: 100

Definition:

The official name of the community-based organization directly-funded by CDC to conduct HIV prevention activities.

Instructions:

Enter the official name of the community-based organization directly-funded by CDC to conduct HIV prevention activities.
Please note: for CBOs that upload CT data, there is currently no way to enter the actual name of the CBO via XML
upload. The system substitutes the CBO ID for the name. System administrators can log into EvaluationWeb® and
update this field to their actual name.

Business rule HIV Testing: Required, see business rule
Partner Services: Not applicable
Business rule for HIV testing:
Required for testing events funded by PS10-1003, PS11-1113 Category A or B, PS13-1310, and PS15-1502 (X137=5 or
6 or 8 or 9 or 11 or 13 or 14).
Not expected otherwise.

A28

CBO Agency ID

Value Option: N/A

XSD (Schema) Name: CBOAgencyID

Format Type: Alpha-Numeric

Min Length: 5

Max Length: 5

Definition:

An alpha-numeric identification assigned by CDC to community-based organizations that CDC has directly funded
since January 1, 2012.

Instructions:

Enter the CDC assigned CBO Agency ID.

Business rules:

HIV Testing: Mandatory, see additional business rule
Partner Services: Not applicable
Additional business rule for HIV testing:
Mandatory for testing events funded by PS10-1003, PS11-1113 Category A or B, PS13-1310, and PS15-1502
Category A or B; (X137=5 or 6 or 8 or 9 or 11 or 13 or 14).

Code

Value Description

Value Definition

AL001

Aletheia House

CDC directly funded community-based organization, Birmingham, AL

AL002

AIDS Alabama, Inc.

CDC directly funded community-based organization, Birmingham, AL

AL003

AIDS Action Coalition

CDC directly funded community-based organization, Huntsville, AL

AL004

Birmingham AIDS Outreach

CDC directly funded community-based organization, Birmingham, AL

AZ001

Southern Arizona AIDS Foundation

CDC directly funded community-based organization, Tucson, AZ

AZ002

Ebony House, Inc.

CDC directly funded community-based organization, Phoenix, AZ

AZ003

Native American Community Health Center, Inc.

CDC directly funded community-based organization, Phoenix, AZ

AZ004

Southwest Center for HIV/AIDS

CDC directly funded community-based organization, Phoenix, AZ

CA001

AmASSI Center of South Central Los Angeles

CDC directly funded community-based organization, Inglewood, CA

CA002

AIDS Healthcare Foundation

CDC directly funded community-based organization, Los Angeles, CA

CA003

AIDS Project Los Angeles

CDC directly funded community-based organization, Los Angeles, CA

CA004

AltaMed Health Services Corporation

CDC directly funded community-based organization, Los Angeles, CA

CA005

Bienestar Human Services

CDC directly funded community-based organization, Los Angeles, CA

CA006

Children's Hospital of Los Angeles

CDC directly funded community-based organization, Los Angeles, CA

CA007

Friends Research Institute, Inc./Friends Community Center

CDC directly funded community-based organization, Los Angeles, CA

CA008

JWCH Institute, Inc.

CDC directly funded community-based organization, Los Angeles, CA

CA009

Los Angeles Gay and Lesbian Center (Metro Homeless Youth
Services of LA)

CA010

Realistic Education in Action Coalition to Foster Health (REACH LA) CDC directly funded community-based organization, Los Angeles, CA

CA011

Special Service for Groups/Asian Pacific AIDS Intervention Team

CDC directly funded community-based organization, Los Angeles, CA

CA012

AIDS Project of the East Bay

CDC directly funded community-based organization, Oakland, CA

CA013

CA Prostitutes Education Project

CDC directly funded community-based organization, Oakland, CA

CA014

HIV Prevention Project of Alameda County

CDC directly funded community-based organization, Oakland, CA

CA015

La Clinica De la Raza, Inc.

CDC directly funded community-based organization, Oakland, CA

CA016

Center for AIDS Research Education & Services

CDC directly funded community-based organization, Sacramento, CA

CA017

Family Health Centers of San Diego

CDC directly funded community-based organization, San Diego, CA

CA018

Asian and Pacific Islander Wellness Center

CDC directly funded community-based organization, San Francisco,
CA

CA019

Larkin St. Youth Services

CDC directly funded community-based organization, San Francisco,
CA

CA020

Stop AIDS Project

CDC directly funded community-based organization, San Francisco,
CA

CA021

Centerforce

CDC directly funded community-based organization, San Rafael, CA

CA022

Tarzana Treatment Centers, Inc.

CDC directly funded community-based organization, Tarzana, CA

CA023

AIDS Services Foundation Orange County

CDC directly funded community-based organization, Irvine, CA CA024

Centro de Salud de San Ysidro dba San Ysidro Health Center

CDC directly funded community-based organization, San Diego, CA

CA025

Black AIDS Institute/African-American AIDS Policy & Training Institute CDC directly funded community-based organization, Los Angeles, CA

CA026

San Francisco AIDS Foundation

CDC directly funded community-based organization, San Francisco,
CA

CO001

Empowerment Program

CDC directly funded community-based organization, Denver, CO

CT001

Latinos Conta Cida (Latino Community Services, Inc.)

CDC directly funded community-based organization, Hartford, CT

DC001

Children's National Medical Center

CDC directly funded community-based organization, Washington, DC

DC002

Deaf-REACH

CDC directly funded community-based organization, Washington, DC

DC003

Sasha Bruce Youthwork, Inc.

CDC directly funded community-based organization, Washington, DC

DC004

The Women's Collective

CDC directly funded community-based organization, Washington, DC

DC005

Us Helping Us, People Into Living, Inc.

CDC directly funded community-based organization, Washington, DC

DC006

Washington Area Consortium on HIV Infection in Youth (dba Metro
Teen AIDS)

CDC directly funded community-based organization, Washington, DC

DC007

La Clinica Del Pueblo, Inc.

CDC directly funded community-based organization, Washington, DC

DC008

Family and Medical Counseling Service, Inc.

CDC directly funded community-based organization, Washington, DC

FL001

Broward House

CDC directly funded community-based organization, Fort Lauderdale,
FL

FL002

River Region Human Services

CDC directly funded community-based organization, Jacksonville, FL

FL003

Jacksonville Area Sexual Minority Youth Network (JASMYN)

CDC directly funded community-based organization, Jacksonville, FL

FL004

EmpowerU

CDC directly funded community-based organization, Miami, FL

FL005

Community AIDS Resource (dba Care Resource)

CDC directly funded community-based organization, Miami, FL

FL006

Miracle of Love

CDC directly funded community-based organization, Orlando, FL

FL007

Comprehensive AIDS Program of Palm Beach County, Inc.

CDC directly funded community-based organization, Palm Springs,

FL008

Gay Lesbian Community Center of Greater Fort Lauderdale

CDC directly funded community-based organization, Wilton Manors,
FL

FL009

Latinos Salud

CDC directly funded community-based organization, Wilton Manors,
FL

FL010

Hope and Help Center of Central FL, Inc.

CDC directly funded community-based organization, Winter Park, FL

FL011

Metropolitan Charities, Inc.

CDC directly funded community-based organization, St. Petersburg,
FL

GA001

Saint Joseph's Mercy Care Services

CDC directly funded community-based organization, Atlanta, GA

GA002

AID Atlanta, Inc.

CDC directly funded community-based organization, Atlanta, GA

GA003

Positive Impact, Inc.

CDC directly funded community-based organization, Atlanta, GA

GA004

AID Gwinnett

CDC directly funded community-based organization, Duluth, GA

GA005

Empowerment Resource Center

CDC directly funded community-based organization, Atlanta, GA

GA006

Recovery Consultants of Atlanta, Inc.

CDC directly funded community-based organization, Decatur, GA

GA007

Positive Impact Health Centers, Inc.

CDC directly funded community-based organization, Atlanta, GA

GA008

Atlanta HARM Reduction Coalition

CDC directly funded community-based organization, Atlanta, GA

GA009

Someone Cares, Inc. of Atlanta

CDC directly funded community-based organization, Marietta, GA

HI001

Life Foundation

CDC directly funded community-based organization, Honolulu, HI

IA001

AID Greater Des Moines, Inc. (AIDS Project of Central Iowa)

CDC directly funded community-based organization, Des Moines, IA

IL001

Access Community Health Network

CDC directly funded community-based organization, Chicago, IL

IL002

Center on Halsted

CDC directly funded community-based organization, Chicago, IL

IL003

Chicago House and Social Service Agency

CDC directly funded community-based organization, Chicago, IL

IL004

Christian Community Health Center

CDC directly funded community-based organization, Chicago, IL

IL005

Heartland Human Care Services

CDC directly funded community-based organization, Chicago, IL

IL006

CALOR

CDC directly funded community-based organization, Chicago, IL

IL007

McDermott Center (dba Haymarket Center)

CDC directly funded community-based organization, Chicago, IL

IL008

Puerto Rico Center (Puerto Rican Cultural Center)

CDC directly funded community-based organization, Chicago, IL

IL009

South Side Help Center

CDC directly funded community-based organization, Chicago, IL

IL010

Taskforce Prevention and Community Services

CDC directly funded community-based organization, Chicago, IL

IL011

Association House of Chicago

CDC directly funded community-based organization, Chicago, IL

IL012

Howard Brown Health Center

CDC directly funded community-based organization, Chicago, IL

KY001

Volunteers of America of Kentucky, Inc.

CDC directly funded community-based organization, Louisville, KY

LA001

HIV/AIDS Alliance for Region Two

CDC directly funded community-based organization, Baton Rouge, LA

LA002

Brotherhood, Inc.

CDC directly funded community-based organization, New Orleans, LA

LA003

Institute of Women and Ethnic Studies

CDC directly funded community-based organization, New Orleans, LA

LA004

NO/AIDS Task Force

CDC directly funded community-based organization, New Orleans, LA

MA001

Boston Medical Center

CDC directly funded community-based organization, Boston, MA

MA002

Fenway Community Health Center

CDC directly funded community-based organization, Boston, MA

MA003

Justice Resource Institute, Inc.

CDC directly funded community-based organization, Boston, MA

MA004

Massachusetts Alliance of Portuguese Speakers (MAPS)

CDC directly funded community-based organization, Cambridge, MA

MA005

Whittier Street Health Services

CDC directly funded community-based organization, Roxbury, MA

MD001

Women Accepting Responsibility

CDC directly funded community-based organization, Baltimore, MD

MD002

Identity, Inc.

CDC directly funded community-based organization, Gaithersburg,
MD

ME001

Regional Medical Center at Lubec

CDC directly funded community-based organization, Lubec, ME

MI001

Teen Hype Youth Development Program

CDC directly funded community-based organization, Detroit, MI

MI002

Community Health Awareness Group

CDC directly funded community-based organization, Detroit, MI

MN001

Indigenous People Task Force

CDC directly funded community-based organization, Minneapolis, MN

MN002

Minnesota AIDS Project

CDC directly funded community-based organization, Minneapolis, MN

MO001

Kansas City Free Health Clinic

CDC directly funded community-based organization, Kansas City, MO

MO002

The Community Wellness Project

CDC directly funded community-based organization, St. Louis, MO

MS001

Building Bridges, Inc.

CDC directly funded community-based organization, Jackson, MS

MS002

My Brother's Keeper, Inc.

CDC directly funded community-based organization, Ridgeland, MS

NC001

Carolina Cares Partnership (formerly Regional HIV/AIDS Consortium) CDC directly funded community-based organization, Charlotte, NC

NC002

Quality Home Care Services

CDC directly funded community-based organization, Charlotte, NC

NJ001

PROCEED

CDC directly funded community-based organization, Elizabeth, NJ

NJ002

Hyacinth, Inc. (dba Hyacinth AIDS Foundation)

CDC directly funded community-based organization, New Brunswick,
NJ

NJ003

Newark Beth Israel Medical Center

CDC directly funded community-based organization, Newark, NJ

NJ004

Newark Community Health Centers

CDC directly funded community-based organization, Newark, NJ

NJ005

North Jersey AIDS Alliance (dba North Jersey Community Research
Initiative)

CDC directly funded community-based organization, Newark, NJ

NY001

AIDS Council of Northeastern New York

CDC directly funded community-based organization, Albany, NY

NY002

Whitney M Young Jr. Health Services

CDC directly funded community-based organization, Albany, NY

NY003

BOOM! Health (Bronx AIDS Services, Inc.)

CDC directly funded community-based organization, Bronx, NY

NY004

CitiWide Harm Reduction Program

CDC directly funded community-based organization, Bronx, NY

NY005

Montefiore Medical Center/Women's Center

CDC directly funded community-based organization, Bronx, NY

NY006

Brookdale University Hospital and Medical Center

CDC directly funded community-based organization, Brooklyn, NY

NY007

Brooklyn AIDS Task Force

CDC directly funded community-based organization, Brooklyn, NY

NY008

Lutheran Family Health Center Network of Luther Medical Center

CDC directly funded community-based organization, Brooklyn, NY

NY009

Wyckoff Heights Medical Center

CDC directly funded community-based organization, Brooklyn, NY

NY010

AIDS Community Services of Western New York

CDC directly funded community-based organization, Buffalo, NY

NY011

Long Island Association for AIDS Care, Inc.

CDC directly funded community-based organization, Hauppauge, NY

NY012

AIDS Service Center of Lower Manhattan, Inc.

CDC directly funded community-based organization, New York, NY

NY013

Asian and Pacific Islander Coalition on HIV/AIDS, Inc. (APICHA)

CDC directly funded community-based organization, New York, NY

NY014

Community Health Project

CDC directly funded community-based organization, New York, NY

NY015

Exponents

CDC directly funded community-based organization, New York, NY

NY016

Foundation for Research on Sexually Transmitted Diseases
(FROSTD)

CDC directly funded community-based organization, New York, NY

NY017

Gay Men's Health Crisis

CDC directly funded community-based organization, New York, NY

NY018

Harlem United Community AIDS Center

CDC directly funded community-based organization, New York, NY

NY019

Hispanic AIDS Forum

CDC directly funded community-based organization, New York, NY

NY020

Iris House A Center for Women Living with HIV

CDC directly funded community-based organization, New York, NY

NY021

Latino Commission on AIDS

CDC directly funded community-based organization, New York, NY

NY022

Planned Parenthood of New York City, Inc.

CDC directly funded community-based organization, New York, NY

NY023

Safe Horizon

CDC directly funded community-based organization, New York, NY

NY024

The Door - A Center for Alternatives, Inc.

CDC directly funded community-based organization, New York, NY

NY025

The Hetrick-Martin Institute

CDC directly funded community-based organization, New York, NY

NY026

The Partnership for the Homeless

CDC directly funded community-based organization, New York, NY

NY027

Community Health Action of Staten Island

CDC directly funded community-based organization, Staten Island,
NY

NY028

The Sharing Community

CDC directly funded community-based organization, Yonkers, NY

NY029

AIDS Center of Queens County, Inc.

CDC directly funded community-based organization, Jamaica, NY

NY030

Harlem Hospital Center/NYC Health & Hospitals Corporation

CDC directly funded community-based organization, New York, NY

NY031

North Shore University

CDC directly funded community-based organization, Manhasset, NY

NY032

William F. Ryan Community Health Center

CDC directly funded community-based organization, New York, NY

NY033

Women's Prison Association & Home

CDC directly funded community-based organization, New York, NY

OH001

AIDS Resource Center Ohio

CDC directly funded community-based organization, Columbus, OH

OH002

Recovery Resources

CDC directly funded community-based organization, Cleveland, OH

OK001

Guiding Right, Inc.

CDC directly funded community-based organization, Midwest City, OK

OR001

Cascade AIDS Project

CDC directly funded community-based organization, Portland, OR

PA001

AIDS Care Group

CDC directly funded community-based organization, Chester, PA

PA002

Family Planning Council

CDC directly funded community-based organization, Philadelphia, PA

PA003

Mazzoni Center

CDC directly funded community-based organization, Philadelphia, PA

PA004

Philadelphia Fight

CDC directly funded community-based organization, Philadelphia, PA

PA005

Public Health Management Corp (dba Philadelphia Health
Management)

CDC directly funded community-based organization, Philadelphia, PA

PA006

The Philadelphia AIDS Consortium

CDC directly funded community-based organization, Philadelphia, PA

PR001

Corporacion de Salud Y Medicina Avanzada (COSSMA)

CDC directly funded community-based organization, Cidra, PR PR002

12
Estancia Corazon (Program Fondita)

CDC directly funded community-based organization, Mayaguez, PR

PR003

Migrant Health Center, Western Region, Inc.

CDC directly funded community-based organization, Mayaguez, PR

PR004

ASPIRA of Puerto Rico

CDC directly funded community-based organization, San Juan, PR

PR005

COAI, Inc.

CDC directly funded community-based organization, San Juan, PR

PR006

Puerto Rico Community Network for Clinical Research on AIDS (PR
CONCRA)

CDC directly funded community-based organization, San Juan, PR

SC001

Palmetto AIDS Life Support Services of SC, Inc.

CDC directly funded community-based organization, Columbia, SC

SC002

South Carolina HIV/AIDS Council

CDC directly funded community-based organization, Columbia, SC

TN001

Women on Maintaining Education and Nutrition

CDC directly funded community-based organization, Nashville, TN

TN002

Le Bonheur Community Health and Well-Being

CDC directly funded community-based organization, Memphis, TN

TN003

Nashville CARES

CDC directly funded community-based organization, Nashville, TN

TX001

AIDS Services of Austin, Inc.

CDC directly funded community-based organization, Austin, TX

TX002

The Wright House Wellness Center

CDC directly funded community-based organization, Austin, TX

TX003

Coastal Bend AIDS Foundation

CDC directly funded community-based organization, Corpus Christi,
TX

TX004

Abounding Prosperity, Inc.

CDC directly funded community-based organization, Dallas, TX

TX005

AIDS Arms, Inc.

CDC directly funded community-based organization, Dallas, TX

TX006

Parkland Health and Hospital System

CDC directly funded community-based organization, Dallas, TX

TX007

Urban League of Greater Dallas, Inc.

CDC directly funded community-based organization, Dallas, TX

TX008

AIDS Foundation Houston, Inc.

CDC directly funded community-based organization, Houston, TX

TX009

Change Happens (formerly Families Under Urban and Social Attack,
Inc.)

CDC directly funded community-based organization, Houston, TX

TX010

Houston Area Community Services, Inc. (HACS)

CDC directly funded community-based organization, Houston, TX

TX011

Legacy Community Health Services, Inc.

CDC directly funded community-based organization, Houston, TX

TX012

St. Hope Foundation

CDC directly funded community-based organization, Houston, TX

TX013

South Texas Council on Alcohol and Drug Abuse

CDC directly funded community-based organization, Laredo, TX

TX014

Beat AIDS Coalition Trust

CDC directly funded community-based organization, San Antonio, TX

VA001

ACCESS AIDS Care

CDC directly funded community-based organization, Norfolk, VA

VI001

Virgin Islands Community AIDS Resource & Education (VICARE)

CDC directly funded community-based organization, Christiansted, VI

VI002

Helping Others in a Positive Environment, Inc. (HOPE)

CDC directly funded community-based organization, St. Thomas, VI

VI003

Frederiksted Health Care, Inc.

CDC directly funded community-based organization, St. Croix, VI

WA001

Neighborhood House

CDC directly funded community-based organization, Seattle, WA

WA002

People of Color Against AIDS Network

CDC directly funded community-based organization, Seattle, WA

WI001

Diverse and Resilient, Inc.

CDC directly funded community-based organization, Milwaukee, WI

Table: S

Site Information

A site is a facility or non-facility based setting (e.g. park, street corner), which serves as a point of service delivery. If an agency has
multiple sites, this table is completed for each site. However, if an agency has multiple sites with the same zip code that are of the same
site type, the agency may use a single site name and ID for the encompassing locations. For example, a mobile van that rotates to
several sites within the same zip code.

S01

Site ID

XSD (Schema) Name: siteId

Value Option: N/A
Definition:

Format Type: Alpha-Numeric

Min Length: 1

Max Length: 32

A unique alpha-numeric identification code used to distinguish the locations where an agency delivers the HIV
prevention service.
A site ID is unique to an agency.
For Partner services (PS), the Site ID distinguishes between the agency site locations and should identify the locality
where the PS case is assigned (i.e., the county health department).

Instructions:

Indicate the unique alpha-numeric ID that will be used to link prevention services delivered by a particular agency to a
specific geographic area and type of setting. If using EvaluationWeb for direct key entry, this ID may be generated for
you.
If a mobile van is used, an agency may assign the same ID to sites that are of the same type AND located within the
same zip code (e.g., all churches in 39126).

Business rules:

S03

HIV Testing: Mandatory
Partner Services: Mandatory

Service Delivery Site Name

Value Option: N/A

XSD (Schema) Name: site/name
Format Type: Alpha-Numeric

Min Length: 1

Max Length: 100

Definition:

The official name of the agency's HIV prevention site of service delivery.

Instructions:

Enter the official name of the site where your agency provides HIV prevention services. The Site Name must be
unique for each site supported by your agency. If your agency’s services are delivered at the same place your
administrative office is located, then this site will automatically be entered in EvaluationWeb. Note: Please provide
the official name for your agency’s HIV prevention site, even though some staff and community residents may refer
to it as something other than its official name.

Business rules:

HIV Testing: Required
Partner Services: Allowed, but not reported to CDC

S04

Site Type

Value Option: Choose only one

XSD (Schema) Name: siteTypeValueCode

Format Type: Alpha-Numeric

Min Length: 3

Max Length: 6

Definition:

The setting of the location in which HIV prevention services are provided. For PS, this is the type of local agency to
which the PS case is assigned.

Instructions:

Select the site type from the list provided that best represents the setting and/or primary type of services offered at
this site of service delivery. You can only choose one site type.

Business rules:

HIV Testing: Required
Partner Services: Required

Code

Value Description

Value Definition

F01.01

Clinical - Inpatient hospital

A health facility that provides medical care to patients that reside
within that facility while they are receiving those services.

F02.12

Clinical - TB clinic

A non-residential health care facility that specializes in the provision
of tuberculosis treatment, care and prevention services.

F02.19

Clinical - Substance abuse treatment facility

A non-residential health care facility that provides alcohol and
chemical dependency treatment services.

F02.51

Clinical - Community health center

A non-residential health care facility that provides primary and
preventative health care services to the members of a community in
which it is located.

F03

Clinical - Emergency department

A section of a hospital or clinic staffed and equipped to provide
emergency care to persons requiring immediate medical treatment
for sudden illness or trauma.

F04.05

Non-clinical - HIV testing site

A facility or non-facility based setting where HIV prevention
counseling and testing services are provided.

F06.02

Non-clinical - Community setting - School/educational facility

A building or place where individuals receive knowledge through
learning and instruction.

F06.03

Non-clinical - Community setting - Church/mosque/synagogue/temple A building where a group of people who adhere to a common faith
gather for prayer.

F06.04

Non-clinical - Community Setting - Shelter/transitional housing

A building or facility that provides supportive housing temporarily or
may be used to facilitate the movement of homeless individuals and
families to permanent housing.

F06.05

Non-clinical - Community setting - Commercial facility

A business or commercial facility (e.g., beauty salon, grocery store,
shopping center) where HIV prevention services may also occur.

F06.07

Non-clinical - Community setting - Bar/club/adult entertainment

A place of entertainment, typically open at night, usually serves food
and alcoholic beverages, and often provides music and space for
dancing or having a floor show which may depict, describe, or relate
to sexual conduct or sexual excitement.

F06.08

Non-clinical - Community setting - Public area

An area, environment or context that is open to the community as a
whole such as a park or city street.

F06.12

Non-clinical – Community setting – Individual residence

An individual’s home or place of residence.

F06.88

Non-clinical - Community setting - Other

A defined area, environment or context (other than those already
specified) in which a group of people live, work or congregate.

F07

Non-clinical - Correctional facility - Non-healthcare

A penal or correctional facility, prison, jail detention center,
community-based rehabilitation center, or any similar institution
designed for the confinement or rehabilitation of criminal offenders

F08

Clinical - Primary care clinic (other than CHC)

A health care facility in which medical care is provided by a clinician
to a patient as part of regular, ambulatory care, and sometimes
followed by referral to other medical providers.

F09

Clinical - Pharmacy or other retail-based clinic

A health care facility or business in which prescription and nonprescription drugs and/or medical equipment are dispensed. Primary
care clinical services may be provided by a practicing nurse or
pharmacist at the facility.

F10

Clinical - STD clinic

A health care facility in which sexual health is specialized in the
prevention and treatment of sexually transmitted infections.

F11

Clinical - Dental clinic

A health care facility in which care is provided for dental patients.
The facility may provide various treatments for the teeth, e.g.
cleaning, X-rays, fillings, extractions, and root canal surgery.

F12

Clinical - Correctional facility clinic

An area within a penal or correctional facility, , including adult or
juvenile detention facilities, that provides medical or health services.

F13

Clinical - Other

A health care facility where medical services are provided, other than
those specified.

F14

Non-clinical - Health department - field visit

Services are provided in an unspecified location away from the
clinician’s usual place of business, except for Correctional Institution,
Inpatient, or Residential Care for adults or children. An example may
be the clients’ home or place of employment.

F15

Non-clinical - Community Setting - Syringe exchange program

A facility or center where clients may exchange used hypodermic
needles for sterile needles.

F40

Mobile Unit

A specialized vehicle used to provide HIV prevention services beyond
the transport of agency staff to the field and/or for client recruitment.

F88

Non-clinical - Other

A site where prevention services are conducted other than those
specified above.

S08

Site - County

Value Option: Choose only one

XSD (Schema) Name: site/county

Format Type: Alpha-Numeric

Min Length: 3

Max Length: 3

Definition:

The county, parish, or municipality where the agency's site of service delivery is physically located.

Instructions:

Indicate the FIPS code of the county where the site of service delivery is physically located. Note: Site County FIPS
codes are unique within a jurisdiction.

Business rules:

HIV Testing: Required
Partner Services: Allowed, but not reported to CDC

S09

Site - State

Value Option: Choose only one

XSD (Schema) Name: site/State

Format Type: Alpha-Numeric

Min Length: 2

Max Length: 2

Definition:

The numeric FIPS code for the state, territory or district in which the official mailing address for the site is physically
located.

Instructions:

Select the value code (numeric FIPS code, not state/territory abbreviation) for the name of the state, territory or
district where the site you entered for variable S03: Site Name is located. This must represent one of the 50 states,
the District of Columbia, the U.S. Virgin Islands, or Puerto Rico. The value codes are numeric FIPS codes and
contain leading zeros. Do not submit your state or territory abbrevision.

Business rules:

HIV Testing: Required
Partner Services: Allowed, but not reported to CDC

Code

Value Description

Value Definition

Alabama

Alaska

Arizona

Arkansas

California

Colorado

Connecticut

Delaware

District of Columbia

Florida

Georgia

Hawaii

Idaho

Illinois

Indiana

Iowa

Kansas

Kentucky

Louisiana

Maine

Maryland

Massachusetts

Michigan

Minnesota

Mississippi

Missouri

Montana

Nebraska

Nevada

New Hampshire

New Jersey

New Mexico

New York

North Carolina

North Dakota

Ohio

Oklahoma

Oregon

Pennsylvania

Rhode Island

South Carolina

South Dakota

Tennessee

Texas

Utah

Vermont

Virginia

Washington

West Virginia

Wisconsin

Wyoming

American Samoa

Federated States of Micronesia

Guam

Marshall Islands

Northern Mariana Islands

Palau

Puerto Rico

Virgin Islands of the U.S.

S10

Site - Zip Code

Value Option: N/A

XSD (Schema) Name: site/zip
Format Type: Alpha-Numeric

Min Length: 5

Max Length: 10

Definition:

The postal zip code associated with the site where services are provided. The site's postal zip code is linked to the
unique Site ID and Site Type.

Instructions:

Enter the postal zip code for the site of service delivery.

Business rules:

HIV Testing: Required
Partner Services: Allowed, but not reported to CDC

Code

Value Description
#####-####

Value Definition
Only the 5 digit zip code is required.

Client Level
This table is for CDC use only. All variables are defined by the CDC for grantee use.
Table: CDC

CDC Use Variables

CDC06

CDC Variable 6

Value Option: TBD

XSD (Schema) Name: otherCdcVariable6
Format Type: TBD

Definition:

TBD

Instructions:

TBD

Min Length: TBD

Max Length: TBD

Business rule HIV Testing: Allowed, but not reported to CDC
Partner Services: Not applicable

CDC07

CDC Variable 7

Value Option: TBD
Definition:

TBD

Instructions:

TBD

XSD (Schema) Name: otherCdcVariable7
Format Type: TBD

Business rule HIV Testing: Allowed, but not reported to CDC
Partner Services: Not applicable

Min Length: TBD

Max Length: TBD

CDC08

CDC Variable 8

Value Option: TBD

XSD (Schema) Name: otherCdcVariable8

Format Type: TBD

Definition:

TBD

Instructions:

TBD

Min Length: TBD

Max Length: TBD

Business rule HIV Testing: Allowed, but not reported to CDC
Partner Services: Not applicable

CDC09

CDC Variable 9

Value Option: TBD

XSD (Schema) Name: CDCVariable9
Format Type: Alpha-Numeric

Min Length: 1

Definition:

This field will be dedicated for Partner Services use. Use is TBD.

Instructions:

Dedicated for Partner Services

Max Length: 100

Business rule
CDC10

CDC Variable 10

Value Option: TBD

XSD (Schema) Name: CDCVariable10
Format Type: Alpha-Numeric

Definition:

This field will be dedicated for Partner Services use. Use is TBD.

Instructions:

Dedicated for Partner Services

Business rule

Min Length: 1

Max Length: 100

Table: G1

Client Characteristics-Demographic

This table is required to be completed by all agencies that provide HIV prevention interventions or services individually to clients (e.g.,
HIV testing).

G101

Date Client Demographic Data Collected

Value Option: N/A

XSD (Schema) Name: collectedDateForClient

Format Type: MM/DD/YYYY

Min Length: 8

Max Length: 10

Definition:

The date on which client demographic data or other information is collected. For reporting to CDC, this should be the
intake date or the date of the first session before the intervention begins.

Instructions:

Enter the date that client demographic data are collected. This should be the intake date or the date of the first
session before the intervention begins.

Business rules:

HIV Testing: Not applicable
Partner Services: Required
Cannot be greater than the current date at the time of data entry.

G103

Local Client ID

Value Option: N/A

XSD (Schema) Name: localClientId
Format Type: Alpha-Numeric

Min Length: 1

Max Length: 32

Definition:

A locally developed alpha-numeric unique client identification code used to distinguish an individual client receiving
multiple services within an agency.

Instructions:

This code can be shared and used by more than one agency throughout a city, territory or state. This code should
not contain personal information that is organized in a way that can be easily deciphered (e.g., birth date, month and
year).

Business rules:

HIV Testing: Allowed, but not reported to CDC
Partner Services: Mandatory
This ID must be unique for each client. At a minimum this ID needs to be unique within an agency.

G112

Date of Birth - Year

Value Option: N/A

XSD (Schema) Name: birthYear

Format Type: Number

Min Length: 4

Definition:

The calendar year in which the client was born.

Instructions:

Enter the year in which the client was born. If birth year is unknown, enter 1800.

Business rules:

HIV Testing: Required
Partner Services: Required

Max Length: 4

Value must be ≥ 1900 or = 1800 if birth year is unknown.
G114

Ethnicity

Value Option: Choose only one

XSD (Schema) Name: ethnicity
Format Type: Alpha-Numeric

Min Length: 2

Max Length: 2

Definition:

The client's self-report of whether they are of Hispanic or Latino origin. Standard OMB ethnicity codes are applied.

Instructions:

Indicate whether the client's self-reported ethnicity of Hispanic/Latino or not Hispanic/Latino.

Business rules:

HIV Testing: Required
Partner Services: Required

Code

Value Description

Value Definition

Declined to answer

The client declines or is unwilling to report his or her ethnicity.

Don't know

The client reports that he or she is unaware of his or her ethnicity.

Hispanic or Latino

A person of Cuban, Mexican, Puerto Rican, South or Central
American, or other Spanish culture or origin, regardless of race.

Not Hispanic or Latino

A person not identified by the definition of Hispanic or Latino.

G116

Race

XSD (Schema) Name: raceValueCode

Value Option: Choose all that apply

Format Type: Alpha-Numeric

Min Length: 2

Max Length: 2

Definition:

A client's self-reported classification or classifications of the biological heritage with which they most closely identify.
Standard OMB race codes are applied.

Instructions:

Indicate the client’s self-reported race(s) using standard OMB race codes. Record all race categories that the client
reports.

Business rules:

HIV Testing: Required, see detailed business rule regarding multiple responses
Partner Services: Required, see detailed business rule regarding multiple responses
Detailed business rule:
Multiple value codes may be selected if value code ≠ 55 or 77 or 99. Not specified should only be selected if
ethnicity is Hispanic or Latino (ethnicity = E1) and no other race is indicated.

Code

Value Description

Value Definition

Not specified

The client reported that he or she is of Hispanic or Latino descent,
but did not specify their race.

Declined to answer

The client declines or is unwilling to report his or her race.

Don't know

The client reports that he or she is unaware of their race.

American Indian or Alaska Native

A person having origins in any of the original peoples of North or
South America (including Central America), and who maintains tribal
affiliation or community attachment.

Asian

A person having origins in any of the original peoples of the Far East,
Southeast Asia, or the Indian Subcontinent including, for example,
Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the
Philippine Islands, Thailand, and Vietnam.

Black or African American

A person having origins in any of the black racial groups of Africa.

Native Hawaiian or Pacific Islander

A person having origins in any of the original peoples of Hawaii,
Guam, Samoa, or other Pacific Islands.

White

A person having origins in any of the original peoples of Europe, the
Middle East, or North Africa.

G120

State/Territory of Residence

Value Option: Choose only one

XSD (Schema) Name: stateOfResidence

Format Type: Number

Min Length: 2

Max Length: 2

Definition:

The state, territory or district where the client was residing at the time of service delivery.

Instructions:

Select the value code for the state, territory or district where the client lives at the time services are delivered. In
some cases, where the client lives may not be the same as where the client is receiving HIV prevention services.
For example, a person could reside in one state (or jurisdiction) but drive to another state to receive HIV testing out
of fear of having their privacy or confidentiality exposed. Leading zeros are retained as the value codes are FIPS

Business rules:

HIV Testing: Required
Partner Services: Allowed, but not reported to CDC

Code

Value Description

Value Definition

Alabama

Alaska

Arizona

Arkansas

California

Colorado

Connecticut

Delaware

District of Columbia

Florida

Georgia

Hawaii

Idaho

Illinois

Indiana

Iowa

Kansas

Kentucky

Louisiana

Maine

Maryland

Massachusetts

Michigan

Minnesota

Mississippi

Missouri

Montana

Nebraska

Nevada

New Hampshire

New Jersey

New Mexico

New York

North Carolina

North Dakota

Ohio

Oklahoma

Oregon

Pennsylvania

Rhode Island

South Carolina

South Dakota

Tennessee

Texas

Utah

Vermont

Virginia

Washington

West Virginia

Wisconsin

Wyoming

American Samoa

Federated States of Micronesia

Guam

Marshall Islands

Northern Mariana Islands

Palau

Puerto Rico

Virgin Islands of the U.S.

Other

Client does not currently reside in a US state, territory, or district.

G123

Assigned Sex at Birth

Value Option: Choose only one

XSD (Schema) Name: birthGenderValueCode
Format Type: Number

Min Length: 1

Max Length: 2

Definition:

The biological sex assigned to the client at birth, (i.e., the sex noted on the client's birth certificate).

Instructions:

Indicate whether the client reports being born a male or female (i.e., born with male or female genitalia).

Business rules:

HIV Testing: Required
Partner Services: Required

Code

Value Description

Value Definition

Male

The sex that produces spermatozoa by which female ova are
fertilized.

Female

The sex that produces ova, can conceive and bear offspring/children.

Declined to answer

The client declines or is unwilling to report his or her assigned sex at
birth.

G124

Current Gender Identity

Value Option: Choose only one

XSD (Schema) Name: currentGenderValueCode

Format Type: Number

Min Length: 1

Max Length: 2

Definition:

The client's current self-reported gender identity. This may include one's social status, self-identification, legal status,
and biology.

Instructions:

Select the value that most closely describes the client's current, self-reported gender identity.

Business rules:

HIV Testing: Required
Partner Services: Required

Code

Value Description

Value Definition

Male

A person who identifies as a male and whose behavioral, cultural, or
psychological traits are typically associated with the male sex.

Female

A person who identifies as a female and whose behavioral, cultural,
or psychological traits are typically associated with the female sex.

Transgender - Male to Female

Individuals whose physical or birth sex is male but whose gender
expression and/or gender identity is female. MTF = male to female.

Transgender - Female to Male

Individuals whose physical or birth sex is female but whose gender
expression and/or gender identity is male. FTM = female to male.

Transgender - Unspecified

Individuals whose physical or birth sex is male or female but whose
gender expression and/or gender identity differs from that which was
documented at birth.

Another Gender

Individuals whose physical or birth sex is male or female but whose
gender expression or gender identity is other than male or female.

Declined to answer

The individual declines to self report his or her current gender identity.

G132

Client - County

Value Option: N/A

XSD (Schema) Name: clientCounty
Format Type: Alpha-Numeric

Min Length: 3

Definition:

The county, parish, or municipality of the client's locating address.

Instructions:

Enter the three-digit FIPS code of the county where the client’s address is located.

Business rules:

HIV Testing: Required
Partner Services: Allowed, but not reported to CDC

Max Length: 3

G134

Client - Zip Code

Value Option: N/A

XSD (Schema) Name: clientZipCode

Format Type: Alpha-Numeric

Definition:

The postal zip code for the client's locating address.

Instructions:

Enter the postal zip code of the client’s locating address.

Min Length: 5

Max Length: 10

These data are collected from clients but not reported to CDC.
Business rules:

Code

HIV Testing: Allowed, but not reported to CDC
Partner Services: Allowed, but not reported to CDC

Value Description
#####-####

Table: G2

Value Definition
Only the 5 digit zip code is mandatory.

Client Characteristics-Risk Profile

This table is required to be completed by all agencies when data are collected on individual clients. This could be part of interventions or
services delivered individually (e.g., HIV testing).

G200

Date Client Risk Collected

Value Option: N/A

XSD (Schema) Name: dateCollectedForRiskProfile

Format Type: MM/DD/YYYY

Min Length: 8

Max Length: 10

Definition:

The date client risk profile data are collected. For reporting to CDC, this should be the intake date or the date of the
first session before the intervention begins.

Instructions:

Enter the date on which these risk profile data are collected. This should be the intake date or the date of the first
session before the intervention begins.

Business rules:

HIV Testing: Not applicable
Partner Services: Required
The client risk profile date collected must be equal or greater than case open date. Date collected cannot be greater
than the date of file submission to CDC.

G204

Previous HIV Test

Value Option: Choose only one

XSD (Schema) Name: previousHivTestValueCode

Format Type: Number

Min Length: 1

Definition:

The client's self-report of having had at least one prior HIV test.

Instructions:

Indicate if the client reports having at least one prior HIV test.

Business rules:

HIV Testing: Required
Partner Services: Required

Max Length: 2

Code

Value Description

Value Definition

The client reports that he or she has never had an HIV test.

Yes

The client reports that he or she has had at least one previous HIV
test.

Don't know

The client reports that he or she is unaware if he or she has had a
previous HIV test.

G205a

Previous HIV Test Result

Value Option: Choose only one

XSD (Schema) Name: previousHIVTestResult

Format Type: Alpha-Numeric

Min Length: 1

Max Length: 2

Definition:

The client's result from his/her most recent HIV test confirmed through record review or surveillance.

Instructions:

If the client reports having had a previous HIV test (i.e., G204: Previous HIV Test = “Yes”), then indicate the client’s
HIV test result as found using a record review or surveillance report. If no report found, may use self-report as
alternative.

Business rules:

HIV Testing: Not applicable
Partner Services: Required

Code

Value Description

Value Definition

Record Found- Positive

Client's HIV status is positive as reported by a medical care provider,
medical record review, other record review, other database (e.g.,
CareWare), or HIV-related laboratory report.

Record Found-Negative

Client's HIV status is negative as reported by a medical care provider,
medical record review, other record review, other database (e.g.,
CareWare), or HIV-related laboratory report.

Record Found- Preliminary Positive

The client had a reactive HIV rapid test but has not received a
conventional confirmatory test as reported by a medical care
provider, medical record review, other record review, other database
(e.g., CareWare), or HIV-related laboratory report.

Record Found-Indeterminate

The client’s results did not conclusively indicate whether he or she is
HIV-positive or HIV-negative as reported by a medical care provider,
medical record review, other record review, other database (e.g.,
CareWare), or HIV-related laboratory report.

No Record Found-Self Report Negative

The client reports that his or her HIV status is negative.

No Record Found-Self Report Positive

The client reports that his or her HIV status is positive based on a
confirmatory test result.

No Record Found- No Self Report

No HIV test result found from a medical care provider, medical
record review, other record review, other database (e.g., CareWare),
or HIV-related laboratory report and the client did not provide an HIV
test result.

G209

Pregnant (Only If Female)

Value Option: Choose only one
Definition:

XSD (Schema) Name: pregnantStatusValueCode

Format Type: Number

Min Length: 1

Max Length: 2

The self-reported pregnancy status of a client with a preliminary or confirmed positive HIV test.
Prior to 2012, these data were collected for only confirmed positive female clients. Currently, they are collected for
both confirmed (conventional, RNA, NAAT or other test) or preliminary (rapid test) positive female clients.

Instructions:

If the client is female and HIV-positive, from any HIV test (conventional, rapid, NAAT, RNA or other), then indicate
whether she is pregnant.

Business rules:

HIV Testing: Required, see detailed business rule
Partner Services: Not applicable
Detailed business rule:
Required for birth gender females (birthGenderValueCode=2) with any positive HIV test (X125 = 1 or 2 or 6 or 7 or 8
or 9).

Code

Value Description

Value Definition

The client reports she is not pregnant.

Yes

The client reports she is pregnant.

Declined to answer

The client declines or is unwilling to report if she is currently pregnant.

Don't know

The client reports that she is unaware if she is currently pregnant.

G210

In Prenatal Care (Only if Pregnant)

Value Option: Choose only one
Definition:

Format Type: Number

XSD (Schema) Name: prenatalCareStatusValueCode

Min Length: 1

Max Length: 2

The self-reported status of the HIV-positive pregnant client's receipt of regular health care during pregnancy.
Prior to 2012, these data were collected for only confirmed positive pregnant female clients. Currently, they are
collected for both confirmed (conventional, RNA, NAAT or other test) or preliminary (rapid test) positive pregnant
clients.

Instructions:

If the client is HIV-positive and pregnant (G209: Pregnant = “Yes”), indicate whether she is receiving prenatal care.

Business rules:

HIV Testing: Required
Partner Services: Not applicable
Detailed business rule:
Required for pregnant females (pregnantStatusValueCode=1).

Code

Value Description

Value Definition

The client reports she is not currently receiving prenatal care.

Yes

The client reports she is currently receiving prenatal care.

Not asked

The provider did not ask the client if she was currently receiving
prenatal care.

Declined to answer

The client declines or is unwilling to report if she is currently receiving
prenatal care.

Don't know

The client reports that she is unaware if she is currently receiving
prenatal care.

G211_01

Injection Drug Use

Value Option: Choose only one

XSD (Schema) Name: injectionDrugUse

Format Type: Number

Min Length: 1

Max Length: 2

Definition:

The client self-reported use in the past 12 months of any injection drugs/substances (including narcotics, hormones,
silicon, etc.).

Instructions:

Indicate if the client reported having used injection drugs within the last 12 months.

Business rules:

HIV Testing: Not applicable
Partner Services: Required

Code

Value Description

Value Definition

Client indicates that he/she did not engage in injection drug use in
the past 12 months.

Yes

Client indicates that he/she engaged in injection drug use in the past
12 months.

Not Asked

The provider did not ask the client that he/she engaged in injection
drug use in the past 12 months.

Declined to Answer

The client declines or is unwilling to report if he/she engaged in
injection drug use in the past 12 months.

G216a

Vaginal or Anal Sex with a Male

Value Option: Choose only one

Format Type: Number

XSD (Schema) Name: withMale

Min Length: 1

Definition:

The client self-reported having vaginal or anal sex with a male in the past 12 months.

Instructions:

Indicate if the client reported vaginal or anal sex in the past 12 months with a male.

Business rules:

HIV Testing: Not applicable
Partner Services: Required

Max Length: 2

Code

Value Description

Value Definition

Client indicates that he or she did not have vaginal or anal sex with a
male in the past 12 months.

Yes

Client indicates that he or she had vaginal or anal sex with a male in
the past 12 months.

Not Asked

The provider did not ask the client that he or she had vaginal or anal
sex with a male in the past 12 months.

Declined to Answer

The client declines or is unwilling to report if he or she had vaginal or
anal sex with a male in the past 12 months.

G216b

Vaginal or Anal Sex with a Female

Value Option: Choose only one

Format Type: Number

XSD (Schema) Name: withFemale

Min Length: 1

Max Length: 2

Definition:

The client self-reported having vaginal or anal sex with a female in the past 12 months.

Instructions:

Indicate if the client reported vaginal or anal sex in the past 12 months with a female.

Business rules:

HIV Testing: Not applicable
Partner Services: Required

Code

Value Description

Value Definition

Client indicates that he or she did not have vaginal or anal sex with a
female in the past 12 months.

Yes

Client indicates that he or she had vaginal or anal sex with a female
in the past 12 months.

Not Asked

The provider did not ask the client that he or she had vaginal or anal
sex with a female in the past 12 months.

Declined to Answer

The client declines or is unwilling to report if he or she had vaginal or
anal sex with a female in the past 12 months.

G216c

Vaginal or Anal Sex with a Transgender Person

Value Option: Choose only one

Format Type: Number

XSD (Schema) Name: withTransgender

Min Length: 1

Max Length: 2

Definition:

The client self-reported having vaginal or anal sex with a transgender person in the past 12 months.

Instructions:

Indicate if the client reported vaginal or anal sex in the past 12 months with a transgender person.

Business rules:

HIV Testing: Not applicable
Partner Services: Required

Code

Value Description

Value Definition

Client indicates that he or she did not have vaginal or anal sex with a
transgender person in the past 12 months.

Yes

Client indicates that he or she had vaginal or anal sex with a
transgender person in the past 12 months.

Not Asked

The provider did not ask the client that he or she had vaginal or anal
sex with a transgender person in the past 12 months.

Declined to Answer

The client declines or is unwilling to report if he or she had vaginal or
anal sex with a transgender person in the past 12 months.

G222

Vaginal or Anal Sex without a Condom (PS only)

Value Option: Choose only one

Format Type: Number

XSD (Schema) Name: vaginalOrAnalSexWithoutCondomPS

Min Length: 1

Max Length: 2

Definition:

The client self-reported having unprotected vaginal or anal sex with a partner during the past 12 months.

Instructions:

Indicate if the client reported unprotected (without a condom) vaginal or anal sex in the past 12 months.

Business rules:

HIV Testing: Not applicable
Partner Services: Required

Code

Value Description

Value Definition

The client indicates they have not had vaginal or anal sex without a
condom in the past 12 months.

Yes

The client indicates they have had vaginal or anal sex without a
condom in the past 12 months.

Not Asked

The provider did not ask the client that they have had vaginal or anal
sex without a condom in the past 12 months.

Declined to Answer

The client declines or is unwilling to report if they have had vaginal or
anal sex without a condom in the past 12 months.

G224

At risk for HIV infection

Value Option: Choose only one

XSD (Schema) Name: atRiskForHIVInfection

Format Type: Number

Min Length: 1

Max Length: 1

Definition:

An indication of whether the client/patient is at risk for HIV infection based on an agency's local risk assessment.

Instructions:

Indicate if the client/patient is at risk for HIV infection.

Business rules:

HIV Testing: Required
Partner Services: Not applicable
Business rule:
Completed for persons who test negative for HIV.
Required if (X125 = 3 or 10 or 11 or 12)

Code

Value Description

Value Definition

The client/patient is not at risk for HIV infection

Yes

The client/patient is at risk for HIV infection

Risk Not Known

It is not know if the client/patient is at risk for HIV infection

Not Assessed

No risk assessment was done

Client Characteristics – Priority Populations

Table: G4

This table is required to be completed by all agencies when data are collected on individual clients as part of HIV testing service delivery.

G400

Sex with a male

Value Option: Choose only one

XSD (Schema) Name: sexWithMale
Format Type: Number

Min Length: 1

Definition:

The client/patient self-reported having sex with a male in the past 5 years.

Instructions:

Indicate if the client/patient reported having sex in the past 5 years with a male.

Business rules:

HIV Testing: Required
Partner Services: Not applicable

Max Length: 1

Code

Value Description

Value Definition

The client/patient indicates he or she did not have sex with a male in
the past 5 years

Yes

The client/patient indicates he or she had sex with a male in the past
5 years

G401

Sex with a female

Value Option: Choose only one

XSD (Schema) Name: sexWithFemale

Format Type: Number

Min Length: 1

Definition:

The client/patient self-reported having sex with a female in the past 5 years.

Instructions:

Indicate if the client/patient reported having sex in the past 5 years with a female.

Business rules:

HIV Testing: Required
Partner Services: Not applicable

Max Length: 1

Code

Value Description

Value Definition

The client/patient reported he or she did not have sex with a female
in the past 5 years.

Yes

The client/patient reported he or she h ad sex with a female in the
past 5 years.

G402

Injection drug use

Value Option: Choose only one

XSD (Schema) Name: injectionDrugUse
Format Type: Number

Min Length: 1

Max Length: 1

Definition:

The client/patient reported having injected drugs/substances in the past 5 years.

Instructions:

Indicate if the client/patient reported having injected drugs/substances in the past 5 years.

Business rules:

HIV Testing: Required
Partner Services: Not applicable

Code

Value Description

Value Definition

The client/patient reported he or she did not inject drugs in the past 5
years that were not prescribed to them by a medical care provider.

Yes

The client/patient reported he or she had injected drugs in the past 5
years that were not prescribed to them by a medical care provider.

Table: H

Client Intervention Characteristics

This table is required to be completed for all interventions in which client level data are collected. This includes HIV prevention
interventions delivered individually to clients (e.g. HIV testing or Partner Services). These data are captured for each provider/client
interaction.

H04a

Form ID

Value Option: N/A

XSD (Schema) Name: formId

Format Type: Alpha-Numeric

Min Length: 1

Max Length: 32

Definition:

A unique alpha-numeric code or identification number used to identify and connect data collected on a standardized
form for a given intervention.

Instructions:

If you use a standardized form to collect data for HIV testing or other interventions enter the Form ID. The Form ID is
used to uniquely identify data collected on the form. Form ID is unique at the agency level.This variable is most often
used for data collected on the EvaluationWeb HIV Test Form template or locally developed HIV testing forms.

Business rules:

HIV Testing: Mandatory
Partner Services: Required
'FORM ID' must be unique within an agency and will be associated with only one client.

H04c

eHARS State Number

Value Option: N/A

XSD (Schema) Name: eHarsStateNumber
Format Type: Alpha-Numeric

Min Length: 1

Max Length: 32

Definition:

A unique state number assigned to each patient throughout the course of HIV infection assigned by the separately
funded state/jurisdiction in which they are reported.

Instructions:

Enter the assigned state number associated with this diagnosed HIV infection.

Business rules:

HIV Testing: Required
Partner Services: Required
Completed for persons who test positive for HIV.
Required if (X104a is 1 or 2) and (X125 = 1 or 2 or 6 or 7 or 8 or 9)

H04d

eHARS City/County Number

Value Option: N/A

XSD (Schema) Name: eHarsCityCountyNumber

Format Type: Alpha-Numeric

Min Length: 1

Max Length: 32

Definition:

A unique city/county number assigned to each patient throughout the course of HIV infection assigned by the
separately funded city in which they are reported.

Instructions:

Enter the city/county number associated with diagnosed HIV infection.

Business rules:

HIV Testing: Required
Partner Services: Required
Completed for persons who test positive for HIV.
Required if (X104a is 1 or 2) and (X125 = 1 or 2 or 6 or 7 or 8 or 9)

H06

Session Date

Value Option: N/A

XSD (Schema) Name: sessionDate
Format Type: MM/DD/YYYY

Min Length: 8

Max Length: 10

Definition:

The calendar date (month, day, and year) on which the session was delivered to the client.

Instructions:

Enter the month, day, and year during which this session was delivered.

Business rules:

HIV Testing: Mandatory
Partner Services: Required, see detailed business rule
Detailed business rule:
Session date cannot be greater than the current date at the time of data entry.
For PS session data, the date falls within a valid case period.

H800

Ever heard of PrEP

Value Option: Choose only one

XSD (Schema) Name: everHeardOfPrEP

Format Type: Number

Min Length: 1

Max Length: 1

Definition:

The client/patient's awareness of HIV Pre-exposure prophylaxis (PrEP), the medication taken daily to reduce the risk
for acquiring HIV infection.

Instructions:

Indicate if the client/patient has ever heard of PrEP.

Business rules:

HIV Testing: Required
Partner Services: Not applicable

Code

Value Description

Value Definition

The client/patient reported he or she had never heard of Preexposure prophylaxis (PrEP)

Yes

The client/patient reported he or she had heard of Pre-exposure
prophylaxis (PrEP)

H802

Used PrEP anytime in the last 12 months

Value Option: TBD

XSD (Schema) Name: usedPrEPInLast12Months

Format Type: Number

Min Length: 1

Max Length: 1

Definition:

An indication of whether the client/patient has used PrEP anytime in the last 12 months.

Instructions:

Indicate if the client/patient used PrEP in the last 12 months.

Business rules:

HIV Testing: Required
Partner Services: Not applicable

Code

Value Description

Value Definition

The client/patient reported he or she had not used PrEP anytime in
the last 12 months

Yes

The client/patient reported he or she had used PrEP in the last 12
months

Table: PCRS-1 Partner Services Case
This table provides details for a Partner Services (PS) case. A PS case will indirectly associate an HIV+ index case to his/her partners
and the intervention through which services are provided.

PCR101

Case Number

Value Option: N/A

XSD (Schema) Name: partnerServiceCaseNumber

Format Type: Alpha-Numeric

Min Length: 1

Max Length: 32

Definition:

A number to uniquely identify a PS case within an agency. This number is system-generated when establishing a PS
case. It can also be an assigned number that is key-entered by the provider.
This number is associated with an index client and links the index client to his/her partner or partners. Only one PS
case may have a status of open for any given index client at any given time.

Instructions:

Select the system-generated PS case number or enter the locally-defined case number.

Business rules:

HIV Testing: Required
Partner Services: Mandatory
A case number uniquely identifies a PS case within an agency.

PCR103

Case Open Date

Value Option: N/A

XSD (Schema) Name: caseOpenDate
Format Type: MM/DD/YYYY

Min Length: 8

Definition:

The calendar date on which the PS case was opened at the agency.

Instructions:

Enter the date on which the PS case was opened at the agency.

Business rules:

HIV Testing: Not applicable
Partner Services: Required, see detailed business rule
Detailed business rule:
The case open date must be less than the date of file submission to CDC.

Max Length: 10

PCR104

Case Close Date

Value Option: N/A

XSD (Schema) Name: caseCloseDate

Format Type: MM/DD/YYYY

Min Length: 8

Definition:

The calendar date on which the PS case was closed at the agency.

Instructions:

Enter the date on which the PS case was closed at the agency.

Business rules:

HIV Testing: Not applicable
Partner Services: Required, see detailed business rule

Max Length: 10

Detailed business rule:
The Case Closed Date must be between the caseOpenDate and the date of file submission to CDC. This date can
be blank.
PCR104a Care Status at Case Close Date
Value Option: Choose only one

XSD (Schema) Name: careStatusAtCaseClose

Format Type: Alpha-Numeric

Min Length: 1

Max Length: 2

Definition:

This is an indication of whether or not the client was in medical care at the time of the case close date.

Instructions:

Indicate whether or not the client was in medical care at the time of the case close date.

Business rules:

HIV Testing: Not applicable
Partner Services: Required
Detailed business rule:
Required if Case Close Date is valid date.

Code

Value Description

Value Definition

In Care

Client has seen a medical care provider at least once in the past 6
months for HIV treatment.

Not In Care

Includes HIV-positive persons who were never-in-care for their HIV
diagnoses as well as those who were previously in HIV medical care,
but are currently out-of-care.

Pending

There is an HIV medical appointment scheduled but the agency has
not confirmed that the client attended.

Declined to Answer

The client declines or is unwilling to report his or her HIV care status.

Don’t Know

The client reports that he or she is unaware of his or
her HIV care status.

Table: PCRS-2 Partner Services Partner
This table provides details about partners for a PS case and will include partner identifying and locating information as well as services
received by the partner.

PCR207

Partner Type

Value Option: Choose only one

XSD (Schema) Name: partnerType

Format Type: Number

Min Length: 1

Max Length: 2

Definition:

The partner's sex and needle-sharing relationship with the index client. This relationship could involve sexual
relations between the client and the partner, needle-sharing between the client and partner or both sex and needlesharing partners.

Instructions:

For each partner identified, indicate whether the partner and client are sex partners, needle-sharing partners or both
sex and needle-sharing partners.

Business rules:

HIV Testing: Not applicable
Partner Services: Required

Code

Value Description

Value Definition

Sex partner

A person who engages in any type of sexual activity with the index
client.

Needle-sharing partner

A person who engages in any type of needle-sharing activity (e.g.,
shares needles to inject drug intravenously), with the index client.

Both sex and needle sharing partner

A person who engages in any type of sexual activity and needlesharing activity (e.g., shares needles to inject drug intravenously),
with the index client.

Table: X-1

HIV Test

This table is completed for each HIV antibody test conducted for a client.

X104a

HIV Test Election

Value Option: Choose only one

XSD (Schema) Name: testElection
Format Type: Number

Min Length: 1

Definition:

An indication of whether the test is linked to a name or is anonymous.

Instructions:

Indicate if the written test record is linked to the client's name.

Business rules:

HIV Testing: Required
Partner Services: Not applicable

Max Length: 2

Business rule:
Required when testing event is reported (sampleDate is not missing).

Code

Value Description

Value Definition

Anonymous

The HIV test was not linked to the client's name.

Confidential

The HIV test was confidential.

Test Not Done

An HIV test was not done.

X105

Specimen Collection Date

Value Option: N/A

XSD (Schema) Name: sampleDate
Format Type: MM/DD/YYYY

Min Length: 8

Max Length: 10

Definition:

The calendar date (month, day, year) that the specimen for the HIV test was collected.

Instructions:

Indicate the month, day, and year that the specimen for the HIV test was collected.

Business rules:

HIV Testing: Required
Partner Services: Required
The specimen collection date cannot be greater than date of submission of XML file or data entry date.

X111

Result Provided

Value Option: Choose only one

XSD (Schema) Name: provisionOfResultValueCode

Format Type: Number

Definition:

The act of informing the client of the HIV test result.

Instructions:

Indicate whether the result of this HIV test was provided.

Business rules:

HIV Testing: Required, see detailed business rule
Partner Services: Required

Min Length: 1

Max Length: 1

Detailed business rule:
Required when at least one testing event occurred (X104a = 1 or 2) and test result final determination is not missing
(X125 is not missing).

Code

Value Description

Value Definition

The result of this HIV test was not provided to the client.

Yes

The result of this HIV test was provided to the client.

Yes, client obtained the result from another agency

The result of this HIV test was provided to the client from a provider
at another agency.

X124

Test Type

Value Option: Choose only one

XSD (Schema) Name: testType

Format Type: Number

Min Length: 1

Max Length: 1

Definition:

Refers to the type of test and technology used for determining the outcome of the current HIV test.

Instructions:

Indicate the type of test used for determining the outcome of the current HIV test.

Business rules:

HIV Testing: Required
Partner Services: Not applicable
Business rule:
Required if at least one HIV test was conducted (X104a = 1 or 2)

Code

Value Description

Value Definition

CLIA-waved point-of-care (POC) Rapid Test (s)

A diagnostic HIV test performed outside of a laboratory that produces
a rapid and reliable result.

Laboratory-based Test (s)

Testing done by a laboratory for the diagnosis of HIV infection.

X125

HIV Test Result - Final Determination

Value Option: Choose only one

XSD (Schema) Name: hivTestResult

Format Type: Alpha-Numeric

Definition:

The outcome of the current HIV test.

Instructions:

Indicate the result of this HIV test.

Business rules:

HIV Testing: Required, see detailed business rule
Partner Services: Required

Min Length: 1

Max Length: 2

Business rule:
Required if at least one HIV test was conducted (X104a = 1 or 2) or specimen collection is not missing (sampleDate
is not missing).

Code

Value Description

Value Definition

Preliminary positive

One or more of the same point-of-care rapid tests were reactive and
none are non-reactive and no supplemental testing was done at your
agency

HIV-1 Negative, HIV-2 inconclusive

Negative for HIV type 1 infection and HIV type 2 antibodies were not
confirmed

HIV-1 Negative

Negative for HIV type 1 infection

HIV Negative

Negative for HIV infection

Inconclusive, further testing needed

HIV antibodies were not confirmed; further testing is needed

Positive

Two or more different (orthogonal) point-of-care rapid tests are
reactive and none are non-reactive and no laboratory-based
supplemental testing was done

Negative

One or more point-of-care rapid tests are non-reactive and none are
reactive and no supplemental testing was done

Discordant

One or more point-of-care rapid tests are reactive and one or more
are non-reactive and no laboratory-based supplemental testing was
done

Invalid

A CLIA-waved POC rapid test result cannot be confirmed due to
conditions related to errors in the testing technology, specimen
collection, or transport.

HIV-1 Positive

Positive for HIV type 1 infection

HIV-1 Positive, possible acute

Positive for HIV type 1 infection and is a possible acute HIV infection

XSD (Schema) Name:
8

HIV-2
Positive
Positive for HIV type 2 infection

HIV Positive,
undifferentiated
Positive for HIV infection. HIV antibodies could not be
differentiated

X126

Preliminary Positive point-of-care rapid test

Value Option: Choose only one

Format Type: Number

Min Length: 1

Max Length: 1

Definition:

An indication that the client/patient had a preliminary positive point-of-care rapid test result prior to the current laboratorybased HIV test.

Instructions:

Indicate if a laboratory-based test was preceded by a reactive (preliminary positive) point-of-care-rapid test.

Business rule

HIV Testing: Required
Partner Services: Not applicable

Business rule:
Required if an HIV test was conducted (X104a = 1 or 2) and basis for final test result determination is laboratory-based
testing (X124 = 2)

Code

Value Description

Value Definition

The client/patient did not have a preliminary positive point-of-care
rapid test prior to the laboratory-based test.

Yes

The client/patient's laboratory-based test was preceded by a
preliminary positive point-of-care rapid test.

X126a

Specimen Collection Date of Preliminary Positive
point-of-care rapid test

XSD (Schema) Name:

Value Option: TBD

Format Type: Date

Min Length: 8

Max Length: 10

Definition:

If the laboratory-based test was preceded by a preliminary positive point-of-care rapid test, this variable refers to the date
the point-of-care rapid test was conducted.

Instructions:

Enter the calendar month, day, and year of the preliminary positive point-of-care rapid test.
Enter 01/01/1800 if date is unknown

Business rule

HIV Testing: Required
Partner Services: Not applicable
Business rule:
Required if X126 = 1

X127

Tests for co-infections

Value Option: Choose only one

XSD (Schema) Name: otherTestingPerformed
Format Type: Number

Min Length: 1

Max Length: 1

Definition:

The client/patient was tested for syphilis, gonorrhea, chlamydial infection, or Hepatitis C in conjunction with this HIV
test.

Instructions:

Indicate whether tests for syphilis, gonorrhea, chlamydial infection, or Hepatitis C were done in conjunction with this
HIV test.

Business rules:

HIV Testing: Required
Partner Services: Not applicable
Business rule: Required if an HIV test was conducted (X104a = 1 or 2).

Code

Value Description

Value Definition

The client/patient was not tested for syphilis, gonorrhea, chlamydial
infection, or Hepatitis C in conjunction with this HIV test.

Yes

The client/patient was tested for syphilis, gonorrhea, chlamydial
infection, or Hepatitis C in conjunction with this HIV test.

X127a

Syphilis Test

Value Option: Choose only one

XSD (Schema) Name: syphilis/testPerformed

Format Type: Number

Min Length: 1

Max Length: 1

Definition:

An indication of whether the client/patient was tested for syphilis in conjunction with this HIV test.

Instructions:

Indicate if the client/patient received a syphilis test in conjunction with this HIV test.

Business rules:

HIV Testing: Required
Partner Services: Not applicable
Business rule:
Required if X127 = 1

Code

Value Description

Value Definition

The client/patient was not tested for syphilis in conjunction with his or
her HIV test.

Yes

The client/patient was tested for syphilis in conjunction with his or her
HIV test.

X127b

Gonorrhea

Value Option: Choose only one

XSD (Schema) Name: gonorrhea/testPerformed

Format Type: Number

Min Length: 1

Max Length: 1

Definition:

An indication of whether the client/patient was tested for gonorrhea in conjunction with this HIV test.

Instructions:

Indicate if the client/patient received a test for Gonorrhea in conjunction with this HIV test.

Business rules:

HIV Testing: Required
Partner Services: Not applicable
Business rule:
Required if X127 = 1

Code

Value Description

Value Definition

The client/patient was not tested for gonorrhea in conjunction with his
or her HIV test.

Yes

The client/patient was tested for gonorrhea in conjunction with his or
her HIV test.

X127c

Chlamydial infection

Value Option: Choose only one

XSD (Schema) Name: chlamydia/testPerformed

Format Type: Number

Min Length: 1

Max Length: 1

Definition:

An indication of whether the client/patient was tested for chlamydial infection in conjunction with this HIV test.

Instructions:

Indicate if the client/patient was tested for Chlamydial infection in conjunction with this HIV test.

Business rules:

HIV Testing: Required
Partner Services: Not applicable
Business rule:
Required if X127 = 1

Code

Value Description

Value Definition

The client/patient was not tested for chlamydial infection in
conjunction with this HIV test

Yes

The client/patient was tested for chlamydial infection in conjunction
with this HIV test

X127d

Hepatitis C

Value Option: Choose only one

XSD (Schema) Name: hepC/testPerformed

Format Type: Number

Min Length: 1

Max Length: 1

Definition:

An indication of whether the client/patient was tested for Hepatitis C in conjunction with this HIV test.

Instructions:

Indicate if the client/patient received a Hepatitis C test in conjunction with this HIV test.

Business rules:

HIV Testing: Required
Partner Services: Not applicable
Business rule:
Required if X127 = 1

Code

Value Description

Value Definition

The client/patient was not tested for Hepatitis C in conjunction with
this HIV test.

Yes

The client/patient was tested for Hepatitis C in conjunction with this
HIV test.

X128a

Result of Syphilis Test

Value Option: Choose only one

XSD (Schema) Name: syphilis/testResult

Format Type: Number

Min Length: 1

Definition:

The outcome of the current syphilis test done in conjunction with this HIV test.

Instructions:

Indicate the result of the current syphilis test done in conjunction with this HIV test.

Business rules:

HIV Testing: Required
Partner Services: Not applicable

Max Length: 1

Business rule:
Required if X127a = 1

Code

Value Description

Value Definition

Newly identified infection

The syphilis screening resulted in identifying a new infection.

Not infected

The client has either never been infected or was previously infected
and successfully treated.

Not Known

The results of the current syphilis test are unknown.

X128b

Result of Gonorrhea Test

Value Option: Choose only one

XSD (Schema) Name: gonorrhea/testResult

Format Type: Number

Min Length: 1

Definition:

The outcome of the current gonorrhea test done in conjunction with this HIV test.

Instructions:

Indicate the result of the current gonorrhea test done in conjunction with this HIV test.

Business rules:

HIV Testing: Required
Partner Services: Not applicable

Max Length: 1

Business rule:
Required if X127b = 1

Code

Value Description

Value Definition

Positive

The client/patient tested positive for gonorrhea.

Negative

The client/patient tested negative for gonorrhea.

Not Known

The result of the current gonorrhea test is unknown.

X128c

Chlamydial infection test result

Value Option: Choose only one

Format Type: Number

XSD (Schema) Name: chlamydia/testResult
Min Length: 1

Max Length: 2

Definition:

The outcome of the current test for chlamydial infection done in conjunction with this HIV test.

Instructions:

Indicate the result of the current test for chlamydial infection done in conjunction with this HIV test.

Business rules:

HIV Testing: Required
Partner Services: Not applicable
Business rule:
Required if X127c = 1

Code

Value Description

Value Definition

Positive

The client/patient tested positive for chlamydial infection.

Negative

The client/patient tested negative for chlamydial infection.

Not Known

The result of the current test for chlamydial infection is unknown.

X128d

Hepatitis C test result

Value Option: Choose only one

XSD (Schema) Name: hepC/testResult

Format Type: Number

Min Length: 1

Max Length: 1

Definition:

The outcome of the current test for Hepatitis C done in conjunction with this HIV test.

Instructions:

Indicate the result of the current test for Hepatitis C done in conjunction with this HIV test.

Business rules:

HIV Testing: Required
Partner Services: Not applicable
Business rule:
Required if X127d = 1

Code

Value Description

Value Definition

Positive

The client/patient tested positive for Hepatitis C.

Negative

The client/patient tested negative for Hepatitis C.

Not Known

The result of the current hepatitis C test is unknown.

X135

Worker ID

Value Option: N/A

XSD (Schema) Name: workerId
Format Type: Alpha-Numeric

Min Length: 1

Max Length: 32

Definition:

A unique alpha-numeric identification code used to distinguish between persons who are delivering services to clients.

Instructions:

Enter the unique ID of the worker delivering the HIV prevention service. Worker ID is unique at the jurisdiction level.
If a state does not tie tests to a worker, no ID should be reported.

Business rules:

HIV Testing: Allowed but not reported to CDC
Partner Services: Not applicable
Allowed when at least one testing event occurred (sampleDate is not missing). Can be missing if a state does not tie
tests to a worker.

X137

Program Announcement

Value Option: Choose only one

XSD (Schema) Name: progAnnouncementProgStrategy

Format Type: Number

Min Length: 1

Max Length: 2

Definition:

The CDC program announcement and category, if applicable, from which the HIV prevention service was funded.

Instructions:

Indicate the CDC funding source from which this HIV prevention service is funded.
Choose only one.

Business rules:

HIV Testing: Mandatory
Partner Services: Required

Code

Value Description

Value Definition

PS 15-1502 – Category A

PS15-1502: HIV prevention services for members of racial/ethnic
minority communities.

PS 15-1502 – Category B

PS15-1502: HIV prevention services for members of groups at
greatest risk for acquiring and transmitting HIV infection, regardless
of race/ethnicity.

PS 15-1506 PrIDE

PS15-1506: Health Department Demonstration Projects to Reduce
HIV Infections and Improve Engagement in HIV Medical Care among
Men Who Have Sex with Men (MSM) and Transgender Persons
(PrIDE) Demonstration Project. This program announcement is
applicable only to 12 funded jurisdictions: Baltimore, California,
Chicago, Colorado, Houston, Los Angeles, Louisiana, Michigan, New
York City, San Francisco, Tennessee, and Virginia.

PS 15-1509 THRIVE

PS15-1509: Health Department Demonstration Projects for
Comprehensive Prevention and Care for Men Who Have Sex with
Men (MSM) of Color at Risk for and Living with HIV Infection. This
program announcement is applicable only to seven funded
jurisdictions: Alabama, Baltimore, District of Columbia, Louisiana,
New York City, Philadelphia, and Virginia.

PS 17-1704 Category A - YMSM

PS17-1704: This category provides funding to Community-Based
Organizations for HIV Prevention Programs for Young Men of Color
Who Have Sex with Men and their partners.

PS 17-1704 Category B - YTG

PS17-1704: This category provides funding to Community-Based
Organizations for HIV Prevention Programs for Young Transgender
Persons of Color and their partners.

PS17-1711

Use of molecular HIV surveillance to identify active HIV transmission
networks and implement HIV interventions for Hispanic/Latino men
who have sex with men.

PS 18-1802

PS18-1802: Integrated HIV Surveillance and Prevention Programs
for Health Departments.

PS 18-1802 Demonstration Projects

PS18-1802 Demonstration Projects: Funding to expand high-impact
HIV prevention and surveillance interventions and strategies.

PS 19-1901 CDC STD

PS 19-1901: STD prevention funding for Health Departments.

Other CDC-funded

A program announcement other than those listed and an
HIV test was conducted using a CDC-funded mechanism.

Other Non-CDC funded

A program announcement other than those listed and an
HIV test was conducted using a non-CDC funded mechanism.

X138

New or Previous HIV-positive Diagnosis

Value Option: Choose only one

Format Type: Number

XSD (Schema) Name: clientHIVStatus

Min Length: 1

Max Length: 2

Definition:

The indication of if the client/patient's HIV infection is a new diagnosis or if their infection was previously diagnosed.

Instructions:

Indicate whether the current positive HIV test is a new diagnosis for this client/patient or if their infection was
previously diagnosed.

Business rules:

HIV Testing: Required, see detailed business rule
Partner Services: Required
Business rule:
Completed for persons who test positive for HIV.
Required if (X104a is 1 or 2) and (X125 = 1 or 2 or 6 or 7 or 8 or 9)

Code

Value Description

Value Definition

New diagnosis, verified

The HIV surveillance system was checked and no prior report was
found and there is no indication of a previous diagnosis by either
client self-report (if the client was asked) or review of other data
sources (if other data sources were checked).

New diagnosis, not verified

The HIV surveillance system was not checked and the classification
of new diagnosis is based only on no indication of a previous positive
HIV test by client self-report or review of other data sources.

Previous diagnosis

Previously reported to the HIV surveillance system or the client
reports a previous positive HIV test or evidence of a previous positive
test is found on review of other data sources.

Unable to determine

The HIV surveillance system not checked and no other data sources
were reviewed and there is no information from the client about
previous HIV test results.

X150

Has the client/patient ever had a positive HIV test

Value Option: Choose only one

XSD (Schema) Name: everHadPreviousPositiveTest

Format Type: Number

Min Length: 1

Max Length: 2

Definition:

The purpose of this variable is to ascertain whether a positive HIV test occurred earlier than the current HIV
diagnosis date.

Instructions:

Indicate if the client/patient has ever had a positive HIV test result

Business rules:

HIV Testing: Required
Partner Services: Not applicable
Completed for all persons who test positive for HIV.
Required if (X125 = 1 or 2 or 6 or 7 or 8 or 9).

Code

Value Description

Value Definition

The client/patient has never had a positive HIV test

Yes

The client/patient had a positive HIV test prior to this positive HIV test

Don't Know

It is unknown whether the client/patient ever had a positive HIV test
prior to this positive HIV test

X150a

Date of first positive HIV test

Value Option: TBD

XSD (Schema) Name: dateOfPreviousPositiveTest
Format Type: Date

Min Length: 8

Definition:

The calendar date (month, day, year) of the earliest known positive HIV test.

Instructions:

Record the date of the earliest known positive HIV test.
Enter 01/01/1800 if the complete date is not known.
If the month and year are known, but the day is not known, enter the "01" for the day.

Business rules:

HIV Testing: Required
Partner Services: Not applicable
Required if X150 = 1

Max Length: 10

66
X151
test

Has the client/patient ever had a negative HIV

Value Option: Choose only one

XSD (Schema) Name: everHadNegativePositiveTest

Format Type: Number

Min Length: 1

Max Length: 2

Definition:

The purpose of this variable is to ascertain whether a negative HIV test occurred earlier than the current
HIV diagnosis date.

Instructions:

Indicate if the client/patient has ever had a negative HIV test result

Business rules:

HIV Testing: Required
Partner Services: Not applicable
Completed for all persons who test positive for HIV.
Required if (X125 = 1 or 2 or 6 or 7 or 8 or 9).

Code

Value Description

Value Definition

The client/patient has never had a negative HIV test

Yes

The client/patient had a positive HIV test prior to this negative HIV test

Don't Know

It is unknown whether the client/patient ever had a negative HIV
test prior to this positive HIV test

X151a

Date of first negative HIV test

Value Option: TBD

XSD (Schema) Name: dateOfPreviousNegativeTest

Format Type: Date

Min Length: 8

Definition:

The calendar date (month, day, year) of the earliest known negative HIV test.

Instructions:

Record the date of the earliest known negative HIV test.
Enter 01/01/1800 if the complete date is not known.
If the month and year are known, but the day is not known, enter the "01" for the day.

Business rules:

HIV Testing: Required
Partner Services: Not applicable
Required if X150 = 1

Max Length: 10

Table: X-2

HIV Test History

This table collects HIV test history.

X224

HIV Stage

Value Option: Choose only one

XSD (Schema) Name: hivStage
Format Type: Number

Min Length: 2

Max Length: 2

Definition:

The stage of the HIV infection of the client. The stage for individuals 6years and older is based primarily on the CD4+
T-lymphocyte count; the CD4+ T-lymphocyte count takes precedence over the CD4 T-lymphocyte percentage, and
the percentage is considered only if the count is missing.

Instructions:

Enter the HIV stage of the client. This should be noted at intake or before the intervention begins.

Business rules:

HIV Testing: Not applicable
Partner Services: Required

Code

Value Description

Value Definition

HIV Stage 0

If there was a negative HIV test within 6 months of the first HIV
infection diagnosis, the stage is 0, and remains 0 until 6 months after
diagnosis.

HIV Stage 1

≥500 Cells/µL or ≥26%

HIV Stage 2

200-499 Cells/µL or 14-25%

HIV Stage 3

<200 Cells/µL or <14%

HIV Unknown

If CD4 test result is missing, the stage is Unknown

Table: X-3

Attempt to Locate

This table is to be completed for each index client or partner to be located. While this table is intended to be for PS, it may be used
optionally for any intervention.

X302

Attempt to Locate Outcome

Value Option: Choose only one

XSD (Schema) Name: attemptToLocateOutcome

Format Type: Number

Min Length: 1

Max Length: 1

Definition:

The result of a PS provider's attempt to locate the index client or the index client's partner(s).

Instructions:

Indicate the result of the attempt to locate.

Business rules:

HIV Testing: Not applicable
Partner Services: Required

Code

Value Description

Value Definition

Unable to locate

The provider did not locate the index client or partner during this
attempt.

Located

The provider located the index client or partner during this attempt.

X303

Reason for Unsuccessful Attempt

Value Option: Choose only one

XSD (Schema) Name: reasonForUnsuccessfulAttempt

Format Type: Number

Min Length: 2

Max Length: 2

Definition:

The explanation for why the location attempt was not achieved.

Instructions:

If the attempt to locate the index client or index client's partner was unsuccessful (X302: Attempt to Locate Outcome
= "Unable to locate"), indicate why the client or partner was unable to be located.

Business rules:

HIV Testing: Not applicable
Partner Services: Required, see detailed business rule
Detailed business rule:
Required if client could not be located (attemptToLocateOutcome = 1).
Not expected if a client was located (attemptToLocateOutcome = 2).

Code

Value Description

Value Definition

Deceased

The index client or partner is no longer alive.

Out of jurisdiction

The index client or partner resides outside of the jurisdiction in which
the provider is authorized to provide services.

Other

The index client or partner was not located due to another reason not
listed.

X306

Enrollment Status

Value Option: Choose only one

XSD (Schema) Name: enrollmentStatus

Format Type: Number

Min Length: 2

Max Length: 2

Definition:

The decision made by the index client or the index client's partner to enroll in PS.

Instructions:

Indicate if the index client or index client's partner accepted or declined enrollment into PS.

Business rules:

HIV Testing: Not applicable
Partner Services: Required, see detailed business rule
Detailed business rule:
Required if a client was located (attemptToLocateOutcome = 2).

Code

Value Description

Value Definition

Accepted

The index client or partner enrolled in PS.

Declined

The index client or partner chose not to enroll in PS.

Client not located

The index client or partner was not located.

Table: X-5

Elicit partners

This table is to be completed for each enrolled PS index client to capture partner information (e.g. number of partners).

X503

Total Number of Partners Claimed

Value Option: N/A

XSD (Schema) Name: totalNumberOfPartnersClaimed

Format Type: Number

Min Length: 1

Max Length: 5

Definition:

The total number of sex or needle-sharing partners reported by the client over the last 12 months. This would include
anonymous partners and partners for which there is not sufficient information to locate and notify.

Instructions:

Enter the total number of partners identified by the index client. This includes all anonymous, male, female, and
transgender partners.

Business rules:

HIV Testing: Not applicable
Partner Services: Required, see detailed business rule.
Detailed business rule:
"Total Number of Partners Claimed" must be greater than or equal to the number of named partners
(totalNumberOfNamedPartners).

X511

Total Number of Named Partners

Value Option: N/A

XSD (Schema) Name: totalNumberOfNamedPartners

Format Type: Number

Min Length: 1

Max Length: 3

Definition:

The total number of sex or needle-sharing partners reported by the client over the last 12 months for which there is
sufficient identifying and locating information.

Instructions:

Indicate the total number of sex or needle-sharing partners named for which there is sufficient information to identify
and locate the partner.

Business rules:

HIV Testing: Not applicable
Partner Services: Required, see detailed business rule
Detailed business rule:
"Total Number of Named Partners" must be less than or equal to the Total Number of Partners Claimed
(totalNumberOfPartnersClaimed).

Table: X-6

Notification of Exposure

This table is completed for each partner located to determine their knowledge of HIV exposure and HIV status.

X600

Partner Notifiability

Value Option: Choose only one

XSD (Schema) Name: partnerNotifiability
Format Type: Number

Min Length: 1

Max Length: 2

Definition:

An indication of whether or not a named partner is determined to be eligible for notification of exposure. Partners that
are found to be deceased or for which there is a risk of domestic violence are not considered to be notifiable.

Instructions:

For each partner named, indicate whether or not he or she is able to be notified of his or her exposure to HIV.

Business rules:

HIV Testing: Not applicable
Partner Services: Required

Code

Value Description

Value Definition

No - Partner is deceased

The partner is no longer alive.

No - Partner is out of jurisdiction

The partner resides outside of the jurisdiction in which the provider is
authorized to provide services.

No - Partner has a risk of domestic violence

The provider has assessed that notifying the partner of his or her
exposure to HIV could pose a risk of domestic violence to the partner.

No - Partner is known to be previously positive

The partner was not notified because he/she is known to be
previously positive for HIV.

Yes - Partner is notifiable

The partner is able to be notified of his/her exposure to HIV.

Yes - Partner is notifiable and known to be previously positive

The partner was notified; he/she is known to be previously positive
for HIV.

No - Other

The partner was not notified due to another reason not listed.

X601

Actual Notification Method

Value Option: Choose only one

XSD (Schema) Name: actualNotificationMethod

Format Type: Number

Min Length: 1

Max Length: 2

Definition:

The actual method used to notify each identified partner that they may have been exposed to HIV.

Instructions:

Indicate the method used to notify each notifiable partner that they may have been exposed to HIV.

Business rules:

HIV Testing: Not applicable
Partner Services: Required, see detailed business rule
Detailed business rule:
Required if the partner is able to be notified (partnerNotifiability =6 or 7).

Code

Value Description

Value Definition

Client notification

The index client informed his or her partner of their possible exposure
to HIV and referred them to counseling, testing, and other support
services.

Provider notification

The PS provider informed the partner of his or her possible exposure
to HIV and referred them to counseling, testing, and other support
services.

Dual notification

The index client informed the partner of his or her serostatus in the
presence of the PS provider.

Third-party notification

A notification strategy whereby the partner was notified by a
professional other than the health department provider (e.g., a private
physician) of his or her possible exposure to HIV.

Refused notification

The index client's partner refused to be informed of his or her
possible exposure to HIV.

Partner Not Notified

The index client's partner was not informed of his or her possible
exposure to HIV.

Table: X-7

Referral

This table is completed for all clients receiving a referral.

X706c

HIV Medical Care Linkage

Value Option: Choose only one

XSD (Schema) Name: currentHIVMedicalCareStatus

Format Type: Number

Min Length: 1

Max Length: 2

Definition:

The current status of the client's HIV medical care after HIV diagnosis, current HIV test, or report to Partner Services.

Instructions:

Select the value that reflects the current status of the client's HIV medical care after HIV diagnosis, current HIV test,
or report to Partner Services.

Business rules:

HIV Testing: Not applicable
Partner Services: Required
Detailed business rule:
Required if HIV Test Results for CLIA-Waved Point of Care Rapid Tests are Positive, or Laboratory-Based Tests
HIV-1 Positive, HIV-1 Positive (Possible acute), or HIV-2 Positive ( hivTestResult=2, 6, 7 or 8).

Code

Value Description

Value Definition

Appointment Pending

There is an HIV medical appointment scheduled but the agency has
not confirmed that the client attended.

Confirmed—Partner Accessed Service Within 14 Days of Positive
Test

Client attended an HIV medical appointment within 14 days of their
positive test as confirmed by a report from a medical care provider,
medical record review, other record reviews, other databases (e.g.,
CareWare), HIV-related laboratory reports, or an ART prescription
filled.

Confirmed—Partner Accessed Service Within 30 Days of Positive
Test

Client attended an HIV medical appointment within 30 days of their
positive test as confirmed by a report from a medical care provider,
medical record review, other record reviews, other databases (e.g.,
CareWare), HIV-related laboratory reports, or an ART prescription
filled.

Confirmed—Partner Accessed Service After 30 Days of Positive Test Client attended an HIV medical appointment after 30 days of their
positive test as confirmed by a report from a medical care provider,
medical record review, other record reviews, other databases (e.g.,
CareWare), HIV-related laboratory reports, or an ART prescription
filled.

Confirmed—Partner Did Not Access Service

Client did not attend an HIV medical appointment as confirmed by a
report from a medical care provider, medical record review, other
record reviews, other databases (e.g., CareWare), or HIV-related
laboratory reports.

Partner Lost to Follow-Up

After 90 days of the positive test, the client’s attendance at an HIV
medical care appointment can't be confirmed.

No Appointment Necessary- Negative Test Result

Client was not referred to HIV medical care because he or she tested
negative.

No Appointment Necessary-Partner Previous Positive and Engaged
in Medical Care

Client was not referred to HIV medical care because he or she is
known to be previous positive and already receiving care.

X706d

Date of 1st HIV Medical Appointment

Value Option: TBD

Format Type: Date

XSD (Schema) Name: firstMedicalCareAppointmentDate
Min Length:

Max Length: TBD

Definition:

Date a client attended his/her HIV medical care appointment after HIV diagnosis, current HIV test, or report to
Partner Services.

Instructions:

Enter the date a client attended his/her HIV medical care appointment after HIV diagnosis, current HIV test, or report
to Partner Services.

Business rules:

X712

HIV Test Performed

Value Option: Choose only one

XSD (Schema) Name: HIVTestPerformed
Format Type: Number

Min Length: 1

Definition:

A client received an HIV test while enrolled in partner services.

Instructions:

Indicate if the client was tested for HIV while enrolled in partner services.

Business rules:

HIV Testing: Not applicable
Partner Services: Required

Max Length: 1

Code

Value Description

Value Definition

The client did not receive an HIV test as a result of a referral from PS.

Yes

The client received an HIV test as a result of a referral from PS.

No, Client is known to be HIV-positive

The client did not receive an HIV test as a result of a referral from PS;
client is known to be HIV-positive.

X712a

Coinfection Screen

Value Option: Choose only one

XSD (Schema) Name: syphilisTest

Format Type: Number

Min Length: 1

Max Length: 2

Definition:

A client received a syphilis test in conjunction with an HIV test during PS activities.

Instructions:

Indicate if a client received a syphilis test in conjunction with an HIV test during PS activities.

Business rules:

HIV Testing: Not applicable
Partner Services: Required

Code

Value Description

Value Definition

The client did not receive a syphilis test in conjunction with the
current HIV test.

Yes

The client received a syphilis test in conjunction with the current HIV
test.

X712b

Coinfection Screen Result

Value Option: Choose only one

XSD (Schema) Name: syphilisTestResult
Format Type: Number

Min Length: 1

Max Length: 1

Definition:

The outcome of the current syphilis test in conjunction with an HIV test while enrolled in partner services.

Instructions:

Indicate the outcome of the current syphilis test in conjunction with an HIV test while enrolled in partner services.

Business rules:

HIV Testing: Not applicable
Partner Services: Required

Code

Value Description

Value Definition

Newly Identified Infection

The syphilis screening resulted in identifying a new infection.

Not infected

Client has either never been infected or was previously infected and
successfully treated.

Not Known

The results of the current syphilis test are unknown.

X714a

HIV Test Results Provided

Value Option: Choose only one

XSD (Schema) Name: HIVTestResultsProvided
Format Type: Number

Min Length: 1

Definition:

The act of informing the client of his or her HIV test result.

Instructions:

Indicate whether or not the result of this HIV test was provided to the partner.

Max Length: 1

Business rule HIV Testing: Not applicable
Partner Services: Required, see detailed business rule
Detailed business rule:
Required if HIV Test Performed =Yes (HIVTestPerformed = 1) and HIV Test Result was Positive (HIVTestResult = 1).
Not expected otherwise.

Code

Value Description

Value Definition

The result of this HIV test was not provided to the partner.

Yes

The result of this HIV test was provided to the partner.

79
X725b

Care Status at Time of the PS Interview

Value Option: Choose only one

Format Type: Number

XSD (Schema) Name: careStatusAtInterview

Min Length: 1

Max Length: 2

Definition:

If a client was interviewed for Partner Services, this is an indication of whether or not he/she was in medical care at
the time of the Partner Services interview.

Instructions:

Indicate whether or not the client was in medical care at the time of the Partner Services interview.

Business rules:

HIV Testing: Not applicable
Partner Services: Required
Detailed business rule:
Required if a client was enrolled (enrollmentStatus = 1).
Not expected if a client wasn't enrolled (enrollmentStatus = 2 or blank).

Code

Value Description

Value Definition

In Care

Client has seen a medical care provider at least once in the past 6
months for HIV treatment

Not In Care

Includes HIV-positive persons who were never-in-care for their HIV
diagnoses as well as those who were previously in HIV medical care,
but are currently out-of-care.

Pending

There is an HIV medical appointment scheduled but the agency has
not confirmed that the client attended.

Declined to Answer

The client declines or is unwilling to report his or her HIV care status.

Don’t Know

The client reports that he or she is unaware of his or
her HIV care status.

X730a

Housing status in past 12 months - revised

Value Option: Enter one value only

Format Type: Number

XSD (Schema) Name: housingStatusRevised

Min Length: 1

Max Length: 2

Definition:

The client's self-report of the most unstable housing status in the past 12 months.
Collection of these data began in 2013.

Instructions:

For clients with a positive HIV test (confirmatory or preliminary), indicate the client's self-reported most unstable
housing status in the past 12 months.

Business rules:

HIV Testing: Required
Partner Services: Allowed, but not reported to CDC
Business rule:
Completed for persons who test positive for HIV.
Required if (X104a is 1 or 2) and (X125 = 1 or 2 or 6 or 7 or 8 or 9)

Code

Value Description

Value Definition

Literally Homeless

Client has lived in places not designed nor typically used as a regular
sleeping accommodation for human beings, including a car, park,
abandoned building, bus/train station or camping ground; or in a
shelter or emergency shelter that provides temporary living
arrangements.

Unstably housed and/or at-risk of losing housing

Client has not been homeless, however, client has experienced
housing instability as evidenced by frequent moves due to economic
reasons, living with others due to economic hardship; eviction from a
private dwelling unit (but having another place to go); living in
overcrowded housing; or being at risk of having no housing options.
This value code includes persons imminently losing housing.

Stably housed

Persons living in a consistent housing facility that is meant for human
habitation and are not at risk of losing housing.

Not asked

Client was not asked about housing status in the past 12 months.

Declined to answer

Client declined to report housing status in the past 12 months.

Don't know

Only select 'don't know' if the client states that he or she doesn't
know housing status in the past 12 months. Do not select 'don't know'
if the client was not asked.

X731

Currently taking daily PrEP medicine

Value Option: Choose only one

Format Type: Number

XSD (Schema) Name: currentlyOnPrEP

Min Length: 1

Definition:

An indication if the client is currently on Pre-exposure prophylaxis (PrEP) medicine.

Instructions:

Indicate if the client is currently on Pre-exposure prophylaxis (PrEP) medicine.

Business rules:

HIV Testing: Required
Partner Services: Required

Max Length: 1

Code

Value Description

Value Definition

The client/patient is not currently taking daily PrEP medicine

Yes

The client/patient is currently taking daily PrEP medicine

X731a

Referred to PrEP Provider

Value Option: Choose only one

XSD (Schema) Name: referredToPrEP
Format Type: Number

Min Length: 1

Max Length: 2

Definition:

An indication if the client was referred to a provider for Pre-exposure prophylaxis (PrEP).

Instructions:

Indicate if the client was referred to a provider for Pre-exposure prophylaxis (PrEP).

Business rules:

HIV Testing: Not applicable
Partner Services: Required

Code

Value Description

Value Definition

Client not offered referral for PrEP.

Yes

Client offered referral for PrEP.

Partner Declined

Client offered referral for PrEP but client declined.

Partner on PrEP

No referral necessary; Client currently on PrEP.

X740

Seen a Medical Care Provider in past 6 months for
HIV treatment

Value Option: Choose only one

Format Type: Number

XSD (Schema) Name: seenMedicalCareProvider

Min Length: 1

Max Length: 2

Definition:

If the client/patient's HIV infection is a previous diagnosis or it is unknown if the diagnosis is a new or previous
diagnosis, indicate if the client/patient has seen a medical care provider in the past six months for HIV treatment.

Instructions:

Indicate whether the client/patient has seen a medical care provider at least once in the past six months for HIV
treatment.
This question should be asked if the client/patient's HIV infection was previously diagnosed or if unable to determine
if the client's infection was a new diagnosis or previous diagnosis.

Business rules:

HIV Testing: Required
Partner Services: Not applicable
Business rule:
Completed if the client's HIV infection is not a new diagnosis.
Required if (X138 = 3 or 4)

Code

Value Description

Value Definition

The client/patient has not seen a medical care provider in the past 6
months for HIV treatment

Yes

The client/patient has seen a medical care provider in the past 6
months for HIV treatment

Declined

The client/patient declined to answer whether he or she had seen a
medical care provider in the past 6 months for HIV treatment

Don't Know

The client/patient does not know if he or she has seen a medical care
provider in the past 6 months for HIV treatment

X741

Attended HIV medical care appointment

Value Option: Choose only one

Format Type: Number

XSD (Schema) Name: attendHIVMedicalCare

Min Length: 1

Max Length: 2

Definition:

Indicate if the client/patient attended a medical care appointment after this positive HIV test.

Instructions:

Indicate whether the client/patient attended an appointment for HIV medical care after this positive test.

Business rules:

HIV Testing: Required
Partner Services: Not applicable
Business rule:
Completed for persons who test positive for HIV.
Required if (X104a is 1 or 2) and (X125 = 1 or 2 or 6 or 7 or 8 or 9)

Code

Value Description

Value Definition

Yes, confirmed

Confirmation that the client/patient did attend his or her HIV medical
appointment after this positive test

Yes, client/patient self-report

The client/patient's self-report of attending his or her HIV medical
care appointment after this positive test

Client did not attend his or her HIV medical appointment after this
positive test

Don't Know

The provider is unaware if the client/patient attended his/her HIV
medical appointment after this positive test

X741a

Appointment Date

Value Option: N/A

XSD (Schema) Name: dateofMedicalCare

Format Type: Date

Min Length: 10

Max Length: 10

Definition:

The calendar month, day, and year on which a client attended his/her HIV medical care appointment after this
positive test.

Instructions:

Indicate the date the client/patient attended his/her appointment for HIV medical care after this positive test.
Enter 01/01/1800 if date is unknown.
If the month and year are known, but the day is unknown, enter the 15th of the month as the day.

Business rules:

HIV Testing: Required
Partner Services: Not applicable
Business rule:
Completed if HIV-positive client attended an HIV medical care appointment.
Required if (X741 = 1 or 2)

X742

Individualized behavioral risk-reduction counseling

Value Option: Choose only one

Format Type: Number

XSD (Schema) Name: behavioralRiskReductionCounseling
Min Length: 1

Max Length: 1

Definition:

Refers to an HIV prevention service directly aimed at reducing risk for transmitting or acquiring HIV infection.

Instructions:

Indicate whether individualized behavioral risk-reduction counseling was provided to the client/patient.

Business rules:

HIV Testing: Required
Partner Services: Not applicable
Business rule:
Completed for persons who test positive for HIV.
Required if (X104a is 1 or 2) and (X125 = 1 or 2 or 6 or 7 or 8 or 9)

Code

Value Description

Value Definition

The client/patient was not provided individualized behavioral riskreduction counseling.

Yes

The client/patient was provided individualized behavioral riskreduction counseling.

X743

Contact information provided for partner services

Value Option: Choose only one

Format Type: Number

XSD (Schema) Name: providedToHDForPS

Min Length: 1

Max Length: 2

Definition:

This is an indication of if the client/patient's contact information was provided to the health department for partner
services.

Instructions:

Indicate whether the client/patient's name and contact information were provided to the health department for partner
services.

Business rules:

HIV Testing: Required
Partner Services: Not applicable
Business rule:
Completed for persons who test positive for HIV.
Required if (X104a is 1 or 2) and (X125 = 1 or 2 or 6 or 7 or 8 or 9)

Code

Value Description

Value Definition

The client/patient's information was not provided to the health
department for partner services

Yes

The client/patient's information was provided to the health
department for partner services.

X744

Interviewed for partner services

Value Option: Choose only one

XSD (Schema) Name: interviewedForPS

Format Type: Number

Min Length: 1

Max Length: 2

Definition:

This is an indication of if the client/patient was interviewed for partner services by health department staff or staff
trained by the health department to conduct partner services interviews.

Instructions:

Indicate if the client was interviewed for partner services.
This variable is only used for HIV testing and for reporting on HIV-positive clients.

Business rules:

HIV Testing: Required
Partner Services: Not applicable
Business rule:
Completed for persons who test positive for HIV.
Required if (X104a is 1 or 2) and (X125 = 1 or 2 or 6 or 7 or 8 or 9)

Code

Value Description

Value Definition

Yes, by health department staff

The client was interviewed for partner services by health department
staff.

Yes, by a non-health department person trained by the health
department to conduct partner services

The client was interviewed for partner services by a non-health
department person who was trained by the health department to
conduct partner services.

The client was not interviewed for partner services.

Don't Know

It is unknown if the client was interviewed for partner services.

X744a

Date of partner services interview

Value Option: N/A

XSD (Schema) Name: dateOfPSInterview

Format Type: MM/DD/YYYY

Min Length: 8

Max Length: 10

Definition:

The calendar month, day, and year on which the client/patient was interviewed for partner services.

Instructions:

Enter the calendar month, day, and year the client/patient was interviewed for partner services.
Enter 01/01/1800 if date is unknown.
If the month and year are known, but the day is unknown, enter the 15th of the month as the day.

Business rules:

HIV Testing: Required
Partner Services: Not applicable
Business rule:
Completed if the client/patient was interviewed for partner services (X744=1 or 2).

X745

Screened for perinatal HIV service coordination
needs (Only if pregnant)

Value Option: Choose only one
Definition:

Format Type: Number

XSD (Schema) Name: screenedForPerinatalHIVCoordination

Min Length: 1

Max Length: 2

An indication of if the client/patient was screened for perinatal HIV service coordination needs.
This variable is used for reporting of perinatal HIV service coordination needs among women living with diagnosed
HIV infection.

Instructions:

If the client/patient is HIV-positive, indicate whether she was screened for perinatal HIV service coordination needs.

Business rules:

HIV Testing: Required
Partner Services: Not applicable
Business rule:
Completed for birth gender females who test positive for HIV.
Required if (birthGenderValueCode=2) and (X125 = 1 or 2 or 6 or 7 or 8 or 9)

Code

Value Description

Value Definition

The client/patient was not screened for perinatal HIV service
coordination needs

Yes

The client/patient was screened for perinatal HIV service coordination
needs.

X746

Perinatal HIV service coordination needs identified

Value Option: Choose only one

Format Type: Number

XSD (Schema) Name: perinatalCoordinationNeedsIdentified

Min Length: 1

Max Length: 1

Definition:

An indication of if perinatal HIV service coordination needs were identified for the client/patient.

Instructions:

If the client/patient is HIV-positive and screened for perinatal HIV service coordination needs, indicate if perinatal HIV
service coordination needs were identified.

Business rules:

Code

Value Description

Value Definition

The client/patient was screened and no HIV service coordination
needs were identified

Yes

The client/patient was screened and HIV perinatal service
coordination needs were identified

X747

Referred for HIV perinatal service coordination

Value Option: Choose only one

Format Type: Number

XSD (Schema) Name: referredForHIVPerinatalServiceCoordi
nation
Min Length: 1
Max Length: 2

Definition:

An indication of whether the client/patient was referred for HIV perinatal service coordination.

Instructions:

If the client/patient is HIV-positive and HIV perinatal service coordination needs were identified, indicate if the
client/patient was given a referral to HIV perinatal service coordination needs.

Business rules:

Code

Value Description

Value Definition

The client/patient was not referred to HIV perinatal service
coordination

Yes

The client/patient was referred to HIV perinatal service coordination

X748

Screened for PrEP eligibility

Value Option: Choose only one

XSD (Schema) Name: screenedForPrEPEligibility

Format Type: Number

Min Length: 1

Max Length: 1

Definition:

Refers to whether an assessment was conducted to determine if he or she meets the appropriate criteria for using
pre-exposure prophylaxis (PrEP).

Instructions:

Indicate whether the client/patient was screened for PrEP eligibility.
This variable is used for reporting on clients who test negative for HIV infection.

Business rules:

HIV Testing: Required
Partner services: Not applicable
Business rule:
Completed for persons who test negative for HIV.
Required if (X125 = 3 or 10 or 11 or 12)

Code

Value Description

Value Definition

The client/patient was not screened for PrEP eligibility

Yes

The client/patient was screened for PrEP eligibility

X749

Eligible for PrEP referral

Value Option: Choose only one

XSD (Schema) Name: eligibleForPrEPReferral

Format Type: Number

Min Length: 1

Max Length: 1

Definition:

An indication of whether the client/patient met the appropriate criteria for receiving a referral for using PrEP.

Instructions:

Indicate whether the client/patient was eligible to receive a referral for PrEP.
This variable is used for reporting on clients who test negative for HIV infection.

Business rules:

HIV Testing: Required
Partner services: Not applicable
Business rule:
Completed for persons who test negative for HIV.
Required if (X125 = 3 or 10 or 11 or 12)

Code

Value Description

Value Definition

The client/patient was not eligible for PrEP referral

Yes, CDC criteria

The client/patient was eligible for PrEP referral based on CDC criteria

Yes, by local criteria or protocol

The client/patient was eligible for PrEP referral based on local criteria
or protocol

X750

Referred to a PrEP Provider

Value Option: Choose only one

XSD (Schema) Name: referredToPrEPProvider

Format Type: Number

Min Length: 1

Max Length: 1

Definition:

An indication of whether the client/patient was given a referral to a PrEP provider. PrEP providers are peers,
volunteers, and staff members of clinics, health departments, and community-based organizations.

Instructions:

Indicate whether the client/patient was given a referral to a PrEP provider.

Business rules:

HIV Testing: Required
Partner services: Not applicable
Business rule:
Completed for persons who test negative for HIV.
Required if (X125 = 3 or 10 or 11 or 12)

Code

Value Description

Value Definition

The client/patient was not referred to a PrEP provider

Yes

The client/patient was referred to a PrEP provider

X751

Assistance with linkage to a PrEP provider

Value Option: Choose only one

Format Type: Number

XSD (Schema) Name: providedAssistanceToPrEPProvider
Min Length: 1

Max Length: 1

Definition:

An indication of whether the client/patient was provided navigation or linkage services to assist with linkage to a PrEP
provider.

Instructions:

Indicate whether the client/patient was provided navigation or linkage services to assist them with linkage to a PrEP
provider.

Business rules:

HIV Testing: Required
Partner Services: Not applicable

Code

Value Description

Value Definition

The client/patient was not provided navigation or linkage services to
assist with linkage to a PrEP provider

Yes

The client/patient was provided navigation or linkage services to
assist with linkage to a PrEP provider

X752a

Navigation services for linkage to HIV medical
care - screened for need

Value Option: Choose only one

Format Type: Number

XSD (Schema) Name: navOrLinkageHIVMedicalCare/screene
dFor
Min Length: 1

Max Length: 1

Definition:

An indication of whether the client/patient was screened for the need of navigation for linkage to HIV medical care.

Instructions:

Indicate whether the client/patient was screened for the need of navigation services for linkage to HIV medical care.

Business rules:

HIV Testing: Required
Partner services: Not applicable
Business rule:
Completed for persons who test positive for HIV.
Required if (X125 = 1 or 2 or 6 or 7 or 8 or 9)

Code

Value Description

Value Definition

The client/patient was not screened for navigation services needs for
linkage to HIV medical care

Yes

The client/patient was screened for navigation services needs for
linkage to HIV medical care

X752b

Navigation services for linkage to HIV medical
care - need identified

Value Option: Choose only one

Format Type: Number

XSD (Schema) Name: navOrLinkageHIVMedicalCare/needIde
ntified
Min Length: 1

Max Length: 1

Definition:

An indication of whether the client/patient was identified as needing navigation services for linkage to HIV medical
care.

Instructions:

Select 'Yes' if the client/patient needed navigation services for linkage to HIV medical care.

Business rules:

HIV Testing: Required
Partner services: Not applicable
Business rule:
Completed for persons who test positive for HIV.
Required if (X125 = 1 or 2 or 6 or 7 or 8 or 9)

Code

Value Description

Value Definition

No service need was identified for navigation services for linkage to
HIV medical care

Yes

Navigation services need was identified for linkage to HIV medical
care was

X752c

Navigation services for linkage to HIV medical
care - provided or referred for service

Value Option: Choose only one

Format Type: Number

XSD (Schema) Name: navOrLinkageHIVMedicalCare/provide
dOrReferred
Min Length: 1

Max Length: 1

Definition:

An indication of whether the client/patient was provided or referred to navigation services for linkage to HIV medical
care.

Instructions:

Indicate if the client/patient was provided or referred to navigation services for linkage to HIV medical care.

Business rules:

HIV Testing: Required
Partner services: Not applicable
Business rule:
Completed for persons who test positive for HIV.
Required if (X125 = 1 or 2 or 6 or 7 or 8 or 9)

Code

Value Description

Value Definition

The client/patient was not provided or referred to navigation services
for linkage to HIV medical care

Yes

The client/patient was provided or was given a referral to navigation
services for linkage to HIV medical care

X752e

Linkage services to HIV medical care – screened for
need

Value Option: Choose only one

Format Type: Number

XSD (Schema) Name: linkageServicesHIVMedicalCare/scree
nedFor
Min Length: 1

Max Length: 1

Definition:

An indication of whether the client/patient was screened for the need of linkage services to HIV medical care.

Instructions:

Indicate if the client/patient was screened for the need of linkage services to HIV medical care.

Business rules:

HIV Testing: Required
Partner services: Not applicable
Business rule:
Completed for persons who test positive for HIV.
Required if (X125 = 1 or 2 or 6 or 7 or 8 or 9)

Code

Value Description

Value Definition

The client/patient was not screened for linkage to HIV medical care
service needs

Yes

The client/patient was screened for linkage to HIV medical care
service needs

X752f

Linkage services to HIV medical care – need
identified

Value Option: Choose only one

Format Type: Number

XSD (Schema) Name: linkageServicesHIVMedicalCare/needI
dentified
Min Length: 1

Max Length: 1

Definition:

An indication of whether the client/patient was identified as needing linkage services to HIV medical care.

Instructions:

Select 'Yes' if the client/patient needed linkage services for linkage to HIV medical care.

Business rules:

HIV Testing: Required
Partner services: Not applicable
Business rule:
Completed for persons who test positive for HIV.
Required if (X125 = 1 or 2 or 6 or 7 or 8 or 9)

Code

Value Description

Value Definition

No need for linkage to HIV medical care services was identified

Yes

A need was identified for linkage to HIV medical care services

X752g

Linkage services to HIV medical care – provided or
referred for service

Value Option: Choose only one

Format Type: Number

XSD (Schema) Name: linkageServicesHIVMedicalCare/provi
dedOrReferred
Min Length: 1

Max Length: 1

Definition:

An indication of whether the client/patient was provided or referred for linkage services to HIV medical care.

Instructions:

Indicate if the client/patient was provided or referred to linkage services for linkage to HIV medical care.

Business rules:

HIV Testing: Required
Partner services: Not applicable
Business rule:
Completed for persons who test positive for HIV.
Required if (X125 = 1 or 2 or 6 or 7 or 8 or 9)

Code

Value Description

Value Definition

The client/patient was not provided or referred to linkage to HIV
medical care services

Yes

The client/patient was provided or referred to linkage to HIV medical
care services

X753a

Health benefits navigation and enrollment screened for need

Value Option: Choose only one

Format Type: Number

XSD (Schema) Name: healthBenefits/screenedFor

Min Length: 1

Max Length: 1

Definition:

An indication of whether client/patients are assessed for health benefits navigation and enrollment needs.

Instructions:

Indicate whether the client/patient was screened for health benefits navigation and enrollment need.

Business rules:

HIV Testing: Required
Partner Services: Not applicable

Code

Value Description

Value Definition

The client/patient was not screened for health benefits navigation and
enrollment service needs

Yes

The client/patient was screened for health benefits navigation and
enrollment service needs

X753b

Health benefits navigation and enrollment - need
identified

Value Option: Choose only one

Format Type: Number

XSD (Schema) Name: healthBenefits/needIdentified

Min Length: 1

Max Length: 1

Definition:

An indication of whether the client/patient was identified as needing health benefits navigation and enrollment
services.

Instructions:

Select 'Yes' if the client/patient needed health benefits navigation and enrollment services.

Business rules:

HIV Testing: Required
Partner Services: Not applicable

Code

Value Description

Value Definition

No need was identified for health benefits navigation and enrollment
services

Yes

A need for health benefits navigation and enrollment services was
identified

X753c

Health benefits navigation and enrollment services provided or referred for service

Value Option: Choose only one

Format Type: Number

XSD (Schema) Name: healthBenefits/providedOrReferred

Min Length: 1

Max Length: 1

Definition:

An indication of whether the client/patient was provided or referred to services for health benefits navigation and
enrollment.

Instructions:

Indicate if the client/patient was provided or referred to services for health benefits navigation and enrollment.

Business rules:

HIV Testing: Required
Partner Services: Not applicable

Code

Value Description

Value Definition

The client/patient was not provided or referred to health benefits
navigation and enrollment services

Yes

The client/patient was provided or referred to health benefits
navigation and enrollment services

100

X754a

Medication adherence support services - screened
for need

Value Option: Choose only one

Format Type: Number

XSD (Schema) Name: medicationAdherence/screenedFor

Min Length: 1

Max Length: 1

Definition:

An indication of whether an assessment was done to determine if the client/patient needed medication adherence
support services.

Instructions:

Indicate whether the client/patient was screened for as needing medication adherence support service.

Business rules:

HIV Testing: Required
Partner services: Not applicable
Business rule:
Completed for persons who test positive for HIV.
Required if (X125 = 1 or 2 or 6 or 7 or 8 or 9)

Code

Value Description

Value Definition

The client/patient was not screened for medication adherence
support service needs

Yes

The client/patient was screened for medication adherence support
service needs

101

X754b

Medication adherence support - need identified

Value Option: Choose only one

Format Type: Number

XSD (Schema) Name: medicationAdherence/needIdentified

Min Length: 1

Max Length: 1

Definition:

An indication of whether the client/patient was identified as needing medication adherence support services.

Instructions:

Select 'Yes' if the client/patient was identified as needing medication adherence support services.

Business rules:

HIV Testing: Required
Partner services: Not applicable
Business rule:
Completed for persons who test positive for HIV.
Required if (X125 = 1 or 2 or 6 or 7 or 8 or 9)

Code

Value Description

Value Definition

No need was identified for medication adherence support services

Yes

A need was identified for medication adherence support services

X754c

Medication adherence support - provided or
referred to service

Value Option: Choose only one

Format Type: Number

XSD (Schema) Name: medicationAdherence/providedOrRefe
rred
Min Length: 1

Max Length: 1

Definition:

An indication of whether the client/patient was provided or referred to medication adherence support services.

Instructions:

Indicate if the client/patient was provided or referred to services for medication adherence support.

Business rules:

HIV Testing: Required
Partner Services: Not applicable

Code
0

Value Description
No

Value Definition
The client/patient was not provided or referred to medication
adherence support services

Yes

The client/patient was provided or referred to medication adherence
support services

102

X755a

Evidence-based risk reduction intervention screened for need

Value Option: Choose only one

Format Type: Number

XSD (Schema) Name: evidenceBaseRiskReduction/screened
For
Min Length: 1

Max Length: 1

Definition:

An indication of whether the client/patient was assessed for evidence-based risk reduction intervention needs.

Instructions:

Indicate whether the client/patient was screened for evidence-based risk reduction intervention need.

Business rules:

HIV Testing: Required
Partner Services: Not applicable

Code

Value Description

Value Definition

The client/patient was not screened for evidence-based risk reduction
intervention needs

Yes

The client/patient was screened for evidence-based risk reduction
intervention needs

X755b

Evidence-based risk reduction intervention - need
identified

Value Option: Choose only one

Format Type: Number

XSD (Schema) Name: evidenceBaseRiskReduction/needIden
tified
Min Length: 1

Max Length: 1

Definition:

An indication of whether the client/patient was identified as needing evidence-based risk reduction intervention
services.

Instructions:

Select 'Yes' if the client/patient needed evidence-based risk reduction intervention services.

Business rules:

HIV Testing: Required
Partner Services: Not applicable

Code

Value Description

Value Definition

No need was identified for evidence-based risk reduction intervention
services

Yes

A need for evidence-based risk reduction intervention services was
identified

103

X755c

Evidence-based risk reduction intervention provided or referred to service

Value Option: Choose only one

Format Type: Number

XSD (Schema) Name: evidenceBaseRiskReduction/provided
OrReferred
Min Length: 1

Max Length: 1

Definition:

An indication of whether the client/patient was provided or referred to evidence-based risk reduction intervention
services.

Instructions:

Indicate if the client/patient was provided or referred to evidence-based risk reduction intervention services.

Business rules:

HIV Testing: Required
Partner Services: Not applicable

Code

Value Description

Value Definition

The client/patient was not provided or referred to evidence-based risk
reduction intervention services

Yes

The client/patient was provided or referred to evidence-based risk
reduction intervention services

X756a

Behavioral health services - screened for need

Value Option: Choose only one
Definition:

Format Type: Number

XSD (Schema) Name: behavioralHealthServices/screenedFo
r
Min Length: 1

Max Length: 1

An indication of whether the client/patient was assessed for behavioral health services need.
Examples of behavioral health services include mental health treatment, and substance use treatment.

Instructions:

Indicate whether the client/patient was screened for behavioral health services need.

Business rules:

HIV Testing: Required
Partner Services: Not applicable

Code

Value Description

Value Definition

The client/patient was not screened for behavioral health services
need

Yes

The client/patient was screened for behavioral health services need

104

X756b

Behavioral health services - need identified

Value Option: Choose only one
Definition:

Format Type: Number

XSD (Schema) Name: behavioralHealthServices/needIdentifi
ed
Min Length: 1
Max Length: 2

An indication of whether the client/patient was identified as needing behavioral health services.
Examples of behavioral health services include mental health treatment, and substance use treatment.

Instructions:

Select 'Yes' if the client/patient needed behavioral health services.

Business rules:

HIV Testing: Required
Partner Services: Not applicable

Code

Value Description

Value Definition

No need was identified for behavioral health services

Yes

A need for behavioral health services was identified

X756c

Behavioral health services - provided or referred to
service

Value Option: Choose only one
Definition:

Format Type: Number

XSD (Schema) Name: behavioralHealthServices/providedOr
Referred
Min Length: 1

Max Length: 1

An indication of whether the client/patient was provided or referred to behavioral health services.
Examples of behavioral health services include mental health treatment, and substance use treatment.

Instructions:

Indicate if the client/patient was provided or referred to behavioral health services.

Business rules:

HIV Testing: Required
Partner Services: Not applicable

Code

Value Description

Value Definition

The client/patient was not provided or referred to behavioral health
services

Yes

The client/patient was provided or referred to behavioral health
services

105

X758a

Social services - screened for need

Value Option: Choose only one
Definition:

XSD (Schema) Name: socialServices/screenedFor

Format Type: Number

Min Length: 1

Max Length: 1

An indication of whether the client/patient was assessed for social services needs.
Examples of social services include housing, transportation, domestic violence intervention, and employment.

Instructions:

Indicate whether the client/patient was screened for social services need.

Business rules:

HIV Testing: Required
Partner Services: Not applicable

Code

Value Description

Value Definition

The client/patient was not screened for social service needs

Yes

The client/patient was screened for social service needs

X758b

Social services - need identified

Value Option: Choose only one
Definition:

XSD (Schema) Name: socialServices/needIdentified

Format Type: Number

Min Length: 1

Max Length: 1

An indication of whether the client/patient was identified as needing social services.
Examples of social services include housing, transportation, domestic violence intervention, and employment.

Instructions:

Select 'Yes' if the client/patient needed social services.

Business rules:

HIV Testing: Required
Partner Services: Not applicable

Code

Value Description

Value Definition

No need was identified for social services

Yes

A need for social services was identified

106

X758c

Social services - provided or referred to service

Value Option: Choose only one
Definition:

Format Type: Number

XSD (Schema) Name: socialServices/providedOrReferred

Min Length: 1

Max Length: 1

An indication of whether the client/patient was provided or referred to social services.
Examples of social services include housing, transportation, domestic violence intervention, and employment.

Instructions:

Indicate if the client/patient was provided or referred to social services.

Business rules:

HIV Testing: Required
Partner Services: Not applicable

Code

Value Description

Value Definition

The client/patient was not provided or referred to social services

Yes

The client/patient was provided or referred to social services

107

Aggregate Level Requirements
Table: ME

Aggregate level Variables

This table should be reported at jurisdiction level and broken out by the program announcement.

ME201a

Total PS18-1802-funded aggregate test events

Value Option: TBD

Format Type: Number

XSD (Schema) Name:
Min Length: 1

Max Length: 8

Definition:

PS18-1802-funded aggregate test events are test events supported in any way by PS18-1802-funded resources
(e.g., funding, test kits, personnel, training and technical assistance, laboratory support), but for which test-level data
are not obtainable.

Instructions:

Enter the total number of PS18-1802-funded aggregate HIV test events conducted during the reporting period.

Business rules:

HIV Testing: Not applicable
Partner Services: Not applicable
HD Aggregate: Required

ME201b

Total reimbursed aggregate test events

Value Option: TBD

Format Type: Number

XSD (Schema) Name:
Min Length: 1

Max Length: 8

Definition:

Reimbursed aggregate test events are done in PS18-1802-supported programs, but are actually paid for by a thirdparty payer (e.g., Medicaid, Medicare, private insurance). They are attributable to PS18-1802 because they would
likely not be done in the absence of the PS18-1802-supported program, but they are not directly paid for by PS181802 funds.

Instructions:

Enter the total number of reimbursed aggregate HIV testing events conducted during the reporting period.

Business rules:

HIV Testing: Not applicable
Partner Services: Not applicable
HD Aggregate: Required

108

ME202a

PS18-1802--funded aggregate newly diagnosed HIVpositive test events

Value Option: TBD

Format Type: Number

XSD (Schema) Name:

Min Length: 1

Max Length: 8

Definition:

PS18-1802-1-funded aggregate test events are test events supported in any way by PS18-1802--funded resources
(e.g., funding, test kits, personnel, training and technical assistance, laboratory support), but for which test-level data
are not obtainable. Newly diagnosed HIV-positive test events include unconfirmed preliminary positive plus confirmed
positive test events.

Instructions:

Enter the total number of PS18-1802--funded aggregate newly diagnosed HIV-positive testing events conducted
during the reporting period.

Business rules:

HIV Testing: Not applicable
Partner Services: Not applicable
HD Aggregate: Required

ME202b

Reimbursed aggregate newly diagnosed HIVpositive testing events

Value Option: TBD

Format Type: Number

XSD (Schema) Name:

Min Length: 1

Max Length: 8

Definition:

Reimbursed aggregate test events are test events that are done in PS18-1802-supported programs, but are actually
paid for by a third-party payer (e.g., Medicaid, Medicare, private insurance). They are attributable to PS18-1802
because they would likely not be done in the absence of the PS18-1802--supported program, but they are not directly
paid for by PS18-1802- funds. Newly diagnosed HIV-positive test events include unconfirmed preliminary positive
plus confirmed positive test events.

Instructions:

Enter the total number of reimbursed aggregate newly diagnosed HIV-positive testing events conducted during the
reporting period.

Business rules:

HIV Testing: Not applicable
Partner Services: Not applicable
HD Aggregate: Required

109

XML Specific Fields
Table: Z1

XML Specific Fields

This table contains the variables and the XML values to be used for records to identify updated and modified records. This table is only
required for jurisdictions that upload XML files to EvaluationWeb. These fields apply to all XML formats, with the exception of the now
obsolete CTv1 format. (Some variable may have had different XSD (Schema) Names in older formats. See the individual variables for
details.

Z01

Status

Value Option: Enter one value only

XSD (Schema) Name: @status

Format Type: Alpha-Numeric

Min Length: 1

Max Length: 1

Definition:

The indicator to define the status of the record. This status indicator is used by a number of different records (Site,
HivForm, aggregateData. Etc.). This indicator is always an attribute (for example …). Check the
relevant XSD to determine which elements can be modified with a status, and which element must be modified with a
status.

Instructions:

Indicate if the records are new, updated, should be deleted, are re-submitted but unchanged from a previous submission,
or, for aggregate data, should be added to existing totals.

Business rule Applicable only for XML uploads

Code

Value Description

Value Definition

Added Record

Applies only to Aggregate Data. This record should be added to the
totals for the period for the variable reported.

Deleted Record

This record is marked for deletion and should be deleted for the
database for this agency.

New Record

This record is a new record and has not been previously submitted to
EvaluationWeb. If the record is in the system from a previous
submission and is not exactly identical to the submitted record, the
system will report an error.

Resubmitted Record

This record has been submitted previously and is not changed in this
submission.

Updated Record

This record is an updated record; the record has been previously
submitted to EvaluationWeb and contains updated information. If the
record is not currently in the system, the system will report an error.

110

Z02

Last Modified Date

Value Option: N/A

XSD (Schema) Name: @lastModifiedDate

Format Type: MM/DD/YYYY

Min Length: 8

Max Length: 10

Definition:

An indicator to denote the date on which the record was modified based on the last time the record was modified This
indicator is always an attribute in the XML. (). See the relevant XSD to
determine which elements may contain a last modified date.

Instructions:

Indicate the date the record was last modified.
If the record is added, the date should be the date the record was added.
If the record should be deleted, the date should be the date when the status changed to a deleted record.
If this is a new record, the date of data entry should be entered.
If the record is resubmitted but unchanged from a previous submission, the date should be the same date as the last
upload/submission.
If the record is an update, the date should be date the record was last modified.
If, for aggregate data, the record is to be added to previous data, the date should be when the record was added.

Business rule Applicable only for XML uploads
Z03a

CT Schema Version Number

Value Option: Enter one value only

Format Type: Number

XSD (Schema) Name: CTSchemaVersion
Min Length: 1

Definition:

Specifies the version of the XSD which has been used to validate the XML file.

Instructions:

This value will be hard coded within the schema.

Max Length: 10

The number should exactly match the version number specified in the appropriate XSD - for 2012 CT data, use 2.1, CT
schema 1.0 does not contain this field.
Business rule Applicable only for XML uploads of CT data.
Z03b

PS Schema Version Number

Value Option: Enter one value only

Format Type: Number

XSD (Schema) Name: psSchemaVersionNumber
Min Length: 1

Definition:

Specifies the version of the XSD which has been used to validate the XML file.

Instructions:

This value will be hard coded within the schema.

Max Length: 10

The number should exactly match the version number specified in the appropriate XSD - for Partner Services use 1.0 or
2.0 depending on which format is being submitted.
Business rule Applicable only for XML uploads of PS data.

111

Z03c

Schema Version Number

Value Option: Enter one value only

XSD (Schema) Name: SchemaVersionNumber

Format Type: Number

Min Length: 1

Max Length: 10

Definition:

Specifies the version of the XSD which has been used to validate the XML file.

Instructions:

This value will be hard coded within the schema.
The number should exactly match the version number specified in the appropriate XSD. For non-CT, non-PS data, it
should be 1.0; for 2013 CT data, it should be 3.0.

Business rule Applicable only for XML uploads after January 2013.
Z04

Agency ID Sending File

Value Option: N/A

Format Type: Alpha-Numeric

XSD (Schema) Name: senderAgencyID
Min Length: 1

Max Length: 12

Definition:

The agency which sent the XML data file. This field allows for better CDC management of multiple files from multiple
entities.

Instructions:

Enter the ID of the agency sending the file to CDC

Business rule Applicable only for XML uploads.
Z05a

First Date of Data Included in File

Value Option: N/A

Format Type: MM/DD/YYYY

XSD (Schema) Name: firstDate
Min Length: 8

Max Length: 10

Definition:

Specifies the first date of data included in the file and allows for better data management (duplicate identification). This
helps to identify the correct data receiving process necessary to handle the XML message.

Instructions:

Enter the first date of data submitted in the current file.

Business rule Applicable only for XML uploads
Z05b

Last Date of Data Included in File

Value Option: N/A

Format Type: MM/DD/YYYY

XSD (Schema) Name: lastDate
Min Length: 8

Max Length: 10

Definition:

Specifies the last date of data included in the file and allows for better data management (duplicate identification). This
helps to identify the correct data receiving process necessary to handle the XML message.

Instructions:

Enter the last date of data submitted in the current file.

Business rule Applicable only for XML uploads

112

Z06

Data Type in File

Value Option: Enter one value only

XSD (Schema) Name: dataType

Format Type: Alpha-Numeric

Definition:

Specifies the type of data being sent.

Instructions:

Enter the date type of data sent.

Min Length: 1

Max Length: 5

Business rule Applicable only for XML uploads.

Code
CBOAG

Value Description
CBO aggregate

Value Definition
Aggregate level directly funded CBO data

CBOCL

CBO client level

Client level directly funded CBO data

Counseling and testing

Client level counseling and Testing Data

HDAG

Health department aggregate

Aggregate level health department data

HDCL

Health department client level

Client level health department non-CT non-PS data

Partner services

Client level partner services data

Z07

Contact Person Information

Value Option: N/A

Format Type: Alpha-Numeric

XSD (Schema) Name: contactPersonInformation
Min Length: 1

Max Length: 100

Definition:

Contact information of the person who manages the packaging and sending of the data.

Instructions:

Provide the contact information of the person who manages the packaging and submission of the data in the current file.
At a minimum, this should include the name and email address.

Business rule Applicable only for XML uploads
Z08

Collection of Agency IDs Included in File

Value Option: TBD

Format Type: Alpha-Numeric

XSD (Schema) Name: agencyIDs
Min Length: 1

Max Length: 1500

Definition:

The IDs of each agency for which data are being transmitted in the file.

Instructions:

List the IDs of each unique agency for whom data are represented in the file. This field should draw from the variables'
Agency ID' and 'CBO Agency ID'. It should reflect all agencies directly-funded by CDC under any program announcement
for whom data are included in the file.

Business rule Applicable only for XML uploads

113

Z09

Date File Was Created

Value Option: N/A

XSD (Schema) Name: dateCreated
Format Type: MM/DD/YYYY

Min Length: 8

Max Length: 19

Definition:

The date (and optionally, the time) the XML file was created.

Instructions:

Enter the date the current XML file was created. There should be sufficient precision to uniquely identify a file.

Business rule Applicable only for XML uploads
Z10

Date File Last Modified

Value Option: N/A

Format Type: MM/DD/YYYY

XSD (Schema) Name: fileLastModifiedDate
Min Length: 8

Max Length: 19

Definition:

If the file has been modified, the date (and optionally, the time) the XML file was last modified.

Instructions:

Enter the date the current XML file was modified. There should be sufficient precision to uniquely identify a file
submission.

Business rule Applicable only for XML uploads
Z11

Special Instructions

Value Option: N/A

XSD (Schema) Name: specialInstructions
Format Type: Alpha-Numeric

Min Length: 1

Max Length: 50

Definition:

Special instructions about XML file, if any.

Instructions:

Indicate any special instructions or notes about the XML file. This might include reasons the file was modified or updated,
or the name of the software that generated the file.

Business rule Applicable only for XML uploads
Z12
Value Option: N/A

Agency Name of Data Owner
Format Type: Alpha-Numeric

XSD (Schema) Name: dataOwnerAgencyName
Min Length: 1

Max Length: 50

114

Budget Allocation
Table: BT

Budget Allocation Variables

This table is completed annually by grantees. It is used to provide their budget allocation information to the CDC

BT100a

Value Option: N/A

Budget allocation reporting year

Format Type: Number

XSD (Schema) Name: budgetAllocationYear

Min Length: 4

Max Length: 4

Definition:

Budget allocation reporting year refers to the 12-month calendar year (January-December) for which the budget allocation
is being reported.

Instructions:

Indicate the year for which the budget allocation data are being provided.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable

BT101a

Value Option: N/A
Definition:

Amount of PS18-1802 Category A funds allocated
for HIV testing in healthcare settings
Format Type: Currency

XSD (Schema) Name: amountHIVtestRoutineCateA

Min Length: 1

Max Length: 8

For PS18-1802 Category A award (HIV Prevention Programs for Health Departments), this value represents the
allocation associated with HIV testing in healthcare settings. HIV testing in healthcare settings is a testing strategy that
involves testing persons regardless of whether they have a recognized behavioral risk or presence of signs or symptoms
of HIV infection.
CDC provides the amount of awarded PS18-1802 Category A funds annually to each grantee.

Instructions:

Indicate the amount of PS18-1802 Category A funds awarded to your agency that have been allocated for routine HIV
testing or screening. If no funds were allocated then enter 0.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable

115

BT101b

Value Option: N/A
Definition:

Amount of PS18-1802 Category B funds allocated for HIV
testing in healthcare settings
Format Type: Currency

XSD (Schema) Name: amountHIVtestRoutineCateB

Min Length: 1

Max Length: 12

For PS18-1802 Category B award (Expanded HIV Testing for Disproportionately Affected Populations), this value
represents the allocation associated with HIV testing in healthcare settings performed using Category B funds. HIV
testing in healthcare settings is a testing strategy that involves testing persons regardless of whether they have a
recognized behavioral risk or presence of signs or symptoms of HIV infection.
CDC provides the amount of awarded PS18-1802 Category B funds annually to each grantee.

Instructions:

Indicate the amount of PS18-1802 Category B funds awarded to your agency that have been allocated for HIV testing in
healthcare settings. If no funds were allocated then enter 0.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable

BT101c

Value Option: N/A
Definition:

Amount of PS18-1802 Category C funds allocated
for HIV testing in healthcare settings
Format Type: Currency

XSD (Schema) Name: amountHIVtestRoutineCateC

Min Length: 1

Max Length: 12

For PS18-1802 Category C award (Demonstration Projects), this value represents the funds allocated from your Category
C award that are for HIV testing in healthcare settings. HIV testing in healthcare settings is a testing strategy that
involves testing persons regardless of whether they have a recognized behavioral risk or presence of signs or symptoms
of HIV infection.
CDC provides the amount of awarded PS18-1802 Category C funds annually to each grantee.

Instructions:

Indicate the amount of PS18-1802 Category C funds awarded to your agency that have been allocated for HIV testing in
healthcare settings. If no funds were allocated then enter 0.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable

116

BT102a

Value Option: N/A

Amount of PS18-1802 Category A funds allocated for HIV
testing in non-healthcare settings
Format Type: Currency

XSD (Schema) Name: amountHIVtestTargetedCateA

Min Length: 1

Max Length: 8

Definition:

For PS18-1802 Category A award (HIV Prevention Programs for Health Departments), this value represents the
allocation associated with HIV testing in non-healthcare settings. HIV testing in non-healthcare settings is a testing
strategy that involves testing persons based on characteristics that increase their likelihood of being infected with HIV.
These characteristics can include the presence of sexually transmitted diseases, behavioral risks, or attendance at
venues frequented by high-risk persons.

Instructions:

Indicate the amount of PS18-1802 Category A funds awarded to your agency that have been allocated for HIV testing in
non-healthcare settings. If no funds were allocated then enter 0.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable

BT102b

Value Option: N/A

Amount of PS18-1802 Category B funds allocated
for HIV testing in non-healthcare settings
Format Type: Currency

XSD (Schema) Name: amountHIVtestTargetedCateB

Min Length: 1

Max Length: 8

Definition:

For PS18-1802 Category B award (Expanded HIV Testing for Disproportionately Affected Populations), this value
represents the allocation associated with HIV testing in non-healthcare settings. HIV testing in non-healthcare settings is
a testing strategy that involves testing persons based on characteristics that increase their likelihood of being infected
with HIV. These characteristics can include the presence of sexually transmitted diseases, behavioral risks, or
attendance at venues frequented by high-risk persons.

Instructions:

Indicate the amount of PS18-1802 Category B funds awarded to your agency that have been allocated for HIV testing in
non-healthcare settings, if implemented or applicable. If no funds were allocated then enter 0.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable

117

BT102c

Value Option: N/A

Amount of PS18-1802 Category C funds allocated for HIV
testing in non-healthcare settings
Format Type: Currency

XSD (Schema) Name: amountHIVtestTargetedCateC

Min Length: 1

Max Length: 8

Definition:

For PS18-1802 Category C award (Demonstration Projects), this value represents the allocation associated with HIV
testing in non-healthcare settings. HIV testing in non-healthcare settings is a testing strategy that involves testing
persons based on characteristics that increase their likelihood of being infected with HIV. These characteristics can
include the presence of sexually transmitted diseases, behavioral risks, or attendance at venues frequented by high-risk

Instructions:

Indicate the amount of PS18-1802 Category C funds awarded to your agency that have been allocated for HIV testing in
non-healthcare settings, if implemented or applicable. If no funds were allocated then enter 0.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable

BT102m

Value Option: N/A

Open-ended question 2 for HIV testing in nonhealthcare settings
Format Type: Alpha-Numeric

XSD (Schema) Name: questionHIVtestTargeted2

Min Length: 1

Max Length: 650

Definition:

Please provide any additional information to explain funding allocation limitations or caveats for HIV testing in nonhealthcare settings that may be a concern to you, if applicable.

Instructions:

Please answer the question in 100 words or less.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable

118

BT103a

Value Option: N/A

Amount of PS18-1802 Category A funds allocated
for comprehensive prevention with positives
Format Type: Currency

XSD (Schema) Name: amountCPPCateA

Min Length: 1

Max Length: 12

Definition:

For PS18-1802 Category A award (HIV Prevention Programs for Health Departments); this value represents the funding
allocation associated with comprehensive prevention with positives (CPP) programs and services. CPP covers a range of
prevention activities including Partner Services, continuum of care (linkage, retention, re-engagement in care, and
treatment adherence), risk-reduction EBIs with HIV-positive people and other prevention programs that are targeted to
HIV-diagnosed individuals and their partners.

Instructions:

Indicate the amount of your PS 12-1201 Category A award that your agency allocated for comprehensive prevention with
positives activities. If no funds were allocated then enter 0.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable

119

BT103b

Value Option: N/A

Amount of PS18-1802 Category B funds allocated for
comprehensive prevention with positives
Format Type: Currency

XSD (Schema) Name: amountCPPCateB

Min Length: 1

Max Length: 12

Definition:

For PS18-1802 Category B award (Expanded HIV Testing for Disproportionately Affected Populations); this value
represents the funding allocation associated with comprehensive prevention with positives (CPP) programs and services.
CPP covers a range of prevention activities including Partner Services, continuum of care (linkage, retention, reengagement in care, and treatment adherence), risk-reduction EBIs with HIV-positives and other prevention programs
that are targeted to HIV-diagnosed individuals and their partners.

Instructions:

Indicate the amount of your PS 12-1201Category B award that your agency allocated for comprehensive prevention with
positives activities. If no funds were allocated then enter 0.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable
BT103c

Value Option: N/A

Amount of PS18-1802 Category C funds allocated
for comprehensive prevention with positives
Format Type: Currency

XSD (Schema) Name: amountCPPCateC

Min Length: 1

Max Length: 12

Definition:

For PS18-1802 Category C award (Demonstration Projects); this value represents the funding allocation associated with
comprehensive prevention with positives (CPP) programs and services. CPP covers a range of prevention activities
including Partner Services, continuum of care (linkage, retention, re-engagement in care, and treatment adherence), riskreduction EBIs with HIV-positive people and other prevention programs that are targeted to HIV-diagnosed individuals
and their partners.

Instructions:

Indicate the amount of your PS18-1802 Category C award that your agency allocated for comprehensive prevention with
positives activities. If no funds were allocated then enter 0.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable

120

BT103i

Open-ended question 1 for comprehensive
prevention with positives

Value Option: N/A Format Type: Alpha-Numeric Min Length: 1

XSD (Schema) Name: questionCPP1

Max Length: 650 Definition: Please identify the

specific prevention activities included in the allocations to “other CPP” activities category. Instructions:

Please answer the

question in 100 words or less.
Business rule HIV Testing: Not applicable
Partner Services: Not applicable
Open ended question, free text field, may be left blank.
BT103k

Value Option: N/A

Amount of PS18-1802 Category A funding allocated
for partner services
Format Type: Currency

XSD (Schema) Name:

Min Length: 1

Max Length: 12

Definition:

For PS18-1802 Category A, this value represents the allocation associated with Partner Services.

Instructions:

Indicate the amount of PS18-1802 Category A funding that your agency allocated for PartnerServcies. If no funds were
allocated, enter 0.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable
BT103l

Value Option: N/A

Amount of PS18-1802 Category B funding allocated
for partner services
Format Type: Currency

XSD (Schema) Name:

Min Length: 1

Max Length: 12

Definition:

For PS18-1802 Category B, this value represents the allocation associated with Partner Services.

Instructions:

Indicate the amount of PS18-1802 Category B funding that your agency allocated for Partner Services. If no funds were
allocated, enter 0.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable

121

BT103m

Value Option: N/A

Amount of PS18-1802 CategoryC funding allocated for partner
services
Format Type: Currency

XSD (Schema) Name:

Min Length: 1

Max Length: 12

Definition:

For PS18-1802 Category C, this value represents the allocation associated with Partner Services.

Instructions:

Indicate the amount of PS18-1802 Category C funding that your agency allocated for Partner Services. If no funds were
allocated, enter 0.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable
BT103n

Value Option: N/A

Amount of PS18-1802 Category A funding allocated
for HIV continuum of care which includes linkage,
retention, and re-engagement in care, and HIV
medication adherence support
Format Type: Currency

XSD (Schema) Name:

Min Length: 1

Max Length: 12

Definition:

For PS18-1802 Category A, this value represents the allocation associated with HIV continuum of care which includes
linkage, retention, and re-engagement in care, and HIV medication adherence support.

Instructions:

Indicate the amount of PS18-1802 Category A funding that your agency allocated for HIV continuum of care which
includes linkage, retention, and re-engagement in care, and HIV medication adherence support. If no funds were
allocated, enter 0.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable

122

BT103o

Value Option: N/A

Amount of PS18-1802 CategoryB funding allocated for HIV
continuum of care which includes linkage, retention, and reengagement in care, and HIV medication adherence support.
Format Type: Currency

XSD (Schema) Name:

Min Length: 1

Max Length: 12

Definition:

For PS18-1802 Category B, this value represents the allocation associated with HIV continuum of care which includes,
linkage, retention, and re-engagement in care, and HIV medication adherence support.

Instructions:

Indicate the amount of PS18-1802 Category B funding that your agency allocated for HIV continuum of care which
includes linkage, retention, and re-engagement in care, and HIV medication adherence support. If no funds were
allocated, enter 0.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable
BT103p

Value Option: N/A
Definition:

Amount of PS18-1802 Category C funding allocated
for HIV continuum of care which includes linkage,
retention, and re-engagement in care, and HIV
medication adherence support
Format Type: Currency

XSD (Schema) Name:

Min Length: 1

Max Length: 12

For PS18-1802 Category C, this value represents the allocation associated with HIV continuum of care which includes
linkage, retention, and re-engagement in care, and HIV medication adherence support.

Instructions: Indicate the amount of PS18-1802 Category C funding that your agency allocated for HIV continuum of care which
includes linkage, retention, and re-engagement in care, and HIV medication adherence support. If no funuds were
allocated, enter 0.
Business rule HIV Testing: Not applicable
Partner Services: Not applicable

123

BT103q

Value Option: N/A

Amount of PS18-1802 Category A funding allocated for riskreduction EBIs with HIV-positive persons
Format Type: Currency

XSD (Schema) Name:

Min Length: 1

Max Length: 12

Definition:

For PS18-1802 Category A, this value represents the allocation associated with risk-reduction EBIs with HIV-positive
persons.

Instructions:

Indicate the amount of PS18-1802 Category A funding that your agency allocated for risk-reduction EBIs with HIVpositive persons. If no funds were allocated, enter 0.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable
BT103r

Value Option: N/A

Amount of PS18-1802 Category B funding allocated
for risk-reduction EBIs with HIV-positive persons
Format Type: Currency

XSD (Schema) Name:

Min Length: 1

Max Length: 12

Definition:

For PS18-1802 Category B, this value represents the allocation associated with risk-reduction EBIs with HIV-positive
persons.

Instructions:

Indicate the amount of PS18-1802 Category B funding that your agency allocated for risk-reduction EBIs with HIVpositive persons. If no funds were allocated, enter 0.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable

BT103s

Value Option: N/A

Amount of PS18-1802 Category C funding allocated
for risk-reduction EBIs with HIV-positive persons
Format Type: Currency

XSD (Schema) Name:

Min Length: 1

Max Length: 12

Definition:

For PS18-1802 Category C, this value represents the allocation associated with risk-reduction EBIs for HIV-positive
persons.

Instructions:

Indicate the amount of PS18-1802 Category C funding that your agency allocated for risk-reduction EBIs with HIVpositive persons. If no funds were allocated, enter 0.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable

124

BT103t

Value Option: N/A

Amount of PS18-1802 Category A funding allocated for other
comprehensive prevention activities with HIV-positive
persons
Format Type: Currency

XSD (Schema) Name:

Min Length: 1

Max Length: 12

Definition:

For PS18-1802 Category A, this value represents the allocation associated with other comprehensive prevention
activities with HIV-positive persons.

Instructions:

Indicate the amount of PS18-1802 Category A funding that your agency allocated for other comprehensive prevention
activities with HIV-positive persons. If no funds were allocated, enter 0.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable

BT103u

Value Option: N/A
Definition:
Instructions:

Amount of PS18-1802 Category B funding allocated
for other comprehensive prevention activities with
HIV-positive persons
Format Type: Currency

XSD (Schema) Name:

Min Length: 1

Max Length: 12

For PS18-1802 Category B, this value represents the allocation associated with other comprehensive prevention
activities with HIV-positive persons.

Indicate the amount of PS18-1802 Category B funding that our agency allocated for other comprehensive prevention
activities with HIV-positive persons. If no funds were allocated, enter 0.
Business rule HIV Testing: Not applicable
Partner Services: Not applicable

125

BT103v

Amount of PS18-1802 Category C funding allocated
for other comprehensive prevention activities with
HIV-positive persons
XSD (Schema) Name:

Value Option: N/A

Format Type: Currency

Min Length: 1

Max Length: 12

Definition:

For PS2-1201 Category C, this value represents the allocation associated with other comprehensive activities with HIVpositive persons.

Instructions:

Indicate the amount of PS18-1802 Category C funding that your agency allocated for other comprehensive activities with
HIV-positive persons. If no funds were allocated, enter 0.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable

126

BT104a

Value Option: N/A
Definition:

Amount of PS18-1802 Category A funding allocated for
condom distribution
Format Type: Currency

XSD (Schema) Name: amountCondomCateA

Min Length: 1

Max Length: 12

For PS18-1802 Category A award (HIV Prevention Programs for Health Departments), this value represents the funding
allocation associated with condom distribution.

Instructions:

Indicate the amount of PS18-1802 Category A funds your agency allocated for condom distribution. If no funds were
allocated then enter 0.
Business rule HIV Testing: Not applicable
Partner Services: Not applicable

BT104g
Value Option: N/A

Open-ended question 2 for condom distribution
Format Type: Alpha-Numeric

XSD (Schema) Name: questionCondom2
Min Length: 1

Max Length: 650

Definition:

Please provide any additional information to explain condom distribution-related funding allocation limitations or caveats
that may be a concern to you, if applicable.

Instructions:

Please answer the question in 100 words or less.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable
BT104h

Value Option: N/A

Amount of PS18-1802 Category C funding allocated
for condom distribution
Format Type: Currency

XSD (Schema) Name:

Min Length: 1

Max Length: 12

Definition:

For PS18-1802 Category C, this value represents the allocation associated with condom distribution.

Instructions:

Indicate the amount of PS18-1802 Category C funding that your agency allocated for condom distribution. If no funds
were allcoated then enter 0.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable

127

BT104i

Value Option: N/A

Amount of PS18-1802 CategoryB funding allocated for
condom distribution
Format Type: Currency

XSD (Schema) Name:

Min Length: 1

Max Length: 12

Definition:

For PS18-1802 Category B, this value represents the allocation associated with condom distribution.

Instructions:

Indicate the amount of PS18-1802 funding that your agency allocated for condom distribution. If no funds were allocated,
enter 0.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable
BT105a

Value Option: N/A

Amount of PS18-1802 Category A allocated for
Policy Initiatives
Format Type: Currency

XSD (Schema) Name: amountPolicyCateA

Min Length: 1

Max Length: 12

Definition:

For PS18-1802 Category A award (HIV Prevention Programs for Health Departments), this value represents the
allocation associated with policy initiatives.

Instructions:

Indicate the amount of PS18-1802 Category A funds your agency allocated for policy initiatives. If no funds were
allocated then enter 0.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable
BT106b

Value Option: N/A
Definition:

Amount of PS18-1802 Category B allocated for
service integration (optional)
Format Type: Currency

XSD (Schema) Name: amountRoutineCateB

Min Length: 1

Max Length: 12

For PS18-1802Category B award (Expanded HIV Testing for Disproportionately Affected Populations), this value
represents the allocation associated with the optional services integration component.

Instructions: Indicate the amount of PS18-1802 Category B funds your agency allocated for the integration of testing programs for
HIV, hepatitis B virus, hepatitis C virus, other STDs and tuberculosis, if implemented. If no funds were allocated then
enter 0.
Business rule HIV Testing: Not applicable
Partner Services: Not applicable

128

BT106e

Value Option: N/A

Open-ended question for PS18-1802 Category B funds
allocated for service integration
Format Type: Alpha-Numeric

XSD (Schema) Name: question121201RCCateB

Min Length: 1

Max Length: 650

Definition:

If you have allocated PS18-1802 Category B funds to other components, please list the programs or activities that you
are going to implement or have implemented.

Instructions:

Please answer the question in 100 words or less.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable
BT106g

Value Option: N/A

Amount of PS18-1802 Category A funding allocated
for other components
Format Type: Currency

XSD (Schema) Name:

Min Length: 1

Max Length: 12

Definition:

For PS18-1802 Category A, this value represents the allocation associated with other non-required prevention activities,
excluding support services.

Instructions:

Indicate the amount of PS18-1802 Category A funding that your agency allocated for other components (non-required
prevention activities excluding support services). If no funds were allocated then enter 0.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable
BT106h

Value Option: N/A

Open-ended question for PS18-1802 Category A
funds allocated for other components
Format Type: Alpha-Numeric

XSD (Schema) Name:

Min Length: 1

Max Length: 650

Definition:

If you have allocated PS18-1802 Category A funds to other components, please list the program or activities that you are
going to implement or have implemented.

Instructions:

Please answer the question in 100 words or less.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable

129

BT106i

Value Option: N/A

Amount of PS18-1802 CategoryB funding allocated for other
components
Format Type: Currency

XSD (Schema) Name:

Min Length: 1

Max Length: 12

Definition:

For PS18-1802 Category B, this value represents the allocation associated with other non-required prevention activities
excluding service integration and support services.

Instructions:

Indicate the amount of PS18-1802 Category B funding that your agency allocated for other components (non-required
prevention activities excluding service integration and support services). If no funds were allocated then enter 0.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable

BT106j

Value Option: N/A

Amount of PS18-1802 Category C funding allocated
for other components
Format Type: Currency

XSD (Schema) Name:

Min Length: 1

Max Length: 12

Definition:

For PS18-1802 Category C, this value represents the allocation associated with other non-required prevention activities
excluding support services.

Instructions:

Indicate the amount of PS18-1802 Category C funding that your agency allocated for other components (non-required
prevention activities excluding support services). If no funds were allocated then enter 0.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable

BT106k

Value Option: N/A

Open-ended question for PS18-1802 Category B
funds allocated for recommended and other
components
Format Type: Alpha-Numeric

XSD (Schema) Name:

Min Length: 1

Max Length: 650

Definition:

If you have allocated PS18-1802 Category B funds to other components, please list the program or activities that you are
going to implement or have implemented.

Instructions:

Please answer the question in 100 words or less.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable

130

BT106l

Value Option: N/A

Open-ended question for PS18-1802 Category C funds
allocated for recommended and other components
Format Type: Alpha-Numeric

XSD (Schema) Name:

Min Length: 1

Max Length: 650

Definition:

If you have allocated PS18-1802 Category C funds ot other components, please list the program or activities that you are
going to implement or have implemented.

Instructions:

Please answer the question in 100 words or less.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable
BT107c

Value Option: N/A

Amount of PS18-1802 Category A funds allocated
for HIV prevention program monitoring and
evaluation
Format Type: Currency

XSD (Schema) Name: amountMandE121201CateA

Min Length: 1

Max Length: 12

Definition:

For PS18-1802 Category A, this value represents the allocation associated with program monitoring and evaluation.

Instructions:

Indicate the amount of PS18-1802 Category A funding that your agency allocated for program monitoring and evaluation.
If no funds were allocated then enter 0.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable

BT107d

Value Option: N/A

Amount of PS18-1802 Category B funds alloacted
for HIV prevention program monitoring and
evaluation
Format Type: Currency

XSD (Schema) Name: amountMandE121201CateB

Min Length: 1

Max Length: 12

Definition:

For PS18-1802 Category B, this value represents the allocation associated with program monitoring and evaluation.

Instructions:

Indicate the amount of PS18-1802 Category B funding that your agency allocated for program monitoring and evaluation.
If no funds were allocated then enter 0.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable

131

BT107e

Value Option: N/A

Amount of PS18-1802 Category C funds allocated for HIV
prevention program monitoring and evaluation
Format Type: Currency

XSD (Schema) Name: amountMandE121201CateC

Min Length: 1

Max Length: 12

Definition:

For PS18-1802 Category C, this value represents the allocation associated with program monitoring and evaluation.

Instructions:

Indicate the amount of PS18-1802 Category C funding that your agency allocated for program monitoring and evaluation.
If no funds were allocated then enter 0.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable
BT108c

Value Option: N/A

Amount of PS18-1802 Cateogry A funds allocated
for Jurisdictional HIV Prevention Planning
Format Type: Currency

XSD (Schema) Name: amountPlanning121201CateA

Min Length: 1

Max Length: 12

Definition:

For PS18-1802 Category A, this value represents the allocation associated with jurisdictional HIV prevention planning.

Instructions:

Indicate the amount of PS18-1802 Category A funding that your agency allocated for jurisdictional HIV prevention
planning. If no funds were allocated then enter 0

Business rule HIV Testing: Not applicable
Partner Services: Not applicable

BT109c

Value Option: N/A

Amount of PS18-1802 Category A funds allocated
for Capacity Building and Technical Assistance
Format Type: Currency

XSD (Schema) Name: amountCBTA121201CateA

Min Length: 1

Max Length: 12

Definition:

For PS18-1802 Category A, this value represents the allocation associated with capacity building and technical assistance

Instructions:

Indicate the amount of PS18-1802 Category A funding that your agency allocated for capacity building and technical
assistance. If no funds were allocated then enter 0.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable

132

BT109d

Value Option: N/A

Amount of PS18-1802 Category B funds allocated for
Capacity Building, Technical Assistance, and systems for
third party reimbursement for HIV testing and other related
co-infections
Format Type: Currency

XSD (Schema) Name: amountCBTA121201CateB

Min Length: 1

Max Length: 12

Definition:

For PS18-1802 Category B, this value represents the allocation associated with capacity building, technical assistance,
and systems for third party reimbursement for HIV testing and other related co-infections.

Instructions:

Indicate the amount of PS18-1802 Category B funding that your agency allocated for capacity building, technical
assistance, and systems for third party reimbursement for HIV testing and other related co-infections. If no funds were
allocated then enter 0.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable

BT109e

Value Option: N/A

Amount of PS18-1802 Category C funds allocated
for Capacity Building and Technical Assistance
Format Type: Currency

XSD (Schema) Name: amountCBTA121201CateC

Min Length: 1

Max Length: 12

Definition:

For PS18-1802 Category C, this value represents the allocation associated with capacity building and technical
assistance.

Instructions:

Indicate the amount of PS18-1802 Category C funding that your agency allocated for capacity building and technical
assistance. If no funds were allocated then enter 0.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable

133

BT110c

Value Option: N/A

Amount of PS18-1802 Category A funds allocated
for agency's general operations or admin activities
Format Type: Currency

XSD (Schema) Name: amountAdmin121201CateA

Min Length: 1

Max Length: 12

Definition:

For PS18-1802 Category A, this value represents the allocation associated with agency's general operations or
administrative activities.

Instructions:

Indicate the amount of PS18-1802 Category A funding that your agency allocated for agency's general operations or
administrative activities. If no funds were allocated then enter 0.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable

134

BT110d

Value Option: N/A

Amount of PS18-1802 Category B funds allocated for
agency's general operations or admin activities
Format Type: Currency

XSD (Schema) Name: amountAdmin121201CateB

Min Length: 1

Max Length: 12

Definition:

For PS18-1802 Category B, this value represents the allocation associated with agency's general operations or
administrative activities.

Instructions:

Indicate the amount of PS18-1802 Category B funding that your agency allocated for agency's general operations or
administrative activities. If no funds were allocated then enter 0.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable

BT110e

Value Option: N/A

Amount of PS18-1802 Category C funds allocated
for agency's general operations or admin activities
Format Type: Currency

XSD (Schema) Name: amountAdmin121201CateC

Min Length: 1

Max Length: 12

Definition:

For PS18-1802 Category C, this value represents the allocation associated with agency's general operations or
administrative activities.

Instructions:

Indicate the amount of PS18-1802 Category B funding that your agency allocated for agency's general operations or
administrative activities. If no funds were allocated then enter 0.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable

BT111
Value Option: N/A

Open-ended question for overall budget allocation
Format Type: Alpha-Numeric

XSD (Schema) Name: questionOverallBT
Min Length: 1

Max Length: 650

Definition:

Please provide any additional information to explain funding allocation limitations or caveats that may be a concern to
you, if applicable, for any of the budget allocation variables.

Instructions:

Please answer the question in 100 words or less.

Business rule HIV Testing: Not applicable
Partner Services: Not applicable

135

Additional HIV Testing Requirement
Table: CBOTEST

Additional HIV Testing Variables

This table is completed by all CDC directly funded community-based organizations

CBOTEST001

Target Population(s)

Value Option: Choose only one

XSD (Schema) Name:
Format Type: Alpha-Numeric

Min Length: 1

Max Length: 1

Definition:

The client belongs to the population(s) targeted by the CBO's PS15-1502-funded targeted HIV testing program.

Instructions:

Indicate whether the client belongs to the primary or secondary population(s) targeted by your agency's PS15-1502funded targeted HIV testing program.

Business rule HIV Testing: Required, see detailed business rule
Partner Services: Not applicable
Detailed business rule:
Should be reported reported by directly funded CBOs funded by PS15-1502 (X137=13 or X137=14).
Value option TP9 should only be selected if TP1, TP2, or TP3 is not selected.

Code

Value Description

Value Definition

TP1

Primary target population

Client is a member of the primary population targeted by the CBO's
PS15-1502-funded targeted HIV testing program

TP2

Secondary target population

Client is a member of the secondary population targeted by the
CBO's PS15-1502-funded targeted HIV testing program

TP3

Both target populations

Client is a member of the primary and secondary target populations

TP9

Not a member of either target population

Client is not a member of the primary or secondary population
targeted by the CBO's PS15-1502-funded targeted HIV testing
program

136

CBOTEST002

High-Risk Client

Value Option: Enter one value only

XSD (Schema) Name:

Format Type: Number

Min Length: 1

Max Length: 1

Definition:

Assessment of a client's risk level is determined on the basis of his/her responses provided on the CBO's risk
assessment tool.

Instructions:

Indicate whether the client is at high-risk for HIV-infection.

Business rule HIV Testing: Required, see detailed business rule
Partner Services: Not applicable

Detailed business rule:
Should only be reported by directly funded CBOs funded by PS15-1502 (X137=13 or X137=14).
Not expected otherwise.

Code

Value Description

Value Definition

Client is not at high-risk for HIV infection as defined by the CBO's
PS15-1502-tunded targeted HIV testing program

Yes

Client is at high-risk for HIV-infection as defined by the CBO's PS151502-funded targeted HIV testing program

Not assessed

No risk assessment was done for this client

137

CBOTEST003

HIV Medical Care at the time of this positive test

Value Option: Enter one value only

Format Type: Number

XSD (Schema) Name:

Min Length: 1

Definition:

At the time of this positive test, is the client already in HIV medical care?

Instructions:

Indicate if the client is already in HIV medical care at the time of this positive test.

Max Length: 1

Business rule HIV Testing: Required, see detailed business rule
Partner Services: Not applicable

Detailed business rule:
Should only be reported by directly funded CBOs funded by PS15-1502 (X137=13 or X137=14).
Not expected otherwise.

Code

Value Description

Value Definition

Client was not in HIV medical care at the time of this positive test

Yes

Client was in HIV medical care at the time of this positive test

Not asked

Client was not asked if he/she was already in HIV medical care at the
time of this positive test

Declined to answer

Client declined to answer if he/she was already in HIV medical care
at the time of this positive test

138

CBOTEST004

Navigation and prevention and essential support services,
HIV Testing

Value Option: Choose all that apply

Format Type: Alpha-Numeric

XSD (Schema) Name:

Min Length: 1

Max Length: 4

Definition:

The navigation, prevention, and essential support services that a client was referred to or provided as part of PS15-1502
HIV testing program

Instructions:

Indicate all navigation, prevention, and essential support services the client was referred to or provided as part of the
CBO's PS15-1502 HIV testing program

Business rule HIV Testing: Required, see detailed business rule
Partner Services: Not applicable
Detailed business rule: Should only be reported by directly funded CBOs funded by PS15-1502 (X137=13 or X137=14). Not
expected otherwise.
Code
P1

Value Description
Value Definition
Provided a High Impact Prevention (HIP) behavioral intevention, HIV- Client was provided a CDC-supported evidence-based behavioral
positive
intervention (EBI) for HIV-positive persons that reduce sexual or drugrelated risks related to the transmission of HIV infection

Provided medication adherence support services, HIV-positive

Provided screening for STDs (syphilis, gonorrhea, and chlamydia),
HIV-positive

Provided screening for viral hepatitis, HIV-positive

Client was provided screening for viral hepatitis, HIV-positive only

Provided screening for TB/TB infection, HIV-positive

Client was provided screening for latent or active strains of
tuberculosis, HIV-positive only

Provided a High Impact Prevention (HIP) behavioral intevention, HIV- Client was provided a CDC-supported High Impact Prevention (HIP)
negative
behavioral intervention for high-risk HIV-negative persons

Provided screening for STDs (syphilis, gonorrhea, and chlamydia),
HIV-negative

Client was provided screening for STDs (syphilis, gonorrhea, and
chlamydia), HIV-negative only

Provided screening for viral hepatitis, HIV-negative

Client was provided screening for viral hepatitis, HIV-negative only

Provided screening for TB/TB infection, HIV-negative

Client was provided screening for latent or active strains of
tuberculosis, HIV-negative only

RF1

Referred to a High Impact Prevention (HIP) behavioral intervention,
HIV-positive

Client was referred to a CDC-supported evidence based behavioral
intervention (EBI) for HIV-positive persons that reduce sexual or drugrelated risks related to the transmission of HIV infection

Client was provided a CDC-supported medication adherence
intervention that improves medication adherence and/or viral load
among HIV patients who have been prescribed antiretroviral
treatment (ART), HIV-positive only
Client was provided screening for STDs (syphilis,
gonorrhea, and chlamydia), HIV-positive only

139

RF10

Referred to non-occupational post-exposure prophylaxis (nPEP), HIV- Client was referred to non-occupational post-exposure prophylaxis
negative
(nPEP), HIV-negative only

RF11

Referred to pre-exposure prophylaxis (PrEP), HIV-negative

RF12

Referred to screening for STDs (syphilis, gonorrhea, and chlamydia), Client was referred to screening for STDs (syphilis, gonorrhea, and
HIV-negative
chlamydia), HIV-negative only

RF13

Referred to screening for viral hepatitis, HIV-negative

Client was referred to screening for viral hepatitis, HIV-negative only

RF14

Referred to screening for TB/TB infection, HIV-negative

Client was referred to screening for latent or active strains of
tuberculosis, HIV-negative only

RF15

Referred to treatment for STDs (syphilis, gonorrhea, and chlamydia),
HIV-negative

Client was referred to treatment for STDs (syphilis, gonorrhea, and
chlamydia), HIV-negative only

Client was referred to pre-exposure prophylaxis (PrEP), HIV-negative
only

140

RF16

Referred to treatment or vaccination for viral hepatitis, HIV-negative

Client was referred to treatment or vaccination for viral hepatitis, HIVnegative only

RF17

Referred to treatment for TB/TB infection, HIV-negative

Client was referred to treatment for latent or active strains of
tuberculosis, HIV-negative only

RF18

Referred to basic education continuation and completion services

Programs that assist the client in improving basic reading, writing,
math, spelling, and language skills (such as GED preparation, or
English as a Second Language (ESL) classes)

RF19

Referred to employment services

Programs that provide employment assistance including vocational
trainings, employment referrals, job placement, skills assessment,
resume building support, etc.

RF2

Referred to medication adherence support services, HIV-positive

Client was referred to a CDC-supported medication adherence
intervention that improves medication adherence and/or viral load
among HIV patients who have been prescribed antiretroviral
treatment (ART), HIV-positive only

RF20

Referred to housing services

Programs that help clients find adequate housing by providing
services such as assistance with homelessness, rental housing, or
home-buying, access/eligibility assessment to HUD/HOPWA housing
programs

RF21

Referred to insurance navigation and enrollment services

Programs that help uninsured clients enroll in public or private
healthcare insurance. Services may include outreach and education
on available insurance options, eligibility assessment, enrollment, etc.

RF22

Referred to mental mental health counseling and services

Programs that are provided by a mental health professional. Services
may include psychiatric assessment, consultation, treatment,
psychotherapy, crisis intervention, etc.

RF23

Referred to sex education, including HIV education

Client was referred to sex education, including HIV education (e.g.
risk education programs, school-based HIV prevention providers) and
HIV/AIDS prevention education

RF24

Referred to substance abuse treatment and services

Client was referred to drug and alcohol abuse treatment and support
programs/services

RF25

Referred to transportation services

Client received a referral to agencies providing transportation
assistance (to and from HIV prevention and medical care
appointments, including HIV medical care appointments),
e.g.through direct transportation services, vouchers, or tokens

141

RF26

Referred to other prevention and essential support services

Other navigation, prevention, and essential support services, e.g.,
social services, peer support, child care assistance, food, services for
youth and/or seniors, etc.

RF3

Referred to screening for STDs (syphilis, gonorhea, and chlamydia),
HIV-positive

Client was referred to screening for STDs (syphilis, gonorrhea, and
chlamydia), HIV-positive only

RF4

Referred to screening for viral hepatitis, HIV-positive

Client was referred to screening for viral hepatitis, HIV-positive only

RF5

Referred to screening for TB/TB infection, HIV-positive

Client was referred to screening for latent or active strains of
tuberculosis, HIV-positive only

RF6

Referred to treatment for STDs (syphilis, gonorrhea, and chlamydia),
HIV-positive

Client was referred to treatment for STDs (syphilis, gonorrhea, and
chlamydia), HIV-positive only

RF7

Referred to treatment or vaccination for viral hepatitis, HIV-positive

Client was referred to treatment or vaccination for viral hepatitis, HIVpositive only

RF8

Referred to treatment for TB/TB infection, HIV-positive

Client was referred to treatment for latent or active strains of
tuberculosis, HIV-positive only

RF9

Referred to a High Impact Prevention (HIP) behavioral intervention,
HIV-negative

Client was referred to a CDC-supported High Impact Prevention
(HIP) behavioral intervention for high-risk HIV-negative persons

CBOTEST004SP Other recommended support services, HIV testing

Value Option: N/A Format Type: Alpha-Numeric Min Length: 1

XSD (Schema) Name:

Max Length: 50

Definition:

Description of other navigation and prevention and essential support services a client was referred to or provided

Instructions:

Enter the type of service the client was referred to or provided

Business rule HIV Testing: Required, see detailed business rule
Partner Services: Not applicable
Detailed business rule:
Text must be entered if other prevention and essential support services (value option RF26) is selected for CBOTEST004.
CBOTEST005 Date client attended first medical appt
Value Option: TBD

Format Type: Date

XSD (Schema) Name:
Min Length: 8

Max Length: 10

Definition:

The calendar month, day, and year that the client attended his/her first medical care appointment.

Instructions:

Enter the date that client attended first medical appointment.

Business rule: CBO: required
Cannot be greater than the current date at
the time of data entry

142

CBO Client Summary
Requirements
Table: CBOCL

CBO Client Summary Variables

This table is completed by all CDC directly
funded community-based organizations
CBOCL003

Value Option: N/A

Client Record Number

Format Type: Number

Min Length: 1

Max Length: 32

Definition:

A locally developed, unique-client number used to distinguish an individual client receiving one or more services within an
agency

Instructions:

Enter the unique client record number assigned by the CBO to an individual client. Client Record Number must not
contain any personally identifiable information (PII).

Business rule HIV Testing: Mandatory, see detailed business rule
Partner Services: Not applicable
Detailed business rule:
Must be reported by directly funded CBOs funded by PS15-1502 (X137=13 or X137=14).

File Type	application/pdf
Author	Janet Heitgerd
File Modified	2018-05-14
File Created	2018-05-14