Instructions: Cluster Investigation Reporting

National HIV Surveillance System (NHSS)

Attachment 4f.
Instructions for Completing the Cluster Report

Instructions for Completing the Cluster Report
Overview
The Cluster Report is designed to assist jurisdictions with tracking the relevant steps of the roadmap for
investigating and intervening in transmission clusters. See the guidance document ‘Detecting and
Responding to HIV Transmission Clusters’ for more information. The Cluster Report is intended for use
with molecular clusters that meet CDC’s definition of a national priority cluster, whether the cluster was
first identified through local or through national analysis, as well as with additional clusters of concern
identified through alternative means (i.e. time-space analysis).

Securely Submitting the Document
Jurisdictions should submit one Cluster Report (i.e. workbook containing all four tabs) per quarter for
each cluster in which ongoing investigation and response activities are occurring. Only one tab should be
filled out each quarter, depending on the stage of cluster detection and response. For example,
jurisdictions that detected a cluster in December 2018 should submit the full workbook with just the
Initial Cluster Report tab completed no later than the end of March 2019. (Note: For more concerning
clusters, jurisdictions are encouraged to submit the Initial Report form earlier, and/or provide CDC with
a courtesy notification about the cluster.) Subsequent quarters would only require updating the Cluster
Follow Up Report and re-submitting the workbook until year-end and/or cluster closeout, in which the
Annual/Closeout Report tab will be completed. Jurisdictions are encouraged to use the same workbook
every time and simply update the information provided in the previous quarter using the Cluster Follow
Up Report (or Annual/Closeout Report, as specified). Jurisdictions should continue to submit Follow Up
and Annual/Closeout Reports every quarter and year, respectively, until investigation and response
activities for the cluster conclude.
Jurisdictions should submit their worksheets securely using the SAMS Cluster folder. Filepaths should
follow this nomenclature so that they can easily be distinguished by CDC: “JURISDICTION
NAME_CR_CLUSTER ID_REPORTING QUARTER AND YEAR.” For issues submitting files through SAMS, or
to request SAMS access, please contact the SAMS helpdesk.
Cluster investigation worksheets should be submitted by the final business day of the last month of each
quarter (March, June, September, and December). A three-month window is provided after initial
cluster detection before the Initial Report Form is due, and Follow Up Report forms for the cluster are
due quarterly. The Annual/Closeout Report is due for all clusters detected 12 or more months prior on
the last business day of December. Below is a breakdown of these timeframes for 2019:
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March 29, 2019: Submit the Initial or Follow Up Report for clusters identified through December
31, 2018. Additionally, submit the Annual/Closeout Report for any clusters for which
investigation and response activities were closed that quarter.

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June 28, 2019: Submit the Initial or Follow Up Report for clusters identified through March 31,
2019. Additionally, submit the Annual/Closeout Report for any clusters for which investigation
and response activities were closed that quarter.
September 30, 2019: Submit the Initial or Follow Up Report for clusters identified through June
30, 2019. Additionally, submit the Annual/Closeout Report for any clusters for which
investigation and response activities were closed that quarter.
December 31, 2019: Submit the Initial Report for clusters identified July 1, 2019 through
September 30, 2019. Additionally, submit the Cluster Report (Annual/Closeout Report) excel
workbook for all clusters identified through December 31, 2018 for which an active investigation
or response is still ongoing. Submit the Follow Up Report for any other clusters identified
between January 1, 2019 and June 30, 2019.

Instructions for completing each report are outlined below.

Initial Cluster Report
General Cluster Information
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Complete the first two rows with the name of the jurisdiction and the name of the person
completing the Cluster Report. List the email address for the person completing the form. Use
the dropdown menu option to indicate whether the jurisdiction is a low morbidity jurisdiction
(defined as membership in the low morbidity jurisdiction workgroup) or not.
Question #1, ‘Date cluster first detected’: Insert the date the cluster was first identified through
any of the methods listed below in Question #5. If national molecular or national space-time
analysis was used, insert the date your jurisdiction was notified of the existence of the cluster by
CDC.
Question #2, ‘Date form completed’: Insert the date the report was completed prior to
submission to CDC. Note: Complete the Initial Cluster Report after the jurisdiction has gathered
information for a preliminary desk review soon after cluster detection (Question #1). This does
not have to be the same date as the date listed in Question #1. Enter the cluster into eHARS
prior to completing this form.
Questions #3, ‘Local Cluster ID entered into eHARS’: Insert the local cluster ID entered into
eHARS from the source that first detected the cluster (see ‘Guidance on Entering Information
Related to HIV Transmission Clusters Into eHARS' for more information on nomenclature for
local cluster IDs).
Question #4, ‘National Cluster ID (if applicable): If the cluster has a national cluster ID (i.e. was
detected by national molecular and/or national time-space analysis), enter that information in
Question #4.
Question #5, ‘Initial cluster detection method that identified this cluster’: Select the method
that initially detected this cluster. Note: Only one option can be selected. This should match the
information that is reported in eHARS.

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Question #6, ‘For clusters identified through molecular analysis, does this cluster meet national
priority cluster criteria?’: Select ‘yes’ or ‘no’ from the dropdown menu if the cluster was
identified through molecular analysis. If the cluster was identified through another method,
such as time-space analysis or provider notification, choose ‘N/A’. Note: Molecular clusters meet
national priority cluster criteria if defined at the 0.5% genetic distance threshold with at least 5
diagnoses in the past 12 months (or at least 3 diagnoses in the past 12 months for low morbidity
jurisdictions).
Question #7, ‘Had this cluster been identified by any other method?’: If the cluster was
identified through multiple detection methods, select ‘yes’ and indicate all additional methods
of cluster detection. Include the cluster ID and date detected for each.
Question #8, ‘Please indicate data reviewed for persons identified in the cluster’: Select all
sources of data that were reviewed for all persons in the cluster, including those in the
transmission cluster as well as those in the risk network. Select ‘yes’ or ‘no’ from the dropdown
menu options—do not leave any dropdown boxes blank. If ‘yes’ is selected as the option for
‘other’, use the cell to the right to specify the data source.

Non-molecular clusters
(Complete this section only for clusters detected through other methods [i.e. time-space analysis or
provider notification]. No further information on the Initial Report Form needs to be completed for nonmolecular clusters.)
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Question #9, ‘Please describe the characteristics of the cluster that have raised concern’:
Provide a brief description of the aspects of the cluster that raised concern and led to the
decision to report the cluster to CDC. For example, a sudden increase in diagnoses compared to
baseline numbers that were detected through time-space analysis, an increase in IDU-associated
HIV-infections, etc.
Question #10, ‘What is your current level of concern for this cluster?’: Select ‘High’ (additional
response is needed), ‘Medium’ (additional information about the cluster is needed), or ‘Low’ (no
additional investigation activities are needed at this time) from the dropdown menu. Note: It is
not required to report clusters of low priority to the CDC unless the cluster meets national
priority cluster criteria, or if enhanced response activities have been initiated.
Question #11, ‘Please briefly describe data review and investigation/response activities
conducted to date for this cluster, and any notable findings.’: Use this space to briefly describe
any activities that have been undertaken so far related to cluster investigation and response,
and any major findings associated with those activities (e.g. commonalities in demographic or
transmission risk factors for cluster members, any common venues identified, high numbers of
anonymous partners, etc.).

Molecular Clusters: Existing Data Review
(Complete this section only for clusters identified through analysis of HIV sequence data.)

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Question #12, ‘Number of HIV-positive persons in the molecular cluster at time of detection
who have a report of HIV in your jurisdiction’: In cell 27D, specify the total number of HIVpositive persons known to be in the molecular cluster at the time of detection (i.e. only cases
detected through molecular analysis). In cell 28D, specify the number of HIV-positive persons in
the molecular cluster who were diagnosed in the 12 months prior to detection. Note: Include
only those persons who have a report of HIV in your jurisdiction. Diagnoses that had been made
prior to cluster detection but were not yet known to be part of the cluster would not be
included.
Question #13, ‘If additional HIV-positive persons with a report of HIV in your jurisdiction have
been added to the molecular cluster (based on any subsequent data analysis) since first
identification, enter current numbers’: Specify the total number of HIV-positive persons in the
molecular cluster at the time of form completion (i.e. only cases detected through molecular
analysis). Note: This number should include the overall number of cases reported in Question
#12, plus any additional cases identified through subsequent analysis in cell 29D. In cell 30D,
indicate the number diagnosed in the past 12 months from the total number reported in 29D.
Include only those persons who have a report of HIV in your jurisdiction.
Question #14, ‘At what genetic distance threshold(s) is this cluster defined?’: Select from the
dropdown menu the option that correctly describes the genetic distance threshold used to
define the molecular cluster: ‘0.5%’, ‘1.5%’, ‘0.5% with first degree links at 1.5%’, or ‘other
(describe)’. If ‘other’ is selected, use the box to the right to describe the genetic distance
threshold used. Refer to the guidance document ‘Detecting and Responding to HIV Transmission
Clusters’ for considerations on what genetic distance threshold to use.
Question #15, ‘What is the time period of HIV diagnoses used to identify this cluster?’: Select
the option that correctly describes the time period of HIV diagnoses included in the molecular
analysis: ‘3 years’, ‘all years’ (greater than 3 years of diagnoses), or ‘other’. If ‘other’ is selected,
use the box to the right to describe the time period used. Note: Refer to the guidance document
‘Detecting and Responding to HIV Transmission Clusters’ for an explanation of CDC’s current
approach of time periods of HIV diagnoses used in molecular analysis
Question #16, ‘How many HIV-positive persons in the molecular cluster reported in question 12
had been interviewed by partner services prior to cluster detection?’: Based on data review, list
the number of molecular cluster members (reported in Question #12) that had been
interviewed by partner services after HIV diagnosis and before identification as part of the
cluster.
Question #17, ‘How many HIV-positive persons in the molecular cluster reported in question 12
were identified as connected to at least one other HIV-positive person in the molecular cluster
through existing partner services data?’: List the total number of unduplicated molecular cluster
members (reported in Question #12) that were known to be connected to at least one other
person in the molecular cluster through existing partner services data. Note: Count each person
that was named only once. For example, if Person A named Person B as a partner and Person B
also named Person A as a partner, you would count both persons only once. Likewise, if Person
A named Person B as a partner but Person B did not name Person A, you would still count both
persons only once.
Question #18, ‘Results of HIV testing of named partners of HIV-positive persons in the molecular
cluster’: Fill in testing information based on your existing data review for named partners of

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molecular cluster members. Note: Only include information about partners residing in your
jurisdiction. Do not include testing information on molecular cluster members even if they were
named as partners by other members of the cluster. Only report numeric data in each of the
cells provided (i.e. the number of new positives, the number of previous positives, the number
not located, etc.). If your system had the functionality to do so, numeric information for 18a.18l. can be pulled directly from your partner services database and shared as a separate excel
attachment instead of reporting that information here.
o For those who were tested (#18a-18f), indicate the number that newly tested as
positive, negative or unknown testing results. New positive is based on patient report
and no evidence of prior positive result in any state’s HIV surveillance system. If the
number of acute positive persons, recent (not acute) positive persons, and PrEP referral
information for negative persons is available, then report those as well.
o For those not tested (#18g-18l), indicate the number not tested classified according to
the reason for why testing was not done. Note: Persons not tested due to being
previously diagnosed with HIV infection should have been previously reported to any
health department’s surveillance registry as being infected with HIV.
Question #19, ‘How many additional persons have been claimed as partners (excluding other
molecular members of the cluster) through DIS interview conducted prior to cluster detection?’:
Report the de-duplicated number of individuals claimed as partners by molecular cluster
members through interviews conducted prior to cluster identification. This number should be
divided into four categories: 1) number of named partners residing in your jurisdiction, 2)
number of named partners residing outside your jurisdiction, 3) number of marginal partners
(e.g., some identifying information given, but not enough to locate the person), and 4) number
of anonymous partners (e.g., no identifying information given). Note: If any of the molecular
cluster members named each other, this should be excluded from the total. Molecular cluster
members that named each other are accounted for in Question #17. Values for Questions #19a
(named partners residing in your jurisdiction) and #19b (named partners residing outside your
jurisdiction) will be auto-filled based on information provided in Question #18 above.
Question #20, ‘Size of transmission cluster in your jurisdiction as identified through review of
available data’: The value for Question #20 will be auto-filled based on information provided in
Question #18 and should equal the number of new and previous positives reported in Questions
#18a and 18g.
Question #21, ‘How many HIV-positive persons in the transmission cluster reported in question
20 have evidence of recent viral suppression (most recent viral load <200 cp/mL and occurred in
the past 12 months)?’: Indicate the number of transmission cluster members (molecular cluster
members plus known HIV-positive partners) with evidence of recent viral suppression (most
recent viral load <200 cp/mL and occurred in the past 12 months). After cluster ID information is
entered into eHARS following the CDC guidance for this variable, this information can be pulled
directly from eHARS. CDC will be developing a SAS program to facilitate this. The SAS program
will generate a separate excel attachment that can be shared with CDC, rather than reporting
that information on the worksheet, if desired.
Question #22, ‘Number of persons in the risk network in your jurisdiction identified through
review of available data who are not known to be HIV infected’: The value for Question #22 will
be auto-filled based on information provided in Question #18. Note: This should equal the

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number of HIV-negative persons and persons with unknown HIV status reported in #18d, 18h,
18i, and 18l.
Question #23, ‘If the transmission cluster or risk network includes persons outside of your
jurisdiction, please describe any collaboration efforts with the other jurisdictions involved.’: Use
the box to the right to describe any collaboration efforts that have taken place to-date with
outside jurisdictions regarding cases in the cluster.

Existing Data Review: Cluster-level characteristics, commonalities and summary
(Complete this section only for clusters detected through molecular analysis.)
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Question #24, ‘Were any common venues or physical sites identified?’: Indicate whether any
common venues or physical sites were identified among persons in the cluster through existing
data review. If you select ‘yes’, use the box to the right to describe.
Question #25, ‘Were any common virtual sites identified?’: Indicate whether any common
virtual sites or apps were identified among persons in the cluster through existing data review. If
you select ‘yes’, use the box to the right to describe.
Question #26, ‘What other factors identified might be associated with increased transmission in
this cluster?’: Use the box to the right to describe any factors that you have identified through
data review and investigation efforts to-date that may be associated with increased
transmission in this cluster.

Key findings from review of partner services, surveillance, and other available data
(Complete this section only for clusters detected through molecular analysis.)
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Question #27, ‘Please provide a brief, narrative summary of key findings based on existing data
review.’: Use the box to the right to report key findings and other observations not captured
above from your review of partner services, surveillance, and other available data.
Question #28, ‘Based on your initial review of the data, what is your level of concern for this
cluster?’: Indicate your level of concern about this cluster based on initial data review: ‘High’
(additional response is needed), ‘Medium’ (additional information about the cluster is needed),
or ‘Low’ (no additional investigation activities are needed at this time).

Cluster Follow Up Report
(Complete this form quarterly for all clusters, regardless of method of detection, beginning with the
quarter after the Initial Cluster Report form has been submitted.)
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Complete the first two rows with the name of the jurisdiction (this will autofill based on the
response provided in the Initial Cluster Report form) and the name of the person completing the

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Cluster Report. The person completing the form should also list their contact information
(email). There is also a dropdown menu option to indicate whether the jurisdiction is a low
morbidity jurisdiction (defined as membership in the low morbidity jurisdiction workgroup) or
not. Note: This value will autofill based on the response you provided in the Initial Cluster
Report form.
Question #1, ‘Date form completed’: Fill in the final date the report was completed prior to
submission to CDC.
Questions #2, ‘Local Cluster ID entered into eHARS’, and #3, ‘National Cluster ID (if applicable)’:
In completing Question #2, use the local cluster ID entered into eHARS from whichever source
first detected the cluster (see ‘Guidance on Entering Information Related to HIV Transmission
Clusters Into eHARS' for more information on nomenclature for local cluster IDs). If the cluster
has a national cluster ID (i.e. was detected by national molecular and/or time-space analysis),
enter that information in Question #3. Note: These values will autofill based on the response
you provided in the Initial Cluster Report form.
Question #4, ‘Are response activities for this cluster currently ongoing?’: Select ‘yes’ or ‘no’ from
the dropdown menu. If you answer ‘no’, DO NOT fill out this form. Complete and submit the
Annual/Cluster Closeout Form instead.
Question #5, ‘Current number of persons in the transmission cluster in your jurisdiction’:
Indicate the total number of persons in the transmission cluster (i.e. molecular cases plus known
HIV-positive partners) residing in your jurisdiction at the time of completion of the form. After
cluster ID information is entered into eHARS for all current cases following the CDC guidance for
this variable, this information can be pulled directly from eHARS. CDC will be developing a SAS
program to facilitate this. The SAS program will generate a separate excel attachment that can
be shared with CDC, rather than reporting that information on the worksheet, if desired. Note:
For non-molecular clusters, report the number of persons who met the case definition for this
cluster.
Question #6, ‘Current number of persons in the risk network in your jurisdiction who are not
known to be HIV positive’: Indicate the total number of persons in the risk network not known
to be HIV positive who are residing in your jurisdiction at the time of completion of the form.
Note: For non-molecular clusters, report the number of HIV-uninfected partners or other
persons known to be connected to members of the cluster who do not have evidence of HIV
infection.
Question #7, ‘Has testing or re-testing been conducted for any persons who were not know to
be HIV positive at the time of identification as part of the risk network?’: Use the dropdown
menu to the right to select ‘yes’ or ‘no’ to indicate whether HIV testing or re-testing has been
conducted for persons not known to be HIV positive at the time of identification as part of the
risk network to-date. Note: For non-molecular clusters, this refers to testing/re-testing efforts
among HIV-uninfected partners or other persons known to be connected to members of the
cluster who did not have evidence of HIV infection at the time of identification.
Question #8, ‘Of persons who were HIV-negative or had unknown HIV status at the time of
identification as part of the risk network, what are the results of testing or re-testing efforts to
date?’: This question consists of three components, and should only be completed if the answer
to Question #7 is ‘yes’. For all, only list the number of persons who were not known to be HIV
positive at the time of identification as part of the risk network who are currently residing in

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your jurisdiction. Information can be pulled directly from your partner services database and
provided as a separate excel attachment rather than reporting that information here, if your
system has the functionality to do this. Note: For non-molecular clusters, this refers to
testing/re-testing efforts among HIV-uninfected partners or other persons known to be
connected to members of the cluster who did not have evidence of HIV infection at the time of
identification.
o For #8a, indicate the total number of persons in your jurisdiction who have been tested
(for persons with HIV-unknown status) or re-tested (for HIV-negative persons) to date,
regardless of whether or not they were tested within 6 months of identification as part
of the risk network.
o For #8b, indicate the number of persons in your jurisdiction who newly tested positive
as a result of testing (for persons with HIV-unknown status) or re-testing (for HIVnegative persons) efforts to-date, regardless of whether or not they were tested within
6 months of identification as part of the risk network.
o For #8c, indicate the total number of HIV-negative persons in your jurisdiction newly
referred for PrEP, regardless of whether or not they were referred within 6 months of
identification as part of the risk network.
Question #9, ‘Please describe any challenges you have encountered in promoting viral
suppression among persons in the transmission cluster, or in conducting testing/re-testing and
PrEP referral among persons in the risk network’: Use the narrative box provided to the right to
describe any challenges you have encountered to-date in promoting viral suppression,
conducting testing/re-testing activities, or referring persons to PrEP. Note: For non-molecular
clusters, this refers to HIV-positive persons who met the case definition for this cluster as well as
HIV-uninfected partners or other people known to be connected to cluster members who did
not have evidence of HIV infection at the time of identification.
Question #10, ‘Since the time of cluster detection, have any of the following investigation
and/or intervention activities been conducted’: Use the dropdown menu choices below to
indicate in 9a-9g whether specific cluster investigation and intervention activities have been
conducted to-date. Choose ‘yes’ or ‘no’ for each question; do not leave questions blank.
o If the answer to #9h is ‘yes’, use the box to the right to describe what types of
messaging activities have been conducted to-date.
o If the answer to #9g is ‘yes’, use the box to the right to describe what additional
investigation and intervention activities have been conducted to-date.
Question #11, ‘What is your current level of concern for this cluster?’: Indicate your current
level of concern about this cluster using the dropdown menu options: ‘High’ (additional
response is needed), ‘Medium’ (additional information about the cluster is needed), or ‘Low’ (no
additional investigation activities are needed at this time).
Space is provided in Question #12 to report key findings and other observations not captured
above.

Annual/Cluster Closeout Report

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(Complete this report annually, and also submit this form as a final report during the quarter in which
you closed investigation and response activities for the cluster. You do not need to submit a Follow Up
Report during the same quarter; the information in the Annual/Closeout Report supplants the
information in the Follow Up Report.)
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Complete the first two rows with the name of the jurisdiction (this will autofill based on the
response provided in the Initial Cluster Report form) and the name of the person completing the
cluster investigation worksheet. The person completing the form should also list their contact
information (email). There is also a dropdown menu option to indicate whether the jurisdiction
is a low morbidity jurisdiction (defined as membership in the low morbidity jurisdiction
workgroup) or not.
Question #1, ‘Date form completed’: Fill in the final date the report was completed prior to
submission to CDC.
Questions #2, ‘Local Cluster ID entered into eHARS’, and #3, ‘National Cluster ID (if applicable)’:
In completing Question #2, use the local cluster ID entered into eHARS from whichever source
first detected the cluster (see ‘Guidance on Entering Information Related to HIV Transmission
Clusters Into eHARS' for more information on nomenclature for local cluster IDs). If the cluster
has a national cluster ID (i.e. was detected by national molecular and/or time-space analysis),
enter that information in Question #3. Note: These values will autofill based on the response
you provided in the Initial Cluster Report form.
Question #4, ‘Are response activities for this cluster currently ongoing?’: Select ‘yes’ or ‘no’ from
the dropdown menu. If you answer ‘no’, you must also complete Questions #5 and #7
(otherwise, you should skip those questions).
Question #5, ‘Date cluster investigation and response activities closed’: Enter the date in which
investigation and response activities ceased and your jurisdiction determined that the cluster
response should be closed. This question should only be answered if you responded ‘no’ to
Question #4 above; otherwise, leave the cell blank or put ‘N/A.’
Question #6, ‘Size of cluster at closeout/current cluster size’: If you are filling out this form as an
annual report, indicate the size of the cluster at the time of completing the report. If you are
filling out this form at cluster closeout, indicate the size of the cluster at the time your
jurisdiction decided to close cluster investigation and response activities (Question #5 above).
The total number should be divided into two categories: transmission cluster members
(molecular cluster members plus known HIV-positive partners) reported by and residing in your
jurisdiction and risk network members (not known to be HIV-infected) residing in your
jurisdiction. Note: For non-molecular clusters, report the number of persons who met the case
definition for this cluster in cell D7. In cell D8, report the number of HIV-uninfected partners or
other persons known to be connected to members of the cluster who do not have evidence of
HIV infection.
Question #7, ‘Reason(s) for closeout’: Briefly describe the reason for closing out the cluster
investigation and response. Complete this question only if the answer to Question #4 is ‘no’;
otherwise, leave blank or put ‘N/A.’
Question #8, ‘Since the time of cluster detection, have any of the following investigation and/or
intervention activities been conducted’: Use the dropdown menu choices below to indicate in

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8a-8g whether specific cluster investigation and intervention activities have been conducted todate. Choose ‘yes’ or ‘no’ for each question; do not leave questions blank.
o If the answer to #8h is ‘yes’, use the box to the right to describe what types of
messaging activities have been conducted to-date.
o If the answer to #8g is ‘yes’, use the box to the right to describe what additional
investigation and intervention activities have been conducted to-date.
Question #9a, ‘How many persons in your jurisdiction did not have evidence of viral suppression
at the time of identification as part of the cluster?’: Report the total number of persons in the
cluster currently residing in your jurisdiction that did not have evidence of viral suppression at
the time of identification as part of the cluster, regardless of when or how the person was
identified as part of the cluster. (Viral suppression is defined as most recent viral load <200
cp/mL and occurred in the past 12 months). This information can be pulled directly from eHARS
and submitted as a separate attachment if desired. Note: For non-molecular clusters, report the
number of persons who met the case definition for this cluster who did not have evidence of
viral suppression at the time of identification as part of the cluster.
o Question #9b, ‘Among persons who did not have evidence of viral suppression at the
time of identification as part of the cluster (9a), how many achieved viral suppression
within six months?’: Report the number of persons in Question #9a who achieved viral
suppression within six months of identification as part of the cluster. This information
can be pulled directly from eHARS and submitted as a separate attachment if desired.
Note: For non-molecular clusters, report the number of persons who met the case
definition for this cluster in Question #9a who achieved viral suppression within six
months of identification as part of the cluster.
Question #10a, ‘How many persons in your jurisdiction were HIV-negative or had unknown HIV
status at the time of identification as part of the risk network?’: Report the total number of
persons residing in your jurisdiction who were HIV-negative or had unknown HIV status at the
time of identification as part of the risk network, regardless of when or how the person was
identified as part of the risk network. Note: For non-molecular clusters, report the number of
HIV-uninfected partners or other persons known to be connected to members of the cluster
who did not have evidence of HIV infection at the time of identification.
o Question #10b, ‘Of persons who were HIV-negative or had unknown HIV status at the
time of identification as part of the risk network (10a), how many were tested/re-tested
within 6 months?’: Report the number of persons in Question #10a who were tested (if
HIV status was unknown at identification as part of the risk network) or re-tested (if HIV
status was negative at identification as part of the risk network) within 6 months. Note:
For non-molecular clusters, report the number of HIV-uninfected partners or other
persons known to be connected to members of the cluster who were tested (for
persons with unknown HIV status) or re-tested (for HIV-negative persons) within 6
months.
o Question #10c, ‘Of persons who were HIV-negative or had unknown HIV status at the
time of identification as part of the risk network (10a), how many were tested/re-tested
at greater than 6 months?’: If any persons in 10a were tested or re-tested more than 6
months after identification as part of the risk network, report that number here. Note:
For non-molecular clusters, report the number of HIV-uninfected partners or other

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persons known to be connected to members of the cluster who were tested (if HIV
status was unknown at identification as part of the risk network) or re-tested (if HIV
status was negative at identification as part of the risk network) greater than 6 months
after identification.
o Information for Questions #10a-10c can be pulled directly from your partner services
database and provided as a separate excel attachment rather than reporting that
information here, if your system has the functionality to do this.
Question #11, ‘Results of testing and re-testing for persons in 10a’: Fill in testing/re-testing
results for the persons reported in #10a above. With the exception of 11j, only include
information on persons residing in your jurisdiction. Only report numeric data in each of the
cells provided (i.e. the number of new positives, the number of previous positives, the number
not located, etc.). Note: Information for 11a.-11l. can be pulled directly from your partner
services database and provided as a separate excel attachment rather than reporting that
information here, if your system has the functionality to do this.
o For those who were tested or re-tested (#11a-11f), indicate the number that newly
tested as positive and those who tested as negative, as well as any with unknown
testing results. If the number of acute positive persons and recent (not acute) persons is
available, report those as well. Report the total number referred for PrEP (regardless of
whether they were referred within 6 months) in 11e.
o For those not tested (#11g-11l), indicate the number not tested classified according to
the reason for why testing was not done. Persons who were initially not known to be
infected with HIV who are now reported as being previously diagnosed with HIV
infection should have been previously reported to a health department’s surveillance
registry as being infected with HIV.
Question #12a, ‘How many persons in your jurisdiction were HIV-negative and not on PrEP at
the time of identification as part of the risk network?’: Report the total number of persons
residing in your jurisdiction who were HIV-negative and not on PrEP at the time of identification
as part of the risk network, regardless of when or how the person was identified as part of the
risk network. Note: For non-molecular clusters, report the number of HIV-uninfected partners or
other persons known to be connected to members of the cluster who did not have evidence of
HIV infection at the time of identification.
o Question #12b, ‘Of all persons who were HIV-negative and not on PrEP at the time of
identification as part of the risk network (12a), how many were screened for PrEP within
6 months?’: Report the total number of persons from Question #12a who were
screened for PrEP within 6 months of identification as part of the risk network. Note: For
non-molecular clusters, report the number of HIV-uninfected partners or other persons
known to be connected to members of the cluster from Question #12a who were
screened for PrEP within 6 months of identification.
o Question #12c, ‘Of all persons who were screened for PrEP within 6 months (12b), how
many were determined to be eligible?’: Report the number of persons from Question
#12b who were determined to be eligible for PrEP within 6 months. Note: For nonmolecular clusters, report the number of HIV-uninfected partners or other persons
known to be connected to members of the cluster from Question #12b who were
determined to be eligible for PrEP within 6 months.

Updated September 10, 2018

Question #12d, ‘Of all persons who were eligible for PrEP within 6 months (12c), how
many were referred?’: Report the number of persons form Question #12c who were
referred for PrEP within 6 months. Note: For non-molecular clusters, report the number
of HIV-uninfected partners or other persons known to be connected to members of the
cluster from Question #12c who were referred for PrEP within 6 months.
Question #13, ‘What key lessons were learned through the course of investigating this cluster?’:
Provide a brief description using the box to the right regarding lessons that were learned
through investigating and responding to this cluster.
Question #14, ‘Please describe the impact of cluster investigation and response activities on
current health department policies and processes’: Use the space to the right to comment on
ways in which cluster investigation and response activities have impacted your health
department’s policies and processes. Examples of topics to include here include (but are not
limited to) the following: whether any enhancements were made to regular HIV prevention and
treatment processes such as provision of case management services or expansion of PrEP
resources, whether communication within the health department or interactions between local
and state health departments changed, whether the cluster was used to advocate for policy
changes, whether additional resources were required to respond to this particular cluster, etc.
Question #15, ‘Briefly describe your current level of concern for this cluster and why ongoing
response is still needed. If the cluster response has been closed, instead describe how you will
continue monitoring the cluster for future growth.’: Provide a brief description of your current
level of concern for the cluster and why ongoing response is still needed, if you are submitting
this form as an annual report. Otherwise, if you are submitting this form as a cluster closeout,
indicate how you plan to continue monitoring the cluster for future growth. Indicate the
person(s) who will be responsible for this activity and their role(s), and how CDC will be notified
if the cluster experiences additional growth in the future.
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Summary Tables
The Cluster Investigation Worksheet contains a Summary Tables tab which is auto-populated based on
responses to questions in the previous tabs. No action is required to complete this tab, provided you
have responded to all questions on the preceding report forms. This information may be useful for your
jurisdiction in planning your cluster response activities and monitoring the progress of key outcome
measures on a cluster level.

Updated September 10, 2018