Initial Cluster Report Form

Form Approved
OMB No. 0920-0573
Expiration Date: 11/30/2022
Cluster Report: Initial Cluster Report   
General Cluster Information
Reporting Jurisdiction Name:

Low morbidity jurisdiction?

Person Completing Report:

Email address:

1. Date cluster first detected    

2. Date form completed 

3. Local Cluster ID entered into eHARS   
A local cluster ID must be populated on this form and in eHARS.
For molecular clusters, the recommended nomenclature is the two-letter jurisdiction
abbreviation followed by the year and month in which the cluster was first identified
and Secure HIV TRACE cluster ID (e.g., GA_YYYYMM_10-5)
For time-space clusters, the recommended nomenclature is the two letter jurisdiction
abbreviation followed by the year and month in which the cluster was first identified
and cluster ID with the initials ‘TS’ (e.g., GA_YYYYMM_TS789). Jurisdictions may use any
naming convention to develop the cluster ID as long as it includes the initials ‘TS’ and
does not contain personal identifiers.

4. National Cluster ID (if applicable)  

5. Initial cluster detection method that identified this cluster (please select one; if 'other' is selected, use the box to the right to
describe):
For clusters identified by time-space analysis, please enter the county or other geographic area of the alert.

5a County of time-space alert
5b Other geographic area of alert
6. For clusters identified through molecular analysis, does this cluster meet national priority cluster criteria? (for cluster defined at 0.5% genetic distance threshold ≥5
diagnoses in past 12 months, or ≥3 diagnoses in past 12 months for low-morbidity jurisdictions) 

7. Had this cluster been identified by any other method?

7a. If the cluster overlaps with another cluster identified by a different method, please
select the method of identification, date of detection and cluster ID

12. Number of people with HIV in the molecular cluster at time of detection who have a report of HIV in your jurisdiction:
13. If additional people with HIV 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: 

Date of detection:

Cluster ID:

Date of detection:

Cluster ID:

Overall number:
Number diagnosed in 12 months prior to
detection:
Overall number:
Number diagnosed in past 12 months:

8. Please indicate which data have been reviewed for persons identified in the cluster:
HIV Partner Services data:

STD Partner Services data:

HIV Partner Services notes:

STD Partner Services notes:

HIV surveillance data:

STD surveillance data:

Viral hepatitis surveillance data:

Ryan White HIV/AIDS Program (including
ADAP):
Discussions with DIS who interviewed
cases:

Social network sites:
Data from other jurisdictions:

Other (specify):
Non-Molecular Clusters. Complete this section only for clusters detected through other methods (i.e. time-space analysis or provider notification).

9. Please describe the characteristics of the cluster that have raised concern (e.g. an increase in diagnoses over a baseline, an
increase in IDU-associated HIV-infections, etc.). 
9b. Please describe the case definition you are using to determine which cases are included in this cluster (i.e., inclusion criteria for
person, place, and time).
10. What is your current level of concern for this cluster?
(Note: Select 'High' if additional response is needed, 'Medium' if additional information about the cluster is needed, or 'Low' if no additional investigation activities are needed at this time. It is not necessary 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)
11. Please briefly describe data review and investigation/response activities conducted to date for this cluster, and any notable
findings.
END OF INITIAL REPORT FORM FOR NON-MOLECULAR CLUSTERS
Molecular Clusters: Existing Data Review. Complete this section only for clusters identified through analysis of HIV sequence data.
12. Number of people with HIV in the molecular cluster at time of detection who have a report of HIV in your jurisdiction:
13. If additional people with HIV 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: 
14. At what genetic distance threshold(s) is this cluster defined?  (If 'other' is selected, use the box to the right to describe)

Overall number:
Number diagnosed in 12 months prior to
detection:
Overall number:
Number diagnosed in past 12 months:

15. What is the time period of HIV diagnoses used to identify this cluster? (If 'other' is selected, use the box to the right to describe)
16. How many people with HIV in the molecular cluster as reported in question 12 had been interviewed by partner services prior to
Number interviewed:
cluster detection? 
17. How many people with HIV 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?

Number connected:

18^. Results of HIV testing of named partners of people with HIV in the molecular cluster:   
(Include partners residing in your jurisdiction; Do not include molecular cases in the cluster even if they were named partners too. Report only numeric data for each category below.)
1

1

18a. No. New Positive :
18b. Acute: (subset of 18a)
18c. Recent (not acute): (subset of 18a)
18d. No. Negative:

18g. No. Previous Positive :  
18h. No. Refused testing:
18i. No. Not Located:
18j. No. Outside Jurisdiction:
18k. No. Not tested because person was
deceased:
18l. No. not tested for other reason:

18e. Referred for PrEP: (subset of 18d)
18f. No. Tested but result Unknown:
1

These persons should be included as members of the larger transmission cluster

19a. Number named partners residing in
your jursidiction: (autopopulated from
#18)
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?  

19b. Number named partners residing
outside your jursidiction: (autopopulated
from #18)
19c. Number marginal partners:
19d. Number anonymous partners:

Transmission cluster size identified
20. Size of transmission cluster in your jurisdiction as identified through review of available data (Should equal the overall number in
through available data: (autopopulated
question 13, plus the number of new and previous positives reported in question 18a and 18g)  
from #13, #18a, and #13g)
21*. How many HIV-positive persons people with HIV in the transmission cluster reported in question 20 have evidence of recent
viral suppression (most recent viral load <200 cp/mL with specimen collection date in the past 12 months)?  

0

0

0

Evidence of recent viral suppression:

22. Number of persons in the risk network in your jurisdiction identified through review of available data who are not known to be Risk network size (HIV-negative and HIVHIV infected (should equal the number of partners with a negative HIV test  [18d], those tested but with an unknown result [18f], or unknown) identified through available
those with an unknown HIV status who were not tested for any reason [18h, 18i, and 18l]) 
data: (autopopulated from #18)

0

23. If the transmission cluster or risk network includes persons outside of your jurisdiction, please describe any collaboration efforts
with the other jurisdictions involved.
Existing Data Review: Cluster-level characteristics, commonalities, and summary
24. Were any common venues or physical sites identified?
(If yes, describe using the box to the right )
25. Were any common virtual sites identified?
(If yes, describe using the box to the right )
26. What other factors identified might be associated with increased transmission in this cluster?
Key findings from review of partner services, surveillance, and other available data
27. Please provide a brief, narrative summary of key findings based on existing data review.
28. Based on your initial review of the data, what is your level of concern for this cluster? (Provide comments regarding your level of
concern in the box to the right.) Note: Select 'High' if additional response is needed, 'Medium' if additional information about the
cluster is needed, or 'Low' if no additional investigation activities are needed at this time.

^This information can be pulled directly from your partner services database and provided as a separate excel attachment rather than reporting separately here, if your system has the functionality to do this.
*This information can be pulled directly from eHARS and provided as a separate excel attachment rather than reporting separately here.
END OF INITIAL REPORT FORM FOR MOLECULAR CLUSTERS

Public reporting burden of this collection of information is estimated to average 60 minutes per response, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing
the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of
information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect
of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office,
1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30329; ATTN: PRA (0920-0573).