AIDS Surveillance from Go
In order to treat and prevent HIV/AIDS, health officials need to know “who’s infected, what the trends are, where there are increases,” says SPH’s Eve Mokotoff.
Epidemiologist and SPH alumna Eve Mokotoff, MPH ’81, is the wizard behind the scenes of HIV/AIDS reporting in the state of Michigan and has been for decades. Her two-dozen colleagues at the Michigan Department of Community Health (MDCH) aren’t likely to disagree, seeing as how she’s taught, mentored, and/or hired many of them.
“I’ve probably been doing this longer than anyone else in the country at this point,” says Mokotoff, who created the AIDS surveillance program in Michigan in 1986. (“Everybody started with AIDS,” she explains, looking back to the earliest days of the epidemic; Michigan added HIV reporting in 1988.) In addition to being a 26-year MDCH veteran, Mokotoff is an adjunct professor of epidemiology at SPH—a title that recognizes the classes she teaches and students she mentors—as well as an expert consultant to the CDC who travels to Atlanta several times a year and an advisor to other states on HIV reporting. In 2003 she organized HIV surveillance coordinators across the United States into a work group within the national Council of State and Territorial Epidemiologists.
She’s committed to the synergy of surveillance, prevention, and patient care all working together closely. “What surveillance does is tell who’s infected, what the trends are, where there are increases,” she explains. “Over the last six years, we’ve seen big increases in 13-to-24-year-old black males, mostly MSM [men who have sex with men]. Knowing information such as this can help with outreach. When community-based organizations in the state ask for data, we say, ‘Of course!’ Getting the data to the people doing the work is what it’s always been about. We work hard to do that, and we’re really proud of it.”
Mokotoff started the AIDS surveillance program for the state from the Detroit Department of Health in 1986. “About 40 percent of the state’s cases have been in Detroit, but the number and proportion of cases have gone down in recent years with declining population in the city,” she says. The majority of the current HIV surveillance staff are still in Detroit, but there are, of course, staff in Lansing as well.
Over the years, rules and practices regarding clinic and lab reporting have evolved. The current challenge, Mokotoff says, “is that the lab algorithm is changing, and it may very soon be possible to diagnose HIV without labs. We’ve always maintained relationships with providers, and will take advantage of that relationship as the lab algorithm changes.”
— by Mary Beth Lewis
In an effort to slow rates of HIV/AIDS transmission among men who have sex with men (MSM)—the dominant transmission group in Michigan—SPH Professor James Koopman is collaborating with epidemiologist Eve Mokotoff, M.P.H. ’81 (more at left), and the Michigan Department of Community Health on a new surveillance approach that for the first time lets researchers infer which groups of people are doing the transmitting, rather than which groups are being infected. A pilot project for a national surveillance system, the Michigan system has shown that 75 percent of transmission occurs early in the transmission process, and that teenage MSM with HIV are getting infected by other teenagers rather than by older men.
“I personally believe this will turn around the almost two decades of rising or steady HIV incidence in MSM,” Koopman says.