• Implement projects that evaluate and expand the uses of HIV infection and AIDS case surveillance and sero-surveillance data so that these data systems can more effectively guide public health policy and provide relevant information necessary to direct and evaluate prevention activities.
• Improve understanding of the natural history of HIV infection as well as the risk factors and protective factors for sexual, drug-related, perinatal, and healthcare worker related HIV transmission in order to develop more effective prevention strategies for all affected populations.

1. Evaluate HIV infection reporting systems (named, anonymous, unique identifier) used nationally for their ability to monitor the epidemic, provide linkages to medical and social services, and to assess their impact on a person's decision to be tested.
2. Characterize high-risk behaviors of persons with evidence of recent HIV infection such as persons with documented HIV seroconversion, high CD4+ counts, or diagnosis of HIV infection in adolescents.
3. Assess the impact of public health guidelines and recommendations and prevention efforts. Characterize persons co-infected with TB and HIV.
4. Evaluate ways to improve the completeness and quality of risk ascertainment on persons reported with HIV and AIDS. Identify and characterize previously unreported AIDS cases among deaths investigated by local medical examiners to assess the impact of under-diagnosis of AIDS cases on AIDS surveillance among disadvantaged populations that often do not receive adequate health care.
5. Test the efficiency of new techniques for reporting HIV and AIDS surveillance data from health care providers and laboratories to health departments.
6. Collect additional data on persons reported through HIV/AIDS surveillance which may be important for the planning and evaluation of prevention and care programs, such as social/economic status, levels of disabilities, drug use history, sex behavior history, utilization of HIV testing and medical care services, and reproductive history in women.
7. Assess the interrelationship of behaviors, HIV markers and surrogates, and their potential role in surveillance systems.
8. Assess the interaction of socioeconomic, behavioral, and biologic factors in HIV transmission.
9. Determine the role of female-specific biological factors that are linked to acquisition and transmission of HIV infection and that influence the course of HIV disease.
10. Determine factors contributing to the efficiency of sexual transmission of HIV.
11. Assess the risk of transmission of HIV and TB from HIV-infected health-care worker to patient and vice versa. Develop systems to monitor the emergence of multidrug-resistant TB in the HIV infected.
12. Continue to develop improved methods for projecting or modeling the HIV epidemic.
13. Develop methods to differentiate HIV-specific antibodies generated in participants in HIV vaccine trials from those generated in response to HIV infection.
14. Develop methods to identify potential cases of HCW-to-patient transmission.
15. Expand HIV reporting systems to collect information about primary and secondary HIV prevention services needed and received by HIV-positive clients (in collaboration with HRSA).
16. Work with providers and users of lab services to develop and implement systems which provide assurance that the capacity and quality requirements for HIV testing are met.
17. Work with international partners to study TB, implement vaccine trials, enhance clinical management, assess prevention efficacy, and improve program management of HIV/AIDS.
18. Develop methods to evaluate the use of HIV infection and AIDS surveillance systems to assess early intervention strategies.

Many of the activities in the above-cited action steps are carried out through cooperative agreements with state and local health departments. In addition, specialized projects and studies also serve to focus attention on these activities, these include:

1. Evaluation of HIV Infection Reporting Systems Project
2. Recent HIV Infection Projects
3. Surveillance to Evaluate Prevention Projects
4. Adult Spectrum of Disease Project
5. TB Project
6. Mode of Transmission Validation Project
7. Medical Examiner Study
8. Enhancement of AIDS Surveillance Efficiency Projec