230 likes | 401 Views
OASIS. Outcomes Assessment Through Systems of Integrated Surveillancegrant awarded October 2000. Reason for Applying. Syphilis epidemic in Marion County (Indianapolis) Indiana in 1999-2000Wanted to identify common behavioral risk factors shared by STDs and HIVFocused on a limited geographic
E N D
1. Linking STD and HIV Morbidity and Risk Behaviors in Indiana James D. Beall, MA
Sr. Public Health Advisor
Indiana State Department of Health
2. OASIS Outcomes
Assessment Through
Systems of
Integrated
Surveillance
grant awarded October 2000
3. Reason for Applying Syphilis epidemic in Marion County (Indianapolis) Indiana in 1999-2000
Wanted to identify common behavioral risk factors shared by STDs and HIV
Focused on a limited geographic area
4. Pre-Application Approvals Program, Division, State Health Department and Local Health Department approval
to match STD and HIV databases
even though the databases were combined in a blinded fashion
allow access to databases by contracted SAS programmer
5. Pre-Application Approvals Community Approval
Stamp Out Syphilis Coalition (SOS)
40 City, State, County Community Group members and the affected neighborhood association
HIV Prevention Community Planning (CPG)
35 individuals representing geographic, HIV service organizations, and risk behaviors reflecting Indiana HIV epidemic
6. Pre-Application Approvals Community Approval
for the mutual beneficial outcome, not a search for recalcitrant behavior
building confidence in our maintaining the confidentiality of the individual STD and HIV databases
7. Purpose of Project Promote integrated interpretation and use of STD and HIV surveillance data
Identify STD and HIV behavioral risk profiles
Share risk profiles with public health and community-based prevention and intervention programs
Improve planning and evaluation of public health programs directed toward STD and HIV prevention
Implement professional management of STD and HIV databases
8. Databases STD/MIS
Chlamydia, Gonorrhea, Syphilis incidents in Indiana residents and DIS interview records of HIV
1999 through 2001 incidents
64,000+ records
HARS (HIV/AIDS Reporting System)
contains individual records all Indiana residents with HIV disease
cumulative since 1982
11,000+ records
9. ISDH Program Areas Division of HIV/STD
Epidemiologic Resource Center to activate a hiring contract for programmer
Information Technology Services
all 3 for concurrence for selection of programmer
LAN administrator to allow access to databases
10. Pre-Integration Activities Determine required match criteria
Identify common fields
Assign common codes to each field
Standardize HIV names and street addresses
Clean STD database of duplicates and data entry errors and omissions
11. Key Construction A weighted combination of variables
18 keys developed
Matches on keys were assigned points
Match on every key worth 100 points
12. Variables Matched Name
last, first, middle initial, alias, maiden name
Single variable ‘address’ split into 10 standard variables
number, direction, street, street type, post office box, city, state
Date of birth
day, month, and year
13. Variables Matched Telephone number
area code, prefix, last four digits
Sex
Race
County
5-digit zip code
14. Scoring Variable Comparison after Key Match Good quality score was valued at 78-82
Birth date data high score = 25
Good score without birth date match = 53-57
Our cutoff set at 65 point match so that a wider net would catch potential matches
Individual review of low scoring matches would determine accuracy of the match
15. Data Observations The HIV surveillance records from 1982 through 2001 were compared to STD morbidity reports from the past three years:
…Chlamydia matches 74
…Gonorrhea matches 132
…Syphilis (any stage) matches 47 (15 in 1999, 16 in 2000 and 16 in 2001)
16. When HIV data (1991-2001) is compared to STD (1999-2001: There were 254 matches for patients with dual infections ( HIV and another STD) in the past three years (1999-2001).
The number of matches for early syphilis cases remained the same each year, while syphilis morbidity increased then decreased.
64% (161) of all matches occurred with patients residing in Marion County.
17. 2001: The data indicate that most dual infections involve patients who become infected with an STD after HIV diagnosis ( 80%)
24% Chlamydia acquired before HIV
25% Gonorrhea acquired before HIV
10% of Syphilis acquired before HIV
18. Marion County Matches 35 of 47 syphilis/HIV matches were in Marion County
Risk factors were only collected in Marion County for syphilis
19. Marion County ResultsThrough August 31, 2001 18 did not identify a risk factor in STD/MIS
4 of these did not identify in HARS
23 did not identify a risk factor in HARS
4 of these did not identify in STD/MIS
20. Marion County ResultsThrough August 31, 2001 1 male had sex with a male in STD/MIS
7 males had sex with males in HARS
implies we are not able to identify and provide appropriate prevention tools
21. Marion County ResultsThrough August 31, 2001 5 STD/MIS patients with more than 1 sex partner in last 90 days were identified in HARS as:
1 IDU
2 heterosexual contact with HIV infected person
2 no identified risk
22. Marion County ResultsThrough August 31, 2001 12 diagnosed with HIV after syphilis
6 white females in same zip codes and not in “hot zone”
4 black males and 6 of 7 females were white
10 concurrent diagnoses were related to non-injection drugs
6 MSM in HARS had no risk identified in STD/MIS
1 MSM in STD/MIS had no risk identified in HARS
23. Risk Factors of 6 White Femaleswith concurrent diagnoses >1 sex partner in last 90 days
In county jail lock-up while infectious
Used condoms with pickups only
Sex with a ‘crack’ user
Sex with a male
“hot zone” linked
24. Recommendations Not include street address
population moves too frequently
Expand STD/MIS years of data to 1993 (morbidity only)
Repeat match each year to examine effect of syphilis outbreak on HIV
to identify subsequent infections with HIV
Include all required fields in new database structures of STDMIS upgrades and HIV Surveillance software