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Shifting Surveillance Paradigms CDC Perspective

Shifting Surveillance Paradigms CDC Perspective. Irene Hall, PhD, FACE HIV Incidence and Case Surveillance Branch. 2012 CSTE Annual Conference HIV Surveillance Pre-conference Workshop Omaha, NE June 3, 2012. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.

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Shifting Surveillance Paradigms CDC Perspective

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  1. Shifting Surveillance ParadigmsCDC Perspective Irene Hall, PhD, FACE HIV Incidence and Case Surveillance Branch 2012 CSTE Annual Conference HIV Surveillance Pre-conference Workshop Omaha, NE June 3, 2012 National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of HIV/AIDS Prevention

  2. HIV Incidence and Case Surveillance Branch

  3. Shifting Paradigms • Epidemiologic profiles for High-Impact Prevention • Evaluation of the goals of the National HIV/AIDS Strategy (NHAS) • Data for public health action

  4. High-Impact Prevention (HIP)Applying the science of implementation to maximize impact Key components • Effectiveness and cost • Feasibility of full-scale implementation • Coverage of targeted population • Interaction and targeting • Prioritizing

  5. Key Approaches and Program Considerations in High-Impact HIV Prevention HIV testing and linkage to care Prevention with positives Policy and structural interventions Targeted interventions Evidence-based planning Surveillance, monitoring, and evaluation Health equity Health reform Program collaboration and service integration

  6. Assessing the Continuum Of HIV Care MMP CDC. Vital Signs: HIV Prevention Through Care and Treatment — United States. MMWR 2011;60:1618-1623.

  7. People with HIV Sources of Reports Aggregate data reports Hospital Practitioners Private Practitioners Public Clinics Laboratories Local Bulletins CDC Semiannual Report HIV Web Sites Public Information Data Set Surveillance Slide Set CDC Local Health Dept 74,353 HIV Report 2001 Region X HIV Case SurveillanceData for Prevention Linkage and re-engagement in care Individual data reports Partner services Case management Diagnosis facilities Care providers Active Case Finding

  8. Completeness of Testing and Treatment History Data1 and STARHS Results2 among Cases Newly Diagnosed with HIV in 2010, Evaluated at 12 Months after Diagnosis Year, 25 Jurisdictions * * Testing and Treatment History Data ---------- 85% TTH Expected Outcome Standard STARHS Result ---------- 60% STARHS Result Expected Outcome Standard Source: Data reported to CDC as of December 31, 2011 and the December 2011 closeout eHARS incidence data submission. For MS* and LA* the January 2012 closeout eHARS incidence dataset submission was used. 1. TTH completeness includes HIS records with at least one response to any of the seven required data elements. 2. STARHS result includes BED recent, long term, reason for not testing for cases NOT diagnosed with AIDS within 6 month of HIV diagnosis.

  9. HIV Surveillance

  10. Laboratory Reporting of all CD4 and Viral Load Test Results • CDC Reporting recommended in 2010 • Institute of Medicine Recommendation 3-2. The Centers for Disease Control and Prevention should take steps to enhance the National HIV Surveillance System including issuing guidelines or criteria for National HIV Surveillance System reporting to include all CD4 and viral load test results IOM. Monitoring HIV Care in the United States: Indicators and Data Systems, 2012

  11. Areas with Laws and Regulations for Reporting all CD4 and Viral Load Values, March 2012 VT NH MA RI CT NJ DE MD DC Laboratory reporting (laws and regulations) Not all values All values, specified All values, not specified Puerto Rico Virgin Islands, U.S.

  12. Lab Reporting Assessment, November 2011 “Does your site receive reports from all laboratories that conduct HIV-related testing in your state?”

  13. Lab Reporting Assessment, November 2011 “Please indicate if your site has entered or imported all CD4 and VL (detectable and non-detectable) test results into eHARS from lab reports received during the following time periods:” * The 5 jurisdictions in the Pacific Islands do not use eHARS

  14. Where we want to go • Accurate data used for • monitoring, planning, and • evaluation • All areas meet process and • outcome standards Strategic Plan for National HIV Surveillance • Barriers • Funding • Laws and regulations • Lack of universal IT standards • Testing technology • Strategies • Integrate program components, inc. eHARS • Promote electronic reporting and standards • Use evaluation results to guide tech. assistance • Search for improved testing technology • Communicate and collaborate with stakeholders • Enhance data dissemination • …feedback from peer review • Where we are • Incomplete data collection • and processing systems • Best practices not fully • implemented • Critical Success Factors • Resources to implement and adherence • to best practices • IT infrastructure • eHARS • Accurate data processing • Monitoring • Annual evaluation

  15. Where we want to go • Accurate data used for • monitoring, planning, and • evaluation • All areas have complete lab • data Strategic Plan for National HIV Surveillance Laboratory Reporting • Barriers • Funding • Laws and regulations • Lack of universal IT standards • Strategies • Promote electronic reporting and standards • Evaluate lab reporting and provide feedback • Communicate and collaborate with stakeholders • Enhance data dissemination Where we are Incomplete lab data • Critical Success Factors • Resources to implement and adherence • to best practices • IT infrastructure • Accurate data processing • Monitoring • Annual evaluation

  16. Surveillance – Program Collaborations Enhanced Comprehensive HIV Prevention Planning (ECHPP) Project • Increase data driven decision making – including incorporating local epidemiologic, cost-effectiveness and efficacy data Supplemental Funds for Surveillance, FY2012 Health Department FOA Category A: Core Prevention Programs Activities must be guided by a more broad-based HIV prevention planning process - a revised HIV Prevention Planning Guidance will soon be issued Category B: Expanded HIV Testing for Disproportionately Affected Populations Category C: Demonstration Projects A range of prevention approaches, including use of surveillance data for public health action

  17. Thank you The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of HIV/AIDS Prevention

  18. ELC ELR Implementation Support and Monitoring Efforts The Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) program is conducting a survey with ELC sites to assess each grantees electronic laboratory infrastructure and capacity Data being collected includes: Who is sending lab reports What is being sent How and what reports are being sent through ELR How many lab reports are being sent Where are ELR being used In an effort to reduce the burden of data gathering they are requesting the ELC grantees include non -ELC funded infectious disease programs including HIV HIV surveillance coordinators will be asked to participate eHARS staff that process or manage electronic lab results should participate in the discussions

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