Shifting Surveillance ParadigmsCDC Perspective

Irene Hall, PhD, FACEHIV 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

HIV Incidence and Case Surveillance Branch

Irene HallBranch Chief

Pamela GruduahDeputy Branch Chief

Reporting, Analysis &

Evaluation TeamSuzanne Whitmore

Acting Team Supervisor

Research and Dissemination

TeamAnna S Johnson

Team Leader

Incidence and Viral Resistance

TeamJoseph Prejean

Team Supervisor

Public Health Advisory TeamPamela Gruduah

Acting Team Leader

Mi ChenAssociate Chief of

Science

Pat SweeneySenior

Epidemiologist

Shifting Paradigms

Epidemiologic profiles for High-Impact Prevention

Evaluation of the goals of the National HIV/AIDS Strategy (NHAS)

Data for public health action

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

Key Approaches and Program Considerations

in High-Impact HIV Prevention

HIV testing and linkage to carePrevention with positivesPolicy and structural interventionsTargeted interventionsEvidence-based planningSurveillance, monitoring, and evaluationHealth equityHealth reformProgram collaboration and service integration

Assessing the Continuum Of HIV Care

CDC. Vital Signs: HIV Prevention Through Care and Treatment — United States. MMWR 2011;60:1618-1623.

MMP

HIV Case SurveillanceData for Prevention

Sources of Reports

Hospital PractitionersPrivate PractitionersPublic ClinicsLaboratories

CDC

74,353

Aggregate data reportsLocal BulletinsCDC Semiannual ReportHIV Web SitesPublic Information Data SetSurveillance Slide Set

Active Case Finding

Local Health Dept HIV Report

2001Region X

People with HIV

Partner servicesCase managementDiagnosis facilitiesCare providers

Individual data reports

Linkage and re-engagement in care

Overa

ll AL AZCAO

CHICO CT

DC FLHOU IN LA LA

C MA MIMS NC NJ

NYSNYC PH

ISC SF

C TX VAW

A0

10

20

30

40

50

60

70

80

90

100

Incidence Funded Jurisdictions

Perc

ent

(%)

Testing and Treatment History Data ---------- 85% TTH Expected Outcome Standard STARHS Result ---------- 60% STARHS Result Expected Outcome Standard

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

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.

* *

HIV Surveillance

Critical Variables

• Date of diagnosis• CD4 and viral load test

results• Facility of diagnosis• Facility of care• Current residence• Date of death• Demographics and risk

factors

Critical Activities

• Full implementation of lab reporting and monitoring

• Lab data import to eHARS• RIDR• Death ascertainment• Surveillance evaluation

Laboratory Reporting of all CD4 and Viral Load

Test Results

CDCReporting recommended in 2010

Institute of MedicineRecommendation 3-2. The Centers for Disease Control and Prevention shouldtake steps to enhance the National HIVSurveillance 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

DE

MARICTNJ

MDDC

NH

VT

Virgin Islands, U.S.

Puerto Rico

Areas with Laws and Regulations for Reporting all CD4 and Viral Load Values,

March 2012

Not all values

All values, specified

Laboratory reporting(laws and regulations)

All values, not specified

Lab Reporting Assessment, November 2011

Yes No Total

52 (80%) 13 (20%) 65

“Does your site receive reports from all laboratories that conduct HIV-related testing

in your state?”

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:”2009 2010 January-September

2011

Yes No Total

Yes No Total Yes No Total

34 (56.7

%)

26 (43.3

%)

60 36 (60%

)

24 (40%

)

60 32 (53.3

%)

28 (46.7

%)

60

* The 5 jurisdictions in the Pacific Islands do not use eHARS

Where we want to goAccurate data used for monitoring, planning, andevaluation•All areas meet process and outcome standards

Where we are•Incomplete data collection and processing systems•Best practices not fully implemented

Barriers•Funding•Laws and regulations•Lack of universal IT standards•Testing technology

Critical Success Factors•Resources to implement and adherence to best practices•IT infrastructure•eHARS•Accurate data processing

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

Monitoring•Annual evaluation

Strategic Plan for

National HIV Surveillance

Where we want to goAccurate data used for monitoring, planning, andevaluation•All areas have complete lab data

Where we areIncomplete lab data

Barriers•Funding•Laws and regulations•Lack of universal IT standards

Critical Success Factors•Resources to implement and adherence to best practices•IT infrastructure•Accurate data processing

Strategies•Promote electronic reporting and standards•Evaluate lab reporting and provide feedback•Communicate and collaborate with stakeholders•Enhance data dissemination

Monitoring•Annual evaluation

Strategic Plan for

National HIV Surveillance

Laboratory Reporting

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 ProgramsActivities 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 ProjectsA range of prevention approaches, including use of surveillance data for public health action

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

Thank you

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