1. The Shifting Role of HIV Surveillance in New York State June 5, 2012 Daniel Gordon Bureau of HIV/AIDS Epidemiology AIDS Institute New York State Department to Health

2. Shifting Roles - Overview Original - Counting and characterizing cases – for Partner Services, program planning and resource allocation Side projects – incidence surveillance MMP New - Assisting in program monitoring and evaluation Responsible for quality of care measures

3. Technical Demands Complexity of analysis and reporting – Greater variety of measures – Greater need for clean, complete data Increasing reliance on laboratory data Expectation about timeliness – Shortening reporting lag – Use of provisional data – Frequent reporting to programs E. g., match to HIV Uninsured Care Programs database to be done twice yearly

4. Legal Picture Through 2005 Named HIV reporting Reporting of positive WB, low CD4, detectable VL 2005-2010 Reporting of all CD4, viral load results, genotypes 2010 NYS HIV Testing Law Mandatory offer of HIV testing Eased requirements concerning informed consent Provision for sharing individual level case data - Among state programs and agencies - NYS able to share additional data elements in RIDR

5. LAWS OF NEW YORK, 2010 CHAPTER 308 § 2135. Confidentiality. All reports or information secured by the department, municipal health commissioner or district health officer under the provisions of this title shall be confidential except:... when used within the state or local health department by public health disease programs to assess co-morbidity or completeness of reporting and to direct program needs, in which case patient specific identifying information shall not be disclosed outside the state or local health department. Information may be disclosed to public health officials in other jurisdictions when necessary to notify the contact or for purposes of de-duplication.

6. Organizational Links 2010 – B. HIV/AIDS Epidemiology moves from Division of Epidemiology to NYS AIDS Institute (AI). – Surveillance formally becomes a component of NYS DOH’s integrated approach to dealing with HIV – Surveillance staff work much more closely with HIV/AIDS programmatic staff. B. STD Prevention and Epidemiology moves into AI Unified HIV & STD Partner Services Challenge: Learning to speak the same language

7. Analytical & Technical Sophistication Frequent/routine matching to other databases – STD, TB, Hepatitis, Medicaid, ADAP – Two-way data flow, where permitted Analysis down to provider-level – Diagnoses (old), – Linkage and retention (new) Reporting NHAS-type measures (linkage to care, retention in care, group VL), but not using CDC programs. – Accessing own databases for this, not eHARS

8. Geographic Analysis In-state and interstate migration Programmatic staff need and demand to know know where people with HIV are, not where they were – Demand to know where people are, regardless of where they were BHAE currently developing methods to determine residence at a given point in time using laboratory data – patient migration. Also attempting to develop method to determine true current case census for geographic areas, regardless of state where originally diagnosed.

9. Changing face of HIV surveillance in NYS - Summary Organizational – HIV surveillance becoming integrated into NYS’s overall approach to the HIV epidemic – HIV surveillance data and procedures becoming linked to those of other infectious diseases Technical – Linked databases – Complex analyses

10. Questions? Comments? Bureau of HIV/AIDS Epidemiology AIDS Institute New York State Department of Health Phone (518) 474-4284 Email deg02@health.state.ny.us