U SE OF P ERSON -S EARCHING S OFTWARE (A CCURINT ) FOR HIV S URVEILLANCE P URPOSES Thomas J. Shavor, MBA, MPH Epidemiology Director, HIV/STD Programs Tennessee Department of Health

HIV Surveillance-Introduction HIV diagnosis (1st positive confirmatory test) Linkage to Care 1st CD4 Count 1st Viral Load Test 1 st Drug Resistance test AIDS 1st CD4 Count <200 or AIDS-OI Retention / Response to Care CD4 or VL Death Measures of HIV morbidity and mortality HIV Infection Entry to care Retention in care and viral suppression

Continuum of HIV Care in the U.S. 80% 62%36%41%28% (MMWR 2011;60(47); )

Background Information  As a participant in the Secretary’s Minority AIDS Initiative Funding for Care and Prevention in the United States (CAPUS) Demonstration Project, the Tennessee Department of Health (TDH) was tasked to use HIV surveillance data in order to equip health department investigators to:  a. Identify and locate known HIV positive individuals who have been out of care for > 1 year and facilitate their re-engagement into HIV care  b. Identify and inform providers of their HIV positive clients who are in care but not achieving optimal virologic and/or immunologic response to care

Background Information-cont.  As all Surveillance staff know- clients frequently change their address over time (sometimes several times a year!)  The primary limitation with using HIV Surveillance data is the accuracy of current address information stored within eHARS (Enhanced HIV/AIDS Reporting System)  Patient addresses are primarily updated from labs that are imported into eHARS via ELR (electronic laboratory reporting)  The HIV/STD Program implemented ELR into eHARS as of 8/2012, but only 3 labs currently submit data in a format that we can use for importation

Accurint Software  To improve the accuracy of our data, we utilized the commercial, person-locating software application Accurint © to compare the potential variances for current address  Software package owned by Lexis-Nexis, an information service company  A direct connection to over 37 billion current public records held within 10,000 databases  Used to verify identities, obtain current address and telephone information, conduct investigations  Same software used by police and fire departments, bill collectors, federal, state, and local agencies  Cost is $160/user/month

Approval Process  Started in March, 2013; Ended September, 2013  Involved MANY people:  TDOH Legal staff  Contract staff  State Epidemiologist  HIV/STD Medical Director  HIV/STD Program Director  HIV/STD Epidemiology Director (me)  Lexis-Nexis Sales representatives  CDC Security/Privacy Officers  TDOH ultimately acquired 3 licenses: 1 admin (me) and 2 users (CAPUS Epi and STD Program staff)

Main Search Screen Page

Advanced Person Search Results

Variations on my Name, DOB, and SSN

Real Time Phone Search Results

CAPUS Data After Accurint Match (N=3,111)

Accountability  As you might imagine, with access to this level of data on individuals, it makes sense to develop some processes to make end users accountable for their actions:  Training- annual training requirements added to existing training.  Addendum to our HIV/STD Security & Confidentiality documents- reflecting the seriousness of the responsibility, and the penalties for non-compliance  System driven reports- Administrator-level reports of EVERY search users have performed

Final Thoughts…  The use of Accurint © identified 678 clients who would have been originally investigated for this project, which saved our program considerable time and labor resources  Tennessee’s HIV surveillance data are much more accurate as a result of using this software  Finally, our health department is going to start using Accurint to assist in:  STD Partner Services (finding unlocatable sexual contacts)  Ryan White (new client address validation)  Validate current address for ALL patients within eHARS (Completed in February, 2014)

Questions?