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 Division of HIV/AIDS Prevention

HIV Incidence and Case Surveillance Branch Irene Hall Branch Chief Pamela Gruduah Deputy Branch Chief Reporting, Analysis & Evaluation Team Suzanne Whitmore Acting Team Supervisor Research and Dissemination Team Anna S Johnson Team Leader Incidence and Viral Resistance Team Joseph Prejean Team Supervisor Public Health Advisory Team Pamela Gruduah Acting Team Leader Mi Chen Associate Chief of Science Pat Sweeney Senior 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 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

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

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

Testing and Treatment History Data % TTH Expected Outcome Standard STARHS Result % STARHS Result Expected Outcome Standard Completeness of Testing and Treatment History Data 1 and STARHS Results 2 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  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

DE MA RI CT NJ MD DC 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 YesNoTotal 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:” January-September 2011 YesNoTotalYesNoTotalYesNoTotal 34 (56.7%) 26 (43.3%) 6036 (60%) 24 (40%) 6032 (53.3%) 28 (46.7%) 60 * The 5 jurisdictions in the Pacific Islands do not use eHARS

Where we want to go Accurate data used for monitoring, planning, and evaluation 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 go Accurate data used for monitoring, planning, and evaluation All areas have complete lab data Where we are Incomplete 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 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

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