1. eSHARE Electronic System for HIV/AIDS Reporting & Evaluation
Institute for Implementation Science In population health at cuNY
CUNY Graduate School of Public Health and Health Policy
June 2016
Disclaimer: The information in this slide set was assembled by the The Institute for Implementation Science in Population Health at CUNY to inform the work of the NYC DSRIP HIV projects. The content of these slides is based on publicly available information as of June
For detailed eSHARE inquiries, see the resources and contact information slides.

2. OUTLINE
Background
Contents
How to use the data
Limitations
Resources

3. Background

4. BACKGROUND (1) What is eSHARE?
Primary data system for contracts with the DOHMH BHIV, including Ryan White Part A (RWPA) funded contracts
Local RWPA services include but are not limited to medical and non-medical case management, transition services for the recently incarcerated, food and nutrition services, mental health counseling, harm reduction/recovery, legal advocacy, home care, HIV testing/early intervention, health education, and housing
Web-based data reporting system implemented in 2011
Meets all regulatory and reporting requirements for federal funders and local evaluation

5. BACKGROUND (2) Population and geography
There are data available on >30,000 unique individuals who have received RWPA-funded services from 2009 to present, at >100 different service provider agencies (hospitals, clinics and CBOs)
In programs other than testing, eligible clients must be HIV-positive, reside in the RWPA grant area, and have income <435% of FPL
RWPA provider reporting covers all NYC and Tri-County programs

6. BACKGROUND (3) Timeframe of available data Accessibility of data
All local RWPA providers were reporting in eSHARE by fall 2012
Ryan White Part A programs transitioned to eSHARE at different times between 2011 and fall 2012, so the number of clients and completeness of data vary before 2013.
No data are captured in eSHARE for years before 2009. 
Accessibility of data
Restricted use dataset
Raw data not readily available to providers
Canned reports available
Currently testing agency-specific client-level data extracts for future implementation within eSHARE (to make more data available to providers)
DOHMH users can access extracts covering nearly all variables in eSHARE

7. AUDIENCES OF eSHARE DATA/REPORTS
Funded Service Providers
Health Resources Services and Administration, Centers for Disease Control
HIV Planning Council of NY
National and International Audiences
DOHMH Staff
NYC Commissioner of Health and Mayor’s Office

8. Contents

9. CONTENTS What’s in the eSHARE data set
Basic demographic data are collected and entered by service providers to “register” a client in the system, prior to any program enrollment.
Psychosocial, socioeconomic and behavioral data are collected from clients at the time of program intake and approximately every 6 months throughout an individual’s participation in a service category.
Clinical data (e.g., ART status, viral loads and CD4 cell counts) are collected at least every 4 months while services are ongoing.
Program enrollment and service-related data are collected as applicable.
Comment from Mary: Not all the clinical data are “self-reported”
“these clinical data are collected through a combination of client self-report, RWPA provider review of clients' laboratory results and/or prescriptions, and/or communication with clients' primary care providers. For some service categories (e.g., MCM), the latter two sources are often available; for others, self-report may be the best available source of such clinical data.”

10. How to use the eSHARE data

11. CURRENT DATA USE EXAMPLES (1)
Outcomes reports by service category
Client-level ARV/VL Report (“Treatment Status Report”)
Service category-specific evaluations and performance monitoring
Quality Management Indicators
Developed in collaboration with service providers
Shared during provider meetings
EMA’s Comprehensive Strategic Plan for HIV/AIDS Services
Annual indicator progress/trends reporting

12. CURRENT DATA USE EXAMPLES (2)
Service Category-specific “Scorecards”
Annual Enrollment Report
Ryan White Part A/MAI Grant Application and Progress Reports
Client sampling for survey projects (e.g., NIH-funded CHORDS study, and RWPA Client Satisfaction Survey)
Annual Ryan White Services Report (RSR) due to HRSA each March

13. PROCESS INDICATOR TRENDS (1)

14. PROCESS INDICATOR TRENDS (2)

15. PROGRESS TOWARD 2013/2014 TARGETS

16. FUTURE DATA USE EXAMPLES
Potential use of eSHARE to further DSRIP PPS work
Flagging of clients who should be re-assessed for ART and/or primary care engagement and, if needed, linked to care/Tx.
Where clients can’t be reached directly to assess engagement, entry of flagged clients’ names for NYC HIV Registry (Care Status Report) confirmation of need for return-to-care efforts.
Manipulation of existing automated reports (“canned reports”) or the payment extract (“PHS extract”) in eSHARE, to answer common program monitoring or evaluation questions.
DOHMH provides trainings on advanced uses of these features.
Manipulation of full extracts (once available in eSHARE at the agency level) to answer more complex questions.
Client data summaries for related/additional grant proposals.

17. Limitations and Strengths

18. LIMITATIONS
Data reflect assessment practices in “real-world” settings (vs. controlled research settings); many different types of personnel administer assessments (in ways we cannot closely monitor), across many different agencies.
Availability of certain data elements depends on the type of enrollment (e.g., food insecurity data are only available for clients enrolled in food and nutrition programs); some assessment items are optional and therefore less complete.
HIV confidentiality laws and regulations, as well as federal Ryan White guidance, limit the ability to share data outside the DOHMH (the administering/grantee agency for the Ryan White Part A program).
Ryan White Part A programs transitioned to eSHARE at different times between 2011 and fall 2012, so the number of clients and completeness of data vary before No data are captured in eSHARE for years before 2009.

19. STRENGTHS (1) Longitudinal data allow for tracking outcomes over time.
Data reflect service utilization in “real-world” settings (vs. controlled research settings).
Assessments cover a wide range of variables, including variables relevant to need/eligibility for services (e.g., household income, insurance status, health functioning, problem substance use, housing stability).
A high proportion of PLWH in NYC receive Ryan White Part A-funded services, yielding large sample sizes.
From Mary: For the 2nd bullet, make sure to acknowledge it has been listed as both a Limitation and a Strength. The Limitation side is that it is more challenging to get to a point of causal inference, for example, because we don’t necessarily know from association if the outcomes achieved are attributable to the RWPA program services reported. The Strength is in the replicability and generalizability, mainly; any utilization or outcomes achieved were able to be achieved in regular program settings, and likely could be achieved in other such settings – no need for perfect laboratory conditions. Aside from that real-world proof of “doability,” there is the value of seeing where implementation may have mirrored or strayed from original program model.

20. STRENGTHS (2)
Allows real time access to data by NYC DOHMH and funded agencies
Facilitates sharing of data between programs within an agency
Enables de-duplication of clients across agencies and programs

21. STRENGTHS (3)
Supports data quality and completeness via built-in controls/validations
Skip patterns, required fields and value limits are enforced automatically, as is the order of some forms (e.g., Demographics and Intake Assessment as prerequisites for Services entry)
The distribution and maintenance of standardized eSHARE data collection forms (and instructions for provider administration) also contributes to data reliability, completeness
Designed specifically for BHIV funded programs
Allows for merged analyses of programmatic and HIV surveillance (or other) data (through the use of full identifiers/names entered)

22. Resources

23. RESOURCES Publications and reports
Feldman, M.B., Alexy, E.R., Thomas, J.A., Gambone, G.F., & Irvine, M.K. (2015). The association between food insufficiency and HIV treatment outcomes in a longitudinal analysis of HIV-infected individuals in New York City. Journal of Acquired Immune Deficiency Syndromes, 69,
Feldman, M.B., Thomas, J.A., Alexy, E.R., & Irvine, M.K. (2015). Crystal methamphetamine use and HIV medical outcomes among HIV-infected men who have sex with men accessing Ryan White services in New York. Drug and Alcohol Dependence, 147,
Hile, S.J., Feldman, M.B., Alexy, E.R., & Irvine, M.K. (in press). Tobacco smoking is associated with poor HIV medical outcomes among HIV-infected Individuals in New York. AIDS and Behavior.
Irvine, M.K., Chamberlin, S.A., Robbins, R.S., Myers, J.E., Braunstein, S.L., et al. (2015). Improvements in HIV care engagement and viral load suppression following enrollment in a comprehensive HIV care coordination program. Clinical Infectious Diseases, 60(2),
Irvine, M.K., Chamberlin, S.A., (2016). Come as you are: Improving care engagement and viral load suppression among HIV Care Coordination clients with lower mental health functioning, unstable housing, and hard drug use. AIDS and Behavior (Accepted).
Guides/guidelines and general information

24. CONTACT INFORMATION
Jacinthe Thomas:
Participating agencies will have an eSHARE administrator

25. CUNY Institute for Implementation Science IN population health
Thank you!
CUNY Institute for Implementation Science IN population health
cunyisph.org