1. Thomas J. Shavor, MBA, MPH Epidemiology Director HIV/STD Surveillance & Data Management Tennessee Department of Health

2.  Definition- Combining all aspects of HIV/STD surveillance activities in order to attain a close and seamless coordination of information/services between: Groups within HIV/STD Surveillance & Data Management (Group Level Integration) Program areas within HIV/STD Section (Program Level Integration)

3.  1982- Tennessee began collecting AIDS case data  1986- Tennessee established an AIDS program within the Bureau of Health Services  1987- AIDS reporting becomes mandatory  1992- HIV reporting becomes mandatory  2001- The STD Prevention, HIV Prevention, and Ryan White programs merged to become the HIV/STD Section  2003- Current organization finalized  2007- HIV/STD Program merged with CEDEP.

4.  Integration occurs at 2 levels: 1. Surveillance level- Core, Partner Services, STD Surveillance, Chlamydia Infertility, and Epi Capacity/Program Evaluation groups occur within a single unit (housed in a secure area within our section) 2. Program level- HIV/STD Surveillance section is integrated with the HIV/STD Prevention, Ryan White Programs within the section.

5. Surveillance Director Core HIV Surveillance Epi Capacity/ Program Evaluation HIV Partner Services Ryan White HIV Prevention STD Surveillance

6. Surveillance & Data Management HIV/STD Prevention Program Ryan White Program

7.  Epidemiology Director- 100% HIV Core Surveillance  Prevention Epidemiologist- funded 50% by HIV Prevention/50% by STD Prevention  STD Public Health Advisor (2)- 100% STD Prevention  HIV Epidemiologist- 90% Epi TA/10% Core Surveillance  Ryan White Epidemiologist- 100% Ryan White Program  HIV Surveillance Reps (10)- 10%-100% HIV Core Surveillance (depending on area)  Clerical Support/ICCR(2)- 100% STD Prevention

8.  Responsible for data analysis/dissemination for grants, including: HIV Surveillance STD Prevention HIV Prevention (DEBI evaluation, etc.) HIV Partner Services Ryan White (Part A and Part B) Chlamydia Infertility MCH, TB, Viral Hepatitis, and anyone else

9.  Manage and analyze data from a variety of databases: eHARS PRISM (STD Case Management System) PTBMIS (Tennessee’s Patient billing system) Ryan White Care-Ware TB and Hepatitis Program Datasets

10. 1. Allows for more effective communication within Surveillance groups & between different programs 2. Helps program staff to see the “big picture” 3. Has potential to save time (fewer mistakes or assumptions about mission) 4. Encourages each program area to participate in collaborative projects 5. Aids in resource planning for future needs 6. Assists in program evaluation activities

11. 1. Cross-training surveillance staff (i.e. “doing more with less”) to perform unfamiliar tasks can lead to major stress! 2. Managers must attain a greater understanding of how other program areas function. 3. Breaking down traditional program barriers can be difficult (“my program-your program”) 4. Explaining “technical” subjects to non-technical people can be frustrating! 5. Getting programs to pay their “fair share” of Surveillance resources used

12. 1. Organize time/materials/resources 2. Learning skills outside of your comfort zone 3. Ensure lines of communication are always open (via regularly scheduled management meetings) 4. Involve others in grant preparation, program evaluation, routine decisions 5. PATIENCE! (Lots and lots…)

13.  Integration has the potential to: Streamline communication Improve our work products Save time (money)  To become fully-integrated requires: LOTS of will LOTS of work LOTS of communication LOTS of patience