Shifting Paradigms of ANR Practices for Forest Productivity_OFSDP
Shifting Surveillance Paradigms CDC Perspective
description
Transcript of Shifting Surveillance Paradigms CDC Perspective
Shifting Surveillance ParadigmsCDC Perspective
Irene Hall, PhD, FACEHIV 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 PreventionDivision of HIV/AIDS Prevention
HIV Incidence and Case Surveillance Branch
Irene HallBranch Chief
Pamela GruduahDeputy Branch Chief
Reporting, Analysis &
Evaluation TeamSuzanne Whitmore
Acting Team Supervisor
Research and Dissemination
TeamAnna S Johnson
Team Leader
Incidence and Viral Resistance
TeamJoseph Prejean
Team Supervisor
Public Health Advisory TeamPamela Gruduah
Acting Team Leader
Mi ChenAssociate Chief of
Science
Pat SweeneySenior
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 carePrevention with positivesPolicy and structural interventionsTargeted interventionsEvidence-based planningSurveillance, monitoring, and evaluationHealth equityHealth reformProgram collaboration and service integration
Assessing the Continuum Of HIV Care
CDC. Vital Signs: HIV Prevention Through Care and Treatment — United States. MMWR 2011;60:1618-1623.
MMP
HIV Case SurveillanceData for Prevention
Sources of ReportsHospital PractitionersPrivate PractitionersPublic ClinicsLaboratories
CDC
74,353
Aggregate data reportsLocal BulletinsCDC Semiannual ReportHIV Web SitesPublic Information Data SetSurveillance Slide Set
Active Case Finding
Local Health Dept HIV Report
2001Region X
People with HIV
Partner servicesCase managementDiagnosis facilitiesCare providers
Individual data reports
Linkage and re-engagement in care
Overal
l AL AZ CAO CH
I CO CT DC FLHOU IN LA LAC MA MI MS NC NJ
NYS NYC PHI SC SFC TX VA WA
0
10
20
30
40
50
60
70
80
90
100
Incidence Funded Jurisdictions
Perc
ent
(%)
Testing and Treatment History Data ---------- 85% TTH Expected Outcome Standard STARHS Result ---------- 60% STARHS Result Expected Outcome Standard
Completeness of Testing and Treatment History Data1 and STARHS Results2 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 SurveillanceCritical 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 shouldtake steps to enhance the National HIVSurveillance 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
MARICTNJ
MDDC
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 valuesAll values, specified
Laboratory reporting(laws and regulations)
All values, not specified
Lab Reporting Assessment, November 2011
Yes No Total
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:”2009 2010 January-September
2011
Yes No Total
Yes No Total Yes No Total
34 (56.7
%)
26 (43.3
%)
60 36 (60%
)
24 (40%
)
60 32 (53.3
%)
28 (46.7
%)
60
* The 5 jurisdictions in the Pacific Islands do not use eHARS
Where we want to goAccurate data used for monitoring, planning, andevaluation•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 goAccurate data used for monitoring, planning, andevaluation•All areas have complete lab data
Where we areIncomplete 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 SurveillanceLaboratory 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 ProgramsActivities must be guided by a more broad-based HIV prevention planning process - a revised HIV Prevention Planning Guidance will soon be issuedCategory B: Expanded HIV Testing for Disproportionately Affected PopulationsCategory C: Demonstration ProjectsA 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 PreventionDivision 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