HIV/STD Surveillance in Tennessee: A fully integrated model

Thomas J. Shavor, MBA, MPHEpidemiology Director

HIV/STD Surveillance & Data ManagementTennessee Department of Health

Surveillance Integration in Tennessee

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)

Tennessee: a short snapshot 2007 Population: 6,054,830 (Source: U.S. Census) Approx. 1,000 new HIV/AIDS diagnoses/year (Source:

Tennessee HARS) 13,521 living with HIV/AIDS as of 12/31/06 (Source:

Tennessee HARS) High historical STD rates (Source 2005 CDC STD

Surveillance Report) 8th highest rates of Chlamydia 13th highest rates of Gonorrhea 10th highest rates of P&S Syphilis

Brief Historical Timeline 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

Levels of Integration Integration occurs at 2 levels:

1. Surveillance level- Core, Incidence, CTS, PEMS (?), Behavioral Surveillance, STD Surveillance, Chlamydia Infertility, and Program Evaluation groups occur within a single unit (housed in a secure area within our section)

2. Program level- HIV/AIDS/STD Surveillance section is integrated with the HIV/STD Prevention, Ryan White, and IT Support programs within the section.

Group Level Integration

Program Level Integration

Surveillance & Data Management

HIV/STDPrevention ProgramRyan White Program

Surveillance Position Funding Sources

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

HIV/STD Surveillance Activities

Responsible for providing data for ALL grants, including:

HIV Surveillance STD Prevention HIV Prevention HIV Counseling/Testing Ryan White (Part A and Part B) Chlamydia Infertility Maternal Child Health, TB, and anyone else

HIV/STD Surveillance Activities-cont.

Manage and analyze data from a variety of databases: HARS/eHARS STD*MIS PTBMIS (Tennessee’s Patient billing system) PEMS (???) Ryan White Care-Ware Chlamydia Infertility database Joint datasets (HIV Unmet Need, etc.)

Benefits of Integration1. 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 meetings)4. Encourages each program area to participate in

collaborative projects5. Aids in resource planning for future needs6. Assists in program evaluation activities

Challenges of Integration1. 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

Integration: Skills needed for success

1. Organize time/materials/resources2. Learning skills outside of your comfort zone3. Ensure lines of communication are always open

(via regularly scheduled management meetings)

4. Involve others in grant preparation, program evaluation, routine decisions

5. PATIENCE!

Questions?