Using HIV Surveillance Data to Inform the ECHPP Evaluation
Using HIV Surveillance Data to Inform the ECHPP Evaluation Holly H. Fisher and Tamika Hoyte 2011 National HIV Prevention Conference Atlanta, GA National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of HIV/AIDS Prevention
ECHPP description Three-year project (Sept. 2010 to Sept. 2013) implemented by health depts in 12 MSAs with highest AIDS burden Project objectives Develop an enhanced plan that aligns the jurisdiction’s prevention and care activities with NHAS Identify/implement optimal combination of prevention, care, and treatment activities Implement activities at appropriate scale Increase targeting of highest risk groups
General General ECHPP activity ECHPP activity category categoryPOLICY, SYSTEMS, Efforts to change existing structures/ HIV TESTING Routine, opt-out screening for HIV in clinicalAND policies /regs that are barriers to an settings of patients ages 13-64ENVIRONMENTAL environment for optimal HIVCHANGE prev/care/tx Policies/procedures that will lead to HIV testing in non-clinical settings to identify provision of ART in accordance with undiagnosed HIV infection current treatment guidelinesLINKAGE, Linkage to HIV prev/care/tx services for BEHAVIORAL Behavioral risk screening followed by riskRETENTION, those testing positive and not currently RISK REDUCTION reduction interventions for HIV-positive pplTREATMENT AND in care INTERVENTIONSADHERENCE, AND Interventions or strategies promoting CONDOM Condom distribution prioritized to target HIV-STD/SUBSTANCE retention in or re-engagement in care DISTRIBUTION positive persons and persons at highest riskABUSESCREENING FOR Interventions or strategies promoting PEP Provision of Post-Exposure Prophylaxis toHIV-POSITIVE adherence to antiretroviral medications populations at greatest riskPERSONS STD screening according to current PERINATAL Prevention of perinatal transmission guidelines TRANSMISSION PREVENTION Linkage to other medical, social services PARTNER Ongoing partner services SERVICES = Required activity
General General ECHPP activity ECHPP activity category categoryALCOHOL Brief alcohol screening and BEHAVIORAL RISK Clinic- or provider-delivered ,evidence-basedSCREENING, interventions for HIV-positive ppl and REDUCTION HIV prevention interventions for HIV-positiveINTERVENTIONS high-risk HIV-negative ppl INTERVENTIONS patients and high-risk, HIV-negative patientsPCSI AND Integrated hepatitis, TB, and STD Behavioral risk screening followed byINTEGRATED testing, partner services, vaccination, individual-, group-level evidence-basedSERVICES and treatment interventions for HIV-negative persons at highest risk of acquiring HIV For high-risk HIV-negative ppl, COMMUNITY Community mobilization to create broadened linkages to, and provision MOBILIZATION environments that support HIV prevention of, services for social factors impacting HIV incidence Targeted use of HIV/STD surveillance COMMUNITY- HIV and sexual health communication or data LEVEL social marketing campaigns INTERVENTIONS, MARKETINGCONDOM Condom distribution for general CAMPAIGNS Community interventions that reduce HIVDISTRIBUTION population risk = Optional activity
Priorit y populations African Americans/ People living with Blacks HIV/AIDS Hispanics/Latinos People at high risk Injection drug users with negative or High-risk unknown HIV status heterosexuals Men who have sex with men
Program Processes ECHPP activities will be monitored throughout implementation period to track delivery of services and programs Were services and programs delivered as intended? What were challenges and successes?
Program Processes Local and core monitoring Grantees will report: • progress on local objectives to project officers (quarterly) • standardized, core process measures to evaluation team (semi-annually) Monitoring of other publicly-funded prevention, care, and tx activities in 12 MSAs Collection of qualitative and contextual data
Communit y-level outcomes Outcomes will be monitored to determine extent to which changes are associated with ECHPP implementation Did risk behaviors among priorit y populations decrease over time? Did service access and overall health outcomes improve among priorit y populations over time?
Communit y-level outcomes Request data annually from CDC clinical and behavioral surveillance data systems Medical Monitoring Project (MMP) • HIV-diagnosed ppl currently receiving HIV medical care • Information re: access to care, HIV treatment and adherence, risk behaviors, health conditions, and prevention activities • Available in 9 MSAs
Communit y-level outcomes Request data annually from CDC clinical and behavioral surveillance data systems National HIV Behavioral Surveillance (NHBS) • MSM, IDU, and high-risk heterosexuals • Information re: HIV testing and treatment experiences, risk behaviors, health conditions, and prevention activities • Available in all 12 MSAs (New) MSM Web Surveillance Project • MSM • Information similar to NHBS survey + items re: stigma and discrimination, partner risk • Respondents will be linkable to all 12 MSAs
Communit y-level outcomes Collect supplemental data in six cities at beginning/end of ECHPP Clinic survey • 200 HIV-diagnosed ppl in care per MSA, per time point • Modeled after MMP Community survey • 100 high-risk heterosexuals, 100 IDUs per MSA, per time point • Modeled after NHBS
Communit y-level impact Track changes in HIV incidence, health outcomes, and disparities over time Was there a reduction in HIV incidence or indicators of risk over time? Was there an increase in, and impact of, prevention and care for ppl living with HIV/AIDS over time? Was there a reduction in HIV/AIDS disparities over time?
Communit y-level impact Request data annually from eHARS (U.S. case surveillance system) Case surveillance data Incidence surveillance data Will also look at long-term outcomes from clinical and behavioral surveillance systems to assess impact
ECHPP activity categories Program processesa For all tests, healthcare and non- healthcare settings: o # of HIV-positive tests o # of newly-identified, conf. HIV- positive tests o % of newly-identified, conf. HIV- HIV testing positive tests o % of newly-identified, HIV-positive tests (separately for prelim. and conf. positive tests) where client was referred to: • HIV medical care • Partner services • Prevention servicesNOTE: Indicator data will be computed separately for each priority population, where possiblea Process data = Program information reported semi-annually by grantees to CDC and other federal agencies ; represents publicly-fundedservices provided in the MSA
Outcomesb Impactc o % of ppl living with HIV who know their statuso % of HIV-pos. tests where o % of HIV-diag. ppl with client received result undetectable viral loado % of newly-identified, HIV- o % of HIV-diag. persons in care o % of ppl newly diagnosed with pos. results where client : who: HIV infection at earlier stage (not • Received result • Were taking ART (separately stage 3:AIDS) • Was linked to HIV medical for all persons and those with o % of ppl diagnosed with a CD4 care (attended first appt most recent CD4 count <500 count within 3 mos of HIV diag. within 3 mos. of diagnosis) cells/µ) o % of HIV-diag. ppl who: • Received professional help • Were linked to HIV medical care for: within 3 mos. Retention and re- • Were in HIV medical care and engagement in HIV most recent viral load test (past medical care 12 mos.) was undetectable ART adherence • Were screened for chlamydia/gonorrhea/syphilisNOTE: Indicator data will be computed separately for each priority population, where possibleb Outcome data = ECHPP program output (blue boxes); self-reported, survey data (12 mo. recall period) includes MMP/clinic survey/ MSM WebSurveillance data (green boxes)c Impact data = Annual, population-based HIV surveillance data, MMP data, and MSM Web Surveillance data (purple boxes)
Data triangulation and synthesis Three-tiered approach that uses existing data systems, as well as new data collections Integrate/synthesize data from different sources Health dept-reported program data Program data obtained from other federal agencies Population-based, self-report survey data Population-based, surveillance data
ECHPP Evaluation Timeline Revised August 2011 Nov April Oct Oct Oct Oct Oct2007-08 2009 2010 2011 2011 2012 2013 2014 2015 Data used in evaluation: ECHPP ECHPP Planning Implementation Process (10-10181) (10-10181) ECHPP Implementation Outcome (11-1117) Impact CDC-funded Program Data ECHPP Process Data Collection Other Federal Agency Data (e.g., HRSA, SAMHSA, CMS) Supplemental data collection (6 cities) Communit y and Communit y and clinic surveys clinic surveysNHBS- NHBS- NHBS- NHBS- NHBS- NHBS- NHBS- NHBS-MSM IDU HET MSM IDU HET MSM IDU MSM web MSM web MSM web MSM web surveillance surveillance surveillance surveillance MMP MMP MMP MMP MMP MMP Clinic survey Clinic survey HIV HIV HIV HIV HIV HIV HIV HIV case case case case case case case casesurveill. surveill. surveill. surveill. surveill. surveill. surveill. surveill. MSM web MSM web MSM web MSM web surveillance surveillance surveillance surveillance MMP MMP MMP MMP MMP MMP Data Triangulation, Synthesis, and Analysis
Linking program and surveillance data Important to connect program (process) to outcome to impact Ultimately, need to assess whether programs contribute to outcomes, which contribute to long-term impact in communit y No true, direct link across… however, through triangulation of data and methods, we might achieve convergence
Firsts for CDC First time CDC will: Connect HIV program data to community-level outcome data to long-term impact Integrate and synthesize HIV-related information gathered from a variety of existing and new data sources Triangulate data to make a broad statement about how/whether public health strategies are working in highest prevalence areas