HIV/STD Surveillance in Tennessee: A fully integrated model

1. HIV/STD Surveillance in Tennessee: A fully integrated model Thomas J. Shavor, MBA, MPH Epidemiology Director HIV/STD Surveillance & Data Management Tennessee Department of Health

2. 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)

3. 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 • 2007- HIV/STD Program merged with CEDEP.

4. Levels of Integration • Integration occurs at 2 levels: • 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. Group Level Integration

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

7. 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% EpiTA/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. HIV/STD Surveillance Activities • 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. HIV/STD Surveillance Activities-cont. • 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. Observed Benefits of Integration • Allows for more effective communication within Surveillance groups & between different programs • Helps program staff to see the “big picture” • Has potential to save time (fewer mistakes or assumptions about mission) • Encourages each program area to participate in collaborative projects • Aids in resource planning for future needs • Assists in program evaluation activities

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

12. Integration: Skills needed for success • Organize time/materials/resources • Learning skills outside of your comfort zone • Ensure lines of communication are always open (via regularly scheduled management meetings) • Involve others in grant preparation, program evaluation, routine decisions • PATIENCE! (Lots and lots…)

13. In Conclusion… • 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

14. Questions?