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

Overview
 ECHPP background and rationale
 ECHPP evaluation plan
 Data triangulation and synthesis
 Questions and discussion

ECHPP BACKGROUND AND
RATIONALE

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

*
Enhanced Comprehensive HIV
Prevention Plans (ECHPP) project

General General
ECHPP activity ECHPP activity
category category

POLICY, SYSTEMS, Efforts to change existing structures/ HIV TESTING Routine, opt-out screening for HIV in clinical
AND policies /regs that are barriers to an settings of patients ages 13-64
ENVIRONMENTAL environment for optimal HIV
CHANGE 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 guidelines

LINKAGE, Linkage to HIV prev/care/tx services for BEHAVIORAL Behavioral risk screening followed by risk
RETENTION, those testing positive and not currently RISK REDUCTION reduction interventions for HIV-positive ppl
TREATMENT AND in care INTERVENTIONS
ADHERENCE, 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 risk
ABUSE
SCREENING FOR Interventions or strategies promoting PEP Provision of Post-Exposure Prophylaxis to
HIV-POSITIVE adherence to antiretroviral medications populations at greatest risk
PERSONS
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 category

ALCOHOL Brief alcohol screening and BEHAVIORAL RISK Clinic- or provider-delivered ,evidence-based
SCREENING, interventions for HIV-positive ppl and REDUCTION HIV prevention interventions for HIV-positive
INTERVENTIONS high-risk HIV-negative ppl INTERVENTIONS patients and high-risk, HIV-negative patients
PCSI AND Integrated hepatitis, TB, and STD Behavioral risk screening followed by
INTEGRATED testing, partner services, vaccination, individual-, group-level evidence-based
SERVICES 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,
MARKETING
CONDOM Condom distribution for general CAMPAIGNS Community interventions that reduce HIV
DISTRIBUTION 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

ECHPP evaluation
 Program processes
 Communit y-level outcomes
 Communit y-level impact

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?

 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

 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

 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 services

NOTE: Indicator data will be computed separately for each priority population, where possible
a Process data = Program information reported semi-annually by grantees to CDC and other federal agencies ; represents publicly-funded

services provided in the MSA

Outcomesb Impactc

o % of ppl living with HIV who
know their status
o % of HIV-pos. tests where
o % of HIV-diag. ppl with
client received result
undetectable viral load
o % 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/syphilis

NOTE: Indicator data will be computed separately for each priority population, where possible
b Outcome data = ECHPP program output (blue boxes); self-reported, survey data (12 mo. recall period) includes MMP/clinic survey/ MSM Web

Surveillance 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

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 Oct
2007-08 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 surveys
NHBS- 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 case
surveill. 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

For more information, please contact:

Dr. Holly H. Fisher
hfisher@ cdc.gov
404-639-1940

Using HIV Surveillance Data to Inform the ECHPP Evaluation

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