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
Surveillance Integration in Tennessee
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Definition- Combining all aspects of HIV/STD
surveillance activities in order to attain a close
and seamless coordination of
information/services between:
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Groups within HIV/STD Surveillance & Data
Management (Group Level Integration)
Program areas within HIV/STD Section (Program
Level Integration)
Tennessee: a short snapshot
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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)
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8th highest rates of Chlamydia
13th highest rates of Gonorrhea
10th highest rates of P&S Syphilis
Brief Historical Timeline
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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:
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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
Core HIV Surveillance
STD Surveillance
Epi Capacity/
Program Evaluation
Surveillance Director
HIV Behavioral
HIV Incidence
Surveillance
CT Infertility
HIV CTS
Program Level Integration
Surveillance & Data Management
Ryan White Program
HIV/STD
Prevention Program
Surveillance Position Funding Sources
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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:
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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.
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Manage and analyze data from a variety of
databases:
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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 Integration
1.
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6.
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 meetings)
Encourages each program area to participate in
collaborative projects
Aids in resource planning for future needs
Assists in program evaluation activities
Challenges of Integration
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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
Integration: Skills needed for success
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5.
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!
Questions?