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NCHHSTP

Surveillance and Strategic Information

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Program Collaboration and Service Integration Surveillance and Strategic Information Kevin Fenton, M.D., Ph.D., F.F.P.H. Director National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Centers for Disease Control and Prevention Surveillance and Program Integration Meeting August 20, 2007
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Program Collaboration and Service Integration Surveillance and Strategic Information
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Overview Overview of NCHHSTP Integration as a Center priority What is PCSI? The role of surveillance in an integrated prevention framework Meeting objectives
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Overview
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NCHHSTP Mission Maximize public health and safety nationally and internationally through the elimination, prevention, and control of disease, disability, and death caused by HIV/AIDS Non-HIV Retroviruses Viral Hepatitis Other Sexually Transmitted Diseases Tuberculosis Non-Tuberculosis Mycobacteria
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NCHHSTP Mission
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About NCHHSTP National Center for HIV, STD, and TB Prevention established in FY 1995 Brought together CDC’s HIV, STD and TB prevention activities Viral hepatitis prevention activities added to mission in 2006, awaiting final approval Center supports both domestic and global activities Size: 1,500+ FTE and non-FTE staff 15% of CDC workforce Diverse staff
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About NCHHSTP
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Burden of disease Estimated 1 million Americans infected with HIV One fourth are unaware of their infection Chronic liver disease is the 10th leading cause of death in U.S. More than half of these deaths due to viral hepatitis Hep C is most common blood-borne disease in U.S. Estimated 18.9 million cases of non-HIV STDs occur each year in U.S. Chlamydia and gonorrhea are most commonly reported infectious diseases Estimated 10 million to 15 million in U.S. have latent TB infection 13,767 had TB disease in 2006
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Burden of disease
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Heterogeneity in National Epidemics of HIV/AIDS, Hepatitis B, TB, and Selected STDs Six line charts showing the heterogeneity within the United States for HIV/AIDS, Hepatitis B, TB and Chlamydia, Gonorrhea, and Syphilis, with Chlamydia showing increasing rates spiking to 35,000,000.
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Heterogeneity in National Epidemics of HIV/AIDS, Hepatitis B, TB,
and Selected STDs
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Geographic heterogeneity in epidemics of HIV/AIDS, Hepatitis B, TB, and Selected STDs Six geographic charts of the United States showing that the incidence for HIV/AIDS, Hepatitis B, TB, Chlamydia, Gonorrhea, and Syphilis tends to be highest in Southern states.
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Geographic heterogeneity in epidemics of HIV/AIDS, Hepatitis B, TB, and Selected STDs
Incidence of these diseases tends to be highest in Southern states.
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HIV/AIDS, Hepatitis, STD and TBCommon determinants --Similar or overlapping at-risk populations --Disease interactions Common transmission for HIV, hepatitis and STDs, e.g., sexual risk behaviors STDs increase risk of HIV infection Clinical course and outcomes influenced by concurrent disease Social determinants Poor access to, and quality of, health care Stigma, discrimination, homophobia Socioeconomic factors, such as poverty Prevention and control Effective interventions exist to reduce the burden of TB, viral hepatitis, most STDs, and HIV Challenges in funding, delivery, monitoring and quality of prevention services
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HIV/AIDS, Hepatitis, STD and TB Common determinants
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NCHHSTP Programs Common Purposes and Strategies Eliminating health disparities, especially in sub-populations with disproportionate burden of disease Managing and reducing stigma and the resulting consequences in accessing and providing services Preventing disease among at-risk/un-infected persons Increasing access to high quality, culturally competent services for marginalized, under and uninsured Interrupting transmission of infection using similar methods of partner counseling, elicitation, referral, and contact investigations Diagnosing disease and providing expeditious treatment and/or referral for care Maintaining systems that assure confidentiality Monitoring infections in the population (i.e., case surveillance)
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NCHHSTP Programs - Common Purposes and Strategies
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CDC Goals and Strategic ImperativesShared Leadership Values Maximizing Global Synergies, Program Integration, Reducing Health Disparities Drug Users, MSM, Corrections, Global Antenatal, Surveillance Strategic Information, Health Disparities, Program Integration, Modeling/Health Results Measures
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CDC Goals and Strategic Imperatives
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Program Collaboration and Service Integration (PCSI) Operating Definition: A mechanism of organizing and blending inter-related health issues, separate activities, and services in order to maximize public health impact through new and established linkages between programs to facilitate the delivery of services Integration should be focused at the field or client level where the interface between the system and the consumer takes place. Integration results in more holistic services for clients, regardless of the agency structure.
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Program Collaboration and Service Integration (PCSI)
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Program Collaboration and Service Integration (PCSI) Goal: Provide prevention services that are holistic, science based, comprehensive, and high quality to appropriate populations at every interaction with the health care system. Vision: Remove barriers to and facilitate adoption of service delivery integration at the client level by aligning NCHHSTP activities, systems, and policies with this goal. 
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Program Collaboration and Service Integration (PCSI)
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Levels of Integration of clinical preventive services in health care settings Limited integration HIV testing Some integration of health information Expanded Service integration across programs funded by CDC based on risk assessment Comprehensive Service integration across systems of care (CDC or other) based on risk assessment
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Levels of Integration of clinical preventive services in health care settings
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NCHHSTP Consultation on PCSI, August 20-22Overall meeting objectives To advise NCHHSTP on the development of Program Collaboration and Service Integration (PCSI) activities over the next five years Assist in establishing priorities for PCSI; short term and longer term Identify what CDC can do to assist local PCSI efforts Identify what CDC can do to improve its own efforts toward PCSI
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NCHHSTP Consultation on PCSI, August 20-22 Overall meeting objectives
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Surveillance is cornerstone of effective prevention programs Prevention is the best strategy for reducing the human and economic toll from HIV/AIDS. To have the largest impact on the HIV epidemic, CDC uses a comprehensive approach to HIV prevention. Comprehensive HIV prevention incorporates surveillance, research, prevention interventions and evaluation. CDC’s surveillance and research activities help to better define and understand the HIV/AIDS epidemic across the nation. CDC’s prevention interventions and capacity-building efforts are based on behavioral, laboratory and medical science and work to contain the spread of HIV and AIDS. Program evaluation and policy research and development assess intervention effectiveness and refine prevention approaches.
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Surveillance is cornerstone of effective prevention programs
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Surveillance/ Strategic Information Gaps Lack of data to describe intersection of: TB and STD Viral hepatitis and STD Viral hepatitis and TB Certain STDs and HIV, Latent TB and HIV Lack of data to assess prevalence and distribution of integrated preventive services Lack of data to monitor and evaluate performance on integration
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Surveillance / Strategic Information Gaps
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NCHHSTP Consultation on PCSI, August 20Surveillance Meeting Objectives 1. Address and Review Summary of input on Surveillance Key Questions What surveillance barriers/facilitators exit that might support or hinder PCSI? What are priority recommendations for surveillance/strategic information collection at local, state, and national levels to support PCSI? 2. Identify highest priority recommendations in surveillance in support of PCSI 3. Prepare to report a summary of meeting and priority recommendations to full consultation
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NCHHSTP Consultation on PCSI, August 20 Surveillance Meeting Objectives
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Key Questions 1. What are the weaknesses and strengths in NCHHSTP’s current strategic information portfolio that can support PCSI? 2. What surveillance barriers/facilitators exist that might support or hinder PCSI? 3. What are priority recommendations for surveillance/strategic information at local and national levels in support of PCSI?
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Key Questions
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Summary Program Collaboration and Service Integration is a major strategic priority for NCHHSTP Surveillance and strategic information are important tools for successful implementation, monitoring and evaluation of PCSI efforts Today’s pre-meeting aims to provide time and space to discuss challenges and opportunities for PCSI development and support by CDC and our partners
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Summary
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