Thomas J. Shavor, MBA, MPH Epidemiology Director HIV/STD Surveillance & Data Management Tennessee Department of Health.

HIV/STD Surveillance in Tennessee: A fully integrated

model

Thomas J. Shavor, MBA, MPHEpidemiology Director

HIV/STD Surveillance & Data ManagementTennessee Department of Health

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)

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.

Levels of Integration

Integration occurs at 2 levels:

1. 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.

Group Level Integration

Surveillance Director

Core HIV Surveillance

Epi Capacity/Program

Evaluation

HIV Partner Services

Ryan White

HIV Prevention

STD Surveillance

Program Level Integration

Surveillance & Data Management

HIV/STDPrevention Program

Ryan White Program

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% 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 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

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

Observed Benefits of Integration

1. Allows for more effective communication within Surveillance groups & between different programs

2. Helps program staff to see the “big picture”3. Has potential to save time (fewer mistakes or

assumptions about mission)4. Encourages each program area to participate in

collaborative projects5. Aids in resource planning for future needs6. Assists in program evaluation activities

Observed Challenges of Integration

1. Cross-training surveillance staff (i.e. “doing more with less”) to perform unfamiliar tasks can lead to major stress!

2. Managers must attain a greater understanding of how other program areas function.

3. Breaking down traditional program barriers can be difficult (“my program-your program”)

4. Explaining “technical” subjects to non-technical people can be frustrating!

5. Getting programs to pay their “fair share” of Surveillance resources used

Integration: Skills needed for success

1. Organize time/materials/resources2. Learning skills outside of your comfort zone3. Ensure lines of communication are always open

(via regularly scheduled management meetings)

4. Involve others in grant preparation, program evaluation, routine decisions

5. PATIENCE! (Lots and lots…)

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

Questions?