NASTAD Recommendations for Cluster and Outbreak Detection and Response & Molecular HIV Surveillance
HIV Cluster Detection and Response (CDR), including Molecular HIV Surveillance (MHS) strategies as one approach for cluster detection, is a key activity in Ending the HIV Epidemic (EHE) efforts. Quickly identifying and responding to clusters and outbreaks provides opportunities to disrupt HIV transmission and can assist in identifying and addressing gaps in prevention and treatment services. However, NASTAD also recognizes that health departments and community partners have expressed concerns about these strategies — concerns that new surveillance technologies may subject people living with HIV (PLWH), and people seeking HIV prevention services, to increased risk of prosecution, misuse of surveillance data in criminal or civil proceedings, or adverse actions by immigration authorities.
Under the leadership of the NASTAD Board of Directors Program and Policy Committee, NASTAD staff and members developed recommendations to implement CDR and MHS strategies in ways that reflect the values and priorities of NASTAD, health departments, and community members. The recommendations are the result of feedback collected from NASTAD members. These recommendations address the following topics:
- Community engagement
- Protection of public health data
- Assessing and addressing HIV criminalization
- Flexible implementation and resources to support program infrastructure
- CDR program utility and evaluation
More detail about each area is below, and further recommendations are included in the full statement.
Community Engagement
It is essential to provide meaningful opportunities for community input, education, and engagement to facilitate continued conversations around CDR and MHS implementation to ensure programs are meeting the community’s needs. For community members to participate in these activities, health departments need to involve those most impacted by this work to be part of the process with partners at the local, state, and national/federal levels.
Protection of Public Health Data
NASTAD’s members call for a technological and regulatory barricade between identifiable health department data and civil, criminal, or administrative proceedings. Putting safeguards in place to protect PLWH from being penalized for participation in surveillance activities would increase engagement in HIV prevention, testing, and care services and build trust between communities and governmental public health.
Assess and Address HIV Criminalization
State and local members identified HIV criminalization as a significant barrier to adequately implement MHS, and a limitation on the ability of health departments to share data with other jurisdictions that have HIV criminalization statutes. A combination of additional support and technical assistance (TA) for individual jurisdictions, along with federal funding to support local educational efforts for state and local legislatures and other law and policy making bodies, around reforming HIV criminalization laws and prosecutorial practices, is necessary to advance these efforts and end the HIV epidemic.
Flexible Implementation and Resources to Support Program Infrastructure
CDR implementation strategies may vary based on HIV prevalence, jurisdictional resources, laws, and utility of CDR approaches locally. As such, NASTAD’s membership recommends a focus on flexibility for tailored local solutions to implement CDR activities and providing additional resources to prevention and surveillance programs to support the staffing and other resources needed for CDR activities.
CDR Program Utility and Evaluation
More research on the utility of CDR and MHS strategies for health departments is needed to determine the value of the implementation of CDR and MHS strategies in relation to the investment of resources required. The utility of using MHS as a tool to end the HIV epidemic depends on timely data and the ability to use these data to implement an appropriate response that slows or halts HIV transmission.
NASTAD supports CDR strategies as one of many tools to work towards EHE goals. NASTAD encourages health departments to continue engaging with their communities, state leadership, and partners around issues related to CDR, and MHS in particular. NASTAD commits to providing leadership support, advocacy, and technical assistance to members as health departments continue to navigate challenges and opportunities presented by CDR implementation.