Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12DATA POINTS: A Health Department Roadmap for Enhancing Data to Care Programs 4 Data to Care is a public health strate- gy that uses HIV surveillance data to identify, link and monitor engagement in HIV medical care. D2C has two pri- mary goals 1) to increase the number of persons who have been diagnosed with HIV in the United States who are engaged in care and 2) to increase the number of persons diagnosed with HIV with an undetectable viral load (virus level < 200 copies/mL). A sup- pressed viral load is associated with a low risk of both disease progression and HIV transmission. The ultimate goal of D2C is to decrease the number of new HIV infections in the U.S., and improve the health outcomes of those living with HIV, particularly among dis- proportionately impacted populations (e.g., young gay men/MSM of color). Haven’thealthdepartmentsbeen usingHIVsurveillance datainthis waybeforetheCentersforDisease ControlandPre- vention(CDC) startedthe D2C strategy? Whatis DatatoCare? Yes, and no. There are several strategies that health departments have used to prevent HIV that are related to D2C such as pre- vention with positives, linkage to care, supporting the HIV Care Continuum, and Treatment as Prevention (TasP). Prevention with Positives is a CDC priority that started with the Recom- mendations for HIV Prevention with Adults and Adolescents with HIV in the United States, 2014 ,which includes an emphasis on prevention of transmis- sion by HIV-infected persons with the recommendation to offer antiretrovi- ral use at the time of diagnosis and There are five check-list steps before starting a D2C program. The health department must: Have laws/regulations that require the reporting of all CD4 and viral load results to the state/territorial/local health department Document that the laboratories that perform HIV-related test- ing for the jurisdiction report a minimum of 95% of HIV-related test results to the state/territori- al/local health department and those data are in eHARS (for a list of states with >95% viral load reporting, see Monitoring Selected National HIV Preven- tion and Care Objectives by Using HIV Surveillance Data United States and 6 Dependent Areas—2014) Additionally, for D2C to be successful it is recommended that jurisdictions: Conduct matches between the state/territorial/local HIV regis- try and the state/territorial vital statistics registry to ascertain vi- tal status of PLWH in the health department’s jurisdiction Communicate with other state, local and territorial health departments to determine if persons who are in the HIV registry have moved out of their jurisdiction Assess the capacity of the care system in their jurisdiction to accept new clients Inadditiontothecheck-liststeps,healthde- partmentsshouldalsoensuretheyhaveother mechanismsinplacetomaximizesuccess. Thesupportof theleadership of thehealthdepartment DevelopingastrongD2Cprogramrequiresthe cooperationofseveral,sometimesseparate,unitsofthe healthdepartmentallwithdifferentfundingstreams and,possibly,differentpriorities.HIVsurveillance,HIV prevention,andHIVcaremustworktogetheronD2C.The vitalregistry,STD,hepatitis,andTBprogramsalongwith MedicaidandDepartmentofCorrectionsallhavedata thatisusedtoensurethattheHIVregistryisascomplete andaccurateaspossible.Healthdepartmentswilllikely D2C PROGRAM MODELS AND OPERATIONAL STEPS Data to Care: Program Models Health Department Model Health Department-initiated linkage and re-engagement outreach Healthcare Provider Model Healthcare Provider-initiated linkage and re-engagement outreach Combination Health Department Healthcare Provider Model Combination of both approaches Basic Operational Steps for a Data to Care Program • Use HIV surveillance data to identify not in care (NIC) individuals • Generate output list from HIV surveillance database with key inclusion data for NIC list • Investigate NIC list to complete missing data and verify care status • Prioritize NIC list for follow-up and outreach • Share key data with field staff and/or providers to locate individuals on NIC list and conduct outreach and linkage or re-engagement activity • Provide missing data located during investigative and/or programmatic activity to HIV surveillance unit for review and quality assurance effectively linking and retaining PLWH in medical care. Historically, HIV surveillance data has not been used to identify and contact PLWH. However, the availability of treatments that can radically improve the health of PLWH and prevent transmission to others initiated a shift in how to use these data. An ethical ex- ploration of these issues can be found in a 2013 article: Shifting the Para- digm: Using HIV Surveillance Data as a Foundation for Improving HIV Care and Preventing HIV Infection HIV surveillance programs collect data on all PLWH in their jurisdiction. This means the data collected are popu- lation based rather than restricted to only the persons presenting for care at a particular agency or medical pro- vider. The comprehensive nature of surveillance data has the potential to make a bigger impact on community viral load. The use of HIV surveillance data to track linkage and retention in HIV care is an important tool for health de­ partments in supporting the HIV care continuum.