Working with Health Departments: Ingredients for Effective Collaboration Between Health Departments and CFARs. Shanell L. McGoy, Ph.D.

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1 Working with Health Departments: Ingredients for Effective Collaboration Between Health Departments and CFARs Shanell L. McGoy, Ph.D. MPH HIV/AIDS in the Southeast: 2 nd Annual CFAR Workshop to Address the Southern Epidemic March 24, 2017

2 Overview

3 Plenary Overview Profile of HIV/AIDS/STD/Viral Hepatitis in Tennessee Partnerships Professional Development Procurement of Funds Procedure and Protocol Patience with Health Departments

4 Division of Communicable & Environmental Diseases & Tennessee Department of Health - CEDEP Emergency Preparedness (CEDEP)

5 Vacant Program Total Funding Funding Sources Activities Ryan White $32,000,000 ADAP, ADAP ERF, Part B Base, Part B Suppl, MAI Safety net HIV Care and Treatment (~7000 $22,000,000 Rebates HIV-Infected Individuals in TN); (meds, $7,200,000 State medical services, case mgmt, wrap-around services) HOPWA $1,000,000 HOPWA Housing opportunities for PLWHA HIV $5,400,000 HIV Prevention HIV education, testing, linkage to care, data-tocare, Prevention $900,000 HIV Testing partner services, pre-exposure $1,700,000 PrEP prophylaxis HIV/STD $1,100,000 Surveillance (NHSS) HIV data import, cleaning, case reporting & Surveillance $2,000,000 Special Populations (NHBS) reconciliation, continuum of care STD $2,100,000 STD Prevention STD education, testing (HDs), treatment, Prevention $300,000 State reporting, case investigation, partner services Viral $100,000 VH Prevention VH surveillance, educ, testing, case Hepatitis $1,400,000 State investigation, outbreak planning, linkage, comm capacity-building TOTAL $77,200,000 ($68.3 million fed + $8.9 million state)

6 Profile of HIV/AIDS/STD/Viral Hepatitis in Tennessee

7 Reportable Diseases (TN, 2017)

8 HIV Epidemiological Profile (TN, 2015) Characteristic Population Diagnosed & Living Newly Diagnosed 6,600,299 n = 16,903 n = 712 Gender Male 49% 74% 79% Female 51% 26% 20% Transgender 0.4% 1% Race / Ethnicity Black (NH) 17% 56% 59% White (NH) 79% 37% 33% Hispanic 5% 5% 6% Transmission Category MSM -- 48% 54% HRH -- 26% 21% IDU -- 7% 5% MSM/IDU -- 3% 2% NIR -- 15% 18% Age (years) % 4% 25% % 17% 35% % 23% 17%

9 HIV Newly Diagnosed Cases vs. Prevalent Cases by Case Count (TN, 2015) Newly Diagnosed Cases Prevalent Cases Tennessee ehars, internal resource

10 HIV Newly Diagnosed Cases vs. Prevalent Cases by Case Rate (TN, 2015) Newly Diagnosed Cases Prevalent Cases Tennessee ehars, internal resource

11 History of the HIV/AIDS Epidemic (TN, ) Tennessee ehars, internal resource

12 HIV Only and Concurrent HIV/AIDS Diagnoses Case Counts (TN, ) 1000 HIV and AIDS Concurrently Number of Persons Diagnosed with HIV Only and HIV/AIDS Concurrently HIV Only Year Tennessee ehars, internal resource

13 TN HIV Continuum of Care: 2010 Status vs Goals 100% 90% 80% 80% TN Goal (2015) TN (2010) 70% 64% 64% Persons with HIV 60% 50% 40% 30% 29% 51% 35% 20% 10% 0% Tennessee ehars, internal resource Diagnosed Linked Retained Achieved Viral Suppression Engagement in HIV Care

14 TN HIV Continuum of Care 2014

15 Tennessee s HIV/AIDS Strategy Progress Report Goal Goal Status (2014) Increase Linkage to HIV Medical Care < 3 Months of Diagnosis Increase Access to Care & Improve Health Outcomes Among Persons Living with HIV Infection 64% 77% > 80% Increase Retention in HIV Medical Care 29% 53% > 64% Increase Viral Suppression 35% 52% > 51% Reduce HIV-Related Disparities Increase Viral Suppression Among MSM by 20% Increase Viral Suppression Among Blacks/AA s by 20% Increase Viral Suppression Among Hispanics by 20% Increase Viral Suppression Among year olds by 20% 39% 56% > 47% 31% 50% > 37% 30% 43% > 36% 28% 45% > 34% Tennessee ehars, internal resource

16 Tennessee Data Summary Progress (2015 compared to 2010) New HIV Diagnoses by 17% Late stage HIV diagnosis by 9% HIV-deaths by 20% Gaps Disparities persist (younger, R/E minorities, PWID) HIV Vulnerability among PWID PWID are at increased risk for HIV, HCV, HBV, and other negative health outcomes. In 2014, 9% of HIV diagnoses were among PWID. Although substantial progress has been made in reducing HIV infections among PWID, recent changes in drug use could challenge this success. Wejnert C et al, MMRW, 2016

17 Reported Cases of Acute HBV in Tennessee US case rate* cases 3,350 2,903 2,895 3,050 2,953 TN case rate* cases rank 4 th 3 rd 3 rd 3 rd 3 rd * per 100,000 population

18 Reported Cases of Acute HCV in Tennessee US case rate cases 850 1,229 1,778 2,138 2,194 TN case rate cases rank 4 th 4 th 4 th 6 th 5 th * per 100,000 population

19 istribution of New Cases in TN: HCV & HIV (2015) Acute HCV Newly Diagnosed Cases Tennessee NBS, accessed February 10, 2017 Note: County Data Unavailable for n=19 HCV Cases Tennessee ehars, internal source Natural Breaks/Manual, 5 Classes

20 CDC s HIV Risk Vulnerability Assessment: TN Profile, County-Level Van Handel MM et al, JAIDS, 2016

21 Partnership

22 Partnership MSM Taskforce

23 Professional Development

24 Biostatistics Clinic Monthly meeting at TDH TDH staff select topics of interest and get 1-hour demonstrations of techniques/programs/methodologies Statistical/Analysis Software Social Network Analysis, R Statistical Software Data De-identification Algorithms and Theories Data Suppression Data Harmonization Review of data systems Open clinic where TDH staff can bring research and design questions to a group of researchers for consultation on approach

25 Presentations

26 Manuscripts Manuscripts in Progress

27 Procurement of Funds

28 Procurement of Funds CDC National HIV Surveillance System Supplement CDC Category 1: PrEP Support Demonstration Projects Targeting MSM and Transgender Persons At Substantial Risk of Acquiring HIV: Health departments will support the implementation of PrEP demonstration projects to expand or enhance HIV prevention activities in local jurisdictions NIH HIV PrEP Implementation Science in CDC-funded Public Health Demonstration Projects

29 Procedure and Protocol

30 Procedure and Protocol Data Use Agreement Workgroups Funding Approval

31 Patiences with Health Department

32 Patience with Health Department Customer Service Data Requests Investigations Local Health Dept & CBO Visits Staff Turnover Grantee Meetings Federal Deliverables, Calls, and Visits

33 Patience with Health Department Occasional WINS

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