Clinical Use and Benefit of HIV Surveillance Data - PowerPoint Presentation

Slide1

Clinical Use and Benefit of HIV Surveillance Data

Mary-Grace Brandt PhD MPH, Section Manager

HIV/STD Surveillance and Epidemiology

MDHHS

Slide2

Outline

The basics of HIV surveillance

Outline

how

surveillance data supports HIV care and prevention goals

New projects that use surveillance data

Data to Care

Molecular HIV Surveillance

How these new projects support HIV care and prevention goals

How HIV/STD care providers statewide can support new projects

Slide3

Role of HIV Surveillance in Michigan

The role of the MDHHS HIV/AIDS Surveillance Program is to monitor the HIV/AIDS epidemic in Michigan, analyze trends in HIV diagnoses and disease morbidity, and provide accurate and complete data for prevention initiatives and

care activities

.

Slide4

HIV Case Finding in Michigan

All laboratories and rapid-testing sites nationwide that run detection tests on Michigan residents have been required to report HIV-related results since April 2005 (MCL 333.5114)

Alere

Determine,

Insti

WBs, 4

th generation lab detection tests

Type Differentiating tests:

Geenius

Viral Loads

CD4 counts and percents

Genotypes

Electronic Matches

NDI, SSDI, Cancer, STD, Prison, TB, Viral

Hep

Provider-Surveillance Relationships

Staff can request site line and discharge lists for case finding

Staff are assigned to sites by county and health system

Slide5

Case Reporting

Laboratory Management System (LMS

)

Manages all electronic lab reports

Each surveillance staff member has a queue

Allow us to share lab reports with LHDs

Paper CRFs

Provides

check/balance with labs from LMS

Used when testing is done via dual-rapids

MDSS

Provides check/balance with labs from LMS

Used for all other communicable diseases including STDs

Slide6

Successes – Quality Data!

Case reporting completeness: >95% for last 10 years

98.7% for 2017

Timeliness: over 95% for last 10 years

98.6% for 2017

Duplicates: <0.1% for last 10 years

0 duplicates in 2017As of July 2017, 82.9% of persons diagnosed in the past 12 months had a reported CD4 or Viral Load Result within 3 months of diagnosis

I

n 2017, 98.9% of new surveillance records pass standard CDC data quality checks

Slide7

2017 HIV Surveillance Summary

Slide8

Data reports and projects

www.Michigan.gov/hivstd

HIV Case Reporting and Data

HIV Statistics and Data Reports

Slide9

The HIV Care Continuum

Slide10

Special Surveillance Projects - MMP

Slide11

Special Surveillance Projects - NHBS

Slide12

Data to Care

Slide13

Data 2 Care in

Michigan (LINK UP MI)

CDC definition: “

Data to Care

 is a new public health strategy that aims to use HIV surveillance 

data to identify HIV-diagnosed individuals not in 

care, link them to care, and support the HIV

Care

 Continuum.”

Basic Concept:

In Michigan, HIV labs are reported to MDHHS

Lab reports are used as a proxy to determine if an HIV-positive individual has been to a medical

appointment for their HIV infection

If some appears to be out of care MDHHS

sends contact information (name, phone # address, place/date of diagnosis) to the local health department

The local health department reaches out to these individuals to offer re-engagement into HIV medical

care and support services

The local health department reports re-engagements efforts back to MDHHS

13

Slide14

2016 HIV Care Continuum

Data to Care

Slide15

D2C:

Basic Process

15

Slide16

D2C COMMUNITY ENGAGEMENT

2016

MEETING

DATES

PRESENTERS

Part A Provider Meeting

All Providers

(program managers

)- March

17,

2016

 

Ryan White Networking (primarily MCM & EIS)- March

15,

2016

Katrease, Leanne

SEMHAC

April

27, 2016

Leanne,

Minoo

Connect 2 Protect

Linkage to Care Subcommittee- April 20,

2016

General

Coalition-

May 20

,

2016

 

Jennifer, Leanne,

Katrease, Amber

Saint Mary’s Community Advisory Board

May

13, 2016

Amber, Minoo,

Yasmin MHACMay 19, 2016Amber, Katie, MinooLocal Health Department Epi Lab Capacity MeetingAugust 3, 2016Jacob, KatieMALPHAugust 8, 2016Katie, YasminHealth Literacy 2.0: Be in the Know TrainingAugust 18, 2016LeanneHIV/STD ConferenceAugust 31, 2016Jacob, Katrease, Mary-GraceNurse Administrators ForumSeptember 13, 2016 Amber, Katie, Minoo, YasminRed Project Community DinnerSeptember 19, 2016Jacob, Minoo, Yasmin RW Collaborative Meetings—Part B/DOctober 6,2016 (Lansing) October 13, 2016 (Grand Rapids) October 20, 2016(Saginaw)Amber, Minoo, Yasmin EIS Part A Meeting October 20, 2016 KevinHealth Education and Health Promotion ForumOctober 26, 2016 Amber, Yasmin ANAC/Michigan HIV Nurse’s NetworkNovember 14, 2016Lindsey, LeanneHIV Providers MeetingDecember 12, 2016Dr. Khaldun, Leanne, Kevin, Lindsey, Mary-Grace

Slide17

Consumer Brochure

Provider Pamphlet

Slide18

What is “not in care”

For Link Up Michigan we have 2 specific definitions

Never linked

Diagnosed between 90 and 365 days prior to list creation

No CD4, Viral load, or Genotype OR only tests are within 8 days of diagnosis

Out Of care

Diagnosed over 365 days prior to list creation

No CD4, Viral load, or Genotype test in previous 15 months

Slide19

What is Shared with LHDs?

As mentioned

earlier…

HIV+ individuals never linked

HIV+ individuals that have fallen out of care

Variables that help the D2C/Link Up Michigan process

Phone numbers, addresses, and diagnosing facilityVariables that MDHHS needs

updated

Race, sex, risk, address, phone numbers

When the lists are sent any individual that has a missing field for risk or race should be priority to update

Slide20

What are the Priorities?

Surveillance uses SAS code to create the lists

Most recent lab(CD4, Geno, VL) is pulled to determine NIC status

NIC list is matched to STD data

Lists are then prioritized by:

Those newly DX

Linkage statusSTD in the past 6 monthsAge (<25)

Transgender status

VL within past 3 years

VL greater than past 3 years

Slide21

Data Returns to Surveillance

An updated case report form is completed when an out of care individual is successfully engaged by the D2C team

Updated demographics

Risk

Testing and Treatment History (including use of ARV)

Current or last site of care and labs

A database is maintained that examines barriers to care and successful engagement strategies, provides a comprehensive needs assessment, and suggests factors that may be associated with successful achievement of viral suppression

Slide22

How Can YOU Support Link Up Michigan?

Be Informed!

Talk it UP!

We get referrals



Refer to our website

www.linkupdetroit.com

Slide23

Molecular HIV Surveillance

Slide24

Background of MHS in Michigan

MI began collecting HIV genotype sequence data in 2004 as VARHS (Variant, Atypical, Resistant HIV Surveillance)

GOAL: to assess rates of drug resistance and subtype prevalence

Today, nearly 80% of all prevalent cases in Michigan have a genotype stored in the HIV surveillance registry,

eHARS

HIV genotype labs are imported into

eHARS

daily from over 20 labs across the county

Slide25

Michigan and SECURE HIV Trace

Since July of 2017 all genotypes analyzed locally via TRACE to look at genetic relationships between HIV strains

Roughly 12,000

total sequences imported

Produced approximately 800

clusters

About 120 w/greater than 5

individuals

Each run gives us several new clusters to analyze

Not

a static environment

– so we run

entire genotype sequence database through TRACE

monthly

Slide26

Clusters linked with Surveillance Data

Slide27

Clusters are Prioritized

Must have at least 3 new cases in past year

All cases with date of dx in past 3 years included in cluster intervention

Clusters with new cases are prioritized by:

High VL

Status of Not in care (NIC)

STD Co-infectionNo evidence of Partner Service or DIS

counseling

Partner Services database and MDSS (local disease surveillance system) used to add supplemental info:

If they were interviewed by PS

How many partners identified

Slide28

The Roll Out to LHDs

Big picture

is shared with

HIV prevention staff

to

understand general trends in new diagnoses

Line lists are shared

with local health department to discuss possible interventions

The Foundation:

Multiple presentations and community engagement events

Developed

a technical guidance document that is posted on our website –

www.Michigan.gov/hivstd

Distributed

letters to all LHDs, CBOs and Providers outlining MHS

goals

Developed Protocol and Scrips with the help of community advocates

Slide29

The Washtenaw/Oakland Cluster

November of 2017

26 Total individuals primarily in Washtenaw/Oakland Counties

Young WHITE MSM

dx between 2015 and

2017IN CARE and VIRALLY SUPRESSED…need to find those “hidden” to our surveillance

CDC called for immediate action:

The

transmission rate

was

120 events/100 person

years

 

US

average is

4/100

 

5/11/2018

29

Person A infected person C, who infected person B

B

A

B

A

B

A

D

Person A infected person B

Person B infected person A

C

A

B

Persons D infected persons A and B

Slide30

The Washtenaw/Oakland Cluster

Met with LHDs – developed plan centered around providers (in care!)

The

index

clients/partners

who did not receive an interview by were

given priority and calls were placed directly to these individuals 

For

index clients who already were

interviewed…

C

all

was placed to their ID

provider to discuss MHS

A

copy of the MDHHS letter

and

an L

HD

molecular cluster letter, addressed to the client, was faxed to the

provider

The

providers agreed to have a conversation with their

patient

at their next visit regarding the molecular cluster and the importance of

PS

 

P

roviders asked to encourage patients

to contact L

HD

for

PS

5/11/2018

30

Slide31

How Can YOU Support MHS in Michigan?

Be Informed!

Talk it UP!

Refer to our website

www.Michigan.gov/hivstd

Slide32

Thank You!

CONTACT INFORMATION:

Mary-Grace Brandt

248 424-7913

brandtm4@Michigan.gov