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Program Collaboration and Service Integration (PCSI) at NCHHSTP

Surveillance and Strategic Information

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Program  Collaboration and Service Integration Surveillance and Strategic Information

Kevin Fenton, M.D., Ph.D., F.F.P.H.
Director 
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention 
Centers for Disease Control and Prevention

Surveillance and Program Integration Meeting
August 20, 2007 
Slide 1

Program Collaboration and Service Integration Surveillance and Strategic Information
PDF File or PPT File


 Overview

Overview of NCHHSTP
Integration as a Center priority
What is PCSI?
The role of surveillance in an integrated prevention framework
Meeting objectives
Slide 2

Overview
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 NCHHSTP Mission

Maximize public health and safety nationally and 
internationally through the elimination, prevention, 
and control of disease, disability, and death caused by
		HIV/AIDS
		Non-HIV Retroviruses
		Viral Hepatitis
		Other Sexually Transmitted Diseases
		Tuberculosis		
		Non-Tuberculosis Mycobacteria
Slide 3

NCHHSTP Mission
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About NCHHSTP

National Center for HIV, STD, and TB Prevention established in FY 1995
Brought together CDC’s HIV, STD and TB prevention activities
Viral hepatitis prevention activities added to mission in 2006, awaiting final approval
Center supports both domestic and global activities
Size: 1,500+ FTE and non-FTE staff
15% of CDC workforce
Diverse staff 
Slide 4

About NCHHSTP
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 Burden of disease

Estimated 1 million Americans infected with HIV
One fourth are unaware of their infection
Chronic liver disease is the 10th leading cause of death in U.S.
More than half of these deaths due to viral hepatitis
Hep C is most common blood-borne disease in U.S.
Estimated 18.9 million cases of non-HIV STDs occur each year in U.S.
Chlamydia and gonorrhea are most commonly reported infectious diseases 
Estimated 10 million to 15 million in U.S. have latent TB infection
13,767  had TB disease in 2006
Slide 5

Burden of disease
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Heterogeneity in National Epidemics of HIV/AIDS, Hepatitis B, TB, and Selected STDs
Six line charts showing the heterogeneity within the United States for HIV/AIDS, Hepatitis B, TB and Chlamydia,  Gonorrhea, and Syphilis, with Chlamydia showing increasing rates spiking to 35,000,000. 
Slide 6

Heterogeneity in National Epidemics of HIV/AIDS, Hepatitis B, TB,
and Selected STDs
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Geographic heterogeneity in epidemics of HIV/AIDS, Hepatitis B, TB, and Selected STDs
Six geographic charts of the United States showing that the incidence for HIV/AIDS, Hepatitis B, TB, Chlamydia, Gonorrhea, and Syphilis tends to be highest in Southern states. 
Slide 7

Geographic heterogeneity in epidemics of HIV/AIDS, Hepatitis B, TB, and Selected STDs
Incidence of these diseases tends to be highest in Southern states.
PDF File or PPT File


 HIV/AIDS, Hepatitis, STD and TBCommon determinants

--Similar or overlapping at-risk populations
--Disease interactions
Common transmission for HIV, hepatitis and STDs, e.g., sexual risk behaviors
STDs increase risk of HIV infection
Clinical course and outcomes influenced by concurrent disease

Social determinants
Poor access to, and quality of, health care 
Stigma, discrimination, homophobia
Socioeconomic factors, such as poverty

Prevention and control
Effective interventions exist to reduce the burden of TB, viral hepatitis, most STDs, and HIV
Challenges in funding, delivery, monitoring and quality of prevention services
Slide 8

HIV/AIDS, Hepatitis, STD and TB Common determinants
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NCHHSTP Programs Common Purposes and Strategies

Eliminating health disparities, especially in sub-populations with disproportionate burden of disease 
Managing and reducing stigma and the resulting consequences in accessing and providing services
Preventing disease among at-risk/un-infected persons
Increasing access to high quality, culturally competent services for marginalized, under and uninsured
Interrupting transmission of infection using similar methods of partner counseling, elicitation, referral, and contact investigations
Diagnosing disease and providing expeditious treatment and/or referral for care
Maintaining systems that assure confidentiality
Monitoring infections in the population (i.e., case surveillance) 
Slide 9

NCHHSTP Programs - Common Purposes and Strategies
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CDC Goals and Strategic ImperativesShared Leadership Values

Maximizing Global Synergies, Program Integration, Reducing Health Disparities

Drug Users, MSM, Corrections, Global Antenatal, Surveillance Strategic Information, Health Disparities, Program Integration, Modeling/Health Results Measures 
Slide 10

CDC Goals and Strategic Imperatives
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Program Collaboration and Service Integration (PCSI)

Operating Definition: 
A mechanism of organizing and blending inter-related health issues, separate activities, and services in order to maximize public health impact through new and established linkages between programs to facilitate the delivery of services  
Integration should be focused at the field or client level where the interface between the system and the consumer takes place. 
Integration results in more holistic services for clients, regardless of the agency structure. 
Slide 11

Program Collaboration and Service Integration (PCSI)
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Program Collaboration and Service Integration (PCSI)

Goal: 
Provide prevention services that are holistic, science based, comprehensive, and high quality to appropriate populations at every interaction with the health care system.
Vision:  
Remove barriers to and facilitate adoption of service delivery integration at the client level by aligning NCHHSTP activities, systems, and policies with this goal. 
Slide 12

Program Collaboration and Service Integration (PCSI)
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Levels of Integration of clinical preventive services in health care settings

Limited integration
HIV testing
Some integration of health information
Expanded
Service integration across programs funded by CDC based on risk assessment
Comprehensive
Service integration across systems of care (CDC or other) based on risk assessment 
Slide 13

Levels of Integration of clinical preventive services in health care settings
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NCHHSTP Consultation on PCSI, August 20-22Overall meeting objectives

To advise NCHHSTP on the development of Program Collaboration and Service Integration (PCSI) activities over the next five years
Assist in establishing priorities for PCSI; short term and longer term
Identify what CDC can do to assist local PCSI efforts
Identify what CDC can do to improve its own efforts toward PCSI 
Slide 14

NCHHSTP Consultation on PCSI, August 20-22 Overall meeting objectives
PDF File or PPT File


Surveillance is cornerstone of effective prevention programs

Prevention is the best strategy for reducing the human and economic toll from HIV/AIDS.  To have the largest impact on the HIV epidemic, CDC uses a comprehensive approach to HIV prevention.  Comprehensive HIV prevention incorporates surveillance, research, prevention interventions and evaluation.  CDC’s surveillance and research activities help to better define and understand the HIV/AIDS epidemic across the nation.  CDC’s prevention interventions and capacity-building efforts are based on behavioral, laboratory and medical science and work to contain the spread of HIV and AIDS. Program evaluation and policy research and development assess intervention effectiveness and refine prevention approaches.  
Slide 15

Surveillance is cornerstone of effective prevention programs
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 Surveillance/ Strategic Information Gaps

Lack of data to describe intersection of:
TB and STD
Viral hepatitis and STD
Viral hepatitis and TB
Certain STDs and HIV, Latent TB and HIV
Lack of  data to assess prevalence and distribution of integrated preventive services
Lack of data to monitor and evaluate performance on integration
Slide 16

Surveillance / Strategic Information Gaps
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NCHHSTP Consultation on PCSI, August 20Surveillance Meeting Objectives

1. Address and Review Summary of input on Surveillance Key Questions
What surveillance barriers/facilitators exit that might support or hinder PCSI?
What are priority recommendations for surveillance/strategic information collection at local, state, and national levels to support PCSI?
2. Identify highest priority recommendations in surveillance in support  of PCSI 
3. Prepare to report a summary of meeting and priority recommendations to full consultation 
Slide 17

NCHHSTP Consultation on PCSI, August 20 Surveillance Meeting Objectives
PDF File or PPT File


Key Questions

1. What are the weaknesses and strengths in NCHHSTP’s current strategic information portfolio that can support PCSI?
2. What surveillance barriers/facilitators exist that might support or hinder PCSI?
3. What are priority recommendations for surveillance/strategic information at local and national levels in support of PCSI? 
Slide 18

Key Questions
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 Summary

Program Collaboration and Service Integration is a major strategic priority for NCHHSTP

Surveillance and strategic information are important tools for successful implementation, monitoring and evaluation of PCSI efforts

Today’s pre-meeting aims to provide time and space to discuss challenges and opportunities for PCSI development and support by CDC and our partners
Slide 19

Summary
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The NCHHSTP Atlas is an interactive tool that provides CDC an effective way to disseminate HIV, Viral Hepatitis, STD and TB data, while allowing users to observe trends and patterns by creating detailed reports, maps, and other graphics. Find out more! http://www.cdc.gov/nchhstp/atlas/


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