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Program Collaboration and Service Integration (PCSI) at NCHHSTP

Slide Set B: Welcome, Vision, and Meeting Objectives

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Program  Collaboration and Service Integration Surveillance and Strategic Information: Welcome, vision, meeting objectives

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

August 21, 2007
Slide 1
Program Collaboration and Service Integration
Welcome, vision, meeting objectives
PDF File or PPT File


Overview
        
NCHHSTP overview
Surveillance data on coinfections
What is PCSI? 
Integration as a Center priority
PCSI Consultation
Slide 2
Overview
PDF File or PPT File


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
PDF File or PPT File


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
PDF File or PPT File


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
PDF File or PPT File


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.
PDF File or PPT File


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
PDF File or PPT File


HIV/AIDS, Hepatitis, STD and TB Common 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
Slide 8
HIV/AIDS, Hepatitis, STD and TB Common determinants
PDF File or PPT File


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
PDF File or PPT File


CDC Goals and Strategic Imperatives Shared 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 Shared Leadership Values
PDF File or PPT File


Overlapping Syndemics of HIV, STDs, TB, and Viral Hepatitis
Four charts showing the co-infection rates between HIV and TB, Syphilis, Gonorrhea, Chlamydia, and Hepatitis C.
Slide 11
Overlapping Syndemics of HIV, STDs, TB, and Viral Hepatitis
PDF File or PPT File


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 12
Program Collaboration and Service Integration (PCSI)
PDF File or PPT File


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 13
Program Collaboration and Service Integration (PCSI)
PDF File or PPT File


What Are the Potential Benefits of PCSI?
        
Increased efficiency and reduced redundancy 

Increased flexibility by enabling partners to adapt, implement, and modify integrated services to increase responsiveness to evolving epidemics or changing contexts

Increased control over operations, using local information from surveillance and key performance indicators
Slide 14
What Are the Potential Benefits of PCSI?
PDF File or PPT File


What Are Current Barriers to PCSI?
        
Lack of national guidelines
Administrative requirements
Data collection and surveillance systems unintegrated
Insufficient support for cross training, evaluation and dissemination of best practices
Uncertainty about available funding
Progammatic concerns
- Loss of program identify, focus and expertise
- Mixing of prevention models
- Loss of control
Slide 15
What Are Current Barriers to PCSI?
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Principles of Effective PCSI
        
Appropriateness
Effectiveness
Flexibility
Accountability
Acceptability
Slide 16
Principles of Effective PCSI
PDF File or PPT File


Essential Public Health Functions

Assurance: Enforce Laws, Link to/Provide Care, Assure Competent Workforce, Evaluate
Assessment: Monitor Health, Diagnose and Investigate
Policy Development: Inform, Educate, Empower, Mobilize Community Partnerships, Develop Policies

Overall System Management and Research
Slide 17
Essential Public Health Functions.
PDF File or PPT File


CDC Consultation on Program Collaboration and Service Integration, August 21-22, 2007, Atlanta, GA.
Slide 18
CDC Consultation on Program Collaboration and Service Integration
PDF File or PPT File


CDC Consultation on PCSI Overall 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 19
CDC Consultation on PCSI Overall meeting objectives
PDF File or PPT File


CDC Consultation on PCSI Process for Identifying PCSI Participants
        
        Planning Committee of national organizations
NCSD, NASTAD, NTCA, Hep. C Coord., UCHAPS, CSTE, NNPTC

Non-CDC members of the Consultation Planning Committee developed peer selection process 

Selection was made with aim toward diversity on these factors:
Large and small size programs (both in funding and population)
Integrated and non-integrated programs (structurally and service delivery)
Urban and rural states; High morbidity and lower morbidity states/cities
Equality across diseases (HIV, TB, STD, viral hepatitis)

Five CBO’s were nominated by DHAP with diverse focus (LGBT, corrections,substance abuse, AF/AM women)

NCHHSTP Divisions nominated surveillance breakout session participants
Slide 20
CDC Consultation on PCSI Process for Identifying PCSI Participants.
PDF File or PPT File


CDC Consultation on PCSI Attendees
        
         Broad range of external and internal stakeholders (approx.100)
Grantees – 7 from each program,  5 CBO’s
NNPTC, RTMCC, AETC
CSTE and 3-4 state surveillance coordinators from each program
CHAC, ACET representation
Representatives from each NCHHSTP Division
Other federal agencies (e.g. HHS,HRSA, SAMSHA, OPA, )
Non federal partners (e.g. ASTHO, NACCHO, ASHA)

40 Project areas represented
Slide 21
CDC Consultation on PCSI Attendees
PDF File or PPT File


CDC Consultation on PCSI
        
        Division Directors selected staff to participate
Number of staff determined by size of Division
HIV: 9
STD: 6
TB: 5
Viral Hepatitis: 4

Program & Leadership (management & policy)
Slide 22
CDC Consultation on PCSI NCHHSTP Participation
PDF File or PPT File


Summary
        
        Welcome to Atlanta!

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 23
Summary
PDF File or PPT File


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 24
Levels of Integration of clinical preventive services in health care settings
PDF File or PPT File

 

 
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