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
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Overview NCHHSTP overview Surveillance data on coinfections What is PCSI? Integration as a Center priority PCSI Consultation


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

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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
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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
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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 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
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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.

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Overlapping Syndemics of HIV, STDs, TB, and Viral Hepatitis
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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 12
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 13
Program Collaboration and Service Integration (PCSI)
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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?
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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

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Principles of Effective PCSI
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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.
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CDC Consultation on Program Collaboration and Service Integration, August 21-22, 2007, Atlanta, GA.

Slide 18
CDC Consultation on Program Collaboration and Service Integration
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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
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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.
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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
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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
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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
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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 24
Levels of Integration of clinical preventive services in health care settings
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