Fostering Governance and Information Partnerships for Chronic Disease Surveillance: The Multi-State EHR-Based Network for Disease Surveillance

CONTEXT

Electronic health records (EHRs) are an emerging chronic disease surveillance data source and facilitating this data sharing is complex.

PROGRAM

Using the experience of the Multi-State EHR-Based Network for Disease Surveillance (MENDS), this article describes implementation of a governance framework that aligns technical, statutory, and organizational requirements to facilitate EHR data sharing for chronic disease surveillance.

IMPLEMENTATION

MENDS governance was cocreated with data contributors and health departments representing Texas, New Orleans, Louisiana, Chicago, Washington, and Indiana through engagement from 2020 to 2022. MENDS convened a governance body, executed data-sharing agreements, and developed a master governance document to codify policies and procedures.

RESULTS

The MENDS governance committee meets regularly to develop policies and procedures on data use and access, timeliness and quality, validation, representativeness, analytics, security, small cell suppression, software implementation and maintenance, and privacy. Resultant policies are codified in a master governance document.

DISCUSSION

The MENDS governance approach resulted in a transparent governance framework that cultivates trust across the network. MENDS's experience highlights the time and resources needed by EHR-based public health surveillance networks to establish effective governance.

Provision of test results and posttest counseling at STD clinics in 24 health departments: U.S., 2007

OBJECTIVE

We determined the demographic and HIV test characteristics of tests conducted in CDC-funded sexually transmitted disease (STD) clinics with provision of test results and posttest counseling.

METHODS

We used CDC's HIV Counseling and Testing System data from 2007 for the 24 U.S. health departments that reported test-level data from STD clinics. We calculated and analyzed newly identified HIV positivity and the percentage of tests with provision of test results and posttest counseling (provision of posttest counseling), by demographic and HIV-related characteristics.

RESULTS

Of 372,757 tests conducted among people without a previous HIV diagnosis by self-report, provision of posttest counseling was documented for 191,582 (51.4%) HIV tests overall and 1,922 (71.2%) newly identified HIV-positive test results. At these STD clinics, provision of posttest counseling varied by HIV serostatus, age, race/ethnicity, test type, and risk category; however, documentation of posttest counseling was missing for more than 20% of tests. The newly identified HIV positivity among all testers was 0.7%.

CONCLUSIONS

One of the main goals of HIV counseling and testing is to inform people of their HIV status, because knowledge of one's HIV-positive serostatus can result in a reduction in risk behaviors and allow the person to access HIV medical care and treatment. STD clinics offering HIV testing may need to further their emphasis on increasing the proportion of clients who are provided posttest counseling and on improving documentation of this information.

Enrollment of racial/ethnic minorities and women with HIV in clinical research studies of HIV medicines

PURPOSE

Inclusion of women and racial/ethnic minorities is a requirement for federally supported clinical research, but data on clinical research participation from women and racial/ethnic minorities with HIV are few. To describe participation in clinical research of HIV medicines among women and racial/ethnic minorities, and associated factors, we used data from a cross-sectional behavioral surveillance interview project conducted in 15 U.S. states.

METHODS

Data were from 6,892 persons living with HIV infection, recruited in facilities in seven U.S. states and using population-based methods in eight other states, between 2000-2004. We calculated self-reported participation in a clinical research study of HIV medicines, factors associated with self-reported study participation among men and women, and reasons for not participating in a study among nonparticipants.

MAIN FINDINGS

Overall, 17% of respondents had ever participated in a clinical research study. For men, the odds of participation were lower for black or Hispanic men (versus white men) and were higher for men whose risk for HIV infection was male-male sex (versus men with male-female sex risk) and for men with AIDS. For men who had not participated in a study, black men were more likely than white men to report not participating in a study because they were unaware of available studies or were not offered enrollment (75% vs. 69%), and because they did not want to be a "guinea pig" (11% vs. 8%). Among women, participation was not associated with race/ethnicity or risk for HIV infection but was associated with living in an area with an NIH- or CDC- supported clinical research network. HIV-infected women were more likely than HIV-infected men with comparable modes of HIV acquisition to have participated in a study.

CONCLUSIONS

Among persons with HIV interviewed in these 15 states, self-reported participation in clinical research studies was higher among women than men, but racial/ethnic minority men were less likely to report study participation. Our data suggest that clinicians and researchers should make increased efforts to offer study participation to racial and ethnic minority men.

Changes in HIV and AIDS in the United States: Entering the third decade

The epidemiology of the HIV transmission in the United States has changed considerably since the epidemic began. Our increased understanding of the virus has fostered development of new treatments to prolong life, and vaccine research has increased hope for those at risk in both developed and less developed countries. In this review, we provide information about current trends in HIV and AIDS among those in the United States most affected by the epidemic.

Changes in HIV and AID in the United States: Entering the third decade

The epidemiology of the HIV transmission in the United States has changed considerably since the epidemic began. Our increased understanding of the virus has fostered development of new treatments to prolong life, and vaccine research has increased hope for those at risk in both developed and less developed countries. In this review, we provide information about current trends in HIV and AIDS among those in the United States most affected by the epidemic.

HIV testing and awareness of care-related services among a group of HIV-positive Asian Americans and Pacific Islanders in the United States: findings from a supplemental HIV/AIDS surveillance project

Compared with other racial/ethnic groups in the United States, Asian Americans and Pacific Islanders (AAPIs) are more likely to be at an advanced stage of AIDS disease and have opportunistic infections at the time of diagnosis. However, it is not clear how these two findings are related to issues such as HIV testing and access to HIV care-related services. We examined HIV testing and awareness of care-related services among a group of HIV-positive AAPIs in the United States. Data are from a multisite supplemental surveillance project, 1990-1999. Compared with Whites, a higher percentage of AAPIs cited "illness" as the main reason for HIV testing and had their tests done as a hospital inpatients--although these differences were not statistically significant. A significantly lower percentage of AAPIs than Whites were aware of their current CD4 count; AAPIs also had significantly lower awareness about a number of care-related services. Among AAPIs, educational level was positively associated with awareness of these services. Efforts are needed to promote service availability among HIV-positive AAPIs.

Older partners and STD prevalence among pregnant African American teens

BACKGROUND

Several recent studies have addressed the question of whether adolescent females who have sex with older partners have a greater risk of sexually transmitted disease (STD) acquisition.

GOAL

The goal was to identify differences in STD prevalence and selected measures of behavioral risk between unmarried pregnant African American adolescent females reporting sex with older partners and those reporting sex with similar-age partners.

STUDY DESIGN

Adolescents (n = 169) were recruited during their first prenatal visit. Adolescents completed a self-administered survey and a face-to-face interview and provided urine specimens for nucleic acid amplification assays.

RESULTS

Approximately 65% of adolescents reported that their male sex partners were >/=2 years older, while 35% reported having similar-age male sex partners. In age-adjusted analyses, adolescents with older partners were four times more likely to test positive for chlamydia (P < 0.04) and were more than twice as likely to report that their partner was also having sex with other women (P < 0.04). With use of a 30-day recall period, the mean number of unprotected vaginal sexual encounters among adolescents with older partners was 4.1, as compared to a mean of 6.9 among those reporting similar-age partners; this difference approached significance (P = 0.051). Prevalence of trichomoniasis as well as scale measures of adolescents' self-efficacy for condom negotiation and frequency of sexual communication with partners did not differ between those adolescents with older or similar-age male sex partners.

CONCLUSION

In resource-constrained clinical settings, one implication of these findings is that pregnant adolescents reporting older partners may be a priority for targeted delivery of partner services. More frequent screening for chlamydia may also be cost-effective for pregnant adolescents with older partners.