BACKGROUND
Accurate HIV surveillance data is essential to monitoring the trends to end the HIV epidemic. Due to strict policies around data security and confidentiality, HIV surveillance data has not been routinely shared across jurisdictions, with the exception of a biannual case-by-case review process to identify and remove duplicate cases (Routine Interstate Duplicate Review, RIDR). HIV surveillance estimates for the District of Columbia (DC) are complicated by migration and care-seeking throughout the metropolitan area, which includes Maryland (MD) and Virginia (VA). To address gaps in HIV surveillance data, the health departments of DC, MD and VA established HIV surveillance data sharing agreements. While the Black Box (a privacy data integration tool external to the health departments) facilitated the secure exchange of data between DC, MD and VA, its previous iterations were limited by frequency and scope of information exchanged. The health departments of DC, MD and VA engaged in data sharing to further improve HIV surveillance estimates.
OBJECTIVE
The objectives of this evaluation were to assess the impact of cross-jurisdictional data-sharing on the estimation of persons living with HIV (PLWH) in DC and the reduction of cases in the RIDR process.
METHODS
The data sharing agreements established in 2014 allowed for the exchange of HIV case information (e.g. current residential address) and laboratory information (e.g. test types, result dates and results) from the enhanced HIV/AIDS Reporting System (eHARS). Regular data exchanges began in 2017. The participating jurisdictions transferred data (via secure file transfer protocol) for individuals having a residential address in a partnering jurisdiction at the time of HIV diagnosis and/or evidence of receiving HIV-related services at a facility located in a partnering jurisdiction. DC DOH compared the data received to the DC eHARS and imported updated data that matched to existing cases. Evaluation of changes in current residential address and HIV prevalence were conducted by comparing data before and after the HIV surveillance data exchanges.
RESULTS
After the HIV surveillance data exchange, an average of 390 fewer cases were estimated to be living in DC for each year from 2012 to 2016. Among cases with a residential status change, 66.4% of cases had relocated to MD and 19.8% had relocated to VA; the majority of these cases had relocated to counties bordering DC. Relocation in and out of DC differed by mode of transmission, race/ethnicity, age group and gender. After the data exchange, the volume of HIV cases needing RIDR decreased by 74% for DC-MD and 81% for DC-VA.
CONCLUSIONS
The HIV surveillance data exchange between the public health departments of DC, MD and VA reduced the number of cases misclassified as DC residents and reduced the number of cases needing RIDR. Continued data exchanges will enhance the ability of the DC DOH to monitor the local HIV epidemic.
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