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BACKGROUND: In 2012, the Fulton County Department of Health and Wellness (FCDHW) HIV prevention program staff noted an increase in infants with perinatal HIV exposure. As a result, an enhanced surveillance system for expedited detection of perinatal HIV exposure was implemented at the local level. FCDHW evaluated this system to characterize its attributes, identify strengths and weaknesses, and provide recommendations for system improvement.
METHODS: FCDHW conducted interviews with internal and external partners and obtained exposure and case data from 2012–2014. System usefulness, simplicity, data quality, acceptability, timeliness, and stability were assessed qualitatively. Data from a state-based perinatal exposure database maintained by Georgia Department of Public Health (GDPH) were used to estimate sensitivity.
RESULTS: Analysis included 72 mother and infant pairs of perinatal HIV exposures and cases identified through reports from clinical facilities in the County during 2010–2014. Usefulness for case management and partner services was determined to be high. Partner investigations of the mothers of these children identified 118 contacts and 25 HIV positive men. The system is complex and engages 11 reporting agencies. Each exposed infant requires extensive follow-up to 18 months for definitive determination of HIV infection status. Databases in this system are fragmented and three different surveillance tools are used, resulting in high variability of data collected for each case. Acceptability was high in maternal interviews with a 97% participation rate. Timeliness of reporting to FCDHW before delivery ranged from six weeks to delivery date, and after delivery average time was 22 weeks (range: 1 week–5 years). Based on a database maintained by GDPH there were an estimated 15 perinatal exposures per year in Fulton County while FCDHW identified an average of 14.4 exposures per year.
CONCLUSIONS: While data quality, timeliness, and stability were identified as weaknesses of this system, the usefulness, acceptability, and sensitivity were strong. Though sensitivity of the system appeared high, the generalizability of the state database to derive estimates for Fulton County needs further assessment. To improve the surveillance system it is recommended that coordination between GDPH and FCDHW be strengthened, a single electronic system should be created and utilized, relationships with partners should be augmented, and trainings for providers on reporting should be developed. Interventions generated from this evaluation will strengthen the system’s sensitivity, ability to detect exposures and cases in a timely manner, and efficiently generate high quality data that will be used to inform prevention priorities.