BACKGROUND: The DC Department of Health has engaged in multiple efforts in recent years to enhance surveillance processes directed at improving the timeliness and completeness of HIV data. Internal procedures such as maintaining all laboratory data not matching persons in the enhanced HIV/AIDS Reporting System (eHARS), in an auxiliary database contributed to a delay in identifying which cases warranting investigation. The inability to quickly identify and prioritize cases for investigation contributed to time being exerting investigating non-confirmed cases. The purpose of this study is to evaluate the impact of surveillance process enhancements on the timeliness and completeness of HIV case resolution.
METHODS: Laboratory data is routinely matched to eHARS. New surveillance procedures were implemented in August 2015. Modified data processing procedures enhanced the identification of highly suspected cases through utilizing SAS codes to the quickly identify all probable cases and additionally aided in the distribution of new cases to be investigated by staff. Cases meeting CDC case definition, were assigned state identification numbers, and uploaded directly into eHARS. Investigators were provided with precise investigation lists based on cases missing CDC required information. The post-implementation comparison group included cases diagnosed between August 2015 and July 2016 which was compared to the pre-implementation group of cases diagnosed between August 2014 and July 2015. An independent t-test was conducted to assess the difference in days between diagnosis date and case resolution. The primary outcome measure of case resolution, was defined as the completion of a Confidential HIV/AIDS Case Report form that included all CDC required data elements such as: last name Soundex, date of birth, birth sex, race and ethnicity.
RESULTS: There were 423 DC residents diagnosed and reported to the DC DOH in the pre-implementation group compared to 359 in the post-implementation group. Prior to the implementation of the streamlined data processing protocol the median number of days between HIV/AIDS diagnosis date and case resolution was 101 days (mean, 142 days). Following the process changes, the median number of days between HIV/AIDS diagnosis date and case resolution was 65 days (mean, 73 days). There was a significant difference for pre and post surveillance enhancement, (p < .001) with it taking fewer days to case resolution after the enhancement when compared to before.
CONCLUSIONS: Internal organizational change involves buy-in and execution from multiple stakeholders. In the DC DOH, implementation of these process changes played a significant role in improving the time from HIV diagnosis to case resolution.