Surveillance Integration in United States STD Control Programs

Background:
Surveillance systems monitor individual cases of STIs, HIV, or hepatitis, but rarely identify those with multiple infections.

Objective:
To determine the degree of surveillance integration in local health departments, learn when integration has been useful, and identify barriers to increased integration.

Method:
We surveyed the 58 local and state Project Areas in the United States using an email questionnaire.

Result:
46 Project Areas (81%) responded. All thought some integration would be useful. Most programs (85%) had compared geographic distributions of STIs and HIV; 43% had done this for STIs and hepatitis. 74% had determined the percentage of syphilis patients co-infected with HIV; 38% had determined gonorrhea and HIV co-infection. Project Areas with at least 100 reported cases of primary and secondary syphilis in 2005 were more likely to have determined occurrence of any co-infections (92% vs. 64%, p=0.02). A majority of Project Areas (54%) reported entering surveillance data for STIs and for HIV into the same database; 11% had done this for STIs and hepatitis. Respondents have used integrated surveillance to identify screening locations for STIs and HIV, and to recommend HIV screening in specific groups. The most common barriers to integration were policies preventing work with HIV data (85%) and incompatible databases (59%). Those STD Programs that had “HIV” in their program name were more likely to report access to data needed for determining co-infection (74% vs. 43%, p=0.03).

Conclusion:
Many programs have integrated surveillance data at some level but barriers persist. Further work is needed to identify benefits and methods for overcoming barriers.

Implications:
Many programs have policies that restrict access to HIV data. Changing these policies would facilitate integration of surveillance. STI, HIV, and hepatitis data management systems are often separate and incompatible; compatible systems should be developed.