Sketching Legal Landscapes to Optimize Integrated Service Delivery and Program Collaboration

Background: Communicable diseases, like HIV/AIDS, viral hepatitis, STDs, and tuberculosis, are likely to co-occur because of common risk factors and modes of transmission. Individuals with these diseases benefit from collaboration among prevention and treatment services and programs. However, collaboration often requires sharing personally identifiable information (PII), and state laws protecting PII confidentiality may produce real or perceived barriers for health departments introducing collaborative strategies.

Methods: We created a 50-state database of statutes and regulations to help health departments access and understand state confidentiality laws affecting how PII is reported to, released outside of, and used within health departments. We focused on 7 diseases: HIV/AIDS, hepatitis B, hepatitis C, syphilis, gonorrhea, chlamydia, and tuberculosis. Working with CDC, we developed research questions regarding (1) whether state law differentiates where PII for these 7 diseases is reported and (2) whether state law allows health departments to release and/or use PII for public health purposes. We developed a detailed research/coding protocol and duplicated research for 17/51 states to verify accuracy and consistency.

Results: All states require health providers to report the 7 diseases, however 9 states have laws that direct these reports to different department jurisdictions/levels, and 15 specify particular programs/units. 20 states have laws allowing health departments to release PII for “public health,” and 23 permit release for “disease prevention/control.” 41 states allow departments to use PII for purposes of “disease investigation” and/or “disease prevention/control.” 

Conclusions: Reporting laws may create information silos when PII goes to different levels/units according to disease, especially in states that also have strict confidentiality laws. Health department policymakers need to ascertain whether these laws actually impair their ability to implement collaborative strategies. In many states, broad public health exceptions may provide an opportunity to implement compliant information-sharing policies and thereby optimize the public health benefit of STD prevention programs.