1. U SE OF P ERSON -S EARCHING S OFTWARE WITHIN HIV S URVEILLANCE TO I DENTIFY C LIENT M IGRATION Thomas J. Shavor, MBA, MPH Epidemiology Director, HIV/STD Programs Tennessee Department of Health

2. HIV Surveillance- Overview HIV diagnosis (1st positive confirmatory test) Linkage to Care 1st CD4 Count 1st Viral Load Test 1 st Drug Resistance test AIDS 1st CD4 Count <200 or AIDS-OI Retention / Response to Care CD4 or VL Death Measures of HIV morbidity and mortality HIV Infection Entry to care Retention in care and viral suppression

3. Why did we need to use person- searching software in the first place?  As all public health staff know- clients frequently change their address over time (sometimes several times a year!)  The primary limitation with using HIV Surveillance data is the accuracy of current address information stored within eHARS (Enhanced HIV/AIDS Reporting System)  Patient addresses within our databases are primarily updated from labs that are imported via ELR (electronic laboratory reporting)  The HIV/STD Program implemented ELR into eHARS as of 8/2012, but only 4 labs currently submit data in a format that we can use for importation (LabCorp, Mayo, ARUP, Quest-Tucker, GA)

4. And then this happened…  National HIV/AIDS Strategy (released June 13, 2010)  The 3 primary goals for the NHAS: a.) Reducing HIV incidence b.) Increasing access to care and optimizing health outcomes c.) Reducing HIV-related health disparities  As a recipient of the Minority AIDS Initiative Funding for Care and Prevention in the United States (CAPUS) Demonstration Project in 2012, the Tennessee Department of Health (TDH) was tasked to use HIV surveillance data in order to equip health department investigators to: Identify and locate known HIV positive individuals who have been out of care for > 1 year and facilitate their re-engagement into HIV care

5. Continuum of HIV Care: National HIV/AIDS Strategy 80% 62%36%41%28% (MMWR 2011;60(47);1618-1623)

6. Accurint Software  To improve the accuracy of our data, we utilized the commercial, person-locating software application Accurint © to compare the potential variances for current address  Software package owned by Lexis-Nexis, an information service company  A direct connection to over 37 billion current public records held within 10,000 databases  Used to verify identities, obtain current address and telephone information, conduct investigations  Same software used by police and fire departments, bill collectors, federal, state, and local agencies  Cost is $160/user/month

7. Approval Process  Started in March, 2013; Ended September, 2013  Involved MANY people:  TDOH Legal staff  Contract staff  State Epidemiologist  HIV/STD Program Staff  Lexis-Nexis Sales representatives  CDC Security/Privacy Officers  TDOH ultimately acquired 3 licenses: 1 admin (me) and 2 users (CAPUS Epi and STD Program staff)

8. Main Search Screen Page

9. Advanced Person Search Results

10. Variations on my Name, DOB, and SSN

11. Real Time Phone Search Results

12. Accurint Match Results CAPUS Eligible Clients HIV Case Registry (eHARS)

13. Accurint Matching on eHARS database  Clients date back to 1982, when AIDS reporting became law in Tennessee  Performed an Accurint batch-match on state’s HIV Case Registry (eHARS) on February 20, 2014  Batch-matching required to process these many records:  Text file created that matches an import schema established by Accurint  File uploaded to their Accurint secure server (part of main application)  Results posted on server and available for download for up to 30 days

14. CAPUS Eligible Clients After Accurint Match (N=3,111)

15. Accurint Match on eHARS Database (N=21,995)

16. Top 10 States Where the Most Migration Occurred  Georgia- 419  Florida- 369  Mississippi- 268  Texas- 255  California- 189  Illinois- 133  North Carolina- 121  Kentucky- 120  Arkansas- 116  Alabama- 110  Notes: Majority of migration among our HIV population occurred among states within the South/Southeast  Migration to states that directly border TN (n=7) was 1,187 or 36% of total migration  This reinforces the fact that HIV prevalence within the South and Southeast have increased over the last decade

17. Accountability  As you might imagine, with access to this level of data on individuals, it makes sense to develop some processes to make end users accountable for their actions:  Training- annual training requirements added to existing training.  Addendum to our HIV/STD Security & Confidentiality documents- reflecting the seriousness of the responsibility, and the penalties for non-compliance  System driven reports- Administrator-level reports of EVERY search users have performed

18. Conclusions   Within our CAPUS eligible clients, the use of Accurint © identified 678 clients who would have been originally investigated for this project, which saved our program considerable time and labor resources  I feel that Tennessee’s HIV prevalence data are much more accurate as a result of using this software  As a result of TN using Accurint, CDC is developing some guidelines around the use of person-searching software within HIV Surveillance  Finally, our health department is going to start using Accurint to assist in:  STD Partner Services (finding unlocatable sexual contacts)  Ryan White (new client address validation)

19. Questions?