1. Enhanced Perinatal Surveillance System in Texas Presenter: Elvia Ledezma May 30, 2007 Texas Department of State Health Services

2. Enhanced Perinatal Surveillance (EPS) Purpose: Monitor and reduce perinatal HIV transmission in Texas.

3. How is EPS data used? Determine effectiveness of perinatal transmission efforts Determine effectiveness of antiretroviral therapy (ART) Determine reasons for prevention failures Evaluate adverse outcomes from ART use

4. Enhanced Perinatal Surveillance (EPS) Project Sites, 1999-2007

5. EPS Data Collection Instrument Basic demographics for both mother and child Maternal information Prenatal care HIV testing ARV therapy Substance use Clinical information

6. EPS Data Collection, cont. Child information Birth history Pediatric history

7. Who Collects Texas EPS Data?

8. Personnel 12 satellite surveillance sites 5 regional public health offices 4 city/county health departments 3 county health departments

9. Texas HARS Sites Arlington Austin Beaumont Cactus Corpus Christi Dallas El Paso Fort Worth Galveston Houston Lubbock San Antonio Tyler

10. Where is EPS Data Collected?

11. Texas EPS Target Area Based on 1999-2005 Data Residence of HIV+ women at time of delivery 108 counties 223 cities 201 hospitals where HIV+ moms gave birth 350 infants born annually to HIV+ moms

12. Based on births from 1999-2005

14. What is the Process of Data Collection?

15. EPS Case Identification Review of medical records Provider/HARS staff communication Lab reports Birth certificate matching

16. EPS Data Collection Medical chart abstraction at provider offices Birth facilities HIV clinical care provider Prenatal care provider Pediatric provider offices Birth/death certificates

17. EPS Data Collection, cont. Follow-up of the child 6 months 12 months 18 months

18. What are the Data Collection Challenges that are Encountered?

19. Types of Challenges Geography Personnel Data sources Identification and follow-up of children

20. Geographical Challenges Sheer size of Texas : 261,797 square miles 660 miles long by 790 miles long 254 counties 550 licensed hospitals

21. Personnel Challenges Multiple tasks Enhanced perinatal surveillance is added to the long list of tasks they already perform

22. Data Collection Challenges Multiple record abstractions Availability of prenatal care provider records Prenatal care and pediatric care provider identification

23. Identification and Follow-up Challenges Identification of infected infants Children lost to follow-up Indeterminate HIV status Lack of medical care Negative PCR Tests Foster care and adoption Change in residency

24. What is the Importance in Collecting EPS data?

25. Comments/Questions

26. Contact Information Elvia Ledezma, MPH Epidemiologist Texas Department of State Health Services (512)-533-2045 elvia.ledezma@dshs.state.tx.us