Janet L. Heitgerd

A Social Vulnerability Index for Disaster Management

Social vulnerability refers to the socioeconomic and demographic factors that affect the resilience of communities. Studies have shown that in disaster events the socially vulnerable are more likely to be adversely affected, i.e. they are less likely to recover and more likely to die. Effectively addressing social vulnerability decreases both human suffering and the economic loss related to providing social services and public assistance after a disaster. This paper describes the development of a social vulnerability index (SVI), from 15 census variables at the census tract level, for use in emergency management. It also examines the potential value of the SVI by exploring the impact of Hurricane Katrina on local populations.

Evaluating HIV Prevention: A Framework for National, State and Local Levels:

Abstract The 21st century brings with it the 20th year of the human immunodeficiency virus (HIV) epidemic in the United States. HIV prevention programs have matured; however, evaluations of those programs have lagged behind. Nationwide, the need for such evaluation has never been greater. It is time to comprehensively assess the status of HIV prevention and control. We must build on previous studies to create a comprehensive, integrated national picture that includes evaluations at national, state, and local levels of the quality, costs, and short- and long-term effectiveness of various HIV prevention programs and policies. The Centers for Disease Control and Prevention (CDC) encourages a phased approach to implementing a comprehensive evaluation strategy. This paper, which describes the 1995–1997 evaluation framework and activities of the Program Evaluation Research Branch, National Center for HIV, Sexually Transmitted Disease (STD), and Tuberculosis (TB) Prevention, is offered as a platform on which future efforts in determining the most effective means to prevent HIV can be built. Lessons learned in developing this comprehensive evaluation framework have advanced HIV prevention. This framework and lessons learned may also, in this era of performance measurement and public accountability, be generalizable beyond HIV prevention to the comprehensive and strategic evaluation of other politically complex, publically-funded disease prevention and health promotion programs.

CDC HIV prevention indicators : monitoring and evaluating HIV prevention in the USA

ObjectiveThis study selected and field tested indicators to track changes in HIV prevention effectiveness in the USA. MethodsDuring 1996–1999, the Centers for Disease Control and Prevention held two 2 day expert consultations with more than 80 national, state and local experts. A consensus-driven, evidence-based approach was used to select 70 indicators, which had to be derived from existing data, available in more than 25 states, and meaningful to state health officials in monitoring HIV. A literature review was performed for each indicator to determine general relevance, validity, and reliability. Two field tests in five US sites determined accessibility, feasibility, and usefulness. ResultsThe final 37 core indicators represent four categories: biological, behavioral, services, and socio-political. Specific indicators reflect the epidemic and associated risk factors for men who have sex with men, injection drug users, heterosexuals at high risk, and childbearing women. ConclusionsDespite limitations, the indicators sparked the regular, proactive integration and review of monitoring data, facilitating a more effective use of data in HIV prevention community planning.

Evaluating national HIV prevention indicators: a case study in San Francisco.

ObjectivesTo field-test the availability, interpretability, and programmatic usefulness of 37 proposed national HIV prevention indicators (HPI) intended to evaluate community-level impact of HIV prevention efforts in San Francisco. MethodsHPI were defined for four populations (high risk heterosexuals, injecting drug users, men who have sex with men, and childbearing women) and for four domains (biological, behavioral, service, and socio-political). HPI were obtained from existing data sources only. Trends in HPI were examined from 1990 to 1997. ResultsExisting data provided 29 (78%) of the 37 proposed HPI; eight HPI were not available because California does not have HIV case reporting. Interpretation was limited for several HPI due to small sample size, inconsistencies in data collection, or lack of contextual information. Data providing behavioral HPI were scarce. HPI were consistent with historical patterns of HIV transmission in San Francisco but also highlighted new and worrisome trends. Notably, HPI identified recent increases in risk for HIV transmission among men who have sex with men. ConclusionsDespite limitations, the proposed national HPI provided evidence of the aggregate effectiveness of prevention efforts in San Francisco. Supplemental or local HPI are needed to fill data gaps, add context, and increase the scope and programmatic usefulness of the national HPI.

Health Department HIV Prevention Programs That Support the National HIV/AIDS Strategy: The Enhanced Comprehensive HIV Prevention Planning Project, 2010-2013.

Objective. The Enhanced Comprehensive HIV Prevention Planning project was the first initiative of the Centers for Disease Control and Prevention (CDC) to address the goals of the National HIV/AIDS Strategy (NHAS). Health departments in 12 U.S. cities with a high prevalence of AIDS conducted comprehensive program planning and implemented cost-effective, scalable HIV prevention interventions that targeted high-risk populations. We examined trends in health department HIV prevention programs in these cities during the project. Methods. We analyzed the number of people who received partner services, condoms distributed, and people tested for HIV, as well as funding allocations for selected HIV prevention programs by year and by site from October 2010 through September 2013. We assessed trends in the proportional change in services and allocations during the project period using generalized estimating equations. We also conducted thematic coding of program activities that targeted people living with HIV infection (PLWH). Results. We found significant increases in funding allocations for HIV testing and condom distribution. All HIV partner services indicators, condom distribution, and HIV testing of African American and Hispanic/Latino populations significantly increased. HIV tests associated with a new diagnosis increased significantly among those self-identifying as Hispanic/Latino but significantly decreased among African Americans. For programs targeting PLWH, health department activities included implementing new program models, improving local data use, and building local capacity to enhance linkage to HIV medical care, retention in care, and treatment adherence. Conclusions. Overall, these findings indicate that health departments in areas with a high burden of AIDS successfully shifted their HIV prevention resources to scale up important HIV programs and make progress toward NHAS goals.

Leveraging Geospatial Data, Technology, and Methods for Improving the Health of Communities: Priorities and Strategies from an Expert Panel Convened by the CDC

In 2008, CDC convened an expert panel to gather input on the use of geospatial science in surveillance, research and program activities focused on CDC’s Healthy Communities Goal. The panel suggested six priorities: spatially enable and strengthen public health surveillance infrastructure; develop metrics for geospatial categorization of community health and health inequity; evaluate the feasibility and validity of standard metrics of community health and health inequities; support and develop GIScience and geospatial analysis; provide geospatial capacity building, training and education; and, engage non-traditional partners. Following the meeting, the strategies and action items suggested by the expert panel were reviewed by a CDC subcommittee to determine priorities relative to ongoing CDC geospatial activities, recognizing that many activities may need to occur either in parallel, or occur multiple times across phases. Phase A of the action items centers on developing leadership support. Phase B focuses on developing internal and external capacity in both physical (e.g., software and hardware) and intellectual infrastructure. Phase C of the action items plan concerns the development and integration of geospatial methods. In summary, the panel members provided critical input to the development of CDC’s strategic thinking on integrating geospatial methods and research issues across program efforts in support of its Healthy Communities Goal.

Assessing Differences in CDC-Funded HIV Testing by Urbanicity, United States, 2016

HIV prevention efforts have contributed to a decline in annual HIV infections in the United States. However, progress has been uneven and certain groups and geographic areas continue to be disproportionately affected. Subsequent to implementation of CDC’s high-impact HIV prevention approach to reducing new infections, we analyzed national-level CDC-funded HIV test data from 2016 to describe the population being reached in three urbanicity settings (metropolitan: ≥ 1,000,000 population; urban: 50,000–999,999; rural: < 50,000). Over 70% of CDC-funded HIV tests and almost 80% of persons newly diagnosed with HIV as a result of CDC-funded testing occurred in metropolitan areas. Nonetheless, CDC-funded testing efforts are reaching urban and rural areas, especially in the South, providing opportunities to identify persons unaware of their HIV status and link those with newly diagnosed HIV to medical care and prevention services. While CDC-funded testing efforts have continued to focus on population subgroups and geographic areas at greatest risk, efforts should also continue in rural areas and among groups in need with a low national burden.

County-Level Correlates of CDC-Funded HIV Testing Events, United States, 2012

HIV prevalence and socio-demographic data were analyzed to assess the alignment of CDC-funded HIV testing activity in 2012 with its high-impact prevention approach. CDC-funded HIV-testing was conducted in counties with high HIV prevalence and in places potentially more affected by HIV as measured by urbanicity, percent black, percent poverty, and percent uninsured. The percent Hispanic/Latino was associated with a lower probability of HIV testing activity. Higher percentages of black and Hispanic/Latino in the population was positively associated with new HIV diagnoses. Analyzing county-level data confirmed the appropriateness of CDC-funded HIV testing activities under a high-impact prevention approach but also suggested areas for possible improvement.