Methods:MHS requires local and state health departments to administer HIV-TRACE monthly to identify and monitor HIV molecular clusters, which is determined by a 0.5% HIV genetic distance threshold within the past three years for ≥3 People Living With HIV (PLWH). HHD established an HIV cluster investigation committee to review and monitor clusters. Molecular clusters were prioritized for PLWH primarily residing in Houston/Harris County, ≥4 LMSM, newly diagnosed, and not virally suppressed. A framework for BIG data was developed to extract confidential data from approximately thirteen local and state databases (e.g., eHARS, STD*MIS, MAVEN) for PLWH to expand the HIV transmission and risk networks based on high-priority molecular clusters. HHD and the Texas Department of State Health Services established data sharing agreements and coordination for cluster investigations. Due to highly sensitive issues related to privacy and confidentiality for the aforementioned BIG data framework it was important for HHD to partner with the community throughout the development and implementation of MHS. HHD established an MHS Community Advisory Board (CAB) to tailor high-impact HIV prevention initiatives for molecular clusters by promoting HIV testing, treatment as prevention for PLWH, and PrEP for people that are HIV negative.
Results:MHS has reconceptualized HIV surveillance, which requires BIG collaborations with the community as well as local and state health departments towards an organized and timely response to prevent HIV transmission within and between multiple jurisdictions. An MHS cluster committee for HHD strengthened identification and monitoring of molecular clusters, but the CAB played an integral role in tailoring high-impact HIV prevention services for LMSM and their social networks.
Conclusion: Health departments have a significant responsibility in protecting confidentiality and privacy rights for highly vulnerable populations. Innovative approaches to integrate big data must establish a partnership with the community to strengthen the development, implementation, and dissemination of prevention services.