Client Data Elements

Form Approved

OMB No: 0920-new

Exp. Date: ##/##/####

Project PrIDE

Attachment 3: PrIDE Data Elements

Public reporting burden of this collection of information is estimated to average 25 Minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-new)

PrIDE DATA ELEMENTS

Aggregate data variables on HIV prevention and care services provided to the target population are listed. These aggregate variables will be reported to CDC twice a year by all PS15-1506 grantees. With some exceptions, the aggregate data will be stratified by major population group characteristics.

PART I. PrEP PROCESSES AND OUTCOMES

Population Characteristics	Categories
Race/ethnicity:	Hispanic/Latino, Non-Hispanic (NH) American Indian/Alaskan Native, NH Asian, NH Black/African American, NH Native Hawaiian/Pacific Islander, NH White, NH multi-race, NH other/unknown
Current gender:	Male, female, male-to-female transgender, female-to-male transgender, unknown gender/ other
Age group:	13-19; 20-29; 30-39; 40-49; 50-59; 60+, unknown year olds
HIV transmission risk group:	MSM, PWID, MSM/PWID, heterosexual, other risk category; and unknown risk category

	Services for Persons at Risk for HIV	Stratified?
	1. HIV Testing
1A	Number of persons who were screened for HIV during the measurement period	Yes
1B	Number of persons newly diagnosed HIV-positive during the measurement period	Yes
1C	Number of persons previously diagnosed HIV-positive during the measurement period	Yes
	Services for HIV-Negative Persons	Stratified?
	2. Screening and Provision of PrEP Services
2A	Number of persons who were screened for PrEP eligibility during the measurement period	Yes
2B	Number of persons who were eligible for PrEP during the measurement period	Yes
2C	Number of persons who were eligible and accepted referral for PrEP during the measurement period	Yes
2D	Number of persons who were referred to an internal or external PrEP provider during the measurement period	Yes
2E	Number of persons who were linked with a PrEP provider during the measurement period	Yes
2F	Number of persons who were prescribed [initiated on] PrEP during the measurement period	Yes
2G	Number of persons on PrEP who were provided adherence support intervention during the measurement period	Yes
2H	Number of persons who were clinically assessed as eligible for PrEP during the measurement period	Yes
2I	Number of persons who accepted PrEP referral during the measurement period	Yes
	3. PrEP Capacity
3A	Number of staff hired/re-assigned during the measurement period	No
3B	Number of vacancies/number staff resigned during the measurement period	No
3C	Number of trainings during the measurement period	No
3D	Number staff trained during the measurement period	No
3E	Number of facilitates/ practices trained during the measurement period	No
3F	Number of new contracts executed during the measurement period	No
3G	Number of new sites that are implementing PrEP activities during the measurement period	No
	4. PrEP Awareness and Knowledge
4A	Number of activities implemented to increase awareness and knowledge during the measurement period	No
4B	Number of target population reached for each activity during the measurement period	No
4C	Number of the type of media placements utilized during the measurement period	No

PART II. DATA-TO-CARE PROCESSES AND OUTCOMES

	Services for Persons Diagnosed with HIV Infection	Stratified?
	5. Linkage to Care and Provision of ARVs for Newly Diagnosed Persons
5A	Number of persons diagnosed with HIV infection during the measurement period who were linked to care (attended an HIV medical care visit) within 30 days or greater of diagnosis	Yes
5B	Number of persons diagnosed with HIV infection during the measurement period who were initiated on ARVs	Yes
	6. Linkage or Re-engagement with Care and Provision of ARVs for Previously Diagnosed Persons Not-in-Care
6A	Number of persons with previously diagnosed HIV infection, identified during the measurement period through HIV testing and determined to be not-in-care, who were linked to or re-engaged with care (attended at least one HIV medical care visit) within 30 days, 31-60 days, or 61+ days after being identified (re-diagnosed)	Yes
6B	Number of persons with previously diagnosed HIV infection, identified during the measurement period through data-to-care activities as not-in-care, who were linked to or re-engaged with care (attended at least one HIV medical care visit) within 30 days, 31-60 days, or 61+ days after being contacted by program staff	Yes
6C	Number of persons with previously diagnosed HIV infection, identified during the measurement period through data-to-care activities as not-in-care, who were initiated on ARVs within 60 days, 61-90 days, or 91+ days after being contacted by program staff	Yes
6D	Number of persons with previously diagnosed HIV infection, identified during the measurement period through HIV testing and determined to be not-in-care	Yes
6E	Number of persons with previously diagnosed HIV infection, identified during the measurement period through data-to-care activities and determined to be not-in-care	Yes
6F	Number of persons with previously diagnosed HIV infection, identified during the measurement period through data-to-care activities and determined to be not-in-care, who were contacted by program staff	Yes
6G	Number of persons with previously diagnosed HIV infection, identified during the measurement period through other data-to-care activities (provider lists, partner services, HIV testing events, etc.) and determined to be not-in-care, who were linked to care (different referral/ entry points to data-to-care outside of the NIC list.	Yes
	7. ART Adherence Support Services
7A	Number of HIV-positive persons on ART within the collaborative during the measurement period who were provided medication adherence support intervention	Yes
7B	Number of HIV-positive persons on ART within the collaborative during the measurement period	Yes
	8. Viral Suppression
8A	Number of HIV-positive persons in care within the collaborative during the measurement period with at least one medical care visit in a 12 month measurement period who had a viral load of <200 copies per mL at last test in the measurement period	Yes
8B	Number of HIV-positive persons in care within the collaborative during the measurement period with at least one medical care visit in a 12 month measurement period	Yes
	9. D2C Capacity
9A	Number of HD and partner staff newly hired or re-assigned to work on D2C activities	No
9B	Number of D2C-related trainings provided	No
9C	Number of HD and partner staff trained	No
9D	Number of facilities or practices trained	No
9E	Number of D2C contracts newly executed (signed) or renewed	No
	10. Use of HIV Surveillance Data to Identify Presumptively Not-in-Care
10A	Number of persons listed as presumptively not-in-care based on surveillance data	No
	11. Use of Other Data Systems to Improve Accuracy of the Presumptive NIC List
11A	Number of persons excluded from the list because person is in care based on other database matching or manual checks	Yes
11B	Number of persons excluded from the list because person is deceased	Yes
11C	Number of persons excluded from the list because person is out of jurisdiction	Yes
11D	Number of persons excluded from the list because person is incarcerated	Yes
11E	Number of persons excluded from the list because of other reasons	Yes
11F	Number of persons presumptively not in care eligible for outreach (revised not-in-care list after exclusions)	Yes
	12. Outcomes of Program Outreach to Persons on the Revised NIC List
12A	Number of persons from revised NIC list not contacted – deceased	Yes
12B	Number of persons from revised NIC list not contacted -- out of jurisdiction	Yes
12C	Number of persons from revised NIC list not contacted – incarcerated	Yes
12D	Number of persons from revised NIC list not contacted -- out of project area	Yes
12E	Number of persons from revised NIC list not contacted -- Unknown/ other reasons	Yes
12F	Number of persons from revised NIC list Contacted -- disposition not known yet	Yes
12G	Number of persons from revised NIC list Contacted -- not in care	Yes
	13. Provision of Linkage/Re-engagement/Navigation Services for Persons Contacted
13A	Number of contacted persons who were not offered navigation/linkage/re-engagement services (yet)	Yes
13B	Number of contacted persons who were offered and refused navigation/linkage/re-engagement services	Yes
13C	Number of contacted persons who were offered but not yet provided navigation/linkage/re-engagement services	Yes
13D	Number of contacted persons who were offered and provided navigation/linkage services	Yes
	14. Outcomes of Linkage/Re-engagement/Navigation Services Provided
14A	Number of persons who were provided navigation/linkage services whose linkage to HIV medical status not determined (yet)	Yes
14B	Number of persons who were provided navigation/linkage services and were confirmed as linked to/re-engaged with HIV medical care	Yes
	15. Linkage within specified time (by entry point)
15A	Number (%) of HIV-dx linked or re-engaged persons in HIV medical care within 90 days of being identified as out of care on the not-in-care list (total of the next two indicators)	Yes
15B	Number (%) of previously HIV-dx and previously linked persons re-engaged in HIV medical care within 90 days of being identified on the not-in-care list	Yes
15C	Number (%) of previously HIV-dx and never in care, linked to HIV medical care not-in-care list within 90 days of being on the not-in-care list	Yes
15D	Number (%) of newly HIV-dx linked within 30 days (if HIV testing is implemented)	Yes
	16. Decreased time from identification to linkage
16A	Number of days between the identification of previously HIV-dx, previously in care persons and re-engagement in care (mean, median, and range)	Yes
16B	Number of days between the identification of previously HIV-dx, never in care persons and linkage to care (mean, median, and range)
16C	Number of days between the initiation of outreach, and re-engagement of previously HIV-dx, previously in care persons and re-engagement in care (mean, median, and range)	Yes
16D	Number of days between the initiation of outreach, and re-engagement of previously HIV-dx, never in care persons and linkage to care (mean, median, and range)
16E	Number of days between the successful contact of previously HIV-dx, previously in care persons and re-engagement in care (mean, median, and range)	Yes
16F	Number of days between the successful contact of previously HIV-dx, never in care persons and linkage to care (mean, median, and range)
16G	Number of days between HIV diagnosis and linkage to care for newly HIV-dx (mean, median, and range)	Yes
	17. Identification of Persons with Persistently Elevated VL (Locally defined)
17A	Number of persons [MSM, TG] in care who have persistently elevated HIV viral load test result identified through D2C activities	Yes
	18. Continuum of Care -- Jurisdiction Wide
18A	Number living with diagnosed HIV (prevalence)	Yes
18B	Number newly diagnosed	Yes
18C	Number linked to HIV medical care	Yes
18D	Number retained in HIV medical care	Yes
18E	Number virally suppressed	Yes
	19. Viral Suppression—Service Delivery
19A	Number of persons identified on list as not being virally suppressed	Yes
	20.  Viral Suppression -- Target Population Only (MSM, TG) at the Jurisdiction Level
20A	Number persons diagnosed living with diagnosed HIV infection in jurisdiction	Yes
20B	Number persons diagnosed living with diagnosed HIV infection in jurisdiction who are virally suppressed	Yes
	21. Viral Suppression -- Target Population Only (MSM, TG) at the Program Level*
21A	Number living with diagnosed HIV -total participated in program	Yes
21B	Number living with diagnosed HIV -total participated in program who are virally suppressed	Yes
	22. Feedback Loop
22A	Number of surveillance case records modified/updated using new information acquired from verifications in other data systems and the data-to-care outreach activities	No

PART III. SUPPORT SERVICES

	Services for HIV-Positive and HIV-Negative persons	Stratified?
	23. STD Screening and Treatment (i.e., Syphilis, Gonorrhea, and Chlamydia Infections)
23A	Number of persons who were screened for STIs during the measurement period	Yes
23B	Number of persons who screened positive for one or more STIs during the measurement period	Yes
23C	Number of persons who screened positive for one or more STIs who were referred to an STD treatment provider during the measurement period	Yes
23D	Number of persons with a positive screen for one or more STIs during the measurement period who were linked to an STD treatment provider	Yes
23E	Number of persons with a positive screen for one or more STIs during the measurement period who were provided STD treatment	Yes
	24. STD and HIV Partner Services (PS)
24A	Number of persons with acute HIV infection newly diagnosed during the measurement period who were interviewed for HIV partner services within 14 days, 15-30 days, or 31+ days of diagnosis	Yes
24B	Number of persons with established HIV infection newly diagnosed during the measurement period who were interviewed for PS within 21 days, 22-60 days, or 61+ days of diagnosis	Yes
24C	Number of HIV-negative persons newly diagnosed with an STD (i.e., syphilis, gonorrhea, chlamydia) during the measurement period who were interviewed for PS within 30 days, 31-60 days, or 61+ days of diagnosis	Yes
	25. Risk Reduction Interventions
25A	Number of persons enrolled in the project during the measurement period who were provided evidence-based behavioral risk reduction counseling or interventions	Yes
	26. Behavioral Health Screening and Linkage -- Mental Health Services
26A	Number of persons enrolled in the project during the measurement period who were screened for mental health service needs	Yes
26B	Number of those screened for mental health service needs during the measurement period who were found to have an unmet need	Yes
26C	Number of those with unmet mental health service need during the measurement period who were referred to mental health service provider	Yes
26D	Number of those with unmet mental health service need during the measurement period who were linked to a mental health service provider	Yes
26E	Number of those with unmet mental health service need during the measurement period who were provided mental health services, including treatment
	27. Behavioral Health Screening and Linkage -- Substance Abuse Services
27A	Number of persons enrolled in the project during the measurement period who were screened for substance abuse service needs	Yes
27B	Number of those screened for substance abuse service needs during the measurement period who were found to have unmet needs	Yes
27C	Number of those with unmet substance abuse service needs during the measurement period who were referred to substance abuse service provider	Yes
27D	Number of those with unmet substance abuse service needs during the measurement period who were linked to a substance abuse service provider	Yes
27E	Number of those with unmet substance abuse service needs during the measurement period who were provided substance abuse services, including treatment	Yes
	28. Social Service Screening and Linkage -- Housing Services
28A	Number of persons enrolled in the project during the measurement period who were screened for housing needs	Yes
28B	Number of those screened for housing needs during the measurement period who were found to have unmet housing needs	Yes
28C	Number of those with unmet housing needs during the measurement period who were referred to housing assistance provider	Yes
28D	Number of those with unmet housing needs during the measurement period who were linked to a housing assistance provider	Yes
28E	Number of those with unmet housing needs during the measurement period who were provided housing assistance	Yes
	29. Social Service Screening and Linkage -- Transportation
29A	Number of persons enrolled in the project during the measurement period who were screened for transportation assistance needs	Yes
29B	Number of those screened for transportation assistance needs during the measurement period who were found to have unmet transportation assistance needs	Yes
29C	Number of those with unmet transportation assistance needs during the measurement period who were referred to transportation assistance provider	Yes
29D	Number of those with unmet employment assistance/job training needs during the measurement period who were linked to a transportation assistance provider	Yes
29E	Number of those with unmet employment assistance/job training needs during the measurement period who were provided transportation assistance	Yes
	30. Social Service Screening and Linkage – Other (TBD by health department if not already included above)
30A	Number of persons enrolled in the project during the measurement period who were screened for other needs	Yes
30B	Number of those screened for transportation assistance needs during the measurement period who were found to have unmet other needs	Yes
30C	Number of those with unmet transportation assistance needs during the measurement period who were referred to other provider	Yes
30D	Number of those with unmet employment assistance/job training needs during the measurement period who were linked to a provider for other services	Yes
30E	Number of those with unmet needs during the measurement period who were provided other services	Yes
	31. Navigation Services
31A	Number of persons enrolled in the project during the measurement period who were provided navigation (or other linkage services) to link them to providers of the needed services	Yes
	32. Health Insurance Screening and Linkage
32A	Number of persons enrolled in the program through HIV testing or data-to-care activities during the reporting period who were screened for health insurance needs	Yes
32B	Number of those screened for health insurance needs during the measurement period who were uninsured or underinsured (including those in need of financial assistance for ART/PrEP)	Yes
32C	Number of those with unmet health insurance needs (uninsured/underinsured) during the measurement period who were referred to health insurance navigator	Yes
32C	Number of those with unmet health insurance needs (uninsured/underinsured) during the measurement period who were linked to health insurance navigator	Yes
32E	Number of those with unmet health insurance needs (uninsured/underinsured) during the measurement period who were enrolled in health insurance plan or provided financial assistance for their prescription	Yes

PART IV. FUNDING ALLOCATIONS REPORT

In this part, the list below includes aggregate data variables on allocation of funds to design and implement program activities and to reach priority population groups. These data are reported to CDC only once a year by all PS15-1506 funded health departments.

	Funding Allocations	Stratified?
FA01	Amount of funds allocated to provide services for persons at risk for HIV	No
FA02	Amount of funds allocated or expended to provide HIV testing services/program	No
	Amount of funds allocated or expended to provide STD testing services/program	No
	Amount of funds allocated or expended to provide PrEP trainings	No
FA03	Amount of funds allocated or expended to provide PrEP services/program (navigation)	No
FA04	Amount of funds allocated or expended to awareness and knowledge (separately to providers and consumers)	No
	Amount of funds allocated or expended data system development for implementing PrEP activities	No
FA05	Amount of funds allocated to provide services for persons living with HIV	No
	Amount of funds allocated or expended to provide Data to Care	No
FA06	Amount of funds allocated or expended to conduct data-to-care program (navigation)	No
	Amount of funds allocated or expended to generate the list	No
	Amount of funds allocated or expended to provide STD testing services/program	No
	Amount of funds allocated or expended data system development for implementing Data to Care activities	No
FA07	Amount of funds allocated to provide navigation/linkage to needed services	No
FA08	Amount of funds allocated for HIV/STD partner services	No
FA09	Amount of funds allocated to provide behavioral risk reduction counseling/interventions	No
FA10	Amount of funds allocated to provide behavioral health services	No
FA11	Amount of funds allocated to provide social services	No
FA12	Amount of funds allocated for program planning	No
FA13	Amount of funds allocated for program monitoring and evaluation (separately for cross-jurisdiction and site-specific)	No
FA14	Amount of funds allocated for capacity building (separately for PrEP and Data to Care)	No
FA15	Amount of funds allocated for general operations and administrative activities	No
FA16	Amount of funds allocated for contracts (separately for PrEP and Data to Care)	No
FA18	Amount of funds allocated to reach various population groups	Yes

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