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First Posted on: Monday, February 12, 2007

Wednesday, June 18, 2008

More Than Half of AIDS-Related Deaths in Washington, D.C., Not Reported

We've long known that HAA has problems with reporting. I've talked numerous times on this blog about the problems with the x-pres data entry system. Now this, from Kaiser Daily:

More than half of the AIDS-related deaths that occurred in Washington, D.C., from 2000 to 2005 were missed by the city's system for reporting such deaths, according to an analysis by the district's Department of Health and CDC that was published recently in CDC's Morbidity and Mortality Weekly Report, the Washington Post reports. The underreporting of AIDS-related deaths suggests that the epidemic "may be taking a far greater toll" on the district than health officials had originally thought, according to the Post.

For the analysis, city health officials worked with CDC to review all death certificates from 2000 to 2005 in an effort to identify deaths that appeared to be AIDS-related. They compared that number with the deaths that had been reported and discovered the discrepancy, the Post reports. According to the analysis, of the 2,460 deaths from AIDS-related illnesses that occurred between 2000 and 2005, 1,337 had not been reported because the city's system for tracking them was "inadequate," the Post reports. Officials launched the investigation because of health officials' increasing concern that they were undercounting the number of district residents living with HIV and those dying of AIDS-related causes, in part because they discovered boxes of unexamined paper records. Shannon Hader, senior deputy of the health department's HIV/AIDS Administration, said the analysis "tells us our surveillance system wasn't complete enough," adding, "We're clearly underreporting."

According to the Post, at least 12,500 district residents have developed AIDS -- one of the highest rates in the country -- and officials estimate that between 3% and 5% of people living in the city are HIV-positive. Hader said that in order to curb the spread of HIV in the district and ensure that HIV-positive people receive appropriate care, the department needs an "accurate count." In addition, the amount of federal HIV/AIDS funding the district receives is based on such estimates, Hader said, adding, "We want everything they owe us."

In response to the findings, Hader said the district has initiated several efforts to improve its reporting system, including a mass mailing in January to about 4,000 physicians and laboratories to try to increase the number of reported diagnoses. Officials also have begun routinely reviewing death records and have launched a campaign to try to identify more people for treatment.

"What we need to do is get more people who don't know they have HIV diagnosed and into care and treatment," Hader said, adding, "Every time you go into a health care provider, they should be offering to test you for HIV. We want to drive down the number of people living with HIV and [who] don't know about it" (Stein, Washington Post, 6/14).

Online The analysis is available online.

Labels: x-pres

posted by David Mariner at 11:20 PM 0 Comments Links to this post

Tuesday, June 26, 2007

Between Promise & Performance: X-Pres

Promise & Performance:
Leadership | Condom Distribution | HIV Testing | X-Pres

X-Pres

One of the most important things the DC Department of Health HIV/AIDS Administration (HAA) does is to make sure that the people living with HIV in DC get the services they need. In order to do that, HAA needs to make sure that the agencies and organizations they give money to actually provide the services they say they are providing. HAA is supposed to accomplish this through site visits, monthly reports, and by tracking the data entered into X-Pres. X-Pres is a computer program that (if it is working) allows organizations that receive HAA funds to enter information about their clients and the services they are providing.

The Promise: Over the years HAA has spent millions on a computer system that is supposed to accurately track the services being provided to people living with HIV/AIDS in the District.

The Performance: X-Pres is currently in a state of failure.

Last month I asked you to send me stories about your experience with X-pres and boy, did you. Here is what I learned.
  • Agencies are not entering data into X-Pres because they have folks who have been waiting months to get trained. Those who have received training in the past year were very critical of the training they received.
  • Agencies are not entering data into X-Pres because they have been waiting (in some cases six months or longer) for usable user-id's and passwords
  • Most agencies that can enter data are not entering accurate information because they have one or more grant numbers that haven't been updated in the X-Pres system. So there is NO way that you can tell whether or not an agency is providing services under current HAA grants
The state of this system is shameful. What is more shameful, however, is that these problems have been brought to the attention of HAA time and time again; month after month; to no avail. I personally sent an e-mail back in May, hoping that the situation could be fixed and it wouldn't be necessary to blog about this. I'm still waiting to here back.

With so many problems with X-pres it is impossible to produce any useable data.

What are the demographics of people living with HIV who access services in the District? Which local AIDS Service Organizations did not meet their goals in providing service last month? Are women less likely than men to access health services in DC? How many people living with HIV accessed any services at all in the past three months?

If X-pres was working properly, getting this kind of data pulled would be a simple task, and it would be incredibly useful information for HAA and for our Ryan White Planning Council.

Once again, however, this is not the case.

Labels: HAA, promise and performance, x-pres

posted by David Mariner at 12:48 PM 0 Comments Links to this post

Wednesday, May 16, 2007

Tell me your X-pres X-periences.

Oh X-pres, the bane of my existence. This post is going out to the folks who work at local AIDS service organizations. If that's not you, please feel free to ignore.

If you are having problems working with X-pres, I want to hear from you! This includes: not having received training on X-pres for an extended period of time, not having a current X-pres password, not having accurate and current grant numbers listed when you enter X-pres data, and of course not having your requests for X-pres technical assistance answered.

Send your experiences with X-press to xpresyourself@fighthivindc.org. We won't be able to fix the problems until they are properly documented.

Labels: HAA, x-pres

posted by David Mariner at 10:31 PM 0 Comments Links to this post



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