New uses of public health surveillance data to improve HIV care and reduce transmission: Applying ethical considerations in public health practice

Using HIV surveillance data to monitor linkage, retention, and success of care is critical to public health efforts to prevent HIV in the U.S. Evolutions in the way we monitor and treat HIV have necessitated changes in the way we collect and use data for HIV surveillance and public health prevention activities. Of particular interest is how viral suppression achieved with antiretroviral therapy benefits both the population by reducing HIV transmission and the individual by reducing morbidity and premature mortality. To follow-up with individuals or their care providers, innovative public health activities that utilize HIV surveillance data have been proposed. However, innovative interventions based on emergent science also create ethical challenges. For example, should surveillance data collected without individual consent be used to follow-up with individuals for public health intervention purposes or to monitor care? What obligation does public health have to use the data it collects? Competing interests and values of stakeholders must be weighed and prioritized in relation to the risks and benefits of interventions. Including ethical analysis when new activities are first proposed can facilitate acceptance and implementation of new practices in public health. This presentation will highlight this process and consideration of the ethical dimensions of using surveillance data for monitoring the care and retention in care of individuals against the backdrop of the historical context of HIV surveillance and the goals of the National HIV/AIDS Strategy.