Annual Performance Plan and Report

Topics on this page: Goal 2. Objective E | Table of Related Performance Measures | Analysis of Results | Plans for the Future | Objective Progress Update Summary

Goal 2. Objective E: Improve laboratory, surveillance, and epidemiology capacity

Three critical elements that underpin public health and regulatory practice — laboratory, surveillance, and epidemiological services — enable the public health field to detect emerging threats, monitor ongoing health issues and their risk factors, and identify and evaluate the impact of strategies to prevent disease and promote health. Carrying out these activities requires quality data and specimen collection, evidence-based epidemiology, and accurate and reliable laboratory services across the departments and organizations that make up the nation’s public health infrastructure.

To this end, HHS is working to strengthen surveillance systems, including the monitoring of health care quality to ensure that best practices are used to prevent and treat the leading causes of death and disability. CDC works to ensure a prepared, diverse, sustainable public health workforce through experiential fellowships and high-quality training programs in many areas, including epidemiology, preventive medicine, and program management. This fills critical gaps in workforce needs at CDC and in the field, including global Ministries of Health (MOH).

HHS is building a robust data system that provides data, feedback, and tools directly to health agencies and health care facilities to improve practices and, ultimately, health. A data system for public reporting and using electronic data sources for data collection and prevention will enhance the nation’s ability to monitor trends in critical health measures among priority populations; monitor health status, health care, and health policy concerns; and conduct in-depth studies of population health at the community level and for specific subpopulations.

ASPR, CDC, FDA, and SAMHSA will have roles in implementing the following strategies to achieve this objective. The Office of the Secretary led this Objective’s assessment as a part of the Strategic Review.

Objective 2.E Table of Related Performance Measures

Increase the number of states that report all CD4 and viral load values for HIV surveillance purposes (Lead Agency - CDC; Measure ID - 2.2.4)

Increase the number of CDC trainees in state, tribal, local, and territorial public health agencies. (Lead Agency - CDC; Measure ID - 8.B.4.2)

Increase epidemiology and laboratory capacity within global health ministries through the Field Epidemiology Training Program (FETP). New Residents (Lead Agency - CDC; Measure ID - 10.F.1a)

Increase epidemiology and laboratory capacity within global health ministries through the Field Epidemiology Training Program (FETP). Total Graduates (Lead Agency - CDC; Measure ID - 10.F.1b)

Analysis of Results

The spread of infectious diseases continue to be a national and international concern, requiring a robust system of detection, monitoring, and prevention. CD4 and viral load reporting provide the fundamental data for four of the National HIV/AIDS Strategy Goals. These goals are to increase the proportion of newly diagnosed persons linked to clinical care, and reduce the proportion of three populations diagnosed with HIV who have undetectable viral loads. Routine reporting of CD4 and Viral Load data to surveillance programs facilitates case finding and follow-up on new cases. These data help to ensure the timeliness, accuracy, and completeness of the national HIV surveillance system. As of FY 2014, 40 states and the District of Columbia reported all CD4 and viral load values for surveillance purposes, exceeding CDC’s target of 36 states.

The detection and monitoring of pathogens and infections is a key component of HHS’s strategic plan to enhance public health. State health departments report shortages of critical disciplines such as epidemiologists, public health nurses, managers, disease investigation specialists, laboratorians, environmental scientists, sanitarians, and informaticians. CDC’s fellowship programs promote service while learning; fellows fill critical workforce needs at CDC and in the field while they are in-training for careers in the field of public health. Targets are set based on the typical, annual class size for each of the fellowship programs included in the measure. In FY 2013, 83 percent of CDC’s fellowship program graduates pursued careers in public health practice, while less than 25 percent of school of public health did so.Over the past three years, CDC exceeded its targets for training up the next generation of the public health workforce. In FY 2014, 310 fellows were placed in state, tribal, local, and territorial field assignments in 44 states, Washington D.C., American Samoa, Guam, Puerto Rico, and six tribal locations, falling short of the target. Results decreased in FY 2014 due to the Public Health Associates Program's (PHAP) transition to a new start-date for its incoming class. CDC's new class of 145 PHAP associates started in fall 2014 (FY 2015), as opposed to summer 2014 (FY 2014), and thus were not included in FY 2014 results. PHAP associates that began in the fall of 2014 will be included in FY 2015 results.

The current ease and frequency of long-range travel can make previously regional diseases and infections local risks. Therefore, HHS supports a number of initiatives to develop local and international workforce to improve public health both at home and abroad. Since 1980, CDC developed 50 international Field Epidemiology Training Programs (FETPs) serving 94 countries and graduated over 3,100 epidemiologists. On average, 80 percent of FETP graduates work within their Ministry of Health after graduation and many assume key leadership positions. Their presence enhances sustainable public health capacity in these countries, which is critical in transitioning U.S. government global health investments to long-term host-country ownership. In FY 2013, CDC exceeded its target for new residents and for total, cumulative graduates. In FY 2013, FETP graduates and residents led 345 outbreak investigations, over 200 planned investigations, and approximately 250 surveillance activities.

Plans for the Future

CDC will hold steady the number of states (including the District of Columbia) that report for HIV surveillance purposes in FY 2015 and slightly increase in FY 2016.  CDC expects performance levels similar to previous years in FY 2015.  CDC is planning for a level number of new residents in FY 2016 based on current participation and funding considerations.  FETP activities are supported by funding from CDC appropriations and inter-agency agreements with the Department of Defense, Department of State, and USAID.  Policy changes within those agencies may affect the number of FETPs supported.  In light of this and the increased FY 2016 funding request, CDC will assess the implications for its performance targets for FY 2016 and adjust as applicable. CDC is working closely with Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET) to implement the accreditation process for the FETPs, which will help maintain the quality of FETPs globally.

Objective Progress Update Summary

HHS demonstrated progress toward this objective as shown by the representative performance measures described in the HHS Annual Performance Plan and Report. Further evidence of progress is described below.

• CDC is working in collaboration with state health departments to better monitor the effects of HIV medical care through expanded reporting of CD4 and viral load test results. For FY 2014, 40 states and the District of Columbia required reporting of all CD4 and viral load values, exceeding the target. CDC programs seek to reduce progression from HIV infection to AIDS and monitor disease progression using surveillance data.
• CDC has made efforts to strengthen informatics capacity at the state, tribal, local, and territorial (STLT) level. In FY 2013, CDC developed the Informatics Training-in-Place Program (I-TIPP) which provides informatics training and guidance to current state and local health department staff who are working on Meaningful Use projects. This training program supplements the informatics training provided through the Public Health Informatics Fellowship (which places doctoral-level fellows at CDC for two years of intense informatics training) and the Applied Public Health Informatics Fellowship (which places masters-level fellows at STLT agencies for one year of applied public health informatics training).
• Since 1980, CDC has developed international Field Epidemiology Training Programs (FETPs) serving 94 countries that have graduated over 3,100 epidemiologists. In FY 2013, FETP graduates and residents led 345 outbreak investigations, over 200 planned investigations, and approximately 250 surveillance activities.