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Notes: |
This template has been pre-filled from the Needs Assessment. You may want to add or change rows if staffing changes. |
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Data should be entered in the row for the type of staff who would normally do the work done during the month, even if someone else did it due to staff being temporarily unavailable. |
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Jurisdictions may determine for themselves how to complete the form. For example, they may appoint a single person to collect data from others, or they may request each person to complete the form in a shared location. |
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We cannot receive the name of individuals. If the form includes names as you collect the data, please have names and staff categories in separate columns and delete the name column before you submit the data. |
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Upload the completed form to Box prior to your monthly call with the TAP. Here is the link: |
Box |
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If you have any questions, please contact Giulia Norton at giulia_norton@abtassoc.com, 617-520-3527. |
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Jurisdiction (select): |
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Month (select): |
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Staff category * |
Hours spent during the month |
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Preparation± |
DUA / MOU / SOP§ |
Training/ Technical Meetings ¥ |
Data linkage € |
Reporting ₭ |
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Branch Supervisor |
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Data Manager |
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STI Data Manager |
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Data Entry Staff |
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Data Analyst |
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Senior level epidemiologist |
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Bioinformatician |
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Doctoral/masters level services planner |
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Clinical quality improvement specialists |
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Disease Intervention specialist |
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Other: |
___________________________ |
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Other: |
___________________________ |
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* |
List all key personnel involved in data linking and sharing of STI/HIV surveillance data. Include personnel involved in reporting of HIV and/or STI surveillance data for ancillary programs and systems, such as viral load and CD4 lab reporting, GISP, and/or SSuN, as applicable. |
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± |
Include time spent planning to do linkage, for example, doing a needs assessment, collecting information about current data structures and sharing, identification of staff who will be involved. |
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§ |
Include all time spent conducting outreach and coordination to get appropriate Data Use Agreements/Memorandum of Understandings in place for linking and sharing STI/HIV surveillance data. Include engaging with the IRB and collecting materials to support data sharing. |
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¥ |
Include all time spent participating in training on linking data and/or using linked data, and technical meetings regarding the linkage process. |
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€ |
Include all time coding and testing. |
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₭ |
Include all time spent (a) developing reports to disseminate linked STI/HIV surveillance data to clinics/providers, including time collecting input from clinics/providers, and (b) creating & disseminating reports to clinics/providers. |
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