Fiscal Year 2004 Proposed Budget

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DEPARTMENT OF HUMAN SERVICES
COMMUNICABLE DISEASE

PROGRAM MISSION: To prevent the spread of communicable disease through prevention, detection, education and outreach in the community.

• The Communicable Disease Program seeks to limit transmission of reportable communicable diseases (such as hepatitis, meningitis and shigella) in the community, as mandated by Virginia State law. Strategies include ongoing community surveillance and prompt response to reports of communicable disease. Education, outreach, and consultation are provided for individuals, community groups, work-sites, schools and daycare providers. The Shelter Liaison public health nurse prevents the spread of communicable disease among homeless individuals, families and shelter staff by identifying communicable diseases and instituting control measures in County shelters. The Refugee Program within the Communicable Disease Program prevents or minimizes the spread of communicable disease and prevents long term chronic illness in people newly arrived in the United States through federal refugee programs.

• The HIV/AIDS and Sexually Transmitted Diseases Program prevents infection and transmission of human immunodeficiency virus (HIV) and sexually transmitted disease (STDs), and provides consultation, testing, referral and treatment for STDs and HIV/AIDS medication services. The major components to the program are testing and counseling, community education and outreach for HIV and STD.

• The Chest Clinic/Tuberculosis Control Program limits transmission of tuberculosis by identification, assessment, monitoring and treatment of individuals with infectious disease and those exposed to tuberculosis in Arlington County. The program provides tuberculosis education and consultation to community members and the medical community.

• Emergency Preparedness Planning became a priority in the Communicable Disease Bureau following the events of September 11th. A public health emergency preparedness planner, an epidemiologist and public health nurses conduct enhanced disease surveillance involving the close monitoring of emergency room visits and hospital admissions, as well as frequent contacts with community physicians and laboratories for early indications of bioterrorism. Monitoring and planning a response to bioterrorism, infectious disease outbreaks and other public health emergencies, necessitate active engagement in multiple local, regional and state groups charged with planning for such events

SIGNIFICANT BUDGET HIGHLIGHTS:

• The FY 2003 adopted budget does not include two supplemental appropriations, fully supported with outside revenue, approved during FY 2003: Virginia Department of Health Bioterrorism Preparedness grant ($175,454, 2.0 FTEs) and Children's Tuberculosis Services grant ($44,517, 0.8 FTE). These grants continue in FY 2004 and are reflected at their projected funding and staffing levels in the FY 2004 proposed budget.

• Personnel costs increase due to normal step increases, and the impact of the additional 2.8 grant funded positions.

• Non-Personnel expenses are reduced $18,645 upon completion of the Geriatric Clinic contract with Georgetown Medical Centers, and due to the elimination of bioterrorism start-up costs ($7,900) and expenses associated with the Ryan White Grant.

• Miscellaneous grants increased for the Bioterroism and Children's TB Control grants.

• Revenues decreased $20,000 in the Refugee program to reflect amount collected in FY 2002.

• Federal grants decline primarily due to the elimination of the Ryan White grant ($37,550), partially offset by increases in the AIDS Minority grant ($7,072) and TB Outreach grant ($10,000).

• FTEs increase due to the addition of 2.8 FTEs funded by the Virginia Department of Health: 2.0 FTEs were for bioterrorism preparedness and 0.8 FTE for a Children's tuberculosis program.

PERFORMANCE MEASURES:

Communicable Disease Program Objective: To assess 100 percent of communicable disease reports within 24 hours of receipt and to provide appropriate control measures. To reduce and control cases of Hepatitis A.

• Significant workload increases are projected due to intense disease surveillance involving monitoring of emergency room visits, hospital admissions, community physicians, and frequent contact with laboratories resulting from bioterrorism threats.

Refugee Clinic Objective: To provide medical screenings for refugees within 30 days and appropriate referrals on all persons meeting criteria as official refugees.

• The Virginia Department of Health establishes goals for the percent of new refugees medically screened within 30 days (if not screened elsewhere).

• A new refugee has come directly to Arlington from his or her country of origin. A secondary refugee comes to Arlington after spending time elsewhere in the United States.

• The Refugee Program was halted after 9/11/01. Since that time, the refugee admission process has become more complex. Many refugees already processed are still awaiting a second security clearance before they are allowed entry into the country. Only 27,000 refugees out of a possible 70,000 (one-third) actually entered the United States in FY 2002.

HIV/AIDS and Sexually Transmitted Disease Program Objectives: (a) To prevent increases in new STDs, and (b) to enable clients with HIV to manage their disease.

• Rates for Syphilis, Gonorrhea and HIV are reported annually, by calendar year, consistent with Virginia Department of Health data. Actual rates are currently available for 2001 only. It is anticipated that rates will stay level for the near future.

Chest Clinic/Tuberculosis Control Program Objective: To assure that appropriate levels of treatment compliance are achieved for persons with active tuberculosis and for those exposed to the disease, as evidenced by 98 percent of clients completing treatment for active TB and a 80 percent completion rate for treatment of latent TB.

• Some clients do not complete treatment for TB because they leave Arlington with no forwarding address or refuse treatment. Completion of treatment is recommended but not required if they do not present an imminent health threat to the community.

• TB cases are mostly foreign born.

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