SET-NET's Impact

Increasing surveillance capacity

Arkansas

When COVID-19 hit, Arkansas used SET-NET to set up processes needed to understand COVID-19's impact on pregnant people and their infants. Because of their experience with Zika, the Arkansas team responded to COVID-19 more easily. The relationships needed were already in place. Experts in birth defects, epidemiology, and medicine came together. According to Dr. Wendy Nembhard, director of the Arkansas Center for Birth Defects Research and Prevention, "The partners who have come together had expertise that we each brought to the table. We had connections within the state that we could pool together." With the support of Dr. William Greenfield, Medical Advisor at the health department, the state focused on outreach to healthcare providers. The state worked to make them aware of the role of SET-NET in Arkansas. They presented to local provider groups, developed a dashboard to show cases among pregnant people, and created a webpage and fact sheets for providers and the public. When asked about SET-NET's potential for the future, Lucy Im, lead epidemiologist for the project in the state, said, "If something arose, we could quickly activate this [SET-NET] again, and we wouldn't have to reinvent it."

Tennessee

Before the COVID-19 pandemic began, health officials in Tennessee used SET-NET to better understand the impact of hepatitis C on pregnant people and their infants. When the pandemic hit, the state quickly built on the partnerships and processes in place for hepatitis C to look at COVID-19 in pregnancy. Dr. Elizabeth Harvey, co-lead for COVID-19 surveillance among pregnant people and their infants, and a CDC Maternal and Child Health Assignee, said "Tennessee would not have been in this position without the previous foundational work of the hepatitis C SET-NET project. That really helped us build the capacity to study COVID-19 and respond quickly." She added that SET-NET highlighted the "work that needs to be done before emergencies happen. We need these structures in place to really respond effectively and quickly."

Pennsylvania

Some areas of Pennsylvania have seen an increase in rates of substance use disorder among women. Substance use disorder is a risk factor for hepatitis C infections in pregnancy. There has been an ongoing, yet unmet, need in the state to monitor the impact of hepatitis C on pregnant people and their infants. Funding provided through the Centers for Disease Control and Prevention's SET-NET program has allowed for this monitoring to begin. Prior to this, no resources existed for monitoring hepatitis C in this specific population. The processes put in place because of SET-NET are also helping link pregnant people to care and treatment for hepatitis C after delivery. Because of SET-NET, the state now has the data and resources it needs to ensure that pregnant people and infants are part of the strategy for hepatitis C elimination efforts. Staff in Allegheny County, home to Pittsburgh, have expressed that they would not be able to do any of this work without SET-NET.

Data for action

Tennessee

SET-NET allowed health officials in Tennessee to collect data on COVID-19 in pregnancy that helped them prioritize public health action. These data showed that Hispanic pregnant people in their state were more likely to get COVID-19. To address this disparity, health officials partnered with the state's Health Disparity Task Force. Together, they developed a public service announcement in Spanish to reach Hispanic women. They featured the message on the state's COVID-19 website. More recently, Tennessee public health officials partnered with their COVID-19 vaccination team, which helped them find groups and areas with low vaccination rates. The health department could then target vaccination campaigns in those areas. The infrastructure that was in place because of SET-NET, combined with these critical partnerships, led to a culture of collaboration in Tennessee that would not have otherwise existed. When reflecting on these experiences, Lindsey Sizemore, co-lead for COVID-19 and hepatitis C surveillance in pregnant people and their infants, said "This is just the beginning." The COVID-19 pandemic showcased the utility of SET-NET to study mother-baby linked data over time.

Bridging silos

New York

Staff at the New York State Department of Health used SET-NET to help understand how COVID-19 impacts pregnant people and their infants. They used SET-NET to find many COVID-19 cases in pregnant people. Specifically, because of SET-NET, they built partnerships with several other divisions within the health department. They also used SET-NET to identify COVID-19 cases outside the standard reporting process. Most importantly, they gained access to the health information exchanges (which are electronic methods of sharing secure health information). This access will help their public health work beyond COVID-19. These connections can be used for access to more timely data during future emergencies. According to Nicole Longcore, an evaluation specialist at the health department, “SET-NET has helped us bridge a lot of the data silos. We are linking data from areas within our division, but also other divisions. We are also linking with other public health agencies and other resources outside of the Department of Health.”

Michigan

When the COVID-19 pandemic hit, Michigan's SET-NET team encouraged maternal and infant health staff to work together across the health department. Staff collaborated to access data on COVID-19 cases and link them to mother and infant data. In addition, an experienced medical record reviewer from the Maternal Mortality Surveillance program joined the SET-NET team. She helped reduce the time needed to access data from hospitals. Michigan’s SET-NET team also began using these linked medical records to gather other valuable information, such as whether the birth was preterm. These streamlined processes will be useful for future projects in this population, ensuring rapid responses and timely data.

Washington

When COVID-19 hit, SET-NET helped health officials in Washington quickly get up to speed. They made connections within the health department, including with the maternal mortality team. They also trained medical record reviewers. Vivian Hawkins, deputy director of the Office of Communicable Disease Epidemiology in the state health department, said SET-NET is a “sustainable approach; we can fold in other conditions as we go along.” Debbie Mbotha, project coordinator for SET-NET, said SET-NET’s existing processes and systems will help the state move forward. “[We are] confident that (the infrastructure built because of SET-NET) is something that we can quickly deploy to address any rising threat to mothers and babies.”

Unique data linkages

Pennsylvania

When the COVID-19 pandemic hit, health department staff started using SET-NET to monitor the impact of COVID-19 on pregnant people and their infants. However, at the start of the pandemic, access to birth and death records was limited. Staff had to find new ways to confirm if a pregnant person had COVID-19. They were able to find infants affected by COVID-19 by using newborn screening records. Funding provided through SET-NET led to increased staffing, increased expertise in medical record review, and increased access to electronic medical records. These advancements will help with future monitoring for hepatitis C or other infections in this population.