NIH Pilot


HIV continues to present substantial health challenges to the US. The concept of a “churn effect” has been borrowed from the business sector to describe the process of bidirectional HIV care migration for people going to or leaving certain places to receive HIV care elsewhere. This concept has been helpful in identifying the demographic profiles of groups that have frequently or more intensely experienced the churn effect in specific geographic locations. Furthermore, it underlines the importance of access to consistent care in mitigating adverse health effects. However, patient in- and out-migration is still considered a large knowledge gap in HIV epidemiology. The US mid-Atlantic region experiences some of the highest prevalence rates among key population groups in the country, and is therefore critical to the national response to HIV. Public health departments and clinical providers in this region have long observed that persons have historically migrated from one jurisdiction to another for HIV care.

In January of 2013, public health officials from the District of Columbia, the State of Maryland and the Commonwealth of Virginia alongside federal public health officials from the Centers for Disease Control and Prevention and the National Institutes of Health joined at Georgetown University with other academic partners to discuss regional sharing of HIV/AIDS data in the DC metropolitan region (including jurisdictions DC, MD and VA) in the US mid-Atlantic. At this conference, they identified the need for a novel real-time and automated approach to data sharing that simultaneously accounts for the highly private and sensitive nature of public health data when exploring the churn effect across this cross-jurisdictional metropolitan area. This project addresses this need, and is conducting a thorough examination of cross-jurisdictional HIV care migration or the regional churn effect among the public health departments of DC, MD and VA using a novel privacy technology.

The Team

  • Michael Kharfen
  • Garret Lum
  • Adam Allston 
  • Colin Flynn 
  • Reshma Bhattacharjee 
  • Sharon Carter 
  • Anne Rhodes
  • Jean Cadet
  • Jeffrey Stover
  • JC Smart 
  • Joanne Michelle Ocampo 
  • Jeff Collmann 
  • Mary Young
  • Seble Kassaye 
  • Joshua Ripple 



  • National Institutes of Health (NIH)
  • DC Department of Health (DOH)
  • MD Department of Health (DOH)
  • VA Department of Health (DOH)
  • Centers for Disease Control and Prevention (CDC)