To enhance service delivery for people living with HIV/AIDS and assist health-care providers in managing reams of client information, a decidedly unique grouping of two states and two counties developed the AIDS Regional Information and Evaluation System (ARIES), a Web-based, centralized HIV/AIDS client management system.

The system -- a joint effort between the California Department of Health Services Office of AIDS, the Texas Department of State Health Services, the San Bernardino County Department of Public Health and the San Diego County Office of AIDS Coordination -- provides a single point of entry for clients, and enhances service delivery by helping providers automate, plan, manage and report on client data.

Despite a few bumps during implementation, ARIES has been a true success story, said Susan Sabatier, chief of the Care Research and Evaluation Section at the California Department of Health Services Office of AIDS. A testament to its value is that more counties and states are vying to join the ARIES partnership to streamline their own HIV/AIDS software applications and meet continuously rigorous government reporting requirements.


Partnering Up
ARIES sprang from a mutual need to track HIV/AIDS patients and give health providers up-to-date information.

Before ARIES, HIV/AIDS patients divulged their health histories and personal information every time they visited new health-care providers. Providers also had to sort convoluted health histories; administrators had to consolidate data from multiple providers; and researchers found it hard to evaluate characteristics of the clientele population sans the appropriate information, according to the Universitywide AIDS Research Project (UARP), which works with the University of California to fund AIDS research.

The pre-ARIES landscape in California was dominated by applications based on MS-DOS, Access and FoxPro, Sabatier said. But before the California Office of AIDS leapt into a costly database venture to replace those applications, the agency asked a 1998 internal working group to see if a prepackaged system could be used -- to no avail, Sabatier said.

"There's no off-the-shelf product out there," she explained. "So we decided a customized data system would work best."

In March 2000, San Bernardino met with four other jurisdictions that used an aging MS-DOS application administered by COMPIS -- including Texas, California, San Diego and Hawaii. Though the original idea was to upgrade the existing COMPIS application to a Windows-based application, the regions instead decided to pool resources and create a new system from the ground up, Sabatier said.

After Hawaii dropped out of the mix, the four partners spent a year cobbling together reporting requirements and funding logistics.


Funding ARIES
The partners' federal funding source -- the U.S. Department of Health and Human Services' Health Resources and Services Administration (HRSA) -- divides money provided from the Ryan White Comprehensive AIDS (CARE) Act among its four programs. Funding programs under the act are based on the type of jurisdiction -- local areas, states, community-based organizations or nonprofits -- and funding varies by program jurisdictional needs, which is where reporting requirements come in.

While California and Texas fall under Title II requirements -- which allot states assistance for primary care and support services -- San Bernardino and San Diego are eligible metropolitan areas (EMAs), and receive both Title I and Title II funding because they've been acutely affected by the HIV/AIDS pandemic.

To qualify as an EMA, more than 2,000 AIDS cases must be reported to the Centers for Disease Control and Prevention in the region during a five-year span (the CARE Act is reauthorized every five years), according to the HRSA Web site.

Moving Forward
The practicality of a county-state partnership goes beyond the issue of meeting federal funding requirements, said Elisabeth Dittrich, who is the senior project manager of ARIES