Anne Rhodes, Director, HIV Surveillance UnitDivision of Disease Prevention Office of Epidemiology

HIV Program Integration

Funding/Changing Grant Requirements• SPNS Systems Linkages – 4 year grant from

HRSA received in 2011 to improve HIV linkage, retention, and viral suppression using state-designed interventions

• CAPUS – 3 year grant from CDC received in 2012 to increase HIV diagnosis rates for racial and ethnic minorities and increase linkage, retention and re-engagement in care for racial/ethnic minorities living with HIV

Division of Disease Prevention

HIV Prevention

HIV Care

HIV SurveillanceSTD Operations (includes DIS)

TB/Newcomer Health

How to Define Care for HIV

CD4 Count

Viral Load

Evidence of HIV

Medication

Medical Visit

Care Markers

Ryan WhiteADAPVACRS

eHARSELR

MMP

Medicaid

HIV TestingCAPUS

Virginia’s HIV Continuum of Care: Before and After Care Markers Database

0%10%20%30%40%50%60%70%80%90%

100%

72.8%

44.9%

30.4% 32.4%

75.1%

49.1%

37.1% 37.5%

Surveillance Only

Surveillance and Ryan White

100%

22,575

Data derived from HIV Surveillance, VACRS, ADAP data; Division of Disease Prevention, Virginia Department of Health; February/March 2014

N=926

Continuum of Care for Ryan White Clients, 2013

0.0%10.0%20.0%30.0%40.0%50.0%60.0%70.0%80.0%90.0%

100.0%100.0% 97.4% 96.4%

85.2%76.7%

410 6,8316,031 5,431

All RW clients living with HIV in Virginia as of 2013

RW clients diagnosed with HIV in 2013 (N=421)

7,083

Persons Living with HIV as of December 31, 2012 With A Care Marker in 2012

*11,082 had a care marker: medical visit, CD4 count, viral load, or ART prescription in 2012; 6 missing and 9 out of state at last locality

Surveillance Data in ADAP• Needs assessment/program planning

• Complete missing data (demographics, labs)

• Quality Indicators, including retention in care, viral suppression, linkage to care rates

• Unmet need

CAPUS Test Sites Map

MMP and Care Markers• Used Care Markers to assist with location of

persons in MMP sample and utilized patient navigators at sites conducting MMP to assist in finding persons for MMP interviews

• Piloted at 2 sites in early 2014, plan to expand to all sites in upcoming cycle of MMP

Re-Engagement in Care Pilot• Developed List of those diagnosed in:– 2013 without a care marker– 2009-2013 without a care marker

Piloting List with 3 local health departments and DIS

Have internal protocol for reviewing lists prior to sending to DIS

CDC Consultation (July 2014)

Cases in Ryan White and not in Surveillance

Who can follow up when

someone falls out of care?

Consumer Input – want

testing sites to do follow up

Reviewed Ethical

Framework for Data to Care

Activities