Assessing Need for Services Among HIV-Positive Persons in ... · Results: UN Framework in MI Column...

Assessing Need for Health Care Services Among HIV-Positive

Persons in Michigan:~~~~~~~~~~~~~~

Data from the FY 2007 Title II Ryan White Care Act Grant Application

~~~~~~~~~~~~~~Melissa Reznar, MPH

February 15, 2007

1

MDCH/Bureau of Epidemiology/HIV/AIDS Surveillance Program

Topics• Background of the RWCA• RWCA in Michigan• Methodology • Results• National Data• HAPIS Future Plans

2


Funding for HIV Care• HIV care is expensive• Populations most affected by HIV

cannot afford care• Gaps in health care affordability

– CDC estimates that 34% are not in regular care

– Of those in care, 20% uninsured and 50% are on Medicaid and/or Medicare

3


Ryan White CARE Act (RWCA)• Federal legislation enacted by Congress in

1990• Provides care to low-income, underinsured,

and uninsured• Has grown to $2.1b and >500,000 individuals

and families• Reauthorized and amended in 1996, 2000,

and 2006

4


CARE Act TitlesTitle I Eligible Metropolitan Areas

(>2,000 AIDS cases and >500k population)

• $611.6 m (30% RWCA)• Funds 20 EMAs and 36 TGAs

Title II States and Territories • $1,134.6 m (55% RWCA)• Funds 59 states/territories• Includes ADAP (70% Title II)

Title III Public & private organizations– EIS/Capacity&Planning

• $196.1 m (10% RWCA)• 364 EIS, 35 Capacity/Planning

Title IV Public & private organizations– Children, youth, women

• $72.7 m (4% RWCA)• 94 Grantees

Title VI Special Programs • $47.8 m (3% RWCA)• SPNS, AETC, Dental, MAI

5


RWCA in MI• Detroit EMA: $ 8.4 m Title I in FY2006• Michigan: $15.9 m Title II in FY2006

– $11.4 m of this is the ADAP Earmark for HIV pharmaceuticals

– In 2006, $20 m for HIV pharmaceuticals, $11.4 m plus ~ $8 m in manufacturer rebates AND $1 m in unspent dollars from 04-05

– ADAP has highest utilization in history with over 2,100 current members

6


RWCA Shift in FocusOLD PURPOSE:“To provide emergency assistance to localities that

are disproportionately affected by the HIV epidemic…”

NEW PURPOSE:“To address the unmet care and treatment needs of

persons living with HIV/AIDS by funding primary health care and support services that enhance access to and retention in care.”

7


What is Unmet Need?Unmet Need

Estimated number of persons living with1) HIV-non AIDS/aware and 2) AIDS

who did not receive HIV primary care during a 12-month time period

HIV Primary Care• HIV Viral Load (VL)• CD4 count/percent• Anti-Retroviral Therapy (ART)

8


Unmet Need Data SourcesJurisdiction 1 Jurisdiction 2 Jurisdiction 3 Jurisdiction 4

Population Sizes

PLWA HARS HARS HARS HARS

PLWH, non-AIDS

CDC midpoint estimate

Estimates based on local

modeling

HARS (HIV- reporting State)

HARS (HIV- reporting State)

Care Patterns

% AIDS in care

Chart review of all PLWA (or

representative sample)

Linked claims databases + private care

Demonstration of viral load,

CD4, or ART in ASD

CD4/viral load reporting in

HARS

% HIV, non-AIDS in care

AIDS progression

study

Linked claims databases + private care

Demonstration of viral load,

CD4, or ART in ASD

CD4/viral load reporting in

HARS

9


Unmet Need Methodology in MI• HIV Surveillance data in MI

– AIDS notifiable since 1983– Name-based HIV notifiable since 1989– PA 514 passed in December 2004– Transition from HARS to eHARS in July 2006

• Unmet Need Data Sources in MI– eHARS for denominator (PLWH/A in MI)– ACCESS database of laboratory data for care

measurements

10


Unmet Need Methodology in MI

• HIV Primary Care– Defined as receipt of VL or CD4 test

between Oct 1, 2005 and Sep 30, 2006 • Population

– All persons with HIV or AIDS currently living in MI

– Diagnosed before Oct 1, 2005

11


Results: UN Framework in MIColumn 1 Column 2 Column 3 Column 4

ValueRow A. PLWA 6,883Row B. PLWH, non-AIDS 5,741Row C. Total PLWH/A 12,624

ValueRow D. PLWA in care 4,558Row E. PLWH, non-AIDS in care 2,793Row F. PLWH/A in care 7,351

Value PercentRow G. Unmet Need in PLWA 2,325 34%Row H. Unmet Need in PLWH 2,948 51%Row I. Unmet Need among all PLWH/A 5,273 42%

Calculated Results

Population Sizes

Care Patterns

12


Results: UN by Sex

77%

23%

77%

23%

0%

20%

40%

60%

80%

100%

Male Female

Sex

Perc

ent o

f Met

/Unm

et

Nee

dMet Need Unmet Need

42%

41%

13


Results: UN by Mode of Transmission

50%

11%5%

15%

3% 3%

16%6% 2% 6%

14%

43%

12%15%

0%

20%

40%

60%M

SM

IDU

MS

M/ID

U

Het

ero

Oth

er

NIR

-Pre

sH

eter

o

NIR

Transmission Category

Perc

ent o

f Met

/Unm

et

Nee

d

Met Need Unmet Need

38%

51%48%

36%

34%

45%

56%

14


2% 3%

27%22%

7%1%1% 4%

32%

19%

6%1%

38%38%

0%

20%

40%

60%0

- 12

y

13 -

19 y

20 -

29 y

30 -

39 y

40 -

49 y

50 -

59 y

60y

+

Age at Diagnosis

Perc

ent o

f Met

/Unm

et

Nee

d

Met Need Unmet Need

30% 46%46% 42%

38%37%

39%

Results: UN by Age at Diagnosis

15


Results: UN by Current Age

1% 1%9%

5%0% 1%

5%

26%

38%

20%29%

37%

19%

9%

0%

20%

40%

60%

0 - 1

2 y

13 -

19 y

20 -

29 y

30 -

39 y

40 -

49 y

50 -

59 y

60y

+

Current Age

Perc

ent o

f Met

/Unm

et N

eed

Met Need Unmet Need

27% 28%

42%

44% 41%

41%

43%

16


Results: UN by Race/Ethnicity

38%

57%

4% 2%

36%

5% 2%

56%

0%

20%

40%

60%

White Black Hispanic Other

Race/Ethnicity

Perc

ent o

f Met

/Unm

et N

eed Met Need Unmet Need

41%42%

50% 49%

17


Results: UN by Region

67%

33%

60%

40%

0%

20%

40%

60%

80%

SE MI Outstate

Region

Perc

ent o

f Met

/Unm

et

Nee

dMet Need Unmet Need

39%

47%

18


Results: UN by Region

3%2%

4%

9%

2% 3% 2% 2%4%

6% 7%6%4%

2%4%

8%

3% 2%

0%

20%W

asht

enaw

Ber

rien

Gen

esee

Ken

t+

Jac

kson

Kal

amaz

oo/C

alho

un

Ingh

am+

Sag

inaw

+

Rur

al

Region - Outstate

Perc

ent o

f Met

/Unm

et

Nee

d

Met Need Unmet Need

43% 45% 46%39%

58% 43% 70% 45%44%

19


Limitations• Laboratory reporting in MI is new• Out of state migration• Deaths• Potential for incorrect matching or non-

matching• No ability to include receipt of ART

20


National Data – FY2006Unmet Need Estimates Title I Title IIRange of unmet need estimatesHIV and AIDS 16% - 71% 9% - 87%

HIV/non-AIDS-aware 12% - 80% 14% - 85%

AIDS 9% - 60% 0% - 75%

Median estimate of unmet need:HIV and AIDS 36% 43%

HIV/non-AIDS-aware 42% 52%

AIDS 29% 38%

Aggregate estimate of unmet needHIV and AIDS 37% (220,666) 43% (325,228)

HIV/non-AIDS-aware 47% (135,475) 52% (185,706)

AIDS 27% (79,934) 33% (128,354)

21


National Data

34%

51%

46%

47%

28%

0% 20% 40% 60%

Percent Unmet Need

Virginia

Tennessee

South Carolina

Ohio

ColoradoMichigan

(42%)

22


Summary• Overall unmet need in MI FY2007

– 34% AIDS– 51% HIV, non-AIDS– 42% HIV and AIDS

• Unmet need highest among – IDU– Persons 20 - 29 years at diagnosis– Outstate MI (esp. Lansing MSA and Jackson Co.)

• National comparisons problematic, but MI falls in line with median estimates

23


HAPIS – Future Plans• Work with surveillance to continue to isolate

particular areas where unmet need is higher• Compare data with that of other states• Identify strategies used in other states to

reduce unmet need• Use unmet need data to specifically

implement care program indicators across all titles of the CARE Act in Michigan

• Implement specific identified strategies in targeted areas and assess outcomes

24


QUESTIONS?

~~~~~~~~~~~~~~~~~~~~~~~~~

Melissa Reznar, MPH(313) 876-4768

[email protected]

Assessing Need for Services Among HIV-Positive Persons in ... · Results: UN Framework in MI Column...

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