Presentation on theme: "Factors Associated with HIV Viral Load Suppression among HIV-positive Adults in Care in Washington"— Presentation transcript
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Factors Associated with HIV Viral Load Suppression among HIV-positive Adults in Care in Washington State in 2009
Council of State and Territorial Epidemiologists Annual ConferenceJune 4, 2012Omaha, NebraskaTom Jaenicke, MPH, MBA, MESWashington State Department of HealthTom.Jaenicke@doh.wa.govSlide2
Outline for today
Overview of the Medical Monitoring Project (MMP)Results from 2009 data collection cycleDescriptive statisticsFocus on factors associated with HIV viral suppressionConclusionsSlide3
Medical Monitoring Project (MMP)
MMP is a stratified complex sample survey with three stages: state, facility and individual patientsProvides much clinical and behavioral dataHealth outcomesHow patients interact with the care systemBarriers to careBehaviors that affect health outcomesBehaviors that affect transmission
Is a primary source for providing HIV viral load data for measuring National HIV/AIDS Strategy progressSlide4
MMP Data Collection
Annual cycle ‘Population Definition Period’ – January through April of the calendar year‘Surveillance Period’ – 12 months before the interview (or attempt to contact if no interview)Two primary methods of collecting dataLengthy and in-depth interview with patientMedical record abstraction (MRA)Slide5
MMP Topic Areas
DemographicsAccess to careHIV treatment and adherenceSexual behaviorDrug and alcohol usePrevention activitiesMental healthHealth conditions and preventive therapyGynecological and reproductive historySlide6
Challenges
Significant logistical challenges associated with sampling, data collection and transferCDC provides direction to 16 states, six large cities and one U.S. territory, some of which consider it surveillance, others researchFacilities and providers are involved with contacting patients and providing access to medical recordsSlide7
MMP weighted data
Centers for Disease Control and Prevention (CDC) responsible for weighting dataPeer-reviewed article in near futureFor 2009 data, 9 strata, 64 clustersSeparate weights for separate datasets Medical recordNine weights, frequency of each ranges from 1 to 113InterviewFive weights, frequency of each ranges from 2 to 89Weighted data provide population estimatesSlide8
Washington MMP participants compared to persons reported to Washington core surveillanceSlide9
WA MMP participants similar to persons reported to core surveillanceSlide10
WA MMP participants similar to persons reported to core surveillance (cont.)Slide11
WA MMP participants similar to persons reported to core surveillance (cont.)Slide12
Antiretroviral (ARV) UseSlide13
ARV useSlide14
ARV use during past 12 months (from medical record)
Odds Ratio = 12.4 (3.3 – 45.8)Slide15
Currently on ARVs (from interview)
Odds Ratio = 25.4 (6.7 - 96.4)Slide16
Ever taken ARVs
(from interview)Odds Ratio = 15.2 (3.8 - 61.0)Slide17
Drug holiday during past year (from interview)
Odds Ratio = 3.7 (1.5 - 9.3)Slide18
Drug and Alcohol AbuseSlide19
Drug and alcohol abuseSlide20
Substance abuse, other than alcohol
(from medical record) No substance abuse vs. 3 or more substances,Odds Ratio = 6.4 (2.2 – 18.1)Slide21
Alcohol abuse
(from medical record)Odds Ratio = 2.8 (1.4 – 5.6)Slide22
Illicit drug use
(from interview)Odds Ratio = 2.4 (1.4 – 4.3)Slide23
IncomeSlide24
IncomeSlide25
Income
(from interview)Odds Ratio = 1.8 (1.2 – 2.7)Slide26
Access to ServicesSlide27
Access to services
Service gap = person claimed to have needed the service, but was unable to get it
Services include:
Case management, counseling, ADAP, medication reminders, peer support, dental, mental health, substance abuse counseling, SSDI, domestic violence services, housing, meals, home health services, transportation, childcare, interpreterPercent of respondents with gap for each service ranged from 1% to 17%
Total service gap for individual participants ranged from zero to fiveSlide28
Access to servicesSlide29
Access to services
(from interview)Odds Ratio = 4.7 (2.0 – 11.0)Slide30
Summary of AssociationsSlide31
Significant associations
Among 250 participants with a Surveillance Period Visit Form (SPVF) and Medical History Form (MHF), there were 40 who did not have an HIV viral load test during the Surveillance Period. There were Standard Interview forms completed for 180 participants. Of these 180, there were 24 who did not have an HIV viral load test during the Surveillance Period.Slide32
Strength of significant associations between viral suppression and various factorsSlide33
Strength of significant associations between viral suppression and various factorsSlide34
Strength of significant associations between viral suppression and various factorsSlide35
Other associations between viral suppression and various factorsSlide36
Conclusions
MMP is a complex survey that provides a wealth of medical and behavioral information about HIV-positive people in careTwo major components include interview and medical record abstractionHIV viral load suppression among persons in care is associated most strongly with ARV use, also with drug and alcohol use, income and access to support servicesComing soon: demonstration project of sampling from eHARS rather than through three stagesSlide37
Acknowledgements
Community and provider advisors:Mark Garrett, Dr. Brad Roter, Dr. Julie DombrowskiPublic Health – Seattle & King County:Elizabeth Barash, Susan Buskin, Shirley Zhang, Winnie Alston, Lexa MoongraceWashington State Department of Health:Maria Courogen, Leslie Pringle, Elizabeth Mack, Katie Heidere, Shawn McBrien, Susan BosseMMP Team at the Centers for Disease Control and Prevention, especially our project officer, Dr. Linda BeerSlide38
Questions?
