Associate Administrator HIVAIDS Bureau HAB Health Resources and Services Administration HRSA Ryan White HIVAIDS Program Update San Antonio Texas August 2123 2017 Secretary Prices Principles and Priorities ID: 744565
Download Presentation The PPT/PDF document "Laura W. Cheever, MD, ScM" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Laura W. Cheever, MD, ScMAssociate AdministratorHIV/AIDS Bureau (HAB)Health Resources and Services Administration (HRSA)
Ryan White HIV/AIDS Program Update
San Antonio, Texas: August 21-23, 2017Slide2
Secretary Price’s Principles and Priorities
Patient-Centered Health Care System: 6 PrinciplesAffordability
Accessibility
Quality
ChoicesInnovationResponsiveness
Clinical PrioritiesSevere mental illnessOpioid epidemicChildhood obesity
2Slide3
HIV/AIDS Bureau Vision and Mission
Vision Optimal HIV/AIDS care and treatment for all.
Mission
Provide leadership and resources to assure access to and retention in high quality, integrated care, and treatment services for vulnerable people living with HIV/AIDS and their families.
3Slide4
Program LegislationThe Ryan White HIV/AIDS Treatment Extension Act is a legislative program:
Public Health Law 111-87 under Title XXVIEnacted into law in 1990
Reauthorized 1996, 2000, 2006, and 2009
The authorization of appropriation for the Ryan White HIV/AIDS Program (RWHAP) expired on September 30, 2013. The Program will not sunset and can continue to operate through Congressional appropriations
4Slide5
HIV/AIDS Bureau Priorities Leadership
PartnershipsIntegration Data Utilization
National Goals to End the HIV Epidemic/President’s Emergency Plan For AIDS Relief (PEPFAR) 3.0
Operations
5Slide6
Ryan White HIV/AIDS Program Appropriations History FY 1991-FY 2017
6Slide7
Ryan White HIV/AIDS Program FY 2017 Full-Year Appropriation- $2,318,781
7
Dollars in thousandsSlide8
Ryan White HIV/AIDS Program
People Living with HIV Served by the ProgramSlide9
Clients Served by the Ryan White HIV/AIDS Program by Race/Ethnicity, 2015—United States and 3 Territories*
*Puerto Rico, Guam, U.S. Virgin Islands
**Hispanics/Latinos can be of any race
Source:
HRSA. Ryan White HIV/AIDS Program Services Report (RSR) 2015. Does not include AIDS Drug Assistance Program
data.Slide10
Clients Served by the Ryan White HIV/AIDS Program by Poverty
Level, 2015—United States and 3 Territoriesa
FPL, federal poverty level.
a
Guam, Puerto Rico, and the U.S. Virgin Islands
.
Source:
HRSA. Ryan White HIV/AIDS Program Services Report (RSR) 2015. Does not include AIDS Drug Assistance Program
data.Slide11
Clients Served by the Ryan White HIV/AIDS Program by Age Group, 2010 and 2015—United States and 3 Territoriesa
11
a
Guam
, Puerto Rico, and the U.S. Virgin Islands.
Source:
HRSA. Ryan White HIV/AIDS Program Services Report (RSR) 2015. Does not include AIDS Drug Assistance Program
data.Slide12
Services Provided by RWHAP-Funded and Non-RWHAP-Funded Outpatient Facilities: Medical Monitoring Project (MMP) 2009-2012
12
Source: Weiser J, Beer L, Frazier EL, Patel R, Dempsey A, Hauck H,
Skarbinski
J. Service delivery and patient outcomes in Ryan White HIV/AIDS Program-funded and -
nonfunded
health care facilities in the Unites States. JAMA Intern Med 2015:4095. Slide13
Health Outcomes Data Guide Program and Innovation
Using Client-Level Data to Identify Opportunities for Improving Health Outcomes for PLWHSlide14
Continuum of Care Among People Diagnosed* with HIV in the United States**
Source: Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas—2014. HIV Surveillance Supplemental Report 2016;21 (No. 4)
*Denominator is 615,836 persons diagnosed with HIV by the end of 2012 and alive through 2013.
**Data from 33 jurisdictions that reported complete CD4 and viral load data. Data from these 33 jurisdictions represent 69.5% of all persons aged ≥13 years living with diagnosed HIV infection at year-end 2013Slide15
Viral Suppression among Clients Served by the Ryan White HIV/AIDS Program 2010–2015—United States and 3 Territories a
The Centers for Disease Control and Prevention estimates that in the U.S., 54.7% of people diagnosed with HIV are virally suppressed.
(Source: Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas—2014. HIV Surveillance Supplemental)
15
Viral
suppression: ≥1 OAMC visit during the calendar year and ≥1 viral load reported, with the last viral load result <200 copies/
mL.
a
Guam, Puerto Rico, and the U.S. Virgin Islands.
a
Source:
HRSA. Ryan White HIV/AIDS Program Services Report (RSR) 2015. Does not include AIDS Drug Assistance Program data.
.Slide16
Viral Suppression among Clients Served by the Ryan White HIV/AIDS Program, by State, 2010–2015—United States and 2 Territoriesa
4
VIRALLY SUPPRESSED
69.5
%
83.4
%
VIRALLY SUPPRESSED
IN 2015
IN 2010
Viral
suppression: ≥1 OAMC visit during the calendar year and ≥1 viral load reported, with the last viral load result <200 copies/
mL
.
a
Puerto Rico and the U.S. Virgin Islands. Due to low numbers, data for Guam are not presented
.
Source:
HRSA. Ryan White HIV/AIDS Program Services Report (RSR) 2015. Does not include AIDS Drug Assistance Program data.Slide17
Viral Suppression among Key Populations Served by the Ryan White HIV/AIDS Program, 2010–2015—United States and 3 Territoriesa
Hispanics/Latinos can be of any race.
Viral suppression:
≥1 OAMC visit during the calendar year and ≥1 viral load reported, with the last viral load result <200 copies/
mL.
a
Guam, Puerto Rico, and the U.S. Virgin Islands.
RWHAP overall, 2015 (83.4%)
RWHAP overall, 2010 (69.5%)
Source:
HRSA. Ryan White HIV/AIDS Program Services Report (RSR) 2015. Does not include AIDS Drug Assistance Program data.Slide18
Improving Health Outcomes: Understanding the Current State
Models of care
study
(evaluation study)
Evaluate the impact of different models of HIV care
Which models of care work best for people with co-morbidities or the aging populationAssessing client factors with detectable viral load (evaluation study)Identify differences between PLWH who are virally suppressed vs. those who are not
Identify new strategies to achieve the 90-90-90 goals
18
MSM
: men who have sex with men; PWID: persons who inject drugs.
Viral
suppression: ≥1 OAMC visit during the calendar year and ≥1 viral load reported, with the last viral load result <200 copies/
mL.
a
Guam, Puerto Rico, and the U.S. Virgin Islands.
.
Source:
HRSA. Ryan White HIV/AIDS Program Services Report (RSR) 2015. Does not include AIDS Drug Assistance Program data.
Viral Suppression among Key Populations
Served by the Ryan White HIV/AIDS Program,
2010‒2015
—United States and 3
Territories
aSlide19
Improving Health Outcomes: Disseminating Effective
Interventions
Dissemination
of Evidence-Informed Interventions to Improve Health Outcomes Along the HIV Care
ContinuumDeveloping four evidence-informed Care and Treatment Interventions (CATI) for
linkage and retentionBased on evidence informed interventions: SPNS Jail, SPNS Buprenorphine, SPNS Outreach, and Re-Engagement and Retention initiatives
Using
Evidence Informed Interventions to Improve Health Outcomes among People Living with HIV
Improving HIV health outcomes for transgender women
Improving HIV health outcomes for black men who have sex with men (MSM)
Integrating behavioral health with primary medical care for PLWH
Identifying and addressing trauma among PLWH
19Slide20
Improving Health Outcomes: Identifying and Disseminating Evidence Informed Interventions – Black Men Who Have Sex with Men
Center
for Engaging Black MSM Across the Care Continuum
His
Health (
www.HisHealth.org) and Well Versed (
www.WellVersed.org
) websites
launched
fall
2016
20
Viral Suppression among Men who have Sex with Men (MSM) Served by the Ryan White HIV/AIDS Program, 2015
N represents the total number of clients in the specific
subpopulation and have
≥1 outpatient/ambulatory medical care visit during the calendar year and ≥1 viral load reported
Viral
suppression:
≥1 outpatient/ambulatory medical care visit during the calendar year and ≥1 viral load reported, with the last viral load result <200 copies/
mL.
a
Guam, Puerto Rico, and the U.S. Virgin Islands.
Source:
HRSA. Ryan White HIV/AIDS Program Services Report (RSR) 2015. Does not include AIDS Drug Assistance Program data.Slide21
Improving Health Outcomes: Identifying
and Disseminating Evidence Informed Interventions – Youth
Building
Futures: Supporting Youth Living with HIV (evaluation study)
Identify
barriers and best practices to support youth living with HIV accessing RWHAP funded services
Youth have lower rates of viral suppression, we need more information and data to improve those rates
21Slide22
Improving Health Outcomes: Addressing Structural Barriers
Improving HIV Health Outcomes through the Coordination of Supportive Employment and Housing Services
Supports the design, implementation, and evaluation of innovative interventions that coordinate HIV care and treatment, housing and employment services to improve HIV health outcomes for low-income, uninsured, and underinsured PLWH in racial and ethnic minority communities
HIV Care & Housing – Using Data Integration to Improve Health Outcomes along HIV Care Continuum
Promotes integration and coordination of HIV and housing services using information technology to Improve entry, engagement, retention in care for HIV positive homeless & unstably housed PLWH with mental illness and substance abuse disorders
22
Viral Suppression among
Clients Served by the Ryan White HIV/AIDS Program,
by Housing Status, 2010‒2015
—United States and 3
Territories
a
Viral suppression: ≥1 OAMC visit during the calendar year and ≥1 viral load reported, with the last viral load result <200 copies/
mL.
a
Guam, Puerto Rico, and the U.S. Virgin Islands.
Source:
HRSA. Ryan White HIV/AIDS Program Services Report (RSR) 2015. Does not include AIDS Drug Assistance Program data.Slide23
Improving Health Outcomes: Enhancing Partnerships
HIV Health Improvement Affinity GroupSupport state collaborations between public health and Medicaid programs
Improve
rates of
viral suppression among Medicaid and CHIP enrollees living with HIV
The Affinity Group is comprised of 19 states which represent over 55% of known living HIV cases in the U.S.
23Slide24
Improving Health Outcomes: Curing Hepatitis C Infection in RWHAP
Estimated 20-25% of RWHAP clients are
coinfected
with HCV
Curing HCV among RWHAP clients is achievableEncourage recipients to leverage RWHAP effective approach to cure HCV among their clientsIncrease availability of HCV treatment and care
Increase number of clients receiving HCV treatment and careNew initiatives demonstrate commitment to curing HCV in PLWH through the infrastructure of the RWHAPJurisdictional approaches to screening, treatment and cure of HCVContract to study barriers to screening, treatment and cure of HCV
Enhancing HCV surveillance systems and treatment of HCV in conjunction with mental health and substance abuse treatment
24Slide25
Improving Health Outcomes: Clinical Quality Management
Development and testing of electronic clinical quality measures (eCQMs)National Quality Forum Endorsement of HIV measures
HIV viral suppression
Prescription of HIV antiretroviral therapy
HIV Medical visit frequencyGap in HIV medical visits HIV
Quality Measures (HIVQM) ModuleDesigned to help recipients track their clinical quality performance measuresRecipients enter performance measure data in aggregate multiple times per year
Generates
reports
that allow an organization to compare themselves
with others who submitted
42 performance measures to select from
25Slide26
HAB Reports and Other Resources
Find the annual RSR data report and other resources online: https://hab.hrsa.gov/data
26Slide27
Thank You!
Laura W. CheeverAssociate Administrator
HIV/AIDS Bureau (HAB)
Health Resources and Services Administration (HRSA)
Email:
LCheever@hrsa.gov Web:
hab.hrsa.gov
Twitter:
twitter.com/
HRSAgov
Facebook:
facebook.com/HHS.HRSA
27