Medical Monitoring Project Demographics Clinical Care Unmet Need and Prevention Services for Persons Receiving HIV Care in North Carolina September 2016 HIVSTD Surveillance Unit Objectives ID: 760817
Download Presentation The PPT/PDF document "North Carolina 2009-2014" 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
North Carolina 2009-2014 Medical Monitoring Project
Demographics, Clinical Care, Unmet Need, and Prevention Services for Persons Receiving HIV Care in North CarolinaSeptember 2016
HIV/STD Surveillance Unit
Slide2Objectives
Describe the Medical Monitoring Project (MMP)Examine characteristics of those in HIV careFrom 2009 to 2014 in North CarolinaLook at demographics, clinical care outcomes, unmet needs, and prevention services
HIV/STD Surveillance Unit
Slide3Background of MMP (2007-2014)
23 project areasInterview + medical record dataRepresentative sample of people in careGoalsUnderstanding health care experience and behaviorsUnderstanding unmet needsEvaluating effectiveness of prevention measures
HIV/STD Surveillance Unit
Slide4Methods
MMP medical abstraction and interview data from 2009 to 2014Data weighted to account for clustering and biasPopulation estimates and 95% confidence intervals generatedLooking at variables specifically to examine demographics, clinical care, and services accessed
HIV/STD Surveillance Unit
Slide5Basic demographics of people in hiv care
HIV/STD Surveillance Unit
Slide6Demographic Results, MMP vs eHARS, 2014
2014 MMP (N=222)People Diagnosed with HIV who Resided in NC as of 12/31/2014 (eHARS) (N=32,042)Demographic Characteristic%*95% Confidence Interval*%Gender Male Female Transgender68.627.14.362.722.11.274.532.27.371.428.6N/ASexual Orientation Homosexual Heterosexual Bisexual Other/Unclassified51.339.09.60.044.632.45.8N/A58.145.713.5N/A54.933.4N/A11.7Race/Ethnicity Black/African American** Hispanic/Latino White/Caucasian** Other***57.329.07.95.951.023.04.32.963.534.911.48.963.46.826.53.3
HIV/STD Surveillance Unit
*Weighted percentage; 95% CI incorporate weighted percentages. **Non-Hispanic/Latino.***Other includes American Indian/Alaska Native and Asian/Pacific Islander. Data Source: enhanced HIV/AIDS Reporting System(data as of June 27, 2016) and 2009-2014 Weighted North Carolina MMP Data (data as of August 4, 2016).
Slide7Age Distribution* Estimate of People in HIV Care, 2014
HIV/STD Surveillance Unit
*Age at time of interview
Data Source: 2009-2014 Weighted North Carolina MMP Data (data as of August 4, 2016).
Slide8People in HIV Care: Structural Factors, 2014
HIV/STD Surveillance Unit
*Poverty
guidelines as defined by the Department of Health and Human Services (HHS) (example: the 2009 guidelines were used for patients interviewed in 2010 and the 2010 guidelines were used for patients interviewed in 2011). Poverty guidelines reflect a 1.5% price increase in 2014 (from CY 2012 and 2013). Data Source: 2009-2014 Weighted North Carolina MMP Data (data as of August 4, 2016).
Slide9People in HIV Care: Health Insurance in Past 12 Months, 2009 -2014
HIV/STD Surveillance Unit
*Includes private insurance, Medicare, Medicaid, and VA/CHAMPUS.
Data Source:
2009-2014 Weighted North Carolina MMP Data (data as of August 4, 2016).
Ryan White/ADAP significant increase from 2009 to 2014
Slide10People in HIV Care: Kinds of Health Insurance*, 2014 (N=222)
HIV/STD Surveillance Unit
Data Source:
2009-2014 Weighted North Carolina MMP Data (data as of August 4, 2016).
Slide11Clinical outcomes of people in hiv care
HIV/STD Surveillance Unit
Slide12People in HIV Care: Stage of Infection, 2009 and 2014
2009 (N=193)2014 (N=222)Stage of HIV Infection%ᵃ95% Confidence Intervalsᵇ%ᵃ95% Confidence IntervalsᵇStage 1ᶜ6.63.49.79.04.613.5Stage 2ᵈ28.521.935.229.323.035.6Stage 3 (AIDS)ᵉ64.859.170.161.753.569.8
HIV/STD Surveillance Unit
ᵃPercentages are weighted percentages.ᵇ95 % Confidence Intervals (CIs) incorporate weighted percentages.ᶜHIV infection, stage 1: No AIDS-defining condition and either CD4 count of greater than or equal to 500 cells/μL or CD4 percentage of total lymphocytes of greater than or equal to 29.ᵈHIV infection, stage 2: No AIDS-defining condition and either CD4 count of 200–499 cells/μL or CD4 percentage of total lymphocytes of 14–28.ᵉHIV infection, stage 3 (AIDS): Documentation of an AIDS-defining condition or either a CD4 count of <200 cells/μL or a CD4 percentage of total lymphocytes of <14. Documentation of an AIDS-defining condition supersedes a CD4 count or percentage that would not, by itself, be the basis for a stage 3 (AIDS) classification.Data Source: 2009-2014 Weighted North Carolina MMP Data (data as of August 4, 2016).
Slide13Viral Suppression* of People in HIV Care, 2009-2014
HIV/STD Surveillance Unit
*Most recent viral load test is less than 200 copies/mL; Percentages are weighted percentages.Data Source: 2009-2014 Weighted North Carolina MMP Data (data as of August 4, 2016).
Slide14Durable Viral Suppression* of People in HIV Care, 2009-2014
HIV/STD Surveillance Unit
*All
measurements in past 12 months less than 200 copies/mL; Percentages are weighted percentages.Data Source: 2009-2014 Weighted North Carolina MMP Data (data as of August 4, 2016).
No significant increase between 2009 and 2014
Slide15HIV Clinical Care Recommendations*2009 and 2014
2009 (N=193)2014 (N=222)Care Recommendation%ᵃ95% Confidence Intervalᵇ%ᵃ95% Confidence IntervalᵇOne or more CD4 Cell Count96.493.199.793.288.198.3Viral Load every 6 months78.072.783.370.456.784.1Influenza Immunization85.180.090.290.786.794.6ARV Prescriptionᶜ90.085.294.997.194.799.5ARV Adherence-self reportedᵈ86.079.592.589.385.093.6Cervical Cancer Screen-Females95.389.7100.0100.0N/AN/APCP prophylaxisᵉ78.262.993.577.962.593.2MAC prophylaxisᵉ86.966.0100.079.359.599.0
HIV/STD Surveillance Unit
*Recommendations (National and Multiagency HIV Care Quality Measures)-aidsinfo.nih.gov/contentfiles/lvguidelines/adultandadolescentgl.pdf.ᵃPercentages are weighted percentages.ᵇ95 % Confidence Intervals (CIs) incorporate weighted percentages.ᶜPrescription documented in medical record.ᵈ100% dose adherence to ARVs in past 3 days (self-reported).ᵉAmong those who met the clinical criteria.Data Source: 2009-2014 Weighted North Carolina MMP Data (data as of August 4, 2016).
Slide16Sexually active People in HIV care
HIV/STD Surveillance Unit
Slide17Hepatitis B Immunization among Self-Reported Sexually Active Persons*, 2009-2014
*Sexual activity was self-reported in the patient interview component of
MMP and was defined as oral sex, anal, or vaginal intercourse.Data Source: 2009-2014 Weighted North Carolina MMP Data (data as of August 4, 2016).
HIV/STD Surveillance Unit
Slide18HIV Prevention Counseling among Self-Reported Sexually Active* People in HIV Care, 2009-2014
*Sexual activity was self-reported in the patient interview component of
MMP and was defined as oral sex, anal, or vaginal intercourse.Data Source: 2009-2014 Weighted North Carolina MMP Data (data as of August 4, 2016).
HIV/STD Surveillance Unit
Slide19STI Screening among Self-Reported Sexually Active People in HIV Care, 2009-2014
HIV/STD Surveillance Unit
*Sexual activity was self-reported in the patient interview component of
MMP and was defined as oral sex, anal, or vaginal intercourse.Data Source: 2009-2014 Weighted North Carolina MMP Data (data as of August 4, 2016).
Significant increase for all STI screening from 2009 to 2014
Slide20Unprotected Sex among Self-Reported Sexually Active People in HIV Care, 2009-2014
HIV/STD Surveillance Unit
*Sexual activity was self-reported in the patient interview component of
MMP and was defined as oral sex, anal, or vaginal intercourse.Data Source: 2009-2014 Weighted North Carolina MMP Data (data as of August 4, 2016).
Slide21Mental health, Smoking, and substance use
HIV/STD Surveillance Unit
Slide22People in HIV Care: Mental Health, Smoking, and Substance Use2009 and 2014
HIV/STD Surveillance Unit
2009 (N=193)2014 (N=222)Categories%ᵃ95% Confidence Intervalᵇ%ᵃ95% Confidence IntervalᵇDepressionᶜ Other Depression12.07.116.99.75.314.2 Major Depression13.16.919.213.89.418.1Current Smoker37.931.644.147.340.754.2Binge Drinkingᵈ19.113.025.215.19.221.0Any Drug Useᵉ29.630.036.228.220.635.7
ᵃPercentages are weighted percentages.ᵇ95% Confidence Intervals (CIs) incorporate weighted percentages.ᶜDepression categories based on Kroenke and Spitzer’s algorithm.ᵈIn past 30 days, 4 or more drinks for females and 5 or more drinks for males in one sitting/time period. ᵉEngaged in any injection or non-injection drug use in the past 12 months. Data Source: 2009-2014 Weighted North Carolina MMP Data (data as of August 4, 2016).
Slide23Prevention services received by people in hiv care
HIV/STD Surveillance Unit
Slide24Prevention Services of People in Care2009 and 2014
2009 (N=193)2014 (N=222)Prevention Services%ᵃ95% Confidence Intervalᵇ%ᵃ95% Confidence IntervalᵇOne-on-One Prevention Conversation41.530.852.338.928.449.3Talked to Counselor about Prevention23.918.429.718.312.424.3Small Group Session12.78.017.48.04.111.8Free Condomsᶜ49.340.757.948.338.458.1
HIV/STD Surveillance Unit
ᵃPercentages are weighted percentages.ᵇ95% Confidence Intervals (CIs) incorporate weighted percentages.ᶜMajority of free condoms were received at a doctor’s office/clinic, followed by community-based organizations.Data Source: 2009-2013 Weighted North Carolina MMP Data (data as of September 25, 2015).
Slide25Unmet Need for Services of Persons in Care, 2009 and 2014Among those who needed services, the percentage of people in HIV care who did NOT receive the services they needed
HIV/STD Surveillance Unit
Slide26Patients Who Needed, but Did Not Receive Clinical Services, 2009 and 2014
2009 (N=193)2014 (N=222)Clinical Services%ᵃ95% Confidence Intervalᵇ%ᵃ95% Confidence IntervalᵇDental Services 23.018.527.527.419.934.9HIV Case Management Services6.42.39.92.60.94.3Medicine through ADAP5.02.27.81.30.02.7Mental Health Services8.12.413.98.14.211.9
ᵃPercentages are weighted percentages. Of those needing services, the percentage who did not receive the service. ᵇ95% Confidence Intervals (CIs) incorporate weighted percentages.Data Source: 2009-2014 Weighted North Carolina MMP Data (data as of August 4, 2016).
HIV/STD Surveillance Unit
Slide27Patients Who Needed, but Did Not Receive Behavioral Services, 2009 and 2014
2009 (N=193)2014 (N=222)Behavioral Services%ᵃ95% Confidence Intervalᵇ%ᵃ95% Confidence IntervalᵇAdherence Services1.20.02.81.70.03.4Drug and Alcohol Counseling2.80.84.81.20.02.7HIV Peer Group Support9.95.214.610.06.313.7
HIV/STD Surveillance Unit
ᵃPercentages are weighted percentages. Of those needing services, the percentage who did not receive the service. ᵇ95% Confidence Intervals (CIs) incorporate weighted percentages.Data Source: 2009-2014 Weighted North Carolina MMP Data (data as of August 4, 2016).
Slide28Patients Who Needed, but Did Not Receive Social Services, 2009 and 2014
2009 (N=193)2014 (N=222)Social Services%ᵃ95% Confidence Intervalᵇ%ᵃ95% Confidence IntervalᵇPublic Benefits, including SSI or SSDI16.68.424.88.85.012.7Transportation Assistance7.92.113.67.54.310.7Home Health Services3.00.35.62.90.65.4
HIV/STD Surveillance Unit
ᵃPercentages are weighted percentages. Of those needing services, the percentage who did not receive the service. ᵇ95% Confidence Intervals (CIs) incorporate weighted percentages.Data Source: 2009-2014 Weighted North Carolina MMP Data (data as of August 4, 2016).
Slide29Want More Information?
HIV/STD Surveillance Unit
Centers for Disease Control and Prevention (CDC)
http://www.cdc.gov/hiv/statistics/systems/mmp
/
North Carolina MMP
Project Coordinator: Mark Turner, MPH
Phone: 919-715-9122, ext.
301; Email: mark.turner@dhhs.nc.gov