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Review of the Medical Monitoring Project Outcomes of Interest Pilot Year Data

Review of the Medical Monitoring Project Outcomes of Interest Pilot Year Data. MMP PAB/CAB Meeting May 31, 2007 Department of State Health Services Epidemiology & Surveillance Unit Sylvia L. Odem, MPH Project Coordinator . Acknowledgements to the Pilot Year TX-MMP Team:.

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Review of the Medical Monitoring Project Outcomes of Interest Pilot Year Data

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  1. Review of theMedical Monitoring Project Outcomes of InterestPilot Year Data MMP PAB/CAB Meeting May 31, 2007 Department of State Health Services Epidemiology & Surveillance Unit Sylvia L. Odem, MPH Project Coordinator

  2. Acknowledgements to the Pilot Year TX-MMP Team: • Katharine Carvelli, Epidemiologist • Mark Heinzke, Data Manager • Sharon K. Melville, Principal Investigator • Nita Ngo, Epidemiologist • Jim Phillips, Data Collector • Renee Ridgley, Data Collector • Tammy Sajak, Co-Principal Investigator • Jose Velez, Data Collector • Simone Wooden-Jackson, Data Collector

  3. What is the Medical Monitoring Project (MMP)? • A survey and medical chart review about the experiences and needs of people living with HIV and AIDS in the US • Behaviors • Clinical outcomes • Type and quality of care received • Identify met and unmet needs for HIV care and prevention services

  4. MMP Goals • Determine access to and use of prevention and support services • Provide local and national estimates for the population in care for HIV • Examine variations of factors by geographic area and patient characteristics (i.e. risk behaviors, quality of care etc.)

  5. How you might use the MMP data • Supplement your local needs assessments • Determine need for new programs in your organization • Use for grant applications and RFP’s • Use as a benchmark for your programs • Requests for special data runs

  6. Nationally Representative Three Stage Sampling Design • 1st stage - Site 20 states + 6 cities randomly selected • 2nd stage - Provider • 40-60 facilities randomly selected - large, medium, and small • 3rd stage - Patient • 400 randomly selected patients Chicago San Francisco New York City Philadelphia LA County Houston High Medium Alaska Hawaii Puerto Rico Low

  7. MMP Success

  8. Pilot Year – 2005 Preliminary data 13 sites Sampled 27 facilities Sampled 150 patients 81 interviews 86 chart abstractions Project Year – 2007 Full year – all 26 sites participating Sampled 47 facilities 27 recruited to-date 400 patients to be sampled 400 interviews & abstractions to be done MMP Data collection

  9. Demographics & Patient Characteristics

  10. Gender

  11. Race/Ethnicity

  12. Age by Race

  13. Age by Race (14%) (21%) (48%) (18%)

  14. Education by Race *Cell suppressed for n<3

  15. Age First Positive by Race (44%) (40%) (15%) (1%)

  16. Number of Years HIV Positive n=25 n=22 n=13 n=12 * *Cell suppressed for n<3

  17. Alcohol and Drug Use n=46 n=21

  18. Date of Last Injection and First Positive Date

  19. Frequency of Alcohol Consumption in Past 12 Months* *51% of those interviewed reported alcohol use in the past 12 months

  20. No. of Alcoholic Drinks in Typical Day in Past 30 Days

  21. Drug Use in Past 12 months *Embalming fluid

  22. Mean Number of Sexual Partners in the Past 12 months

  23. Male: Male Partner(s) • 64% of men interviewed reported having male sexual partner(s) in the past 12 months *Among men who reported having anal sex in past 12 months

  24. Male: Male Partner(s) – Last Time You Had Sex

  25. Male: Female Partner(s) • 10% (n=7) of men interviewed reported having female sexual partner(s) in the past 12 months *Cell suppressed for n<3

  26. Female: Male Partner(s) • 46% (n=6) of women had male sexual partner(s) in the past 12 months *Cell suppressed for n<3

  27. Access to Care & Need for Services

  28. Public Assistance and Homelessness in Past 12 Months n=45 n=7 *57% (n=4) of homeless were receiving public assistance

  29. Health Insurance Coverage

  30. Payment Method for HIV Meds & Other Meds in Past 12 Months

  31. Time to Start HIV Care

  32. Reasons for Delay in HIV Care • Didn’t want to think about being HIV positive (main reason) • Felt good, didn’t need to go • Too busy to go • Didn’t want to believe HIV test results • Drinking or using drugs • Fear of being socially ostracized • Felt meds were dangerous

  33. Need and Receipt of Services in the Past 12 Months

  34. Reasons for Not Receiving Services Needed • Didn’t know where to go/who to call (n=12) • Service not available in patient’s area (n=4) • Waiting list too long (n=7) • Transportation problems (n=*) • Not eligible or denied services (n=*) • Services too costly (n=*) *Cell suppressed for n<3

  35. Receipt of Prevention Activity Itemsin Past 12 Months *Percentage computed using those who had received condoms as the denominator † 25% reported ever injecting drugs, but 0% have injected drugs in the past 12 months

  36. Free Condom Source

  37. Preventive Therapies and Screenings

  38. Preventive Therapy *Only prescribed to patients who have a CD4 cell count <49.

  39. Reasons For Not Receiving Hepatitis Vaccination • Patient already has hepatitis • Doctor indicated vaccine not necessary • Patient did not believe they were at risk for contracting hepatitis • Patient doesn’t like needles • Patient was not aware vaccine was available • Patient did not complete the series

  40. Ever Tested for and Ever Had Hepatitis

  41. Prevention: Tests †Among patients who have ever had a TB skin test *Cell suppressed for n<3

  42. STD Screening in Past 12 months

  43. Female Sexual Health n=13 n=10

  44. Female Sexual Health n=12 n=11 n=12 n=11 n=5 n=5 n=5 n=5 *Among patients who ever had a PAP smear

  45. Facility Type for Last Pelvic Exam

  46. CD4, Viral Load Tests & ARV Medications

  47. CD4 and Viral Load Tests in Past 12 Months

  48. Antiretroviral Usage n=76 n=63 n=12

  49. Drug Combinations of ARV Meds Currently Using *Includes combinations such as 3 nukes and 2 PIs; 3 nukes and 1 non-nuke; 3 nukes, 2 PIs, and 1 combination drug; 2 nukes, 1 PI, and 1 combination drug; 1 nuke, 1 non-nuke, and 1 combination drug †Including combinations such as 1 nuke and 1 PI; 1 nuke and 1 non-nuke; 1 nuke and 1 combination drug

  50. Reason Never Started Antiretroviral Treatment • Doctor advised to delay treatment (main reason) • CD4 counts and/or viral load good • Felt good and didn’t need them • Concerned about side effects

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