1 / 65

Planning and Priority Setting to Address the HIV Epidemic in Broward County: Data Presentation

Planning and Priority Setting to Address the HIV Epidemic in Broward County: Data Presentation. June 2008 Julia Hidalgo, ScD, MSW, MPH Positive Outcomes, Inc. & George Washington University.

jacob
Download Presentation

Planning and Priority Setting to Address the HIV Epidemic in Broward County: Data Presentation

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Planning and Priority Setting to Address the HIV Epidemic in Broward County:Data Presentation June 2008 Julia Hidalgo, ScD, MSW, MPH Positive Outcomes, Inc. & George Washington University

  2. We acknowledge the efforts of HIV program staff in Broward County, as well as the Part A Grantee William Green, Leonard Jones, Lorene Maddox, Spencer Lieb, Patricia Callahan, Regine Lefevre Michele Rosiere and Devlon Jacksonin preparing the information presented

  3. What are questions we must address to plan and set priorities for Part A funds? • What is the scope of the HIV/AIDS epidemic in Broward County? • What population groups have unique service needs that must be addressed? • Which funders pay for HIV care, how much do they allocate for core medical and support services, and are those funds sufficient to meet demand for HIV services? • In the Broward County Part A Program, what services are funded, how many people are served, and what are their service utilization characteristics? • Are high quality services being provided by Part A-funded agencies? • What are the unmet need for HIV services and service gaps in Broward County? • What factors must we consider in setting priorities for Part A funds?

  4. What is the scope of the HIV/AIDS epidemic in Broward County?Data from the Florida Department of Health (DOH)

  5. What is the scope of the HIV/AIDS epidemic in Florida as of 2007? • Population: 18.8 million • 4th in the US in population size • Cumulative AIDS cases: 109,364 • 3rd in nation • Cumulative pediatric AIDS cases: 1,523 • 2nd in nation • Cumulative HIV (not AIDS) cases as of 1997: 40,642 • Persons living w/ HIV/AIDS (PLWHAs): 87,500 reported cases • HIV prevalence estimate: 125,000

  6. What is the scope of the HIV/AIDS epidemic in Broward County as of 2007? • Population: 1.8 million • AIDS case rate through 2006: 43.0 per 100,000 population • Broward ranked 2nd in the U.S. for 2005 and 2006, behind Miami • Cumulative pediatric AIDS cases through 2006: 262 per 100,000 population • 4th in the U.S., excluding Puerto Rico and DC • Cumulative AIDS through 2007: 17,184 through 2007 • Cumulative HIV (not AIDS) through 2007: 7,073 • Persons living with HIV/AIDS (PLWHAs): 14,131 • Estimated prevalence: 20,507 • One in 125 Broward County residents is living with HIV/ AIDS, compared to one in 218 FL residents

  7. Another Way of Looking at HIV Prevalence Estimates and 2007 HIV and AIDS Cases in Broward County

  8. What has been the impact of the new FL HIV / AIDS reporting statue that went into effect on 11/20/06? • A positive Western blot is reportable by labs and physicians and is considered diagnostic of HIV (i.e., confirmatory) • The reporting requirement was implemented in November 1997 • NEW: • A detectable viral load (VL) (or equivalent viral test) is reportable, and is considered evidence of HIV • Other reportable virologic tests considered to be evidence of HIV are: p24 antigen, Nucleic Acid Test (NAT/NAAT), viral culture • CD4 counts/percents are reportable, but follow-up is conducted only if it is <200 or <14%

  9. Changes in FL HIV reporting have seriously and negatively impacted Broward and other FL counties • The increase of new HIV cases observed in 2007 was primarily due to the change in the law which requires viral load reporting • This increase may not level off until 2009 • Persons with undetectable viral tests results are NOT reportable • In 2007, many labs (including Labcorp) switched from paper to electronic lab reporting (ELR) • Due to technical difficulties, 2007 tests were un-retrievable from ELR in 2007 • In January 2008, surveillance staff performed retroactive review of Western Blot data received through ELR, thus leading to an unexpected increase of new HIV cases in 2008 • The number of HIV cases reported in 2008 is expected to increase significantly over 2007, due to the results of the review • It is expected that these trends should level back off in 2009

  10. The impact of delayed investigation and processing of HIV/AIDS case reports may result in potential losses of federal care and housing funds • Over 1,300 Broward HIV and AIDS cases reported in 2007 were not investigated or processed by local DOH HIV/AIDS surveillance staffbefore the CDC submission deadline and therefore, these cases were not credited to Broward County for the upcoming FY 2009 Part A formula award • The impact of the delayed reporting was offset for the FY 2008 Part A award by the “hold harmless” clause of the Ryan White HIV/AIDS Treatment Modernization Act • It is unclear what impact this delayed reporting may have in relation to making the case for FY 2009 Part A supplemental or MAI funding • Due to this delayed reporting, 2007 HIV and AIDS case data are unreliable and should be considered with caution, making planning for services more challenging than ever before

  11. What advise is offered to local planning bodies from the FL DOH HIV/AIDS surveillance staff? • “So…. With the increase in HIV cases and the drop in AIDS cases, how should you use these data for program planning? • Forget using % change for the next two years!!”

  12. FL HIV Cases, by Year of Report (1998-2007) and Year of Diagnosis (1998-2006) VL & WB Year of Report Year of Diagnosis WB Note: Y-axis begins at 4,000 to magnify trends for discussion. Testing Initiatives

  13. Where does Broward County rank in the percentage changes in HIV and AIDS cases reporting among FL counties for 2006 versus 2007? Is this a true decrease, or the result of delayed HIV/AIDS reporting in Broward County? Note: 27 counties included with 20+ HIV cases and 20+ AIDS cases in 2006

  14. What are the trends in AIDS cases and annual AIDS case rates per 100,000 population for Broward County between 1998 and 2007? Note: The advent of HAART was associated with decreases in AIDS cases in the late 1990s. Generally, AIDS cases fluctuated in the early 2000s, with an increase in 2004 due to increased CD4 testing statewide. Increasingly, an AIDS diagnosis reflects late diagnosis of HIV and limited access to treatment.

  15. What are the trends in HIV cases and annual HIV case rates per 100,000 population for Broward County between 1998 and 2007? Note: Generally, HIV cases remained fairly stable with an increase in 2002 due to increased HIV testing statewide as part of the “Get to Know Your Status” campaign. Since that time, newly reported HIV cases have decreased each year, however, in 2006 there was an increase in reported cases.

  16. In the absence of accurate and reliable HIV/AIDS epidemiologic data, it is important to hope for the best and plan for the worst

  17. Males Females What are the trends in adult AIDS cases among men and women in Broward County between 1998 and 2007? M:F Ratio* 1997 2.4:1 2007 1.7:1

  18. What are the trends in adult HIV cases among men and women in Broward County between 1998 and 2007?

  19. What are the trends in adult HIV cases among racial and ethnic groups in Broward County between 1998 and 2007?

  20. White, non- Hispanic Hispanic Black, non- Hispanic Among adult males, what are the trends in HIV cases by race and ethnicity for 1998 through 2007?

  21. Black, non- Hispanic White, non- Hispanic Hispanic What are the trends among Broward County adult female HIV cases when race, ethnicity, and year of report are considered?

  22. Black Hispanic Other White Significant disproportionate impact among adolescent and adult HIV and AIDS racial and ethnic minorities are identified when comparing the rates to the Broward County population in 2007 2007 Broward County Population Estimates* (N=1,473,035) AIDS (N=641) HIV (N=823) Note: In this snapshot of 2007, blacks are over-represented among the AIDS cases, accounting for 59% of adult cases, but only 23% of the adult population. A group is disproportionately impacted to the extent that the percentage of cases exceeds the percentage of population. *Other includes Asian/Pacific Islanders and Native Alaskans/American Indians.

  23. Another approach to demonstrating disproportionate impact on Broward County men and women of color is to calculate reported AIDS case rates per 100,000 population in 2007 MALES Rate ratios Blacks: Whites, 3.2:1 Hispanics: Whites, 1.2:1 FEMALES Rate ratios Black: Whites, 12.8:1 Hispanics: Whites, 0.9:1

  24. A similar disproportionate impact is seen in HIV population adjusted HIV cases among women and men of color in Broward County in 2007 MALES Rate ratios Blacks: Whites, 1.8:1 Hispanics: Whites, 1.2:1 FEMALES Rate ratios Black: Whites, 14.9:1 Hispanics: Whites, 1.9:1

  25. The disproportionate impact of the HIV/AIDS epidemic is also seen in population adjusted HIV/AIDS case rates among men and women of color livingwith HIV/AIDS in 2007 MALES Rate ratios Blacks: Whites, 2:1 Hispanics: Whites, 1:0 FEMALES Rate ratios Black: Whites, 16:1 Hispanics: Whites, 2:1

  26. How did the distribution of HIV/AIDS cases among racial/ ethnic minorities compare to other FL counties in 2006?

  27. Another way to consider geographic and racial/ethnic differences among the five counties with the largest rates of HIV/AIDS in FL in 2006 is to use “one in” statements The one-in statement is an expression of the impact (or rate) of disease on the community

  28. Let’s shift gears and consider the relationship between age and HIV cases among Broward County adults Note: The percentage of newly reported cases has shown increases among the 20-29 age group over the past several years.

  29. The emerging HIV epidemic among young adults is reflected in adult HIV cases rates among Broward County residents in 2007, particularly among young females Males (N=580) Females (N=243) Percent Percent

  30. Now let’s address the role of exposure category on trends in Broward County HIV case rates among adults Note: NIRs redistributed Note: From 2001 – 2006, MSM HIV cases increased by 23%, while heterosexual male cases decreased by 5% and IDU male cases decreased 53%.

  31. Among Broward County adult female HIV cases, the predominance of heterosexual exposure has been consistent in the past ten years, with the number of cases related to injecting drug use dropping slightly Note: NIRs redistributed

  32. The transition in the HIV/AIDS epidemic among adult males is illustrated when you compare AIDS and HIV cases identified in 2007 by mode of exposure AIDS (N=407) HIV (N=580) Note: NIRs redistributed

  33. Striking differences among Broward County living adult male HIV/AIDS cases can be seen in 2007 when adjusting for race and ethnicity White, non-Hispanic N=(4,429) Black, non-Hispanic N=(3,666) Hispanic N=(1,457) Heterosexual MSM IDU

  34. Among Broward County adult female HIV/AIDS cases, the distribution of risk among whites differs from that among blacks and Hispanics, although heterosexual contact is the major risk for all races White, non-Hispanic N=(467) Black, non-Hispanic N=(3,324) Hispanic N=(299) Heterosexual IDU

  35. Let’s move on to consider the relationship between area of residence and presumed living female and male HIV/AIDS cases. We will explore the story that ZIP code mapping provides. • Adult males and females living with HIV/AIDS tend to reside in highly concentrated locales in the central eastern areas of Broward County • It should be noted, however, that HIV/AIDS cases reside throughout Broward County • Thus, it is important to ensure geographically accessible core medical and support services

  36. Let’s move from our focus on living HIV/AIDS cases to consider Broward County residents that had deaths related to HIV/AIDS in the last decade* Source: Office of Vital Statistics, Death Certificates*A change in coding of HIV/AIDS deaths from ICD-9 to ICD-10, effective in 1999, has resulted in an estimated increase of approximately 14% in the annual number of HIV/AIDS deaths.

  37. What population groups have unique service needs that must be addressed?

  38. What HIV special populations’ needs are currently addressed with Part A funds? • MSM, including racial/ethnic minority MSM • Women, infants, children, and youth (WICY) • Recently incarcerated • PLWHAs also diagnosed with Hepatitis C, mental illness, and/or addictions • Including crystal meth users • Immigrants (including long term and recent)

  39. Why are these populations specifically highlighted for Part A-funded services?

  40. What have we learned from Part A-sponsored special population studies? • Six studies have been completed • Haitian, Hispanic, homeless, MSM, recently incarcerated, persons out of care • Findings • Increased training opportunities are needed for providers serving these populations on culture and care seeking behaviors • Training for special population groups is needed on availability and costs of services • Expand availability of multicultural and multilingual services • Employ peers to access and retention in care • Several service categories already employ peers • More coordinated and deliberate scopes of work

  41. What else have we learned from Part A-sponsored special population studies? • Improve referrals made by case managers and primary care providers • Improve follow-up mechanisms to ensure completion of referrals • Adopt better tracking, use of peers, and implement multi-disciplinary care teams • Improve training regarding special populations by • Mandatory, frequent training for providers on the culture of these special populations • Educate special population members regarding key points of entry, increase information dissemination, train key informants/gate keepers on availability and costs of care

  42. Are there any other lessons learned from Part A-sponsored special population studies? • Improve the HIV care continuum by • Expanding multicultural and multilingual service provision, program directives • Exploring the latest strategies from the Office of Minority Health on CLASS standards of care • Address Comprehensive Plan Goals 1- 4 • Enhance Continuum of Care • Ensure the availability of core services • Eliminate disparities in access • Develop strategies for PLWHAP who know their status and are not in care

  43. Which funders pay for HIV care, how much do they pay, and are those funds sufficient to meet demand for HIV services?

  44. What are the sources and amounts of public funding for direct HIV services in Broward County for FY 2008? Does not include $217,234 in Part A banked units and $932,497 in unreimbursed expenditures

  45. How are public funds for HIV in Broward County distributed by direct service category?

  46. What is the average number of core medical service “visits” received per Broward County resident receiving Ryan White Program-funded services in 2007? Based on Calendar Year 2007 Ryan White Program Data Reports

  47. In the Broward County Part A Program, what services are funded, how many people are served, and what are their service utilization characteristics?

  48. What is the “inventory” of Part A-funded services?

  49. Your handouts summarize: • What core medical services were made available with Ryan White HIV/AIDS Program funds in 2007? • What non-core services are made available with Ryan White HIV/AIDS Program funds in 2007? • How many HIV+ clients and affected family members received Ryan White HIV/AIDS Program-funded services in 2007?

  50. What other Ryan White Program-funded services are provided to HIV+ Broward County residents? • The FL Part B program directly funds • FL AIDS Drug Assistance Program • AIDS Insurance Continuation Program (AICP) • Health insurance premium and co-payment assistance • We are awaiting data from the Part B Program to assess trends in utilization and expenditures among Broward County HIV+ residents

More Related