2010-2011 Ryan White Services Report Data

CAPT Tracy MatthewsActing Director, Division of Policy and Data

E. Amaka Nwankwo-IgomuChief, Data Management Branch

U.S. Department of Health and Human Services

Health Resources and Services Administration

HIV/AIDS BureauFebruary 5, 2014

Objectives

• At the end of this presentation, participants will be able to:• Describe the Ryan White HIV/AIDS Program

(RWHAP) and the HIV epidemic in the United States

• Discuss Ryan White Services Report (RSR) data results

• Identify the impact RWHAP has had on the HIV epidemic

• Identify planned future analyses using RSR data

Presentation Overview

• HIV Epidemiology• RWHAP Background• RSR Background• Program Reach• RSR Demographics• RWHAP Funded Services• Summary and Future Data

HIV Epidemiology in the United States

Overview

• CDC estimates that 1,148,200 persons ages 13 years and older are living with HIV infection; 207,600 (18.1%) are unaware of their infection (Source: CDC Fact Sheet HIV in the United States: At A Glance, February 2013)

• At the end of 2010, an estimated 888,921 adults and adolescents were living with diagnosed HIV infection in the United States and six dependent areas(Source: CDC slide set, Epidemiology of HIV Infection through 2011)

Ryan White HIV/AIDS Program Background

About the Ryan White HIV/AIDS Program

• The Ryan White HIV/AIDS Program (RWHAP) provides HIV-related services to more than half a million people each year

• First enacted in 1990 as the Ryan White CARE (Comprehensive AIDS Resources Emergency) Act

• Amended and reauthorized four times: in 1996, 2000, 2006, and 2009

About the Ryan White HIV/AIDS Program

• Largest Federal program focused exclusively on HIV/AIDS care

• Through a number of programs, called Parts, RWHAP works with cities, states, hospitals, community health centers and other organizations

• For individuals living with HIV/AIDS who have: o No health insurance (public or private) o Have insufficient health care coverage o Lack financial resources to get the care they need

for their HIV disease

RSR Data Management Background

RSR Data Background

• In 2009, outpatient ambulatory medical care (OAMC), medical case management (MCM) and case management (CM) providers were required to report client-level data for the first time

• In 2010, all providers were required to report client-level datao Ryan White Services Report (RSR)

• The Ryan White Data Report (RDR) was retired in 2010

• RSR refers to all RWHAP “client-level data”

RSR Background

• Data are reported annually during submission periodo Calendar year data reported

• The HIV/AIDS Bureau needed to develop a data management process for client-level datao Six stage process

RSR Data Management Process

Raw Data Files

Clean #1

De-duplicat

eMerge Clean

#2Analytic Files

12-18 months

RSR Data Management Process

• De-duplicationo Probabilistic record linking approachoUnique eUCIs are considered unique

• Uses several demographic data elements• Felligi-Sunter model used to assign each

record pair a score based on the demographic data elements

• Threshold for accepting or rejecting match is established

RSR Data - The Details

Important things to keep in mind:• This is a new dataset and as such is not

considered to be matureo2011 data are preliminaryoData quality issues such as high

missing/unknown valuesoReflects data reported but may not fully reflect

services provided

Ryan White HIV/AIDS Program Response to the Epidemic

Overview

• During calendar year 2011, an estimated 553,999 individuals received at least one RWHAP-funded service in calendar year (Source: preliminary Ryan White Services Report data, CY 2011)

• Based on CDC estimates, in the United States, RWHAP is serving 48% of estimated persons living with HIV infection (n= 1,148,200) and 62% of estimated persons living with diagnosed HIV infection (n=888,921)

Gender of Adults and Adolescents Living with Diagnosed HIV Infection as of the End of 2010

and RWHAP Clients, Calendar Year 2011

Male Female Transgender0%

20%

40%

60%

80%

100%

75%

25%

69%

30%

<1%

HIV Surveillance RSRHIV Epidemiology source: CDC Slide set, Epidemiology of HIV Infection through 2011. Gender represents adult and adolescent cases living as of 12/31/2010.Ryan White HIV/AIDS Program source: RSR preliminary 2011 data. Gender represents clients who received at least one RWHAP-funded service in calendar year 2011.

Race/Ethnicity of Adults and Adolescents Living with Diagnosed HIV Infection as of the End of 2010 and

RWHAP Clients, Calendar Year 2011

White NH Black/African American NH

Hispanic Other0%

20%

40%

60%

80%

100%

33.9%43.8%

18.9%

3.2%

27.8%

47.3%

21.9%

2.9%

HIV Surveillance RSRHIV Epidemiology source: CDC Slide set, Epidemiology of HIV Infection by Race/Ethnicity through 2011. Race/ethnicity represents adult and adolescent cases living as of 12/31/2010. RWHAP source: RSR preliminary 2011 data. Race/ethnicity represents clients who received at least one RWHAP-funded service in calendar year 2011.

Demographics

Ryan White Services Report, 2010 & 2011Gender of Clients Served

2010

2011

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

68.5%

69.1%

30.7%

30.1%

Male Female Transgender*

*Less than 1% of clients served were transgender. Gender was unknown or missing for 413 clients in 2010 and 233 clients in 2011.

N = 553,766

N = 555,762

Ryan White Services Report, 2010 & 2011Race/Ethnicity of Clients Served

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

2010 (N=543,075) 2011 (N=540,192)

Race/ethnicity is unknown or missing for 13,100 clients in 2010 and 13,807 clients in 2011. Race and ethnicity required for all clients regardless of services received.

Ryan White Services Report, 2010 & 2011Age of Clients Served*

< 2 2-1213-24

25-29 30-39

40-4950-59

60+0.0%5.0%

10.0%15.0%20.0%25.0%30.0%35.0%40.0%

2010 (N=555,955)

Birth year is missing for 220 clients in 2010 and 13 clients in 2011. Birth year required for all clients regardless of services received.

Ryan White Services Report, 2010 & 2011Client Payer Source

2010

2011

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

13.0%

13.3%

9.3%

9.2%

27.4%

27.0%

7.8%

6.8%

26.1%

27.8%

3.6%

2.7%

12.9%

13.2%

Private Medicare Medicaid Other Public No Insurance Other Mulitple Ins.

Payer source is unknown or missing for 78,463 clients in 2010 and 45,918 clients in 2011. Payer source is required for clients who received any core medical service or non-medical case management services.

N = 466,819

N = 429,256

Ryan White Services Report, 2010 & 2011Housing Status For Clients Served

2010 (N=395,568) 2011

(N=426,069)

0.0%

25.0%

50.0%

75.0%

100.0%

84.2%84.2%

12.8% 12.4%3.0% 3.4%

Housing Status By Year

Unstable HousingTemporary Hous-ingStable Housing

Housing status is unknown or missing for 60,346 clients in 2010 and 43,441 clients in 2011. Housing status is required for clients who received outpatient ambulatory medical care, medical case management, non-medical case management, or housing services.

Ryan White Services Report, 2010 & 2011HIV Status of Clients Served

0.0%

25.0%

50.0%

75.0%

100.0%HIV Status by Year

HIV status is unknown or missing for 4,150 clients in 2010 and 4,919 clients in 2011. HIV status is required for clients who received outpatient ambulatory medical care, medical case management, or non-medical case management services.

Ryan White Services Report, 2010 & 2011Annual Household Income for Clients Served

2010

2011

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

66.6%

66.6%

21.7%

21.7%

6.5%

6.7%

5.2%

4.9%

< = 100% FPL 101% - 200% FPL 201% - 300% FPL < 300% FPL

Annual household income is unknown or missing for 76,134 clients in 2010 and 49,743 clients in 2011.

N = 376,816

N = 416,653

Ryan White Funded Services

Top 10 Services Used, By YearService 2010 20111. Outpatient Ambulatory Medical Care* 56.7% 57.0%2. Medical Case Management* 52.9% 54.2%3. Case Management 26.1% 27.0%4. Oral Health* 15.8% 16.1%5. Transportation 14.2% 14.0%6. Mental Health* 13.6% 13.8%7. Health Education Risk Reduction 12.8% 12.0%8. Food Bank 12.0% 10.7%9. Psychosocial Support 11.4% 10.6%

10. Treatment Adherence 9.4% 10.3%

*Core Medical Services

2010 Ryan White Services Report (RSR)Number of Clients Served and Visits for Core Medical

ServicesCore Medical Services

Clients Served

Total Visits

Mean Visits/Client

Median Visits/Client Range

Outpatient Ambulatory Medical Care 315,270 1,868,501 5.93 4.0 1 – 353

Oral Health Care 88,132 320,393 3.64 2.0 1 – 100

Early Intervention Services 22,205 71,842 3.24 1.0 1 – 155

Home Health Care 1,670 25,981 15.56 6.0 1 – 362

Home & Community-Based Health Care 1,803 45,278 25.11 9.0 1 – 360

Hospice 196 3,845 19.62 3.0 1 – 365

Mental Health 75,639 511,544 6.76 3.0 1 – 361

Medical Nutrition Care 44,328 168,304 3.80 1.0 1 – 368

Medical Case Management 294,224 3,072,822 10.44 5.0

1 – 368

Substance Abuse - Outpatient 25,922 351,608 13.56 3.0 1 – 368

2011 Ryan White Services Report (RSR)Number of Clients Served and Visits for Core Medical

Services

Core Medical ServicesClients Served

Total Visits

Mean Visits/Client

Median Visits/Client Range

Outpatient Ambulatory Medical Care 319,649 1,776,340 5.56 4.0 1-304

Oral Health Care 89,183 304,541 3.41 2.0 1-75

Early Intervention Services 18,027 77,698 4.31 1.0 1-174

Home Health Care 1,493 20,928 14.02 5.0 1-362Home & Community-Based

Health Care 1,504 32,848 21.84 7.0 1-298

Hospice 160 7,643 47.77 8.0 1-365

Mental Health 76,320 503,474 6.6 3.0 1-259

Medical Nutrition Care 46,012 180,013 3.91 1.0 1-368

Medical Case Management 300,455 3,135,945 10.44 5.0 1-363

Substance Abuse - Outpatient 24,131 303,183 12.56 3.0 1-368

Ryan White Services Report, 2010 & 2011Percentage of Clients Served By Core Medical

Service

Substance Abuse Tx - Outpatient

Med. Case Mgmt.

Med. Nutrition

Mental Health

EIS

Oral Health

Outpatient Medical Care

0 10 20 30 40 50 60 704.7

52.9

8

13.6

4

15.8

56.7

4.4

54.2

8.3

13.8

3.3

16.1

57.7

2011 2010Fewer than 1% of clients received the following services: home health care, home and community-based case, and hospice.

Ryan White Services Report, 2010 & 2011 Percentage of Clients Receiving Support

Services*

Treatment Adherence

Referrals to Health Care and Support Services

Psychosocial Support

Outreach

Transportation

Legal Services

Housing

Health Education/Risk Reduction

Food Bank/Home Delivered Meals

Emergency Financial Assistance

Case Management - Non-Medical

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0%9.40%

5.50%

11.40%

5.80%

14.20%

2.70%

3.40%

12.80%

12.00%

5.60%

26.10%

10.3%

6.1%

10.6%

5.7%

14.0%

2.5%

3.2%

12.0%

10.7%

4.9%

27.0%

*Fewer than 1% of clients received the following services: childcare, developmental assessment, linguistics, permanency planning, rehabilitation, respite care, and substance abuse treatment, residential.

Summary of the Ryan White HIV/AIDS Program in Context

Summary of the Ryan White HIV/AIDS Program

• Compared to national surveillance data, the RWHAP serves a higher proportion of:o Womeno Racial/Ethnic Minorities

• RWHAP serves almost half (48%) of estimated persons living with HIV infection (n= 1,148,200)

• Approximately 62% of estimated persons living with diagnosed HIV infection (n=888,921) are RWHAP clients

A Look at 2011 State Profiles

• State-level information related to the Ryan White HIV/AIDS Program

• Data sources: o Health Resources and Services

Administration o Census Bureau (Poverty and Health

Insurance data)o Centers for Disease Control and Prevention

(CDC) (HIV/AIDS Surveillance data)

State Profiles Overview

State Profiles Content

• Section A — State Overview• Section B — HIV/AIDS Epidemic • Section C — Program Grantees and Funding • Section D — Provider Characteristics• Section E — Client Characteristics  • Section F — Services  • Section G — Clinical Data NEW!• Section H — AIDS Drug Assistance Program  • Section I — Oral Health NEW!• Section J — HHS Indicators NEW!• Section K — National HIV/AIDS Strategy NEW!

Future/Next Steps

Future/Next Steps

• 2014 Upcoming Data Releases o RSR 2012 Preliminary Datao Continuum of HIV care among Ryan White

HIV/AIDS Program clients—United States, 2010 and 2011 (Doshi, R. et al. In Progress)

• National HIV/AIDS Strategy and Health and Human Services Indicators

HRSA/HAB HIV Care Continuum: Initial Concepts

Cheever L. Clinical Infectious Diseases 2007;44:1500-2.

CDC Stages of Care – 2009 National HIV Surveillance System & Medical

Monitoring Project

CDC. HIV in the United States: Stages of Care. July 2012.Hall HI, Frazier EL, Rhodes P, et al. JAMA Internal Medicine. Jun 17 2013:1-7.

Persons in Care: Ryan White Services Report, 2010 and 2011

Retention in HIV Care and Viral Suppression

Ryan White Services Report, 2010 and 2011

Retention in HIV careNumerator: At least 2 HIV care visits at least 90 days apart during the calendar yearDenominator: HIV+, RWHAP-funded HIV care, visit dates available

Viral suppressionNumerator: HIV-1 RNA <200 copies/ml at the most recent check during the calendar yearDenominator: HIV+, RWHAP-funded HIV care, visit dates & viral load available

HHS Indicators

HHS INDICATORS DEFINITIONS

HIV Positivity Percentage of HIV test that were HIV positive

Antiretroviral Therapy (ART) Among Persons in HIV Medical Care

Percentage of HIV positive clients who had at least one OAMC visit and were prescribed ART

Viral Load Suppression Among Persons in HIV Medical Care

Percentage of HIV positive clients who had at least one outpatient ambulatory medical visit, had at least one viral load reported, and the most recent viral load was <200 copies

Housing Status Percentage of clients with a known status whose status was HIV positive non-AIDS, AIDS status unknown, or AIDS who were unstably housed

Questions?

Amaka Nwankwo-Igomu301-443-6561

enwankwo-igomu@hrsa.gov

Contact Information