Morbidity Monitoring ProjectData for Resource Planning and Evaluation

A.D. McNaghten

Centers for Disease Control and Prevention

Data for HIV Prevention and CARE Planning

• Who is infected with HIV (race, risk, gender)?• What behaviors are persons who are and are

not HIV-infected engaging in?• Are patients receiving care and treatment in

accordance with USPHS guidelines?• Are patients receiving care in Ryan White

funded facilities receiving the same quality of care as patients in private facilities?

• What are the barriers to receiving care and services?

Surveillance Tools• SHAS (interview)

– Risk behaviors of persons with HIV infection– Reasons for testing– Factors associated with receipt of antiretroviral therapy – Adherence to therapy– Sex and drug use behaviors

• ASD (medical record abstraction)– Clinical outcomes of HIV infection

– Trends and risk factors for opportunistic infections – Evaluate impact of treatment and prophylaxis on disease

progression and survival

Surveillance Tools

• SHDC and SHDC+ (abstraction + interview)– Population-based– Clinical outcomes, treatment– Behaviors

• Limitations– ASD and SHAS convenience samples– SHDC not representative of entire state or nation– Limited areas participating

• Lack of nationally representative estimates of persons infected with HIV who are in care and

• Type and quality of care received• Behaviors currently engaging in

Surveillance Tools• Morbidity Monitoring Project (interview +

abstraction)– Locally and nationally representative sample of HIV

infected adults in care– Behaviors

• Adherence; sexual; drug use; care-seeking

– Clinical outcomes• Treatment; CD4 and viral load; opportunistic illnesses

– Type and quality of care received– Identify met and unmet needs for HIV care and

prevention services• To inform community and care planning groups, health care

providers and other stakeholders

Morbidity Monitoring Project1st stage

• Sampling frame – 50 states + Puerto Rico + District of Columbia

were eligible

• Sample selected– Probability Proportional to Size (PPS)

• Based on prevalent AIDS cases within each area

– 20 areas selected• Based on available funds• Estimated to include >80% of US AIDS cases

Morbidity Monitoring Project 2nd/3rd stage

• Sample of providers (~40-60)– Will include large, medium and small

facilities/clinics/practices– Public and private– HRSA-funded and non HRSA-funded

• Sample of patients (~400)– Randomly sampled within each facility

• ≥18 years old; HIV+; receiving care

Morbidity Monitoring ProjectFocus Areas

Social Support

Adherence

Substance use

Access to care

Quality of care

TreatmentMorbidity

Morbidity Monitoring ProjectAccess to Care

Among PLWH:• What proportion use

multiple sources of care?• What are the met/unmet

needs for medical services?

• What proportion who know their diagnosis are not in care?

Morbidity Monitoring ProjectTreatment

Among PLWH: • What proportion are

receiving treatment and care according to the PHS guidelines?

• Of those eligible for ART, what proportion are prescribed ART?

• What proportion on ART are adherent to the current regimen?

• What factors are associated with non-adherence to ART?

Morbidity Monitoring ProjectBehaviors

Among PLWH: • What risk behaviors for

HIV are people engaging in?

• To what extent do they feel stigmatized due to HIV?

• What prevention and support services are they receiving?

Where are we?

Morbidity Monitoring Project Plan

Year 1 Data Collection 2005– 13 sites

• 6 interview and abstraction• 6 interview only • 1 abstraction only

– 13 sites start-up activities

• Year 2-4 Data Collection (2006-2008)– 26 sites to conduct data collection– Interviews and abstractions

Critical Issues

Provider Acceptance

• Locally– Conduct provider education sessions – Identify key members of clinical and public

health community to promote and support the project

• Nationally– Convening a provider advisory board– Provide technical assistance in development

of provider education materials and recruitment

Community and Consumer Acceptance

• Locally– Community involvement in the MMP– Identify key members of community to

promote support of the project and get community and consumer input

• Nationally– Convening a community advisory board– Provide technical assistance in development

of consumer education materials and patient recruitment

Ongoing Collaboration

• Community, providers, local/state health departments, CDC

• Provider recruitment

• Patient recruitment

• Data collection– Needed data for allocation of prevention and

care resources