Using Data to Improve Linkage to Care

Debbie Wendell, PhD, MPH Louisiana STD/HIV Program

Louisiana STD/HIV Program

How can data be used to improve programs?

• Where are the biggest gaps in the HIV continuum of care?

• Are there race, gender or age disparities? • How quickly are clients getting linked to

care? • Are clients retained in care? • How does my agency compare to others?

How do we measure linkage, retention and viral suppression?

• Use CD4/VL results as a proxy for an HIV-related medical visit

o All HIV-related test results are reportable in Louisiana

o Most are reported electronically on a daily basis

• Measurement standards o Linkage: Was a person newly-diagnosed with HIV

linked to HIV-related medical care within 90 days?

o Retention: Did a person living with HIV have 2 or more care visits within a 12 month period?

o Viral Suppression: Was the most recent VL <=200?

HIV Continuum of Care Louisiana, 2013

100%

69%

54% 49%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Persons living with HIV In HIV care Retained in HIV care Viral suppression (<=200)

Perc

enta

ge

18,199

9,774

12,536

8,831

70% of PLWH in care were virally suppressed

Louisiana STD/HIV Program

Percent Retained in Care among PLWH by Region, Louisiana, 2013

Louisiana STD/HIV Program

52%

60% 60%

54%

46% 51%

46% 51%

53%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Pe

rce

nta

ge

Region

Louisiana STD/HIV Program

Percent Virally Suppressed among PLWH in Care by Region, Louisiana, 2013

Louisiana STD/HIV Program

68% 71%

75% 75% 71% 71% 68%

72% 76%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Pe

rce

nta

ge

Region

Louisiana STD/HIV Program

HIV Continuum of Care by Race/Ethnicity Louisiana, 2013

100% 100% 100%

70%

45%

70%

54%

35%

55%

46%

35%

58%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Black Hispanic White

Perc

enta

ge

PLWH

In HIV care

Retained in care

Viral suppression

66% of PLWH in care were virally

suppressed

77% of PLWH in care were virally

suppressed

82% of PLWH in care were virally

suppressed

N = 12,442

N = 693

N = 4,861

Louisiana STD/HIV Program

HIV Testing by Site Type Louisiana, 2013

Total Number of Tests

(% of Tests)

Number of Positive Results

% Positivity Total

Positives

Number of New

Positives

% Positivity New

Positives

Total 95,656 1,069 1.1% 532 0.6%

Parish health unit 36,347 (38%) 226 0.6% 146 0.4%

Emergency department 19,484 (20%) 235 1.2% 130 0.7%

Correctional facility 16,385 (17%) 275 1.7% 27 0.2%

Community-based org 15,701 (16%) 279 1.8% 198 1.3%

Community health clinic 4,206 (4%) 45 1.1% 25 0.6%

Substance abuse clinic 2,805(3%) 5 0.2% 2 0.7%

School/college 728 (1%) 4 0.5% 4 0.5%

Linkage to Care within 90 Days Louisiana, 2007 -2014

67% 70% 70%

73% 74% 78% 79%

83%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2007 2008 2009 2010 2011 2012 2013 2014

Year of Diagnosis

National HIV/AIDS Strategy Objective: 85%

Louisiana STD/HIV Program

Linkage to Care within 90 Days by Region, 2013

Louisiana STD/HIV Program

78% 74%

86%

78%

90% 87%

74%

83% 85%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Pe

rce

nta

ge

Region

National HIV/AIDS Strategy Objective: 85%

Louisiana STD/HIV Program

Linkage to Care – New Positives By Site Type, Louisiana, 2013

Number of New

Positive Results

Number Linked to

Care within 90 Days

% Linked to Care within

90 Days

Total 532 365 69%

Community-based org 198 138 70%

Parish health unit 146 85 58%

Emergency department 130 111 85%

Correctional facility 27 12 44%

Community health clinic 25 17 69%

Substance abuse clinic 2 0 0%

School/college 4 2 50%

Time to Linkage to Care New Positives - CBOs, Louisiana, 2013

0

10

20

30

40

50

0-7 8-15 16-30 31-45 46-90 91-180 181-270 >270

Days to Entry into Care Louisiana STD/HIV Program

Linkage to Care within 90 Days New Positives - CBOs, Louisiana, 2013

79%

100%

54%

81% 80%

57%

84%

70%

60%

100% 100%

0%

20%

40%

60%

80%

100%

A B C D E F G H I J K

CBO Louisiana STD/HIV Program

National HIV/AIDS Strategy Objective: 85%

Linkage to Care – New Positives By Gender and Race/Ethnicity, CBOs, 2013

Number of New

Positive Results

Number Linked to

Care within 90 Days

% Linked to Care within

90 Days

Total 198 138 70%

Female 30 16 53%

Male 168 122 73%

African American/Black 118 73 62%

Hispanic/Latino 6 6 100%

White 68 55 81%

Linkage to Care – New Positives By Age Group, CBOs, 2013

Number of New

Positive Results

Number Linked to

Care within 90 Days

% Linked to Care within

90 Days

Total 198 138 70%

16-24 years old 65 48 74%

25-44 years old 99 68 69%

>=45 years old 33 21 64%

Initial CD4 and Viral Load CBOs, 2013

• CD4 count o Range: 6 - 1,169 o Median: 448 o Average: 439 o 28 clients had a CD4 count <=200 (meet AIDS case

definition)

• Viral load o Range: <20 – 5,589,140 o Median: 37,080 o Average: 164,125 o 8 clients had a VL<=200 (i.e., virally suppressed)

HIV Continuum of Care - 2014 CBO – New Positives Diagnosed in 2013

100%

76%

60% 56%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

New Positives Dx in 2013

In HIV care Retained in HIV care Viral suppression (<=200)

Perc

enta

ge

198

118

150

111

74% of persons in care were virally suppressed

Louisiana STD/HIV Program

Evaluating Linkage to Care

• How do you evaluate linkage/retention in care at your agency?

• Do you collect any data to look at linkage to care?

• What are the data gaps? • How can SHP help provide you useful data?

Questions?

For more information: Debbie Wendell, PhD, MPH STD/HIV Program Louisiana Office of Public Health (504) 568-7474 debbie.wendell@la.gov