anne rhodes, director, hiv surveillance unit division of disease prevention office of epidemiology...
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Anne Rhodes, Director, HIV Surveillance UnitDivision of Disease Prevention Office of Epidemiology
HIV Program Integration
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Funding/Changing Grant Requirements• SPNS Systems Linkages – 4 year grant from
HRSA received in 2011 to improve HIV linkage, retention, and viral suppression using state-designed interventions
• CAPUS – 3 year grant from CDC received in 2012 to increase HIV diagnosis rates for racial and ethnic minorities and increase linkage, retention and re-engagement in care for racial/ethnic minorities living with HIV
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Division of Disease Prevention
HIV Prevention
HIV Care
HIV SurveillanceSTD Operations (includes DIS)
TB/Newcomer Health
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How to Define Care for HIV
CD4 Count
Viral Load
Evidence of HIV
Medication
Medical Visit
Care Markers
Ryan WhiteADAPVACRS
eHARSELR
MMP
Medicaid
HIV TestingCAPUS
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Virginia’s HIV Continuum of Care: Before and After Care Markers Database
0%10%20%30%40%50%60%70%80%90%
100%
72.8%
44.9%
30.4% 32.4%
75.1%
49.1%
37.1% 37.5%
Surveillance Only
Surveillance and Ryan White
100%
22,575
Data derived from HIV Surveillance, VACRS, ADAP data; Division of Disease Prevention, Virginia Department of Health; February/March 2014
N=926
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Continuum of Care for Ryan White Clients, 2013
0.0%10.0%20.0%30.0%40.0%50.0%60.0%70.0%80.0%90.0%
100.0%100.0% 97.4% 96.4%
85.2%76.7%
410 6,8316,031 5,431
All RW clients living with HIV in Virginia as of 2013
RW clients diagnosed with HIV in 2013 (N=421)
7,083
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Persons Living with HIV as of December 31, 2012 With A Care Marker in 2012
*11,082 had a care marker: medical visit, CD4 count, viral load, or ART prescription in 2012; 6 missing and 9 out of state at last locality
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Surveillance Data in ADAP• Needs assessment/program planning
• Complete missing data (demographics, labs)
• Quality Indicators, including retention in care, viral suppression, linkage to care rates
• Unmet need
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CAPUS Test Sites Map
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MMP and Care Markers• Used Care Markers to assist with location of
persons in MMP sample and utilized patient navigators at sites conducting MMP to assist in finding persons for MMP interviews
• Piloted at 2 sites in early 2014, plan to expand to all sites in upcoming cycle of MMP
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Re-Engagement in Care Pilot• Developed List of those diagnosed in:– 2013 without a care marker– 2009-2013 without a care marker
Piloting List with 3 local health departments and DIS
Have internal protocol for reviewing lists prior to sending to DIS
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CDC Consultation (July 2014)
Cases in Ryan White and not in Surveillance
Who can follow up when
someone falls out of care?
Consumer Input – want
testing sites to do follow up
Reviewed Ethical
Framework for Data to Care
Activities