Establishing the H4C Viral Suppression Cohort Michael

Overview H4C participants at LS1 discussed overall collaborative impact assessments and the need for a more direct measurement of impact Creation of cohort to show patient-level improvement in viral load suppression in H4C Updated annually to see improvement in this cohort over a two-year period

Expectations for Participation Submit baseline performance data and annual updates (2015 & 2016) to NQC Note that this continues after the transition to the sustainability phase in July 2015 Roll up data similarly to performance measurement: Grantees roll up subgrantee data Grantee reports data to Response Team Response Team submits data to NQC

Measure Definitions – Establish Cohort Definition of the cohort Patients, regardless of age, with a diagnosis of HIV with a HIV viral load greater than or equal to 200 copies/mL at last HIV viral load between July 1, 2013 – June 30, 2014 Numerator Number of patients in the denominator with a HIV viral load greater or equal to than 200 copies/mL at last HIV viral load test during the measurement period between July 1, 2013 – June 30, 2014 Denominator Number of patients, regardless of age, with a diagnosis of HIV with at least one medical visit between July 1, 2013 – June 30, 2014 Exclusions 1. Patients who are documented to be deceased during the measurement year 2. Patients who were incarcerated for the greater than 6 months of the measurement year 3. Patients who relocated out of the care site’s geographic catchment during the measurement year 4. Patients who transferred HIV medical care during the measurement year

Measure Definitions Update #1: 2015 Viral suppression among cohort Patients, regardless of age, with a diagnosis of HIV with a HIV viral load less than 200 copies/mL at last HIV viral load between July 1, 2014 – June 30 , 2015 Numerator Number of patients in the denominator with a HIV viral load less than 200 copies/mL at last HIV viral load test between July 1, 2014 and June 30, 2015 Denominator Number of cohort patients (number of patients, regardless of age, with a diagnosis of HIV with at least one medical visit and not virally suppressed between July 1, 2013 – June 30, 2014) Exclusions 1. Patients who are documented to be deceased during the measurement year 2. Patients who were incarcerated for the greater than 6 months of the measurement year 3. Patients who relocated out of the care site’s geographic catchment during the measurement year 4. Patients who transferred HIV medical care during the measurement year

Measure Definitions Update #2: 2016 Viral suppression among cohort Patients, regardless of age, with a diagnosis of HIV with a HIV viral load less than 200 copies/mL at last HIV viral load between July 1, 2015 – June 30, 2016 Numerator Number of patients in the denominator with a HIV viral load less than 200 copies/mL at last HIV viral load test between July 1, 2015 and June 30, 2016 Denominator Number of cohort patients (number of patients, regardless of age, with a diagnosis of HIV with at least one medical visit and not virally suppressed between July 1, 2013 – June 30, 2014) Exclusions 1. Patients who are documented to be deceased during the measurement year 2. Patients who were incarcerated for the greater than 6 months of the measurement year 3. Patients who relocated out of the care site’s geographic catchment during the measurement year 4. Patients who transferred HIV medical care during the measurement year

Eligible patients: Number of patients, regardless of age, with a diagnosis of HIV with at least one medical visit between July 1, 2013 and June 30, 2014 Virally suppressed: Patients with a HIV viral load less than 200 copies/mL at last HIV viral load test Closed Cohort/Not virally suppressed: Patients with a HIV viral load greater than or equal to 200 copies/mL at last HIV viral load test (not virally suppressed) between July 1, 2013 – June 30, 2014 Censorship: Patients who have died, moved away, transferred their care, or were incarcerated more than 6 months Update 1: Of those in the closed cohort, patients in the with a HIV viral load less than 200 copies/mL at last HIV viral load test between July 1, 2014 and June 30, 2015 Censorship: Patients who have died, moved away, transferred their care, or were incarcerated more than 6 months Update 2: Of those in update 1, patients in the with a HIV viral load less than 200 copies/mL at last HIV viral load test between July 1, 2015 and June 30, 2016

Cohort Viral Load Suppression Rate for 2015 = Those in denominator with suppressed viral load for last test in 2014/2015 reporting period Cohort Viral Load Suppression Rate for 2015 = Moved, transferred. incarcerated, died as of June 30, 2015 Original Closed Cohort Those in denominator with suppressed viral load for last test in 2015/2016 reporting period Cohort Viral Load Suppression Rate for 2016 = Denominator from 2015 update (green minus red boxes above) Moved, transferred, incarcerated, died as of June 30, 2016

Setting Goals * 20% improvement goal based on NHAS goals  State Cohort Denominator Based on Apr 2014*** 20%* Improvement Goal: Estimated Number of Patients achieving Viral Load Suppression by June 2016** AR 325 65 MO 631 126 MS 1328 266 NJ 3407 681 OH 2424 485 All States 8115 1625 * 20% improvement goal based on NHAS goals ** Will be updated to reflect new baseline date *** Based on H4C Round 1 data submission

Timelines and Milestones April 2014: cohort discussed by H4C participants June 2014: cohort designed by HAB and NQC July 2014: cohort finalized by NQC with H4C team input August 2014: cohort study announced to all H4C teams October 2014: H4C teams submit cohort baseline data (n.i.n) December 2014: H4C teams submit complete cohort baseline data October 2015: H4C teams submit cohort update 1 October 2016: H4C teams submit cohort update 2

Review of Data Collection Tool Michael

Group Discussion