Morbidity Monitoring Project Data 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 Project 1 st 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 2 nd /3 rd 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 Project Focus Areas Social Support Adherence Substance use Access to care Quality of care Treatment Morbidity

Morbidity Monitoring Project Access 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 Project Treatment 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 Project Behaviors 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 ( ) –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