The Spectrum of Engagement in HIV Care at the Northwest Pennsylvania Rural AIDS Alliance By: Tyler Kitzmiller

What is HIV?  Human Immunodeficiency Virus  Causes Acquired Immune Deficiency Syndrome (AIDS)  Transferred through sex and blood-to-blood contact  34 million people

National Study on HIV Care  “The Spectrum of Engagement in HIV Care and its Relevance to Test-and-Treat Strategies for Prevention of HIV Infection” – Edward Gardner, et. al.  Looked at the level of engagement in HIV care in the United States  Purpose was to quantify the spectrum of engagement in HIV care.  Wide range of care in the United States

Findings of the Study

Statistical Breakdown Category ComparedPercent Comparison Percent of patients diagnosed who are linked to care 75% Percent of patients linked to care and retained in care 67% Percent of patients who are retained in care and need ARV therapy 80% Percent of patients who need ARV and are on ARV 75% Percent of patients who are on ARV and are adherent/undetectable 80% Percent of diagnosed patients who are adherent/undetectable 24%

My Project  Northwest PA Rural AIDS Alliance  Comparing the Engagement in Care

Northwest PA Rural AIDS Alliance  Grant-funded program under Clarion University, founded in 1991  Works to improve the health of underserved people affected by HIV/AIDS.  Provides care and medical case management to patients infected with HIV or co-infected with HIV and HCV.  Serves 13 counties in Northwest PA

Northwest Alliance Counties Served

Hypothesis & Alternate Hypothesis  Hypothesis  If I compare the rational analysis of the Northwest Alliance with that of the study, the adherence of patients at the Northwest Alliance will be equal to what was found in the national study.  Alternate Hypothesis  If I compare the rational analysis of the Northwest Alliance with that of the study, the adherence of patients at the Northwest Alliance will be less than what was found in the national study.

Why should you care?  Spread of HIV  Undiagnosed patients  Out-of-Care  Non-adherent patients  Medication Resistance

Data from the Alliance Stage of Engagement in CareNumber of Individuals HIV Diagnosed325 Linked to HIV Care325 Retained in HIV Care173 Need Anti-retroviral (ARV) Therapy67 On ARV Therapy61 Adherent/Undetectable34

Rational Analysis Comparison between the Study and Alliance Category Compared Percent Comparison from the Study Percent Comparison from the Alliance Percent patients diagnosed who are linked to care 75%100% Percent of patients linked to care and retained in care 67%53% Percent of patients who are retained in care and need ARV therapy 80%39% Percent of patients who need ARV and are on ARV 75%91% Percent of patients who are on ARV and adherent/undetectable 80%56% Percent of diagnosed patients who are adherent/undetectable 24%10%

Alliance Successes

Alliance Areas for Improvement

Conclusion  What the Alliance does well:  Linking patients to care  Starting and continuing medication treatment for patients  Areas of Improvement:  Retaining patients in care  Having patients be adherent/undetectable  When I compared the rational analysis of the Northwest Alliance with that of the study, the adherence of patients at the Northwest Alliance was less than what was found in the national study.

Further research  Why are patients not retained in care at the Alliance?  Why are patients not undetectable?  Are there similarities among these patients?  Race/Culture  Language barrier (non-English speaking?)  Gender  Medication  Are the patients attending their regularly scheduled doctor’s visit?  How is the Alliance successful at linking all of their patients to care?  How is the Alliance successful at making sure patients who need to be put on medication are put on medication?

Thank You  Dr. Doug Smith  Dr. Hallie Savage  Leah Magagnotti, BSN  Northwest PA Rural AIDS Alliance  Honors Program

References 1.Gardner, E. M., M. P. McLees, J. F. Steiner, C. Del Rio, and W. J. Burman. "The Spectrum of Engagement in HIV Care and Its Relevance to Test-and-Treat Strategies for Prevention of HIV Infection." Clinical Infectious Diseases 52.6 (2011): Print. 2."U.S. Statistics." U.S. Statistics. N.p., n.d. Web. 14 May Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 23 Apr Web. 14 May "CD4 Count, HIV, and AIDS: Test and Results -- What They Mean." WebMD. WebMD, 02 Apr Web. 14 May "HIV Classification: CDC and WHO Staging Systems." HIV Classification: CDC and WHO Staging Systems. N.p., n.d. Web. 14 May "Transmission of HIV." Transmission of HIV. N.p., n.d. Web. 14 May Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 15 Apr Web. 14 May 2013.