1. Review of the Medical Monitoring Project Outcomes of Interest Pilot Year Data MMP PAB/CAB Meeting May 31, 2007 Department of State Health Services Epidemiology & Surveillance Unit Sylvia L. Odem, MPH Project Coordinator

2. Acknowledgements to the Pilot Year TX-MMP Team: Katharine Carvelli, Epidemiologist Mark Heinzke, Data Manager Sharon K. Melville, Principal Investigator Nita Ngo, Epidemiologist Jim Phillips, Data Collector Renee Ridgley, Data Collector Tammy Sajak, Co-Principal Investigator Jose Velez, Data Collector Simone Wooden-Jackson, Data Collector

3. What is the Medical Monitoring Project (MMP)? A survey and medical chart review about the experiences and needs of people living with HIV and AIDS in the US Behaviors Clinical outcomes Type and quality of care received Identify met and unmet needs for HIV care and prevention services

4. MMP Goals Determine access to and use of prevention and support services Provide local and national estimates for the population in care for HIV Examine variations of factors by geographic area and patient characteristics (i.e. risk behaviors, quality of care etc.)

5. How you might use the MMP data Supplement your local needs assessments Determine need for new programs in your organization Use for grant applications and RFP’s Use as a benchmark for your programs Requests for special data runs

6. Nationally Representative Three Stage Sampling Design 1 st stage - Site 20 states + 6 cities randomly selected 2 nd stage - Provider 40-60 facilities randomly selected - large, medium, and small 3 rd stage - Patient 400 randomly selected patients High Medium Low LA County Alaska Hawaii Puerto Rico New York CitySan Francisco Houston Chicago Philadelphia

7. MMP Success MMP COMMUNITYPROVIDERS

8. MMP Data collection Pilot Year – 2005 Preliminary data 13 sites Sampled 27 facilities Sampled 150 patients 81 interviews 86 chart abstractions Project Year – 2007 Full year – all 26 sites participating Sampled 47 facilities 27 recruited to-date 400 patients to be sampled 400 interviews & abstractions to be done

9. Demographics & Patient Characteristics

10. Gender

11. Race/Ethnicity

12. Age by Race

13. (14%)(21%)(48%)(18%)

14. Education by Race WhiteBlackHispanicOtherTotal Grades 1-11 6%37%25%0%18% Completed high school or GED 22%37%20%*24% Some college, associate's degree or technical degree 44%26%45%*39% Bachelor's degree or postgraduate studies 25%0%10%*17% Total 45%24%25%4%100% *Cell suppressed for n<3

15. Age First Positive by Race (44%)(40%)(15%)(1%)

16. Number of Years HIV Positive n=25 n=22 n=12 n=13 * *Cell suppressed for n<3

17. Alcohol and Drug Use n=46 n=21

18. Date of Last Injection and First Positive Date

19. Frequency of Alcohol Consumption in Past 12 Months* *51% of those interviewed reported alcohol use in the past 12 months

20. No. of Alcoholic Drinks in Typical Day in Past 30 Days

21. Drug Use in Past 12 months *Embalming fluid

22. Mean Number of Sexual Partners in the Past 12 months Mean Male: Male Partner(s)2 Male: Female Partner(s)1 Female: Male Partner(s)1

23. Male: Male Partner(s) 64% of men interviewed reported having male sexual partner(s) in the past 12 months n (%) Last partner main21 (43%) Last partner casual16 (33%) Anal sex 28 (57%) Unprotected anal sex* 13 (46%) Insertive partner*5 (18%) Receptive partner6 (21%) Insertive and receptive partner 17 (61%) Discussed HIV status before 1 st sex w/ last partner* 8 (29%) *Among men who reported having anal sex in past 12 months

24. Male: Male Partner(s) – Last Time You Had Sex Last Time You Had Sex:(n=39) Oral Sex Only14 (36%) Sexual Partner was a Main Partner22 (56%) Sexual Partner was a Casual Partner17 (44%) Knew HIV Status of Last Partner32 (82%) Partner was HIV+15 (47%) Partner was HIV-17 (53%)

25. Male: Female Partner(s) 10% (n=7) of men interviewed reported having female sexual partner(s) in the past 12 months Last partner main5 (71%) Last partner casual* Vaginal Sex5 (71%) Unprotected vaginal sex3 (60%) Anal sex* Unprotected anal sex* Discussed HIV status before 1 st sex* *Cell suppressed for n<3

26. Female: Male Partner(s) 46% (n=6) of women had male sexual partner(s) in the past 12 months Last partner main6 (100%) Last partner casual0 Vaginal Sex6 (100%) Unprotected vaginal sex* Anal sex0 Unprotected anal sex0 Discussed HIV status before 1 st sex* *Cell suppressed for n<3

27. Access to Care & Need for Services

28. Public Assistance and Homelessness in Past 12 Months n=7 n=45 *57% (n=4) of homeless were receiving public assistance

29. Health Insurance Coverage

30. Payment Method for HIV Meds & Other Meds in Past 12 Months Payment Method for Treatmentn (%) Not on meds6 (8%) Healthcare coverage 22 (27%) Received meds from public clinic4 (5%) Out-of-pocket2 (2%) Out-of-pocket & healthcare coverage4 (5%) ADAP alone or in combination27 (33%) Other combination4 (5%) Other12 (15%)

31. Time to Start HIV Care

32. Reasons for Delay in HIV Care Didn’t want to think about being HIV positive (main reason) Felt good, didn’t need to go Too busy to go Didn’t want to believe HIV test results Drinking or using drugs Fear of being socially ostracized Felt meds were dangerous

33. Need and Receipt of Services in the Past 12 Months Needed Not Received HIV Case Management 46%14% Mental Health Counseling 30%17% Social Services 25%20% Help finding dental services 17%7% Help with finding meals/food 17%14% Transportation assistance 17%29% Education or information on HIV risk reduction 16%2% Help finding shelter or housing 12%70% Help finding a doctor for ongoing medical services 7%17% Adherence support services 6%40% Home health services, such as home nursing care 4%33% Chore or homemaker services 4%33% Childcare Services 0%N/A

34. Reasons for Not Receiving Services Needed Didn’t know where to go/who to call (n=12) Service not available in patient’s area (n=4) Waiting list too long (n=7) Transportation problems (n=*) Not eligible or denied services (n=*) Services too costly (n=*) *Cell suppressed for n<3

35. Receipt of Prevention Activity Items in Past 12 Months Free Condoms Free Needles Free Kits Received 36% (n=29) †† Used product 69%* (n=20) N/A Now more likely to use 83%* (n=24) N/A *Percentage computed using those who had received condoms as the denominator † 25% reported ever injecting drugs, but 0% have injected drugs in the past 12 months

36. Free Condom Source % Community Health Ctr / Public Health Clinic 41% HIV/AIDS focused Community Based Org 24% Adult HIV/AIDS Specialty Clinic 24% Drug Treatment Program 7% Private Doctor’s Office/HMO 3% Other: Event 3%

37. Preventive Therapies and Screenings

38. Preventive Therapy YesNo Don’t Know Pneumocystis carinii pneumonia meds ever prescribed to treat/prevent 48%49%3% Mycobacterium avium complex meds ever prescribed to treat/prevent* 27%55%18% Pneumonia vaccine in past 5 years68%27%5% Flu vaccine in past 12 months83%16%1% Vaccine for Hepatitis A, B, or both59%30%11% *Only prescribed to patients who have a CD4 cell count <49.

39. Reasons For Not Receiving Hepatitis Vaccination Patient already has hepatitis Doctor indicated vaccine not necessary Patient did not believe they were at risk for contracting hepatitis Patient doesn’t like needles Patient was not aware vaccine was available Patient did not complete the series

40. Ever Tested for and Ever Had Hepatitis

41. Prevention: Tests YesNo Don’t Know TB skin test ever95%4%* Last TB test within past 12 months † 55%35%10% Last TB test positive4%90%6% † Among patients who have ever had a TB skin test *Cell suppressed for n<3

42. STD Screening in Past 12 months

43. Female Sexual Health n=13 n=10

44. Female Sexual Health n=11 n=5 n=12 n=5 *Among patients who ever had a PAP smear

45. Facility Type for Last Pelvic Exam

46. CD4, Viral Load Tests & ARV Medications

47. CD4 and Viral Load Tests in Past 12 Months CD4 CountViral Load 0-2 tests14% 3-4 tests57%54% ≥ 5 tests26%27%

48. Antiretroviral Usage n=76 n=63 n=12

49. Drug Combinations of ARV Meds Currently Using Number of Drugsn=63 ≥ 3 Drugs*27 (43%) 2 Drugs † 25 (40%) 1 Drug8 (13%) *Includes combinations such as 3 nukes and 2 PIs; 3 nukes and 1 non-nuke; 3 nukes, 2 PIs, and 1 combination drug; 2 nukes, 1 PI, and 1 combination drug; 1 nuke, 1 non-nuke, and 1 combination drug † Including combinations such as 1 nuke and 1 PI; 1 nuke and 1 non-nuke; 1 nuke and 1 combination drug

50. Reason Never Started Antiretroviral Treatment Doctor advised to delay treatment (main reason) CD4 counts and/or viral load good Felt good and didn’t need them Concerned about side effects

51. Reason Not Currently on ARV Meds Doctor advised to delay treatment CD4 counts and/or viral load good Felt good and didn’t need them Concerned about side effects Allergic to medicines Tired of taking medicines Patient believed medicines complicate his/her life

52. Last Time Missed Any ARV Dose* *Among patients who were currently taking antiretrovirals

53. Adherence to Medication Instructions in Past 2 Days *Among patients who were currently taking antiretrovirals with special instructions

54. Reason for Missing Doses of Antiretroviral Meds Forgot to take41% Problems getting refill22% Had problems taking at specified times16% Felt too ill13% Change in daily routine13% Wanted to avoid side effects6% Busy with other things6% Couldn’t get to a doctor or clinic6% Felt depressed or overwhelmed6% Had too many pills to take3% Other16%

55. Contact Information Email: TXMMP@dshs.state.tx.usTXMMP@dshs.state.tx.us Call Sylvia Odem, Project Coordinator at (512) 533-3053 National website under reconstruction Sign up for receiving newsletter