Unmet Need: Aware and Not in Care

1
Unmet Need Aware and Not in Care

• Nicole Diehl, Mark Turner, Kay Holladay
• Division of Surveillance and Care Delivery,
  HIV/STD Service

2
Background

• In 1983, the OSDH made AIDS reportable
• In May 1987, an active/passive surveillance
  system and software were initiated for AIDS
  
• In June 1988, an active/passive surveillance
  system and software were initiated for HIV
  
• In 1990, one single surveillance software was
  deployed for both HIV and AIDS
  
• In 1993, CD4 condition
  
• In 1997, HIV PCRS was offered to persons
  identified through the surveillance system

3
Limitations

• HARS is a surveillance database
• - Treatment is not one of the 616 HARS
  variables
  
• - Viral load is not part of the surveillance
  definition for an AIDS case, neither is it a
  reportable condition
  
• - CD4 cell counts above 200 are not part of
  the surveillance definition for an AIDS case
  
• - AIDS cases were not updated with additional
  CD4 counts

4
Limitations, cont.

• CD4 500 is not a reportable condition
• CD4 is not a reportable condition

5
Methodology

• Social Security Death Index 1937 1999 79
  out-of-state cases
  
• Medicaid 2004 729 HIV infected persons, 679
  (93) were in-care, 50 (7) out-of-care
  
• 2004 RW CAREWare, HIV Drug Assistance Program
  (HDAP), Health Insurance Assistance Program
  (HIAP), 1,721 HIV infected persons, 1,287 (75)
  were in-care, 432 (25) were out-of-care
• HARS local screen variable

6
Methodology, cont.

• Chart Reviews 3,497 charts were reviewed by the
  Field Surveillance Specialists
  
• Of these
• - there were 1,512 (43) persons with no known
  provider
  
• - 1,193 (34) were found to be in care
• - 607 (17) had moved to another state
• - 185 (5) not in-care in 2004 but were in- care
  in 2005

7
Future Plans

• Update HIV and AIDS cases with all reported CD4
  cell counts, CD4 s, and viral loads
  
• Deploy routine follow-up of all persons without a
  HRSA definition of in-care update for all persons
  that are not lost to follow-up
  
• Perform a 2000 2004 Social Security Death Index
  cross match with the HIV/AIDS database

8
Unmet Need Framework
9
Overall Unmet Need Estimate

• 5,327 People Living with HIV/AIDs (PLWH/A) as of
  12/31/2004 and Aware of Their Status
  
• 2,735 (51) PLWH/A In Care with at least 1 CD4
  count, Viral Load, or provision of antiretroviral
  therapy in 2004
  
• 2,592 (49) PLWH/A Out of Care in 2004

49 of those living with HIV/AIDS in Oklahoma are
estimated to be out of primary medical care in
2004
10
Out of Care by HIV/AIDS Status
People Living With HIV/non-AIDS make up 52 of
the total HIV/Aware population, yet account for
63 of the out of care cases. 3 out of every 5
(60) HIV/non-AIDS cases are out of care.
11
Out of Care by Gender
12
Out of Care by Race
13
Out of Care by Exposure Behavior
14
Out of Care by HRSA Special Needs Populations
15
Out of Care by Metropolitan Statistical Area (MSA)
16
Key Points

• Overall 49 of the Total HIV/Aware population
  are out of care.
  
• HIV Status 63 of those out of care are
  HIV/non-AIDS when they make up only 52 of the
  total HIV/Aware population.
  
• Race Blacks and Hispanics are disproportionately
  out of care. Native Americans and Whites are more
  likely to be in care.
  
• Exposure Injection Drug Users are
  disproportionately out of care.
  
• Special Needs More than half of HIV/Aware Women
  over 50 and Hispanic MSM are out of care.
  
• 73 of cases diagnosed in the Lawton MSA are out
  of care.
  

17
Programs Currently Addressing Unmet Need

• Outreach Case Management Program OKC, Red Rock
  Behavioral Health Services
  
• Community Case Management Program Lawton, RAIN
  Oklahoma
  
• Emerging Communities, Primary Medical CareOKC,
  OU IDI
  
• Minority AIDS Initiative, Outreach to HIV
  African Americans Out of Care OKC, Guiding
  Right, Inc.
  
• In-Reach/Out-Reach Peer to Peer Program Tulsa,
  OSU CHS COM
  
• Partner Notification Services statewide, OSDH

18
Acknowledgements

• Surveillance Field
• Operations Staff
• Terrainia Harris, OSDH
• Dr. Fahmida Kahn, OSDH
• Anne Kozak, OSDH
• Sandy Lucas, OSDH
• Christie McDonald, OSDH
• Sam Nimo, OSDH
• Brady Parsons, OSDH
• Olivia Scott, OSDH

• Guiding Right, Inc.
• Long Term Care Authority
• Oklahoma Healthcare Authority
• Oklahoma Infectious Disease Physicians
• OU Infectious Diseases Institute
• OU Pharmacist Care Center
• OHTCC
• OSU CHS COM
• Red Rock Behavioral Health Services
• RAIN Oklahoma
• Tulsa C.A.R.E.S