2015 Priorities Decision-Making Process Denver HIV Resources - - PowerPoint PPT Presentation

2015 Priorities Decision-Making Process Denver HIV Resources Planning Council

Needs Assessment Results Center for Research Strategies August 2015

Overview of the Needs Assessment Process

Priority Setting Resource Allocation Development of Annual Implementation Plan Implementation/ Contracting Services Evaluation Needs Assessment

Components of the Needs Assessment

• Epidemiologic Profile
• HIV Care Continuum
• Profile of PLWH In-Care and Out-of-Care
• Overall Service Needs and Barriers
• Special Needs Populations
• Provider Capacity
• Unmet Needs and Service Gaps

Survey of PLWH Service Needs and Barriers

• 16 page paper survey sent by CDHPE to 3,200 clients enrolled in ADAP

– Electronic survey an alternative option – Spanish language survey made available

• $10 incentive in alternative formats offered to respondents
• Response rate = 22%

Profile of Survey Respondents

• Higher proportion of MSM (78%); lower proportion of IDU (3%)
• Most were 45-64 years of age (62%); lower proportion of those 25-44

(22%)

• Whites represented 61%; blacks (13%), Latinos (14%)
• Twenty percent identified as Hispanic.

Additional Survey Respondent Characteristics

• Nearly half (46%) had a high school education or less.
• Only a quarter (26%) were working full time.
• Most had health insurance; only 3% were uninsured.
• Two percent report being undocumented.

Immigration Status

N = 441

85.5% (377) 8.8% (39) 1.1% (5) 1.8% (8) 1.4% (6) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Permanent Resident US Citizen 5+ yrs US Citizen Less than 5 yrs Undocumented Prefer Not to Answer

Top HIV Services Clients Need and Use

N = 442 (avg across all service categories)

95% 76% 63% 56% 48% 44% 37% 32% 30% 26% 23% 18% 14% 10% 10% 10% 8% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Top HIV Services Clients Need but Can’t Access

N = 442 (avg across all service categories)

MEDICAL TRANSPORTATION HOME DELIVERED MEALS PSYCHO-SOCIAL SUPPORT CASE MANAGEMENT MENTAL HEALTH HOUSING HEALTH INSURANCE ASSISTANCE EMERGENCY FINANCIAL ASSISTANCE FOOD BANK ORAL HEALTH 4% 5% 5% 5% 5% 7% 7% 11% 11% 12% 20% 18% 17% 14% 15% 24% 12% 25% 13% 20%

Needed But Couldn't Get Didn't Know

Top HIV Services Clients Used versus Services They Couldn’t Get N = 442 (avg across all service categories)

MED TRANSPORTATION HOME MEALS PSYCHO-SOCIAL SUPPORT CASE MANAGEMENT MENTAL HEALTH INSURANCE ASSIST HOUSING EMERG FIN ASSIST FOOD BANK ORAL HEALTH CARE 4 5 5 5 5 7 7 11 11 12 10 10 14 56 23 63 18 32 30 44

Needed/Couldn't Get Needed and Used

Gap Between Services Didn’t Need/Couldn’t Get

N = 442 (avg across all service categories)

0% 10% 20% 30% 40% 50% 60% 70% 80% Medical Transportation Home Delivered Meals Psycho-Social Support Case Management Mental Health Health Insurance Assistance Housing Emergency Financial Assistance Food Bank Oral Health 66% 67% 64% 26% 57% 19% 52% 32% 47% 24% 4% 5% 5% 5% 5% 7% 7% 11% 11% 12% Didn't need Needed But Couldn't Get

HIV Services Clients Don’t Know are Available

N = 442 (avg across all service categories)

28% 26% 25% 24% 20% 20% 18% 17% 16% 15% 14% 13% 12% 9% 7% 3% 2% 0% 5% 10% 15% 20% 25% 30%

Care Continuum Responses for the Past Year

N = 459 (avg across response categories)

98.5% 98.7% 98.3% 97.8% 97% 97% 98% 98% 98% 98% 98% 99% 99% Seen a Med Provider Taken Meds Had a VL Test Had a CD4 Test

Frequency of Seeing an HIV MD

N = 460

45.4% (209) 44.3% (204) 8.5% (39) 1.7% (8) 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% Every 3 Mths Every 6 Mths Once/Yr Other

Reasons Clients Stopped Seeing an HIV MD

N = 469

4.5% (21) 4.5% (21) 4.5% (21) 4.3% (20) 3.6% (17) 3.6% (17) 3.4% (16) 3.4% (16) 3.0% (14) 0% 1% 1% 2% 2% 3% 3% 4% 4% 5% 5% Felt Fine Cost Overwhelmed Didn't Want Meds Wanted Break Med Side Effects Drinking/Drugs Lost Insurance Mental Health

Services to Help Clients Remain in HIV Medical Care

N= 469

34.3% (161) 16.2% (76) 6.6% (31) 4.3% (20) 3.6% (20) 3.2% (15) 0% 5% 10% 15% 20% 25% 30% 35% 40% Food Vouchers Legal Services Home Health Rehab Services Outreach Respite

Special Issues – Dental Care Trouble Paying for Dental Care

N= 458

50.9% (233) 39.1% (179) 10.0% (46) 0% 10% 20% 30% 40% 50% 60% Yes No Unsure

Special Issues – Choice for Dental Care

N= 434

48.6% (211) 26.5% (115) 19.8% (86) 3.9% (17) 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% Same Dentist HIV Friendly Dentist HIV Dental Clinic Don't Go

Special Issues – Housing Challenges

N = 469

14.1% (66) 6.8% (32) 4.9% (23) 3.2% (15) 0% 2% 4% 6% 8% 10% 12% 14% 16% Costs Location Privacy Issues Unstable

Special Issues – Housing Assistance

N = 469

57.8% (271) 11.7% (55) 5.5% (26) 5.3% (25) 1.1% (5) 0% 10% 20% 30% 40% 50% 60% 70% No Assistance Section 8 HOPWA Help from AIDS Org Emergency Assist

Special Challenges – Adequacy of Housing Assistance

N = 469

54.8% (257) 17.1% (80) 11.5% (54) 0% 10% 20% 30% 40% 50% 60% Not Applicable Yes No

Special Issues – Housing Rent Increases in the Past Year

N = 469

26.9% (126) 21.7% (102) 8.7% (41) 4.5% (21) 4.3% (20) 1.7% (8) 0% 5% 10% 15% 20% 25% 30% $1-$200 No Increase $200-$400 $600-$800 $400-$600 More than $1,000

Special Issues – Homelessness

N = 469

72.3% (339) 11.3% (53) 11.3% (53) 9.% (4) .9% (4) .6% (3) 0% 10% 20% 30% 40% 50% 60% 70% 80% Own House/Apt Subsidized Housing With Family/Friends Combination Shelter Other

Transportation Limiting Use of HIV Services

N = 469

9.2% (42) 8.3% (39) 10.4% (49) 38.8% (182) 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% Great Extent Somewhat Occasionally Never

Special Issues – Transportation Challenges

N = 469

13.0% (61) 10.0% (47) 10.9% (51) 7.2% (34) 5.3% (25) 0% 2% 4% 6% 8% 10% 12% 14% No Car Cost Inconvenient Not Enough Tokens Clinic Location

Client Challenges – Alcohol and Drugs

N = 469

14.9% (70) 16.8% (79) 6.2% (29) 7.7% (36) 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% Drank More than Meant to Should Cut Down on Alcohol Used Drugs More than Meant to Should Cut Down on Drugs

Focus Groups and Interviews

Spanish-Speaking (some undocumented, MSM) Servicios de la Raza 4 men, 4 women Clinica Tepeyac 2 men Denver Health 4 men Recently Incarcerated and History of Substance Use It Takes a Village 5 men, 4 women Empowerment 6 women History of IDU Substance Use ARTS 4 men, 1 woman MSM and Undocumented DCAP 2 men Refugee Interviews It Takes a Village 1 Congolese woman Children’s Hospital 1 Congolese woman

HIV-related Needs Identified via the Focus Groups

Common across all groups HIV medications Dental care Transportation Affordable housing in Central Denver Food bank Spanish-speaking groups Limited Spanish-speaking services in some agencies (more access in Denver Metro than other areas) Services for undocumented (available but limited) Recently incarcerated and history of substance use groups Access to information for HIV negative partner

Common across all groups Extensive paperwork to apply for services Confusion about services, coverage and where/how to apply Difficulty taking time off from work to get to appointments (transportation and living far from service agencies) Spanish-speaking groups Spanish-speaking services Services for undocumented (available but more limited) Fear of filing complaints regarding housing and other inadequate services for fear of deportation Stigma related to mental health services Recently incarcerated and history of substance use groups Access to services more limited for clients actively using substances Difficult to obtain housing with prison history

Barriers to Accessing Services

Reasons Clients are Out of Care

Common across all groups Losing insurance coverage or a way to pay for services and medications Laziness and not making it a priority to take care of one’s health Unhappy with the care or doctor providing it Spanish-speaking groups Challenge of finding available Spanish-speaking services Stigma related to HIV Not educated about HIV, so don’t know to go in for testing or care Fatalistic attitude Recently incarcerated and history of substance use groups Active substance use Difficult to get re-connected to the system after incarceration

Assistance Needed to Stay in Care

Common across all groups Streamline paperwork Connect highest needs clients with community-based

• rganizations that provide case management

Appointment reminders Provide personalized care that clients can understand in lay terms Better/easier access to public transportation (van service, bus passes vs tokens) Spanish-speaking groups Extensive case management available in Spanish Client support groups How to educate HIV negative partner and how to disclose HIV positive status

Provider Survey

• Electronic survey sent to 112 providers (including both Part A

and Part B Providers)

– Questions focused on client needs, service capacity and strategies for client outreach – Responses from 48 providers

• Focus group held with 16 Denver area HIV Providers

Provider Perspective on Service Capacity- Services Least Available

N = 42

FOOD BANK MED CASE MANAGEMENT ORAL HEALTH HEALTH INSURANCE SA OUTPATIENT EMERGENCY FINANCIAL HOME MEALS PSYCHO-SOCIAL SUPPORT MENTAL HEALTH LINGUISTIC SERVICES MED TRANSPORTATION FOOD VOUCHERS HOME HEALTH MED NUT THERAPY HOUSING SA INPATIENT 48% 41% 40% 45% 46% 50% 45% 63% 66% 52% 64% 44% 52% 52% 61% 49% 6% 15% 17% 12% 15% 14% 19% 3% 6% 23% 12% 34% 32% 33% 31% 46%

Partially Available Not Available

Provider Perspective on Service Capacity Services Most Available

N = 42

0.1 0.2 0.3 0.4 0.5 0.6 AIDS Drug Assistance Program Primary Medical Care Referrals Pharmacy Early Intervention Case Management Health Education Treatment Adherence 23% 24% 39% 23% 38% 42% 34% 50% 4% 18% 6% 23% 8% 5% 13% 3% Partially Available Not Available

Provider Perceptions Why Clients Leave Care

88% 79% 74% 71% 60% 60% 50% 50% 48% 45% 40% 40% 36% 33% 31% 31% 29% 26% 19% 7% 10 20 30 40 50 60 70 80 90 100

Reasons PLWHIV Leave Care N = 42

Provider Perceptions Regarding Non- Adherence

86% 81% 74% 57% 45% 40% 40% 38% 33% 33% 31% 31% 31% 26% 24% 24% 24% 21% 14% 2% 10 20 30 40 50 60 70 80 90 100

Reasons for PLWHIV Non-Adherence to Treatment N = 41

Provider Capacity Development Needs

44% 30% 26% 26% 22% 22% 22% 22% 22% 17% 13% 9% 9% 9% 5 10 15 20 25 30 35 40 45 50

Most Common Capacity Development Needs N = 23

Data Limitations

• Data collection from the clients should be scheduled over four months instead of two

months, allowing for more follow-up.

• To capture as much information as possible, both the provider and the client survey

forms were very long, impacting the response rate.

• Spanish-language surveys should be sent to targeted clients at the front end instead of

being offered after the surveys are distributed.

• With more time, additional supplementary data collection efforts could be conducted.

Key Takeaways

• Top services clients use are ADAP and HIV medical care followed by health

insurance assistance and case management.

• Top services clients need but can’t access are oral health, food bank,

emergency financial assistance, health insurance assistance and housing.

– Transportation and housing are challenges to clients mainly because of cost. – Paperwork and establishing eligibility are barriers for many clients.

• Biggest capacity gaps according to providers are inpatient substance abuse

services and housing.

– Substance abuse, mental health and homelessness are main reasons clients leave care.