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 Needs Priority Assessment Setting Resource Evaluation Allocation Development of Implementation/ Annual Contracting Implementation Services Plan
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 90% 85.5% (377) 80% 70% 60% 50% 40% 30% 20% 8.8% (39) 10% 1.8% (8) 1.4% (6) 1.1% (5) 0% 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) 100% 90% 95% 80% 70% 76% 60% 63% 50% 56% 48% 40% 44% 30% 37% 32% 30% 20% 26% 23% 18% 10% 14% 10% 10% 10% 8% 0%
Top HIV Services Clients Need but Can’t Access N = 442 (avg across all service categories) Needed But Couldn't Get Didn't Know 12% 20% ORAL HEALTH 11% 13% FOOD BANK 11% 25% EMERGENCY FINANCIAL ASSISTANCE 7% 12% HEALTH INSURANCE ASSISTANCE 7% 24% HOUSING 5% 15% MENTAL HEALTH 5% 14% CASE MANAGEMENT 5% 17% PSYCHO-SOCIAL SUPPORT 5% 18% HOME DELIVERED MEALS 4% 20% MEDICAL TRANSPORTATION
Top HIV Services Clients Used versus Services They Couldn’t Get N = 442 (avg across all service categories) Needed/Couldn't Get Needed and Used 12 44 ORAL HEALTH CARE 11 30 FOOD BANK 11 32 EMERG FIN ASSIST 7 18 HOUSING 7 63 INSURANCE ASSIST 5 23 MENTAL HEALTH 5 56 CASE MANAGEMENT 5 14 PSYCHO-SOCIAL SUPPORT 5 10 HOME MEALS 4 10 MED TRANSPORTATION
Gap Between Services Didn’t Need/Couldn’t Get N = 442 (avg across all service categories) 24% 12% Oral Health 47% 11% Food Bank 32% 11% Emergency Financial Assistance 52% 7% Housing 19% 7% Health Insurance Assistance 57% 5% Mental Health 26% 5% Case Management 64% 5% Psycho-Social Support 67% 5% Home Delivered Meals 66% 4% Medical Transportation 0% 10% 20% 30% 40% 50% 60% 70% 80% Didn't need Needed But Couldn't Get
HIV Services Clients Don’t Know are Available N = 442 (avg across all service categories) 30% 28% 26% 25% 24% 25% 20% 20% 20% 18% 17% 16% 15% 14% 13% 15% 12% 9% 10% 7% 3% 5% 2% 0%
Care Continuum Responses for the Past Year N = 459 (avg across response categories) 99% 98.7% 99% 98.5% 98% 98.3% 98% 98% 97.8% 98% 98% 97% 97% Seen a Med Provider Taken Meds Had a VL Test Had a CD4 Test
Frequency of Seeing an HIV MD N = 460 50% 45.4% (209) 44.3% (204) 45% 40% 35% 30% 25% 20% 15% 8.5% (39) 10% 5% 1.7% (8) 0% Every 3 Mths Every 6 Mths Once/Yr Other
Reasons Clients Stopped Seeing an HIV MD N = 469 5% 4.5% (21) 4.5% (21) 4.5% (21) 4.3% (20) 5% 4% 3.6% (17) 3.6% (17) 3.4% (16) 3.4% (16) 4% 3.0% (14) 3% 3% 2% 2% 1% 1% 0% Felt Fine Cost Overwhelmed Didn't Want Wanted Break Med Side Drinking/Drugs Lost Insurance Mental Health Meds Effects
Services to Help Clients Remain in HIV Medical Care N= 469 40% 34.3% (161) 35% 30% 25% 20% 16.2% (76) 15% 10% 6.6% (31) 4.3% (20) 3.6% (20) 3.2% (15) 5% 0% Food Vouchers Legal Services Home Health Rehab Services Outreach Respite
Special Issues – Dental Care Trouble Paying for Dental Care N= 458 60% 50.9% (233) 50% 39.1% (179) 40% 30% 20% 10.0% (46) 10% 0% Yes No Unsure
Special Issues – Choice for Dental Care N= 434 50% 48.6% (211) 45% 40% 35% 30% 26.5% (115) 25% 19.8% (86) 20% 15% 10% 3.9% (17) 5% 0% Same Dentist HIV Friendly Dentist HIV Dental Clinic Don't Go
Special Issues – Housing Challenges N = 469 16% 14.1% (66) 14% 12% 10% 8% 6.8% (32) 6% 4.9% (23) 4% 3.2% (15) 2% 0% Costs Location Privacy Issues Unstable
Special Issues – Housing Assistance N = 469 70% 57.8% (271) 60% 50% 40% 30% 20% 11.7% (55) 10% 5.5% (26) 5.3% (25) 1.1% (5) 0% No Assistance Section 8 HOPWA Help from AIDS Org Emergency Assist
Special Challenges – Adequacy of Housing Assistance N = 469 60% 54.8% (257) 50% 40% 30% 17.1% (80) 20% 11.5% (54) 10% 0% Not Applicable Yes No
Special Issues – Housing Rent Increases in the Past Year N = 469 30% 26.9% (126) 25% 21.7% (102) 20% 15% 8.7% (41) 10% 4.5% (21) 4.3% (20) 5% 1.7% (8) 0% $1-$200 No Increase $200-$400 $600-$800 $400-$600 More than $1,000
Special Issues – Homelessness N = 469 80% 72.3% (339) 70% 60% 50% 40% 30% 20% 11.3% (53) 11.3% (53) 10% 9.% (4) .9% (4) .6% (3) 0% Own House/Apt Subsidized Housing With Family/Friends Combination Shelter Other
Transportation Limiting Use of HIV Services N = 469 45% 38.8% (182) 40% 35% 30% 25% 20% 15% 10.4% (49) 9.2% (42) 8.3% (39) 10% 5% 0% Great Extent Somewhat Occasionally Never
Special Issues – Transportation Challenges N = 469 14% 13.0% (61) 12% 10.9% (51) 10.0% (47) 10% 8% 7.2% (34) 6% 5.3% (25) 4% 2% 0% No Car Cost Inconvenient Not Enough Tokens Clinic Location
Client Challenges – Alcohol and Drugs N = 469 18% 16.8% (79) 16% 14.9% (70) 14% 12% 10% 7.7% (36) 8% 6.2% (29) 6% 4% 2% 0% 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
Barriers to Accessing Services 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
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 organizations 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
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