Delaware HIV Planning Council July 22, 2015 12:00-3:00 IN - - PowerPoint PPT Presentation

IN COLLABORATION WITH:

Delaware HIV Planning Council

July 22, 2015 12:00-3:00

Introductions

Name Organization and/or Location Question of the day:

How long have you been active in the field of HIV/AIDS?

M E M B E R S H I P & C O M M U N I T Y E N G A G E M E N T ( M C E ) W O R K I N G G R O U P

Committee Report

S P E C I A L C O M M I T T E E O N P A R T Y R O L E S A N D R E S P O N S I B I L I T I E S

Committee Report

Committee Tasks

1.

Develop a set of roles and responsibilities to guide HPC, and HPC subcommittee work.

2.

Develop annual work plan and timeline to guide HPC.

3.

Develop Memorandum of Understanding between HPC, DPH, and DHC.

Committee Process

Meetings:

Meeting 1: June 23, 2015 Meeting 2: July 7, 2015

Deliverables:

Party Roles and Responsibilities Work Plan Memorandum of Understanding

Committee Findings: Delaware Division of Public Health

Uses HPC advice and recommendations, and Department expertise to

act as final decision maker regarding HIV planning and fund usage:

1.

Creates HPC; reviews and approves HPC policies and procedures; and, collaborates and provides guidance to HPC – where appropriate.

2.

Prepares and submits:

• Statewide Coordinated Statement of Need (SCSN); and,
• Integrated Comprehensive HIV Prevention and Care Plan.

3.

Sets funding priorities; allocates HIV prevention and care resources.

4.

Using HPC guidance, participate in community engagement process.

5.

Collects, analyzes, and reports quality measurement data for HIV grantees.

Committee Findings: Delaware HIV Consortium

Assists the HPC in carrying out its responsibilities:

1.

Logistical and staff support for all HPC-, and HPC committee-meetings

2.

Provide research, analytical, and writing support in the completion of HPC duties.

3.

Manage the HPCs budget and reporting requirements

4.

Serve as intermediary between the DPH, and the HPC.

Committee Findings: Delaware HIV Planning Council

Serve as an advisory body to the state’s Division of Public Health:

1.

Institute policies and procedures that reflect CDC and HRSA “best practices” for HIV community planning.

2.

Actively participate in the development and implementation of the state’s mandated deliverables.

3.

Advise DPH on needs assessment methodology – participate as needed.

4.

Provide recommendations on service priorities to improve care continuum

5.

Work with DPH to determine additional responsibilities to fall under HPC purview.

Committee Findings: Work Plan

Needs Assessment CDC/HRSA Integrated Statewide Coordinated Statement of

Need/Prevention and Care Plan

Priority Setting and Resource Allocation Community Engagement Process Quality, Performance, and Evaluation Data

Committee Findings: HPC Working Groups

Committee Recommendations

1.

Motion to accept the findings from the Special Committee

• n Roles and Responsibilities regarding the roles and

responsibilities of the HPC, HPC working groups, the DPH, and the DHC.

• 2. Motion to use findings language in the development of the

HPC Work Plan and timeline, and in the Memorandum of Understanding between HPC leadership, DPH leadership, and DHC leadership.

2015 HIV/AIDS Epidemiology Update

2014 Data

James Dowling Health Program Coordinator Division of Public Health

EXECUTIVE SUMMARY

As an addition to the biannual HIV/AIDS report last produced in 2014 by the Delaware HIV/AIDS Surveillance Office, this document is intended to provide nurses, doctors and various planning groups the information required to understand the current status of the HIV epidemic in Delaware. By the end of 2014, Delaware had 3,540 persons living in the state with HIV disease. Unfortunately, African Americans in Delaware continue to be disproportionately represented among newly infected

• persons. In 2014 alone, African Americans were a full 62% of all new infections in Delaware despite being
• nly 22% of the total population.

By gender, males made up 64% of the new infection in 2014 and females 36%. African American males were 64% of all new infections in 2014 among all males and a full 41% of the total new infections in 2014 regardless of gender. By age group the highest level of new infections occurred among the 20-29 year olds with 33% of all new infections in 2014 occurring among this group. While it is often difficult to pin down exact cause of death with relation to AIDS patients, one trend remains undeniable in Delaware. Less people with AIDS are dying when compared to the 1980’s and 1990’s, while the total number of persons living in the state is exponentially larger than in those earlier

• times. This provides clear indication that medical treatment in Delaware has been very successful at

keeping people with HIV and AIDS alive. By exposure factor, we do recognize an increase in the number of new infections among males who have sex with males (MSM) over the last four years. This fact has caused this risk factor to be the top cause of new infections on average from 2010 through 2014. This report goes beyond these limited data points and the reader should take advantage of this information by giving the report a start to stop analysis.

Primary Sources

Evaluation HIV/AIDS Reporting System

(EHARS) – Collects infection data from all legally bound reporting sources throughout the State.

2014 U.S. Census Estimates 2012 CDC HIV/AIDS Surveillance Report

Questions

Special data request must be made through

HIV/AIDS Surveillance Coordinator James Dowling

– Phone – (302)744-1143 – Email – james.dowling@state.de.us – (special data is that which is not specifically

covered in the following slides)

HIV/AIDS Trends in Delaware

3,540 living cases of HIV/AIDS (December 2014)

Delaware infected

1 out of every 264 (n = 3,540)

• -AA = 1/92 (n = 2,147)
• -White = 1/554 (n = 1,074)
• -Hispanic = 1/340 (n = 247)

(ratios based on latest available U.S. Census Estimates and reported Living HIV/AIDS cases)

Gender Groups

TRENDS IN HIV/AIDS IN DE

Gender

• -Males - 48% of Delaware’s population, yet

71% of all HIV/AIDS cases through 2014

• -Females - 52% of Delaware’s population, 29% of

all reported Delaware cases through 2014

New Infections in Delaware by gender 1997 - 2014

50 100 150 200 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14

Male Female

207 220 146 223 279 215 232 216 182 151 173 Year Total #

HIV Reporting Began 07/01 Note: Data perspective change from number of HIV cases and number AIDS cases to the number of New Infections

160 153 131 109 136 115 116

Race Ethnicity Groups

TRENDS IN DE (Cont)

Ethnicity

• - African Americans (disproportionately high

HIV/AIDS rate) 44% cases attributed to African-Americans in the late 80s---Stands at 65% at the end of 2014 despite being 22% of Delaware’s population

50 100 150 200 250 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14

Caucasian AA Hispanic Other

New Infections Diagnosed in Delaware Race/Ethnic Groups, 1997-2014

Year Total #

HIV Reporting Began 07/01

NOTE: Other = Am Indian, Native Alaskan Asian, Native Hawaiian and Multi Race

207 220 146 223 279 215 232 216 182 151 173 160 153 131 109 136 115 116

20 40 60 80 100 120 140 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14

Caucasian Male Caucasian Female AA Male AA Female Hispanic Male Hispanic Female Other Male Other Female Unknown

New Infections Diagnosed in Delaware by Gender and Race/Ethnic Groups, 1997-2014

HIV Reporting Began 07/01

Year Total # 207 220 146 223 279 215 232 216 182 151 173 160 153 131 109 136 115 116

Age Groups

TRENDS IN DE (Cont)

AGE

HIV

• 58% reported were between ages of 20 – 39 at

diagnoses

• Teen groups not infected at rates seen in many other

states, DE = 6%

Stage 3 HIV (AIDS)

• 70% reported were between ages 30-49 at diagnoses

New Infections Diagnosed in Delaware by age Group, 1997-2014

Mortality

TRENDS IN DE (Cont)

Mortality

Better Treatment = Longer lives

HIV/AIDS Deaths

50 100 150 200 9 1 9 3 9 5 9 7 9 9 1 3 5 7 9 1 1 1 3

Deaths

3,540 Living with HIV/AIDS in December 2014

Combination therapy begins

523 Living with HIV/AIDS in December 1988 2014 death ascertainment incomplete

• 20

20 40 60 80 100 120

91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14

Year Number of Deaths Black White Hispanic Other

HIV/AIDS Deaths by Race, 1991 to 2014

Note: Deaths are proportionate to infections across groups 2014 death ascertainment incomplete

20 40 60 80 100 120 140 160

91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14

Year Number of Deaths Male Female

HIV/AIDS Deaths by Gender, 1991 to 2014

2014 death ascertainment incomplete

Geography

• -49% of all HIV/AIDS cases reported in Delaware through 2014 originated

from Wilmington Metropolitan area.

2014 Estimated Delaware Pop.= 933,547

Source: US Census

64% 16% 20%

22% 30% 48% Delaware Land Area 1,954 square miles

Cumulative HIV/AIDS Cases January 1981 – Dec 2014 n = 5,750

74% 11% 15%

22% 30% 48%

Delaware Land Area 1,954 square miles

2014 Delaware Pop.= 933,547 64% 16% 20%

67% 13% 20%

Living HIV/AIDS Jan 1981 – Dec 2014 n = 3,540

74% 11%

15%

Cumulative HIV/AIDS Cases Jan 1981 – Dec 2014 n = 5,750

Behavioral Risk Groupings

Risk Categories by County of Residence

Risk Categories in Wilmington Metro Area

20 40 60 80 100 120 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14

MSM IDU MSM and IDU Hetero No Risk/Other

New Infections Diagnosed in Delaware by Risk Group, 1997-2014

Total # Year 207 220 146 223 279 215 232 216 182 151 173 160 153 131 109 136 115 116

10 20 30 40 50 60 70 80 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14

MSM IDU MSM and IDU Hetero No Risk/Other

New Infections in Males Diagnosed in Delaware by Risk Group, 1997-2014

Total # Year 150 148 93 152 180 144 145 137 117 105 137 108 110 104 81 98 85 74

10 20 30 40 50 60 70 80 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14

IDU Hetero No Risk/Other

New Infections in Females Diagnosed in Delaware by Risk Group, 1997-2014

57 72 53 71 99 71 87 79 65 46 36 Total # 52 Year 43 27 28 38 30 42

National VS. Delaware Living HIV Cases by Race

National - 2012 Delaware - 2014

The distribution of living HIV cases by race nationally is % Among HIV 34% White 44% Black 19% Hispanic 3% other races Delaware’s living HIV cases through 2014 by race are % Among HIV 32% White 59% Black 7% Hispanic 2% other races

National VS. Delaware Living AIDS Cases by Race

National - 2012 Delaware - 2014

The distribution of living AIDS cases by race nationally is % Among AIDS 33% White 42% Black 22% Hispanic 3% other races Delaware’s living AIDS cases through 2013 by race are % Among AIDS 30% White 61% Black 7% Hispanic 2% other races

DE Care Continuum

DE Care Continuum

DE Care Continuum

DE Care Continuum

DE Care Continuum

Email Questions To james.dowling@state.de.us (302) 744-1016

Discussion Questions

1.

From this presentation what do we now know about the socio-demographic characteristics and long term trends in Delaware’s HIV epidemic?

What does this mean for our handling of the continuum of care?

2.

After this presentation what do we still not know about how the socio- demographic characteristics of PLWH as a group as it compares to Delaware’s HIV-negative community, and those at high-risk for HIV acquisition?

3.

Data presented today is all HIV surveillance data collected by DPH. What data will we need to gather on our own to complete our mandated tasks?

1.

What working groups should handle this data collection and analysis?

Jurisdictional Plan 2016

HIV Prevention Program

Bob Vella, MPH, MS HIV Prevention Administrator

Delaware Division of Public Health

What is the Jurisdictional Plan?

Provides a blueprint for HIV planning within

• ur state and is structured to:

Support National HIV/AIDS Strategy

Support implementation of High Impact Prevention Programs Ensures collaboration and coordination across prevention, care and treatment services

The Jurisdictional Plan Outline

• General Epidemic Overview
• The National HIV/AIDS Strategy and brief
• verview of CDC’s recommended

strategies for any health department

• Plan of action, goals and objectives for

2016

HIV PREVENTION

BACKGROUND

HIV Prevention Federal Funding 2011 – 1.87 million 2012 – 1.41 million 2013 – 1.24 million 2014 – 1.00 million 2015 – 976 K 2016 – 905 K (projected) ** 52% cut in funds over six years

CDC Requirements

• Required Core Components
• Recommended Components

Required Core Components

• HIV Counseling, Testing and Referral
• Comprehensive Prevention with Positives
• Condom Distribution
• Policy Initiatives

**95% of our funding is spent here

Recommended Components

• Prevention Interventions with high-risk negative
• Social Marketing, Media and Mobilization
• PrEP and nPEP

*We earmark 5% of our budget here

HIV PREVENTION

THE PLAN

Required Core Component 1

HIV Testing in Non Medical Settings

Goal 1: Maintain current levels of HIV screening among highest-need populations (goal: 3,000 tests)

Collaborate with AIDS DE, BGOC, Camp Rehoboth Collaborate with Bureau of Health Equity Collaborate with the Ryan White Program

Required Core Component 1

HIV Testing in Non Medical Settings

Goal 2: Request Capacity Building Assistance for those CBOs that fail to reach 1% positivity rate for 2015

Analyze HIV targeted testing data in Evaluation Web

Required Core Component 1

HIV Testing in Medical Settings

Goal 3: Maintain current levels of HIV screening among contracted providers of CTR services (SSC, Title X, School Based Wellness) (Goal 6,000 tests)

Align kit funding with agencies who identify positives Implement testing of DE’s migrant seasonal workers Implement targeted testing in Western Sussex County Collect HIV testing data from SAMSHA sponsored agencies

Required Core Component 1

Goal 4: Increase the proportion of HIV dx gay and bisexual men, African American and Latinos with undetectable viral loads by 5% Collaborate with HIV Surveillance on a treatment cascade Increase engagement in continuous HIV care and medical compliance with our patients

• -Reconnecting patients to care is critical

Required Core Component 2

Prevention for positives and high risk negatives

Goal 5: Maintain the number of clients enrolled in CRCS and SWC (goal: CRCS 60; SWC 50)

Both programs are very successful at reaching those most likely to pass or obtain HIV with meaningful counseling and risk reduction strategies

Required Core Component 2

Prevention for positives and high risk negatives Lost to Care

Goal 6: Reduce number of HIV+ “lost to care” by 25% statewide (Baseline 810 clients) Goal 7: Reconnect at least 8 clients to care

Required Core Component 3

Condom Distribution

Goal 8: Distribute 250,000 condoms to CBOs, SSCs, and other collaborative agencies across DE Goal 9: Enroll at least 75 new HIV+ clients into the mail order condom distribution program

Required Core Component 4

Policy Initiates

Goal 10: Increase awareness of PrEP statewide

Contract with a HIV educational organization to inform providers on the benefits of PrEP

Required Core Component

Planning

Goal 11: Produce and obtain concurrence on HIV Prevention Jurisdictional Plan for 2017 Goal 12: Produce new integrated HIV Prevention and Care Plan (2017-2021)

2016 JURISDICTIONAL PLAN

QUESTIONS???

Committee Recommendations

1.

Motion to vote on Letter of [Concurrence, Concurrence with Reservations, or Non-Concurrence] with 2016 Jurisdictional Plan.

E M E R G I N G T R E N D S I N H I V P R E V E N T I O N / C A R E I N D E

Member Discussion

Announcements

Updated timeline HPC Website Transportation