San Francisco Medical Monitoring Project (MMP) Maree Kay Parisi - - PowerPoint PPT Presentation

San Francisco Medical Monitoring Project (MMP)

Maree Kay Parisi Applied Research, Community Health Epidemiology and Surveillance

Medical Monitoring Project

 Overview  National prospective  Local data and findings  Future of MMP

Medical Monitoring Project (MMP) Background

 Supplemental surveillance

system

 Created in response to 2004

Institute of Medicine report

 Need for population-based,

nationally representative data

• n HIV-infected persons in care

Methods: MMP Design

 Complex sample cross-sectional survey

• 17 states or territories sampled from 50 US states, Washington DC

and Puerto Rico

• Contain 73% of all adults diagnosed with HIV in the US
• Outpatient HIV care facilities within sampled states or territories
• HIV-infected adults receiving medical care during January-April

within sampled facilities

MMP Participating Project Areas, 2009-2014

VA MI WA

New York City

OR

Philadelphia Los Angeles County San Francisco Houston Chicago CA OR WA MI IL IN TX MS GA FL NC VA DE NY NJ PA PR

Methods: Data Collection

 Interview: Self-reported demographics, experiences

and behaviors

 Medical record abstraction (MRA): Documented clinical

care

 Linkage to the National HIV Surveillance System (NHSS)

• Minimum data set (MDS)

 Facility characteristics  HIV provider survey

Collaborations

CDC COLLABORATIONS



Division of HIV/AIDS Prevention

• HIV Incidence and Case

Surveillance Branch

• Prevention Communication

Branch

• Prevention Research Branch
• Prevention Evaluation Branch
• Epidemiology Branch



Division of STD Prevention



Division of TB Elimination



Office of Smoking and Health EXTERNAL COLLABORATIONS



HIV Medicine Association (HIVMA)



American Academy of HIV Medicine (AAHIVM)



AIDS Education Training Centers (AETCs)



Association of Nurses in AIDS Care (ANAC)



Health Resources and Services Administration (HRSA)



Institute of Medicine (IOM) Committee on Monitoring HIV Care



White House Office of National AIDS Policy (ONAP)



Kaiser Family Foundation (KFF)



Emory University School of Public Health



London School of Hygiene and Tropical Medicine

Overview of San Francisco MMP

1464 total participants in San Francisco from 2007-2013

Year n 2007 147 2008 182 2009 212 2010 220 2011 219 2012 249 2013 235

Private/ HMO 61% (n=888) VA 3% (n=44) Public clinic 15% (n=219) Public hospital 21% (n=313)

Facility type of participants 2007-2013

MMP patient characteristics 2009-2010

Weighted %* Male 93% Female 4% Transgender 3% 25-34 years 6% 35-44 years 22% 45-54 years 40% 55+ years 31% Any MSM (MSM only+MSMW) 84% MSW only 7% Any WSM (WSM only+WSMW) 4% White 57% African American 11% Hispanic 19% Other 13% Have continuous health coverage 92% At or below poverty level 11% Homeless 15% HIV diagnosis <5 years 13% HIV diagnosis 5-9 years 14% HIV diagnosis ≥10 years 73%

*data were weighted to adjust for probability of selection and facility and patient nonresponse

ART, viral suppression and prevention counseling 2009-2010

Prescription of ART (%) Viral suppression among those on ART (%) Prevention counseling by a health care provider (%) Weighted %* Weighted %* Weighted %* 25-34 86% 68% 48% 35-44 83% 81% 44% 45-54 90% 85% 37% >=55 94% 90% 13% Male 90% 85% 30% Female 96% 72% 50% Black or African American 84% 76% 42% Hispanic or Latino** 83% 85% 41% White 93% 86% 25% Other 89% 86% 37% Men who have sex with men 90% 87% 29% Men who have sex with women only 89% 69% 44% Women who have sex with men 96% 72% 50% Total 90% 85% 32%

*data were weighted to adjust for probability of selection and facility and patient nonresponse

Services with the largest unmet need 1. Dental services 2. HIV peer group support 3. Mental health 4. Transportation services 5. HIV Case Management

2000 4000 6000 8000 10000 12000 Childcare Services Interpreter services Domestic violence services Home health services Drug or alcohol counseling/treatment Adherence services Shelter services HIV prevention education HIV peer group support Transportation Assistance Services Meals or food services HIV Case Management Services AIDS Drug Assistance Program (ADAP) Mental Health Services Public benefits incl SSI/SSDI Dental Services

Met and Unmet Needs for Services, 2009-2010 (N = 418)

Met need Unmet Need

Is age associated with unmet need for supportive services among HIV-infected patients receiving HIV care?

• 761 MMP participants in SF: 3% were ages 18-29, 13% were 30-

39 years, 39% 40-49 years and 46% were ≥50 years old

• 86% had at least one supportive service need and 45% had at

least one unmet service need in the past 12 months

• Age was not associated with need for any supportive service
• Patients from public facilities and uninsured reported higher

need for any supportive service.

79% 83% 67% 39% 44% 50% 18% 11% 20% 22% 11% 4% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Total MSM MSW WSM

Sexual Behavior, 2009-2010 (N = 418)

Any sex Unprotected sex Unprotected sex with HIV negative or unknown status partner

Percentage of Persons with HIV Engaged in Selected Stages of the Continuum of Care — United States

82 37 33 25 10 20 30 40 50 60 70 80 90 100 Diagnosed Retained in care Prescribed ART Viral suppression

Hall et al. JAMA Int Med. 2013; DOI:10.1001/jamainternmed.2013.6841

Linkage, Retention, ART Use and Viral Suppression

• Successful HIV treatment involves:

– Timely linkage to medical care – Ongoing engagement in care – Access and adherence to effective HIV treatment

• CDC. Vital signs: HIV prevention through care and treatment

– United States. MMWR 2011; 60:1617-23.

28% get to viral suppression 80%

2000 4000 6000 8000 10000 12000 14000 16000 18000

HIV-infected HIV Diagnosed Linked to care In care On ART Suppressed Number of persons

Stages of HIV Care, San Francisco

80%

100% (n=17,665) 80% (n=14,132) 68% (n=12,012) 57% (n=10,034) 50% (n=8,930) 46% (n=8,216)

92% 89% 71% 85%

62% 41% 36% 28% 54% 31% 26% 22% 62% 53% 47% 41% 58% 39% 34% 27% 68% 57% 50% 46%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Linked to Care In Care On ART** Suppressed viral load***

Percent of estinated total HIV-infected

US (Total infected=1,178,350) Chicago (Total infected=23,799) Los Angeles County (Total infected=47,658) Philadelphia (Total infected=19,691) San Francisco (Total infected=17,665) *Includes people diagnosed with and unaware of their HIV infection **Percent of people in care on antiretroviral therapy from Medical Monitoring Project *** Most recent HIV viral load test indicating <=200 copies/mL among those on ART from Medical Monitoring Project

Percentage of estimated number of HIV-infected persons* in stages of the continuum of HIV care in four large United States cities through December 2009 compared to national estimates; Chicago, Philadelphia, Los Angeles and San Francisco.

Future of MMP

• Case Surveillance Based Sampling (CSBS)
• Sample is based on diagnosis date and last

known residence

• Potential to sample people who are out of

care

Acknowledgements

• SF MMP Team

Susan Scheer, PhD, MPH Principal Investigator Anthony Buckman, MS Anne Hirosawa, MPH Alison Hughes, MPH Patrick Norton, PhD, MA Kristiana Dhillon Maree Kay Parisi Project Coordinator Patrick Norton, PhD, MA Rolando Ramirez Nashanta Stanley Maya Yoshida-Cervantes Zachary Matheson

• All MMP participants and participating facilities
• Andrew Lopez, SF MMP Community Advisory Board
• Dr. Toby Dyner, SF MMP Provider Advisory Board