Using Data to Improve LTC - Debbie Wendell
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The document discusses using HIV program data to evaluate gaps and disparities in linkage to care. It provides examples of how Louisiana measures linkage, retention, and viral suppression, and presents HIV continuum of care data for the state overall and by region, race/ethnicity, and testing site. Linkage to care rates for newly diagnosed individuals are shown to be improving over time but still lag the national goal of 85% linked within 90 days. Community-based organizations see variation in their linkage rates that could be improved. The presentation raises questions about how agencies evaluate their own linkage efforts and ways state assistance could strengthen local data collection and use.
Using Data to Improve LTC - Debbie Wendell
- 1. Using Data to Improve Linkage to Care Debbie Wendell, PhD, MPH Louisiana STD/HIV Program Louisiana STD/HIV Program
- 2. How can data be used to improve programs? • Where are the biggest gaps in the HIV continuum of care? • Are there race, gender or age disparities? • How quickly are clients getting linked to care? • Are clients retained in care? • How does my agency compare to others?
- 3. How do we measure linkage, retention and viral suppression? • Use CD4/VL results as a proxy for an HIV-related medical visit o All HIV-related test results are reportable in Louisiana o Most are reported electronically on a daily basis • Measurement standards o Linkage: Was a person newly-diagnosed with HIV linked to HIV-related medical care within 90 days? o Retention: Did a person living with HIV have 2 or more care visits within a 12 month period? o Viral Suppression: Was the most recent VL <=200?
- 4. HIV Continuum of Care Louisiana, 2013 100% 69% 54% 49% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Persons living with HIV In HIV care Retained in HIV care Viral suppression (<=200) Percentage 18,199 9,774 12,536 8,831 70% of PLWH in care were virally suppressed Louisiana STD/HIV Program
- 5. Percent Retained in Care among PLWH by Region, Louisiana, 2013 Louisiana STD/HIV Program 52% 60% 60% 54% 46% 51% 46% 51% 53% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Percentage Region Louisiana STD/HIV Program
- 6. Percent Virally Suppressed among PLWH in Care by Region, Louisiana, 2013 Louisiana STD/HIV Program 68% 71% 75% 75% 71% 71% 68% 72% 76% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Percentage Region Louisiana STD/HIV Program
- 7. HIV Continuum of Care by Race/Ethnicity Louisiana, 2013 100% 100% 100% 70% 45% 70% 54% 35% 55% 46% 35% 58% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Black Hispanic White Percentage PLWH In HIV care Retained in care Viral suppression 66% of PLWH in care were virally suppressed 77% of PLWH in care were virally suppressed 82% of PLWH in care were virally suppressed N = 12,442 N = 693 N = 4,861 Louisiana STD/HIV Program
- 8. HIV Testing by Site Type Louisiana, 2013 Total Number of Tests (% of Tests) Number of Positive Results % Positivity Total Positives Number of New Positives % Positivity New Positives Total 95,656 1,069 1.1% 532 0.6% Parish health unit 36,347 (38%) 226 0.6% 146 0.4% Emergency department 19,484 (20%) 235 1.2% 130 0.7% Correctional facility 16,385 (17%) 275 1.7% 27 0.2% Community-based org 15,701 (16%) 279 1.8% 198 1.3% Community health clinic 4,206 (4%) 45 1.1% 25 0.6% Substance abuse clinic 2,805(3%) 5 0.2% 2 0.7% School/college 728 (1%) 4 0.5% 4 0.5%
- 9. Linkage to Care within 90 Days Louisiana, 2007 -2014 67% 70% 70% 73% 74% 78% 79% 83% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 2007 2008 2009 2010 2011 2012 2013 2014 Year of Diagnosis National HIV/AIDS Strategy Objective: 85% Louisiana STD/HIV Program
- 10. Linkage to Care within 90 Days by Region, 2013 Louisiana STD/HIV Program 78% 74% 86% 78% 90% 87% 74% 83% 85% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Percentage Region National HIV/AIDS Strategy Objective: 85% Louisiana STD/HIV Program
- 11. Linkage to Care – New Positives By Site Type, Louisiana, 2013 Number of New Positive Results Number Linked to Care within 90 Days % Linked to Care within 90 Days Total 532 365 69% Community-based org 198 138 70% Parish health unit 146 85 58% Emergency department 130 111 85% Correctional facility 27 12 44% Community health clinic 25 17 69% Substance abuse clinic 2 0 0% School/college 4 2 50%
- 12. Time to Linkage to Care New Positives - CBOs, Louisiana, 2013 0 10 20 30 40 50 0-7 8-15 16-30 31-45 46-90 91-180 181-270 >270 Days to Entry into Care Louisiana STD/HIV Program
- 13. Linkage to Care within 90 Days New Positives - CBOs, Louisiana, 2013 79% 100% 54% 81% 80% 57% 84% 70% 60% 100% 100% 0% 20% 40% 60% 80% 100% A B C D E F G H I J K CBO Louisiana STD/HIV Program National HIV/AIDS Strategy Objective: 85%
- 14. Linkage to Care – New Positives By Gender and Race/Ethnicity, CBOs, 2013 Number of New Positive Results Number Linked to Care within 90 Days % Linked to Care within 90 Days Total 198 138 70% Female 30 16 53% Male 168 122 73% African American/Black 118 73 62% Hispanic/Latino 6 6 100% White 68 55 81%
- 15. Linkage to Care – New Positives By Age Group, CBOs, 2013 Number of New Positive Results Number Linked to Care within 90 Days % Linked to Care within 90 Days Total 198 138 70% 16-24 years old 65 48 74% 25-44 years old 99 68 69% >=45 years old 33 21 64%
- 16. Initial CD4 and Viral Load CBOs, 2013 • CD4 count o Range: 6 - 1,169 o Median: 448 o Average: 439 o 28 clients had a CD4 count <=200 (meet AIDS case definition) • Viral load o Range: <20 – 5,589,140 o Median: 37,080 o Average: 164,125 o 8 clients had a VL<=200 (i.e., virally suppressed)
- 17. HIV Continuum of Care - 2014 CBO – New Positives Diagnosed in 2013 100% 76% 60% 56% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% New Positives Dx in 2013 In HIV care Retained in HIV care Viral suppression (<=200) Percentage 198 118 150 111 74% of persons in care were virally suppressed Louisiana STD/HIV Program
- 18. Evaluating Linkage to Care • How do you evaluate linkage/retention in care at your agency? • Do you collect any data to look at linkage to care? • What are the data gaps? • How can SHP help provide you useful data?
- 19. Questions? For more information: Debbie Wendell, PhD, MPH STD/HIV Program Louisiana Office of Public Health (504) 568-7474 debbie.wendell@la.gov