Metrics for Monitoring and Evaluating the Enhanced Comprehensive Prevention Plan
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This document outlines Tiffany West's work monitoring disease burden and implementing scalable interventions as part of the DC Department of Health Strategic Information Bureau. It discusses expanding HIV testing, including routine opt-out testing, screening in non-clinical settings, and incorporating prevention into care. Key metrics proposed to evaluate programs include the number of HIV tests conducted and positivity rates by site type and high risk population. The goal is to reduce new HIV infections, increase access to care, and achieve a more coordinated local response to the HIV epidemic through data-driven policies and programs.
Metrics for Monitoring and Evaluating the Enhanced Comprehensive Prevention Plan
- 1. Tiffany West, DC Department of Health, Strategic Information Bureau
- 2. Monitor Burden of Disease Develop and Implement scalable Interventions Ensure Quality Service Delivery Assess Impact of Response Assess Effectivness and Cost Effectiveness
- 3. Routine Opt Out HIV Screening Health Communication and HIV Screening in Non-Clinical Settings Social Marketing PEP Policy Review Integrated Hep, STD, TB, Incorporating HIV Prevention HIV testing, partner into HIV Care services, vaccination and Scale up of STD Screening Guidelines treatment Prevention of Perinatal Transmission Targeted use of HIV/STD Integrated HIV/STD Partner Services Behavioral Risk Reduction for HIV + Surveillance Data Retention and Re-engagement Focus on High Risk Condom Distribution Negatives Community Mobilization EVALUATION PCSI
- 4. Program Collaboration and Service Integration (PCSI) Process Reduce the HIV, STD, TB, and hepatitis- related morbidity and mortality Increasing Access to Care and Reducing HIV-Related Achieving a More Coordinated Reduce New HIV Improving Health Outcomes for Disparities and Health National/Local Response to the Infections People Living with HIV Inequities HIV Epidemic Immediately link people to Reduce # of people Reduce HIV-related continuous and coordinated Ensure there data driven unaware of their HIV mortality in communities at quality care when they are policies and programs Status high risk for HIV infection diagnosed with HIV Adopt community-level Increase the coordination of Reduce Impact of Risk Strengthen retention and recapture approaches to reduce HIV HIV, STD, Hepatitis and Behaviors among Target of HIV positive individuals into infection in high-risk TB Prevention, care and Populations HIV care communities treatment programs (PCSI) Intensify HIV prevention Increase the number and diversity Reduce stigma and Improve fiscal and efforts in the communities of available providers of clinical discrimination against operational efficiencies and where HIV is most care and related services for people living with HIV accountability heavily concentrated. people living with HIV. Establish models to Support people living with HIV Assess effective, cost Routinize HIV prevention, more efficiently link HIV-infected clients to with co-occurring health care and treatment as effectiveness and impact of care conditions standard of care programs Improve results and health Expand innovative outcomes partnerships Data to Drive Policies and Programs: Strategic Information
- 5. Care Information Systems Medicaid ADAP HIV, STD TB, Hepatitis PEMS I: CTR Laboratory Data, Surveillance PEMS 2: HERR Vital Statistics, Disease Registries Electronic Medical BRFSS, YRBS, Epidemiologic Records, Hospital Other Population Data: NHBS, Local Discharge Data Studies Study Data, HPTN 065
- 6. Defining Indicators by Type (1) Input Indicators: Measure the quantity, quality, and timeliness of resources — human, financial and material, technological and information — provided for an activity/project/program. • # of FTEs • Cost of Intervention • Materials or In prints (social marketing) • Change in legislation or rules governing HIV testing Process Indicators: Measure the progress of activities in a programme/project and the way these are carried out • # of providers fully implementing routine opt out HIV screening • # of stakeholder meeting to discuss testing policy
- 7. Defining Indicators by Type (2) Output Indicator: Measure the quantity, quality, and timeliness of the intervention that are the result of an activity/service/project/program • # of HIV publically funded HIV tests • # of Positives • Proportion of positives linked to care within 3 months of diagnosis Outcome Indicators: Measure the quality and quantity of long- term results generated by programme outputs (morbidity and mortality) • Decrease in AIDS Cases • Reduction in incidence • Change in behavior
- 8. # of providers conducting routine opt out screening by site type # of hospitals ED conducting routine screening # of providers approached to expand testing efforts # of non clinical targeted testing sites Description of Provider Population # of providers doing social network testing Number of social marketing Advertisements on testing
- 9. Impact Indicators: HIV Testing HIV Routine Opt-Out Testing Expansion Publicly-Supported Rapid Tests, 2007-2010 120,000 Start of routine testing expansion 19.0% increase in 100,000 number of tests done 18.0% 27.3% increase in number of tests done 14.7% 80,000 Non-Clinical 12.7% Clinical 60,000 68.4% increase in 82.0% number of tests done 40,000 85.3% 40,000 18.2% 87.3% 20,000 20,000 81.8% 0 2004 2005 2006 2007 2008 2009 0 FY 2007 FY 2008 FY 2009 FY 2010 N=43,271 N=72,864 N=92,748 N=110,358
- 10. # of HIV Tests conducted by site type (publically funded settings) Positivity Rate by site type (publically funded settings) # of publically funded HIV tests by high risk population Positivity Rate by high risk population Provider Population Positivity rate among social network providers and within social networks
- 11. 800 Start of routine testing expansion 700 600 Number of AIDS Cases 500 400 Men Women Total 300 200 100 0 2005 2006 2007 2008 2009 Year of Diagnosis Confidential Source: DC Department of Health HIV/AIDS Epidemiology Update, 2009
- 12. Proportion of AIDS cases who are late testers (eHARS) Proportion of DC residents tested within the last 12 months (BRFSS) Number of new HIV cases diagnosed by funded and non funded clinical providers (eHARS) HIV Prevalence among MSM, IDU, HET (NHBS) Proportion of MSM, IDU, HET Unaware of HIV Status (NHBS) Proportion of MSM, IDU, HET tested in last 12 months (NHBS)
- 13. # and Type of Provider distributing condoms (public and private sector) Location of providers distribution condoms Assess Client Population of Providers Distribution Condoms (Population Served) # and imprints of Social Marketing Messages Related to Condoms
- 16. Condom use at last sex (overall)-BRFSS Condom use at last vaginal sex (IDU, HET) – NHBS Condom use at last anal sex (MSM, IDU, HET) – NHBS Proportion of youth a condom at last sexual intercourse among currently sexually active youth -YRBS
- 17. Process Evaluation • Challenge: Different Funding Streams, (CDC-Linkage, HRSA- EIS) • Align to create comprehensive linkage to care strategy • One set of tools (PEMS Form 2 Plus) • Preliminary Positive=Named Case/ False Positives <2% # of providers funded for linkage programs (by provider and by type of program) # of preliminary positives by program by type • Red Carpet Entry, Latino, Adolescent, Unaffiliated Linkage, Department of Correction # and Proportion of clients linked to care within 3 months by linkage or navigation program type # of confirmed positives by provider and linkage type
- 18. 1,114 1,222 1,226 999 726 100% *2008 Clinical 80% Site Partners, 77% Linkage 60% Percent 40% 20% 0% 2005 2006 2007 2008 2009 Year of HIV Diagnosis <3 Months 3-6 Months 6-12 Months >1 Year 18
- 19. Proportion of Ryan White clients with at least 2 outpatient ambulatory visits in the last 12 months (Impact) Proportion of new diagnosis remaining in care after 12 months ( Impact) Proportion of people living with HIV receiving care primary and support service( Impact ) # of providers funded for retention programs ( Process) # of clients served through retention programs, by type (Process) # of visits per program (Impact ) Proportion of clients served by retention programs that had at least 2 medical visits in the last 12 months (Impact )
- 20. Re-engagement # of clients loss to follow up among funded providers ( Impact) # of clients contacted through loss to follow up programs ( Impact ) # of appointments made through loss to follow up programs (Impact) Number of appointments kept through loss to follow up programs ( Impact) Average number of contacts required for recapture by program type ( Impact )
- 22. Purpose: To re-engage people living with HIV in care who are ‘loss to care’ Define: Loss to care: Not in care for more than 6 months Methods: Primary Medical Care Providers send list of clients not seen in their clinics for greater than 6 months. HAHSTA “matched” these lists to e-HARS, labs surveillance and ADAP databases. • Providers are given “yes” or “no” for those found to be in care in another location • 90 day “blitz”; Providers prioritized for recapture those whose last activity was > 6 months
- 24. “ Treatment of Demand”: Proportion of Newly Diagnosed People with HIV/AIDS Meeting HHS Treatment Guidelines for ARV Initiation, 2005- 2009 N = 1,144 N = 1,281 N = 1,315 N = 1,087 N = 766 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 2005 2006 2007 2008 2009 24 Confidential Eligible) <350 (Treatment 350-499 500 and above No CD4
- 25. Mean Community Viral Load among White and Black MSM with HIV/AIDS in DC, 2008 45,000 Mean Community Viral Load (copies/mL) 40,000 35,000 31,404 30,000 25,000 20,000 19,732 15,000 10,000 5,000 0 White MSM Black MSM N=645 N=901
- 26. Mean Community Viral Load among Whites and Blacks Living with HIV/AIDS in DC, 2008 50,000 45,000 Mean Community Viral Load (copies/mL) 40,000 39,173 35,000 30,000 25,000 20,000 18,283 15,000 10,000 5,000 0 White Black N=762 N=3,395
- 27. 100 95 90 85 Site 10 80 75 70 65 Site 9 60 55 Site 2 Average is 51.5% 50 Site 1 45 Site 4 and Site 13 40 Site 11 35 Site 5 30 25 20 15 10 5 0
- 28. Defining Input Indicators: DC PCSI Project Identify Efficiencies in Current System for Collaboration and Integration • Increase Impact, Increase Cost Effectiveness, • Decrease Cost Hepatitis/STD/HIV/TB • Integrated Strategic Information to measure health outcomes • Moving towards medical system as a point of delivery for HIV Prevention • Multiple Morbidities Testing, Screening and Treatment
- 29. Data Driven Social Marketing 80.0% “Safer” Sex Behaviors among Study Participants 72.7% 70.0% 67.4% 66.4% 64.1% 60.9% 60.0% 57.4% 49.7% 50.0% 40.0% Heterosexuals MSM* 29.9% 30.0% 30.0% IDU 20.0% 10.0% 0.0% **Other mode of transmission includes hemophilia, blood transfusion, Condoms Use at Knew own Status Knew Partner's occupational exposure (healthcare workers), and perinatal. Last Sex Status
- 30. Impact Indicator: Behavior Change: Social Marketing
- 31. Act on Results • Reallocation of Resources (Internal and External) Silos in Reporting, Communication, Data Collection Local and Federal Level Multiple Data Reporting Streams contrary to systemic planning and coordination • RW Reporting for All Parts • Locally and Directly Funded Prevention Programs Capacity vs. Ideology
- 32. 12 Cities Initiative is an opportunity to develop new, innovative programs, develop and strengthen relationships and change existing policies • SAMSHA/Mental Health/Substance Abuse FOA • Surveillance Supplemental Application Redefine Response to Epidemic • Affordable Care Act • Provider Response
- 33. Monitoring and Evaluation is a critical component to scale up of NHAS Existing Models and Best Practices: Peer to Peer TA-Collectively Learning Opportunity for Jurisdictions Success Depends on Continued Coordination, Collaboration, Infrastructure Investments