Download - Overview Neel Reilley
IHS HIV Program Update
May 2012
IHS HIV Program Update
May 2012
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Discussion OverviewDiscussion Overview
• Programmatic Update– AI/AN Epidemiology– New Resources– IHS HIV/AIDS Program Initiatives
• Where We Are Headed• Program Performance
• Programmatic Update– AI/AN Epidemiology– New Resources– IHS HIV/AIDS Program Initiatives
• Where We Are Headed• Program Performance
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EpidemiologyEpidemiology
Including CDC-Generated Statistics
Including CDC-Generated Statistics
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AI/AN HIV EpidemiologyAI/AN HIV Epidemiology
• HIV Estimates, 20091
– Incidence rate : 14.1/100K– About 26% AI/AN People Living with HIV were estimated
to be unaware of status• HIV Diagnosis, 20082
– Prevalence (# living with diagnosed HIV infection): 2,387• AIDS Diagnosis, since 1985
– AI/AN ever diagnosed with AIDS (estimated): 3,7023
• HIV Estimates, 20091
– Incidence rate : 14.1/100K– About 26% AI/AN People Living with HIV were estimated
to be unaware of status• HIV Diagnosis, 20082
– Prevalence (# living with diagnosed HIV infection): 2,387• AIDS Diagnosis, since 1985
– AI/AN ever diagnosed with AIDS (estimated): 3,7023
1Estimated rates of new HIV infections, 50 U.S. states and the District of Columbia, 20092Diagnosis from 40 states and 5 dependent areas, 2008
3 All states and 5 dependent areas, 20094
Rates of HIV Infection Diagnosis/ 100K* Rates of HIV Infection Diagnosis/ 100K*
*40 states with long-term confidential name-based HIV infection reporting
Dependent areas not included due to limited census information
(Adults/Adolescents/Children)
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AI/AN HIV EpidemiologyAI/AN HIV Epidemiology• HIV diagnosis rate for AI/AN men (18.4 per 100K)
slightly higher than white men (14.8)• HIV diagnosis rate for AI/AN women (6.6) more than
double the rate for white women (2.4)
• HIV diagnosis rate for AI/AN men (18.4 per 100K) slightly higher than white men (14.8)
• HIV diagnosis rate for AI/AN women (6.6) more than double the rate for white women (2.4)
Diagnosis from 40 states only, 2009 6
Proportion of Persons Surviving following an AIDS Diagnosis 2001-2005
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New Resources of NoteNew Resources of Note
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Epidemiology ResourceEpidemiology Resource• http://www.cdc.gov/Features/AtlasTool/• http://www.cdc.gov/Features/AtlasTool/
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New WebsiteNew Website• http://www.ihs.gov/hivaids/• http://www.ihs.gov/hivaids/
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AIDS 2012AIDS 2012• IHS presence• HUB opportunities
– Applications open now– Applications close on September 15, 2012– Recorded sessions will be available free of charge– http://www.aids2012.org/hubs.aspx
• Technical Assistance
• IHS presence• HUB opportunities
– Applications open now– Applications close on September 15, 2012– Recorded sessions will be available free of charge– http://www.aids2012.org/hubs.aspx
• Technical Assistance
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IHS HIV/AIDS Program Initiatives:
IHS HIV/AIDS Program Initiatives:
Secretary’s Minority AIDS Initiative Fund
Secretary’s Minority AIDS Initiative Fund
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Major IHS HIV InitiativesMajor IHS HIV Initiatives
• Enhanced Medical Information Technology • Patient-Centered Delivery of Medical Services/
Enhancing Continuity of Care• Clinical Capacity Enhancements and Hepatitis
Integration into Care• Effective Behavioral Interventions• Media Interventions (esp. youth and LGBT)• Continued Testing Expansions and Technical Assistance
• Enhanced Medical Information Technology • Patient-Centered Delivery of Medical Services/
Enhancing Continuity of Care• Clinical Capacity Enhancements and Hepatitis
Integration into Care• Effective Behavioral Interventions• Media Interventions (esp. youth and LGBT)• Continued Testing Expansions and Technical Assistance
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IHS HIV Program Partnerships, 2009
Where Are We Headed?Where Are We Headed?
• Effective Behavioral Interventions Outcomes Dissemination
• Expanded relationships with Tribes and Communities: Including consultation
• Further expansion of HIV Testing• Improving linkages to care, engagement in
care• Improving integration with other IHS
programs and services• Reporting, monitoring and evaluation of
programs: HHS Streamlining of Metrics• Further growth of the HIV network in I/T/U
• Effective Behavioral Interventions Outcomes Dissemination
• Expanded relationships with Tribes and Communities: Including consultation
• Further expansion of HIV Testing• Improving linkages to care, engagement in
care• Improving integration with other IHS
programs and services• Reporting, monitoring and evaluation of
programs: HHS Streamlining of Metrics• Further growth of the HIV network in I/T/U 16
Program Performance and Measurement
How are we doing?
Program Performance and Measurement
How are we doing?
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4 Performance Measures2010
4 Performance Measures2010
1. HIV Screening of 13-64 y.o.: 7%2. Prenatal HIV Screening (GPRA): 82%3. Comprehensive of STI+ patients: 31%4. Chlamydia screening of sexually active 15-24
y.o. females annually: 26%
All 4 measures based on national guidelines and recommendations
1. HIV Screening of 13-64 y.o.: 7%2. Prenatal HIV Screening (GPRA): 82%3. Comprehensive of STI+ patients: 31%4. Chlamydia screening of sexually active 15-24
y.o. females annually: 26%
All 4 measures based on national guidelines and recommendations
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Reducing Infections: ScreeningReducing Infections: Screening
Number of HIV Tests Performed per Year 2000 - 2010
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Impact: GPRA Prenatal HIV Screening
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Successful ScreeningSuccessful Screening• Sites understand screening rationale
• Use of standing protocols or clinical reminders for patients eligible for screening
• Medical team comfortable offering HIV test and test results
• Clear responsibility for who offers HIV test
• Clear linkage to care for HIV+
• Generally “provider-endorsed, nurse-driven”
• Sites understand screening rationale
• Use of standing protocols or clinical reminders for patients eligible for screening
• Medical team comfortable offering HIV test and test results
• Clear responsibility for who offers HIV test
• Clear linkage to care for HIV+
• Generally “provider-endorsed, nurse-driven”
Successful screeningSuccessful screening
• Replicates exisiting prenatal HIV screening practices
• Replicates exisiting prenatal HIV screening practices
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Reminder/Dialogue ChallengesReminder/Dialogue Challenges
• Inaccurate
• Too many
• Inflexible
• Inaccurate
• Too many
• Inflexible
Deploying Reminders (AK site method)
Deploying Reminders (AK site method)
1) Pilot test and refine with 1-2 providers2) Deploy reminder with all providers3) Data feedback for providers to teams to see
screening scores (iCare)4) Delegate screenings away from physicians5) Each professional only sees a subset of total
reminders
source: Onders et. al. JAMIA [in press]
1) Pilot test and refine with 1-2 providers2) Deploy reminder with all providers3) Data feedback for providers to teams to see
screening scores (iCare)4) Delegate screenings away from physicians5) Each professional only sees a subset of total
reminders
source: Onders et. al. JAMIA [in press]
New measureNew measure
• HCV screening, once only, birth cohort of persons born 1945-1965
• Already incorporated in CRS logic as national indicator
• HCV screening, once only, birth cohort of persons born 1945-1965
• Already incorporated in CRS logic as national indicator
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Thank YouThank You
Lisa C. Neel, MPHProgram Analyst, HIV ProgramIHS Headquarters801 Thompson Ave, Suite 304BRockville, MD 20852(301) [email protected]
http://www.ihs.gov/hivaids/
Lisa C. Neel, MPHProgram Analyst, HIV ProgramIHS Headquarters801 Thompson Ave, Suite 304BRockville, MD 20852(301) [email protected]
http://www.ihs.gov/hivaids/
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