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) 443-4305lisa.neel@ihs.gov

http://www.ihs.gov/hivaids/

Lisa C. Neel, MPHProgram Analyst, HIV ProgramIHS Headquarters801 Thompson Ave, Suite 304BRockville, MD 20852(301) 443-4305lisa.neel@ihs.gov

http://www.ihs.gov/hivaids/

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