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Estimating the number of Kentuckians living with HIV disease with unmet needs for HIV-related
primary care in calendar year 2010
1
MPH ,
Peace Julie Nakayima,
Kraig E Humbaugh, MD,
Sara Robeson, MA,
1Cabinet for Health and Family Services, Kentucky Department for Public Health, 275 E Main St, Frankfort KY
Background
 Reducing new HIV infections is the first primary goal of the
National HIV/AIDS Strategy (NHAS).
 Increasing the number of persons diagnosed and linked into
effective care and prevention services has the potential to
significantly reduce morbidity and premature death, and decrease
new HIV infections over time.
1
MPH ,
Results
Overall estimate: Of the 5,132 Kentuckians living with a diagnosis of HIV disease at the end of 2010, an estimated 38%
had HIV-related unmet needs.
Of the 246 Hispanics living with HIV disease at the end of 2010;
Figure 1. Unmet Needs among Kentuckians in 2010 by
Race/Ethnicity
80
%
Objective
62%
60
40
 To estimate the number of Kentuckians living with HIV disease and
aware of their status, who did not receive HIV-related primary care in
calendar year 2010.
 Persons with unmet needs were those who were aware of their HIV
status and not receiving HIV-related primary care through laboratory
testing, or the Kentucky HIV/AIDS Care Coordinator Program (KHCCP),
or Medicaid.
20
45%
5%
Almost half had unmet needs (49%)
66%
55%
Almost half had unmet needs (45%)
34%
60%
35%
Overall
Hispanic
Unmet Need
Black
 All counts and percentages are estimates, due to limitations
discussed.
Limitations
Met Need
Sex and Race/Ethnicity:
Minority males living with HIV disease at the end of 2010 had
the highest percentages of unmet needs:
Figure 2. Unmet Needs among Kentuckians in 2010 by Sex
and Race/Ethnicity
100
80
%
52% of Hispanic males
60
52% 48%
48% 52%
40
48% of black males
63%
61%
70%
66%
39%
37%
34%
30%
Hispanic
Females
Black
Females
White
Males
White
Females
20
Minority females had comparable percentages of unmet needs:
39% of Hispanic females
0
Hispanic
Males
Black
Males
Unmet Need
Met Need
37% of black females
Key point: HIV-related unmet needs were highest among Hispanic males, black males, Hispanic females and black
females in comparison to their white counterparts.
Mode of Transmission:
Of the 218 MSM and injection drug users (MSM/IDU) living with HIV disease
39% had unmet needs
Figure 3. Unmet Needs among Kentuckians in 2010 by Mode
of Transmission
%
80
60
61%
58%
42%
39%
62%
38%
65%
35%
70%
30%
20
No Risk
MSM/IDU
Unmet Need
IDU
Met Need
MSM
Of the 452 injection drug users (IDU) living with HIV disease
38% had unmet needs
Of the 2719 men who have sex with men (MSM) living with HIV disease
0
 Statistical analyses were completed using SAS® software, version
[9.2] and record linkages performed with Link Plus software.
Over a third had unmet needs (34%)
Key Point: HIV-related unmet needs were highest within minority groups in comparison to whites.
40
 Evidence of care through Medicaid records for 2010.
Of the 3027 whites living with HIV disease at the end of 2010;
White
100
 Evidence of care through the KHCCP database (CAREWare)
during 2010; or
Of the 1788 blacks living with HIV disease at the end of 2010;
0
Inclusion criteria:
 Persons included were diagnosed with HIV disease by the end of
2010, while residing in Kentucky at time of diagnosis and living
through December 31, 2010. Persons meeting these criteria and
reported in the enhanced HIV/AIDS registry (eHARS) were analyzed
for:
 Laboratory reports of viral loads or CD4 assays collected in
2010; or
49% 51%
38%
Methods
HIV-related unmet needs definition:
Geographic Distribution
Race/Ethnicity:
100
 The Kentucky Department for Public Health conducted a
retrospective analysis of Kentucky residents diagnosed with HIV
disease by December 31, 2010 and reported by December 31, 2011.
1
MSPH
Hetero
35% had unmet needs
Of the 820 high risk heterosexuals (HRH) living with HIV disease
30% had unmet needs
Key Point: HIV-related unmet needs among Kentuckians were comparable by mode of transmission.
 The estimate does not account for migration in and
out of the state. Kentucky is bordered by seven states.
If treatment was sought out of state and testing done
at a non-reference laboratory, then these persons
may have been classified as out of care.
 Although the definition calls for persons who are
aware of their HIV status, Kentucky surveillance does
not capture this information routinely. Therefore, the
estimate includes persons reported in eHARS,
regardless of HIV status awareness.
Conclusions
Minority racial/ethnic groups have the highest
percentages of unmet needs, therefore interventions
should target these demographic groups. The
percentages of Kentuckians with unmet needs are
similar by sex and mode of transmission.
Local and state programs across the U.S. can use
similar methodology as a model in the first step
toward facilitating program planning to increase
linkage to and retention in care.
Acknowledgements
The authors thank all programs within the Kentucky
Cabinet for Health and Family Services for providing
data for this analysis including:
The Ryan White Part B Care Coordinator Program
Department for Medicaid Services