Transcript Outcomes - Texas Department of State Health Services

Review of the
Medical Monitoring Project
Outcomes of Interest
Pilot Year Data
MMP PAB/CAB Meeting
May 31, 2007
Department of State Health Services
Epidemiology & Surveillance Unit
Sylvia L. Odem, MPH
Project Coordinator
Acknowledgements to the Pilot Year
TX-MMP Team:
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Katharine Carvelli, Epidemiologist
Mark Heinzke, Data Manager
Sharon K. Melville, Principal Investigator
Nita Ngo, Epidemiologist
Jim Phillips, Data Collector
Renee Ridgley, Data Collector
Tammy Sajak, Co-Principal Investigator
Jose Velez, Data Collector
Simone Wooden-Jackson, Data Collector
What is the Medical Monitoring Project
(MMP)?
 A survey and medical chart review about
the experiences and needs of people living
with HIV and AIDS in the US
Behaviors
Clinical outcomes
Type and quality of care received
Identify met and unmet needs for HIV care
and prevention services
MMP Goals
Determine access to and use of prevention and
support services
Provide local and national estimates for the
population in care for HIV
Examine variations of factors by geographic
area and patient characteristics (i.e. risk
behaviors, quality of care etc.)
How you might use the MMP
data
Supplement your local needs
assessments
 Determine need for new programs in
your organization
 Use for grant applications and RFP’s
 Use as a benchmark for your
programs
 Requests for special data runs

Nationally Representative
Three Stage Sampling Design
1st stage - Site
20 states + 6 cities
randomly selected
Chicago
San Francisco
New York City
Philadelphia
2nd stage - Provider
40-60 facilities randomly
selected - large, medium,
and small
LA County
Houston
Alaska
Hawaii
High
Puerto Rico
Medium
Low
3rd stage - Patient
400 randomly selected
patients
MMP Success
MMP
PROVIDERS
COMMUNITY
MMP Data collection
Pilot Year – 2005
 Preliminary data
 13 sites
 Sampled 27 facilities
 Sampled 150 patients
 81 interviews
 86 chart abstractions
Project Year – 2007
 Full year – all 26 sites
participating
 Sampled 47 facilities
 27 recruited to-date
 400 patients to be
sampled
 400 interviews &
abstractions to be
done
Demographics & Patient
Characteristics
Gender
100%
80%
84%
60%
40%
20%
16%
0%
Birth Gender
Female
Male
Race/Ethnicity
B la c k
24%
Whit e
45%
R e f us e d t o
A ns we r
1%
O t he r
5%
H is pa nic
25%
Age by Race
30%
25%
20%
17%
15%
16%
15%
15%
10%
5%
7%
9%
7%
5%
1%
3%
1%
1%
1%
0%
Under 30
30-39
40-49
Age
White
Black
Hispanic
Other
50-59
Age by Race
1
40
13
30
2
11
20
0
10
7
4
2
2
6
0
13
11
6
0
Under 30
(14%)
30-39
40-49
(21%)
(48%)
50+
(18%)
Age
White
Black
Hispanic
Other
Education by Race
White
Black
Hispanic
Other
Total
Grades 1-11
6%
37%
25%
0%
18%
Completed high school or GED
22%
37%
20%
*
24%
Some college, associate's degree
or technical degree
44%
26%
45%
*
39%
Bachelor's degree or postgraduate
studies
25%
0%
10%
*
17%
Total
45%
24%
25%
4%
100%
*Cell suppressed for n<3
Age First Positive by Race
35
3
30
7
1
10
25
20
9
7
15
10
16
3
3
5
14
5
1
0
Under 30
(44%)
White
30-39
40-49
(40%)
(15%)
Age
Black
Hispanic
50+
(1%)
Other
Number of Years HIV Positive
50%
40%
34%
30%
30%
18%
20%
n=25
16%
n=22
10%
n=13
n=12
3%
*
0%
0-5
6-10
11-15
Years HIV Positive
*Cell suppressed for n<3
16-20
20+
Alcohol and Drug Use
Alcohol or noninjection drug use in
past 12 months
n=21
Ever injected drugs
Injected drugs in
past 12 months
0%
57%
n=46
25%
0%
15%
30%
45%
60%
75%
Date of Last Injection and First
Positive Date
Last Injection
After First
Positive
33%
Last Injection
Prior to First
Positive
67%
Frequency of Alcohol Consumption
in Past 12 Months*
50%
37%
40%
30%
22%
17%
20%
12%
10%
5%
5%
2%
0%
More than Once a day More than
Once a day
once a
week
Once a
week
More than
once a
month
Once a
month
Less than
once a
month
*51% of those interviewed reported alcohol use in the past 12 months
No. of Alcoholic Drinks in Typical
Day in Past 30 Days
75%
60%
45%
40%
29%
20%
30%
9%
15%
3%
0%
1-2
3-5
6-10
> 10
No. of Drinks per Day
Don't
Know
Drug Use in Past 12 months
Other*
2%
Ecstasy
2%
A mphetamines
2%
M ethamphetamines
4%
P ainkillers
7%
Do wners
7%
Crack
11%
P o ppers
11%
20%
Co caine
52%
M arijuana
0%
*Embalming fluid
15%
30%
45%
60%
75%
Mean Number of Sexual Partners
in the Past 12 months
Mean
Male: Male Partner(s)
2
Male: Female Partner(s)
1
Female: Male Partner(s)
1
Male: Male Partner(s)
 64% of men interviewed reported having male
sexual partner(s) in the past 12 months
n (%)
Last partner main
21 (43%)
Last partner casual
16 (33%)
Anal sex
28 (57%)
Unprotected anal sex*
13 (46%)
Insertive partner*
5 (18%)
Receptive partner
6 (21%)
Insertive and receptive partner
17 (61%)
Discussed HIV status before 1st sex w/ last
partner*
8 (29%)
*Among men who reported having anal sex in past 12 months
Male: Male Partner(s) – Last Time
You Had Sex
Last Time You Had Sex:
(n=39)
Oral Sex Only
14 (36%)
Sexual Partner was a Main Partner
22 (56%)
Sexual Partner was a Casual Partner
17 (44%)
Knew HIV Status of Last Partner
32 (82%)
Partner was HIV+
15 (47%)
Partner was HIV-
17 (53%)
Male: Female Partner(s)

10% (n=7) of men interviewed reported having
female sexual partner(s) in the past 12 months
Last partner main
Last partner casual
Vaginal Sex
Unprotected vaginal sex
5 (71%)
*
5 (71%)
3 (60%)
Anal sex
*
Unprotected anal sex
*
Discussed HIV status before 1st sex
*
*Cell suppressed for n<3
Female: Male Partner(s)

46% (n=6) of women had male sexual
partner(s) in the past 12 months
Last partner main
Last partner casual
Vaginal Sex
6 (100%)
0
6 (100%)
Unprotected vaginal sex
*
Anal sex
0
Unprotected anal sex
0
Discussed HIV status before 1st sex
*
*Cell suppressed for n<3
Access to Care
& Need for Services
Public Assistance and
Homelessness in Past 12 Months
75%
56%
60%
45%
30%
n=45
9%
15%
n=7
0%
Received Public
Assistance
Homeless
*57% (n=4) of homeless were receiving public assistance
Health Insurance Coverage
Any Health
Insurance
72%
43%
Private or HMO
45%
Medicare
34%
Medicaid
0%
20%
40%
60%
80%
Payment Method for HIV Meds &
Other Meds in Past 12 Months
Payment Method for Treatment
n (%)
Not on meds
6 (8%)
Healthcare coverage
22 (27%)
Received meds from public clinic
4 (5%)
Out-of-pocket
2 (2%)
Out-of-pocket & healthcare coverage
4 (5%)
ADAP alone or in combination
Other combination
Other
27 (33%)
4 (5%)
12 (15%)
Time to Start HIV Care
85%
100%
80%
60%
40%
15%
20%
0%
≤ 4 months
≥ 5 months
Time between Positive test
and Receiving HIV Care
Reasons for Delay in HIV Care
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Didn’t want to think about being HIV positive
(main reason)
Felt good, didn’t need to go
Too busy to go
Didn’t want to believe HIV test results
Drinking or using drugs
Fear of being socially ostracized
Felt meds were dangerous
Need and Receipt of Services in
the Past 12 Months
Needed
Not
Received
HIV Case Management
46%
14%
Mental Health Counseling
30%
17%
Social Services
25%
20%
Help finding dental services
17%
7%
Help with finding meals/food
17%
14%
Transportation assistance
17%
29%
Education or information on HIV risk reduction
16%
2%
Help finding shelter or housing
12%
70%
Help finding a doctor for ongoing medical services
7%
17%
Adherence support services
6%
40%
Home health services, such as home nursing care
4%
33%
Chore or homemaker services
4%
33%
Childcare Services
0%
N/A
Reasons for Not Receiving
Services Needed
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Didn’t know where to go/who to call (n=12)
Service not available in patient’s area (n=4)
Waiting list too long (n=7)
Transportation problems (n=*)
Not eligible or denied services (n=*)
Services too costly (n=*)
*Cell suppressed for n<3
Receipt of Prevention Activity Items
in Past 12 Months
Free
Condoms
Free
Needles
Free
Kits
†
†
Received
36%
(n=29)
Used
product
69%*
(n=20)
N/A
N/A
Now more
likely to
use
83%*
(n=24)
N/A
N/A
*Percentage computed using those who had received condoms as the denominator
† 25%
reported ever injecting drugs, but 0% have injected drugs in the past 12
months
Free Condom Source
%
Community Health Ctr / Public Health Clinic
41%
HIV/AIDS focused Community Based Org
24%
Adult HIV/AIDS Specialty Clinic
24%
Drug Treatment Program
7%
Private Doctor’s Office/HMO
3%
Other: Event
3%
Preventive Therapies and
Screenings
Preventive Therapy
Yes
No
Don’t
Know
Pneumocystis carinii pneumonia
meds ever prescribed to treat/prevent
48%
49%
3%
Mycobacterium avium complex meds
ever prescribed to treat/prevent*
27%
55%
18%
Pneumonia vaccine in past 5 years
68%
27%
5%
Flu vaccine in past 12 months
83%
16%
1%
Vaccine for Hepatitis A , B, or both
59%
30%
11%
*Only prescribed to patients who have a CD4 cell count <49.
Reasons For Not Receiving
Hepatitis Vaccination
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Patient already has hepatitis
Doctor indicated vaccine not necessary
Patient did not believe they were at risk for
contracting hepatitis
Patient doesn’t like needles
Patient was not aware vaccine was
available
Patient did not complete the series
Ever Tested for and Ever Had
Hepatitis
100%
88%
80%
68%
67%
60%
60%
38%
40%
21%
14%
20%
6%
0%
Any Hepatitis
Hepatitis A
Had
Hepatitis B
Tested
Hepatitis C
Prevention: Tests
Yes
No
Don’t
Know
TB skin test ever
95%
4%
*
Last TB test within past 12
months†
55%
35%
10%
Last TB test positive
4%
90%
6%
†Among patients who have ever had a TB skin test
*Cell suppressed for n<3
STD Screening in Past 12 months
60%
44%
50%
37%
40%
30%
26%
27%
23%
20%
11%
10%
0%
Chlamydia Gonorrhea
Syphilis
Herpes
HPV
Sexually Transmitted Disease
NGU
Female Sexual Health
100%
100%
77%
80%
60%
n=13
n=10
40%
20%
0%
Pelvic Exam Ever
Pelvic in last 12 months
Female Sexual Health
PAP Smear Ever
n=12
n=11
PAP at Last Pelvic*
n=12
n=11
100%
42%
n=5
n=5
Abnormal PAP Ever*
92%
Follow-up to
Abnormal PAP
n=5
n=5
0%
20%
40%
100%
60%
*Among patients who ever had a PAP smear
80%
100%
Facility Type for Last Pelvic Exam
Clinic/Doctor's
office (not usual
source of care)
8%
OB/GYN Office
8%
Usual Source of
non-HIV Care
8%
HIV Care Facility
76%
CD4, Viral Load Tests &
ARV Medications
CD4 and Viral Load Tests
in Past 12 Months
CD4 Count
Viral Load
0-2 tests
14%
14%
3-4 tests
57%
54%
≥ 5 tests
26%
27%
Antiretroviral Usage
94%
100%
78%
80%
60%
n=76
n=63
40%
15%
20%
n=12
0%
Ever Taken
Antiretrovirals
Currently Taking
Antiretrovirals
Taken Drug Holiday
in Past 12 Months
Drug Combinations of ARV Meds
Currently Using
Number of Drugs
n=63
≥ 3 Drugs*
27 (43%)
2 Drugs†
25 (40%)
1 Drug
8 (13%)
*Includes combinations such as 3 nukes and 2 PIs; 3 nukes and 1 non-nuke; 3 nukes, 2 PIs, and 1
combination drug; 2 nukes, 1 PI, and 1 combination drug; 1 nuke, 1 non-nuke, and 1 combination
drug
†Including combinations such as 1 nuke and 1 PI; 1 nuke and 1 non-nuke; 1 nuke and 1 combination
drug
Reason Never Started Antiretroviral
Treatment
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Doctor advised to delay treatment (main
reason)
CD4 counts and/or viral load good
Felt good and didn’t need them
Concerned about side effects
Reason Not Currently on ARV
Meds
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Doctor advised to delay treatment
CD4 counts and/or viral load good
Felt good and didn’t need them
Concerned about side effects
Allergic to medicines
Tired of taking medicines
Patient believed medicines complicate
his/her life
Last Time Missed Any ARV Dose*
Within the past w eek
8%
1-2 w eeks ago
11%
3-4 w eeks ago
5%
1-3 months ago
11%
16%
> 3 months ago
29%
Never Skip
21%
Don't Know
0%
10%
20%
30%
*Among patients who were currently taking antiretrovirals
40%
50%
Adherence to Medication
Instructions in Past 2 Days
100%
80%
63%
60%
40%
17%
20%
5%
7%
7%
0%
Alw ays
Most of the Half of the Some of the
time
time
time
Never
*Among patients who were currently taking antiretrovirals with special instructions
Reason for Missing Doses of
Antiretroviral Meds
Forgot to take
41%
Problems getting refill
22%
Had problems taking at specified times
16%
Felt too ill
13%
Change in daily routine
13%
Wanted to avoid side effects
6%
Busy with other things
6%
Couldn’t get to a doctor or clinic
6%
Felt depressed or overwhelmed
6%
Had too many pills to take
3%
Other
16%
Contact Information
Email: [email protected]
 Call Sylvia Odem, Project Coordinator
at (512) 533-3053
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