Review of theMedical Monitoring Project Outcomes of InterestPilot Year Data: 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 andamp; Surveillance Unit Sylvia L. Odem, MPH Project Coordinator


Acknowledgements to the Pilot Year TX-MMP Team:: Acknowledgements to the Pilot Year TX-MMP Team: 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)?: 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: 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 : 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: Nationally Representative Three Stage Sampling Design 1st stage - Site 20 states + 6 cities randomly selected 2nd stage - Provider 40-60 facilities randomly selected - large, medium, and small 3rd stage - Patient 400 randomly selected patients High Medium Low LA County Alaska Hawaii Puerto Rico New York City San Francisco Houston Chicago Philadelphia


MMP Success: MMP Success


MMP Data collection: 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 andamp; abstractions to be done


Demographics & Patient Characteristics: Demographics andamp; Patient Characteristics


Gender: Gender


Race/Ethnicity: Race/Ethnicity


Age by Race: Age by Race


Age by Race: Age by Race (14%) (21%) (48%) (18%)


Education by Race: Education by Race *Cell suppressed for nandlt;3


Age First Positive by Race: Age First Positive by Race (44%) (40%) (15%) (1%)


Number of Years HIV Positive: Number of Years HIV Positive n=25 n=22 n=12 n=13 * *Cell suppressed for nandlt;3


Alcohol and Drug Use: Alcohol and Drug Use n=46 n=21


Date of Last Injection and First Positive Date: Date of Last Injection and First Positive Date


Frequency of Alcohol Consumption in Past 12 Months*: Frequency of Alcohol Consumption in Past 12 Months* *51% of those interviewed reported alcohol use in the past 12 months


No. of Alcoholic Drinks in Typical Day in Past 30 Days: No. of Alcoholic Drinks in Typical Day in Past 30 Days


Drug Use in Past 12 months: Drug Use in Past 12 months *Embalming fluid


Mean Number of Sexual Partners in the Past 12 months: Mean Number of Sexual Partners in the Past 12 months


Male: Male Partner(s): Male: Male Partner(s) 64% of men interviewed reported having male sexual partner(s) in the past 12 months *Among men who reported having anal sex in past 12 months


Male: Male Partner(s) – Last Time You Had Sex: Male: Male Partner(s) – Last Time You Had Sex


Male: Female Partner(s): Male: Female Partner(s) 10% (n=7) of men interviewed reported having female sexual partner(s) in the past 12 months *Cell suppressed for nandlt;3


Female: Male Partner(s): Female: Male Partner(s) 46% (n=6) of women had male sexual partner(s) in the past 12 months *Cell suppressed for nandlt;3


Access to Care & Need for Services: Access to Care andamp; Need for Services


Public Assistance and Homelessness in Past 12 Months: Public Assistance and Homelessness in Past 12 Months n=7 n=45 *57% (n=4) of homeless were receiving public assistance


Health Insurance Coverage: Health Insurance Coverage


Payment Method for HIV Meds & Other Meds in Past 12 Months: Payment Method for HIV Meds andamp; Other Meds in Past 12 Months


Time to Start HIV Care: Time to Start HIV Care


Reasons for Delay in HIV Care: Reasons for Delay in HIV Care 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: Need and Receipt of Services in the Past 12 Months


Reasons for Not Receiving Services Needed: Reasons for Not Receiving Services Needed 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 nandlt;3


Receipt of Prevention Activity Itemsin Past 12 Months: Receipt of Prevention Activity Items in Past 12 Months *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: Free Condom Source


Preventive Therapies and Screenings: Preventive Therapies and Screenings


Preventive Therapy: Preventive Therapy *Only prescribed to patients who have a CD4 cell count andlt;49.


Reasons For Not Receiving Hepatitis Vaccination: Reasons For Not Receiving Hepatitis Vaccination 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: Ever Tested for and Ever Had Hepatitis


Prevention: Tests: Prevention: Tests †Among patients who have ever had a TB skin test *Cell suppressed for nandlt;3


STD Screening in Past 12 months: STD Screening in Past 12 months


Female Sexual Health: Female Sexual Health n=13 n=10


Female Sexual Health: Female Sexual Health n=11 n=11 n=5 n=5 n=12 n=12 n=5 n=5 *Among patients who ever had a PAP smear


Facility Type for Last Pelvic Exam: Facility Type for Last Pelvic Exam


CD4, Viral Load Tests & ARV Medications: CD4, Viral Load Tests andamp; ARV Medications


CD4 and Viral Load Tests in Past 12 Months: CD4 and Viral Load Tests in Past 12 Months


Antiretroviral Usage: Antiretroviral Usage n=76 n=63 n=12


Drug Combinations of ARV Meds Currently Using: Drug Combinations of ARV Meds Currently Using *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: Reason Never Started Antiretroviral Treatment 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: Reason Not Currently on ARV Meds 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*: Last Time Missed Any ARV Dose* *Among patients who were currently taking antiretrovirals


Adherence to Medication Instructions in Past 2 Days: Adherence to Medication Instructions in Past 2 Days *Among patients who were currently taking antiretrovirals with special instructions


Reason for Missing Doses of Antiretroviral Meds: Reason for Missing Doses of Antiretroviral Meds


Contact Information: Contact Information Email: TXMMP@dshs.state.tx.us Call Sylvia Odem, Project Coordinator at (512) 533-3053 National website under reconstruction Sign up for receiving newsletter