HRSA HIV/AIDS Bureau Updates

Transcription

1 HRSA HIV/AIDS Bureau Updates Minority AIDS Initiative (MAI): 15 Years Later What s Been Achieved? What Are the Ongoing Barriers to Success? October 2, 2014 Harold J. Phillips Deputy Director Division of State HIV/AIDS Programs (DSHAP) HIV/AIDS Bureau Health Resources and Services Administration U.S. Department of Health and Human Services

2 Ryan White HIV AIDS Treatment Extension Act Largest Federal government program specifically designed to provide services for people living with HIV/AIDS Third largest Federal program serving people living with HIV/AIDS after Medicaid and Medicare Enacted as the Ryan White Comprehensive AIDS Resources Emergency Act August 18,1990 Amended in 1996, 2000, 2006, 2009 no longer an emergency act 2

3 Ryan White HIV/AIDS Program - Intent Increase access to care for people living with HIV disease (PLWH) Only disease-specific discretionary grant program for care and treatment of PLWH Payer of last resort safety net for uninsured and lowincome individuals living with HIV/AIDS Funding for: o Primary health care including medications o Provider training o Support services o Technical assistance (TA) o Demonstration projects 3

4 Ryan White HIV/AIDS Programs Cities (Part A) States and Territories (Part B) o AIDS Drug Assistance Program (ADAP) Health Care Agencies 349 CHCs, health departments, hospitals, and other community based organizations in 49 states, DC, Puerto Rico and the U.S. Virgin Islands o Early Intervention Services and Capacity Development (Part C) o Women, Infants, Children and Youth (Part D) Other programs (Part F) o Dental, Education/Training, Planning, Capacity Development and Demonstrations, Minority AIDS Initiative 4

5 HIV/AIDS Bureau s Framework

6 HIV/AIDS Bureau s Framework Zero New Infections The Ryan White HIV/AIDS Program (RWHAP) supports the goals of the National HIV/AIDS Strategy (NHAS) by: Funding a comprehensive care system for low-income people living with HIV that: o Reduces new HIV infections o Improves health outcomes and increases quality of life for PLWH o Decreases HIV-related health disparities Including PLWH in the planning of services Employing a public health approach to care and treatment 6

7 FY 2014 Ryan White HIV/AIDS Appropriations $2.319 Billion HRSA 7

8 RWHAP and MAI Funding The Minority AIDS Initiative (MAI) was established by Congress under each of the Ryan White HIV/AIDS Program Parts A, B, C and D to address the HIV/AIDS care needs of disproportionately impacted minority communities o Part A provides core medical and related support services to improve access and to reduce health disparities in health outcomes in metropolitan areas o Part B funds outreach and education services designed to increase minority access to HIV/AIDS medications provided through State-run AIDS Drug Assistance Programs (ADAP) o Part C funds are used by community health centers and other service providers to improve access to early intervention services o Other HAB MAI funds support technical assistance to expand the capacity of agencies to deliver HIV/AIDS care to minority persons, and studies on the most effective means to reach underserved populations 8

9 Ryan White Part A Core Medical Services 1. Outpatient and Ambulatory Health Services 2. Medications: AIDS Drug Assistance Program (ADAP) 3. Local Pharmaceutical Assistance Program (LPAP) 4. Oral Health Care 5. Early Intervention Services (EIS) 6. Substance Abuse Services Outpatient 7. Mental Health Services 8. Medical Case Management including Treatment Adherence 9. Health Insurance Premium & Cost Sharing Assistance 10. Home Health Care 11. Home & Community- Based Health Services 12. Medical Nutrition Therapy 13. Hospice Services * Can all be supported by MAI funding with planning council approval 9

10 Ryan White Part A Support Services 1. Case management (nonmedical) 2. Child care services 3. Emergency financial assistance 4. Food bank/home-delivered meals 5. Health education/risk reduction 6. Housing services 7. Legal services 8. Linguistics services (interpretation and translation) 9. Medical transportation services 10. Outreach services 11. Psychosocial support services 12. Referral for health care/supportive services 13. Rehabilitation services 14. Respite care 15. Substance abuse services residential 16. Treatment adherence counseling * Can all be supported by MAI funding with planning council approval 10

11 HAB and Secretary s Minority AIDS Initiative Funding (SMAIF) The following are HAB projects that include funds awarded from the Secretary s Minority AIDS Initiative Funding (SMAIF) These funds are awarded competitively to Federal agencies by HHS to provide technical assistance to expand the capacity of agencies to delivery HIV care to minority persons The activities include training, technical assistance and capacity development designed to address the disparities in HIV health outcomes experienced by the minority community, support the NHAS and focus on the continuum of care 11

12 HAB and Secretary s Minority AIDS Initiative Funding (SMAIF) FY 2013 HAB SMAIF Projects: RWHAP Minority Outreach and Enrollment in Health Insurance UCARE4Life Collaborative Project for the Enhancement and Alignment of the Continuum of Care to Increase Linkage and Retention in Care of Minority Adolescents (HIV/AIDS Bureau and National Institutes of Health) U.S. Mexico Border Interagency Collaborative for HIV AETCs along the border involving CA, AZ, NM, TX in partnership with Substance Abuse and Mental Health Services Administration (SAMHSA), Office of Population Affairs, Centers for Disease Control and Prevention (CDC) and National Tuberculosis Training Centers Reaching Low Volume Clinicians/Providers Through Telehealth Training Centers AETCs Replication of a Public Health Information Exchange to Support Engagement in HIV Care (Georgia and North Carolina Departments of Health) 12

13 HAB and Secretary s Minority AIDS Initiative Funding (SMAIF) FY 2014 HAB SMAIF Projects: RWHAP Minority Outreach and Enrollment in Health Insurance Collaborative Project for the Enhancement and Alignment of the Continuum of Care to Increase Linkage and Retention in Care of Minority Adolescents (HIV/AIDS Bureau and NIH) U.S. Mexico Border Interagency Collaborative for HIV AETCs along the border involving CA, AZ, NM, TX in partnership with SAMHSA, OPA, CDC, and National Tuberculosis Training Centers Reaching Low Volume Clinicians/Providers Through Telehealth Training Centers ($1.1 Million) AETCs Replication of a Public Health Information Exchange to Support Engagement in HIV Care (Georgia and North Carolina Departments of Health) Black MSM Resource and Technical Assistance Resource Center Health Literacy Project Targeting Adult and Young Black MSM New Contract 13

14 RWHAP and Minorities During calendar year 2012, an estimated 536,219 individuals received at least one RWHAP-funded service Based CDC (2011) estimates, the RWHAP served 60% of estimated persons diagnosed HIV infection (n=888,921)

15 Ryan White Services Report, Race/Ethnicity of Clients Served 50% 40% 30% 20% 10% 0% 2010 (N=543,075) 2011 (N=540,192) 2012 (N=540,219) Race/ethnicity is unknown or missing for 13,100 clients in 2010, 13,807 clients in 2011, and 9,973 clients in Race and ethnicity is required for all clients regardless of services received.

16 Ryan White Services Report, , Age of Clients Served* 40% 35% 30% 25% 20% 15% 2010 (N=555,955) 2011 (N=553,986) 2012 (N=536,200) 10% 5% 0% < Birth year is missing for 220 clients in 2010, 13 clients in 2011, and 19 clients in Birth year is required for all clients regardless of services received.

17 2012 RSR Data Retention in Care and Viral Load Suppression by Race/Ethnicity

18 HIV in the South, 2012 RSR Retention in Care and Viral Load Suppression Rates by Race/Ethnicity

19 MSM HIV Outcomes Data, 2012 RSR Black MSM: 32.4% of all MSM o Represent 66.4% of the MSM ages (youth) o Represent 61% of the MSM ages (young adult) o 29.4% are ages (older/aging) Approximately two-thirds of Black MSM are 100% below FPL Almost half (48.7%) of Black MSM had no insurance at some time during the year

20 MSM and IDU Retained in Care and Virally Suppressed Source: 2012 RSR data (preliminary) 100% 90% 80% 70% 60% 50% 82% 82.05% 79.6% 81.30% 74.4% 75.10% 76.39% 74.50% 67.8% 52.9% All RSR clients MSM 40% Black MSM 30% 20% Young (13-24) MSM IDU 10% 0% Retained in care Virally suppressed Retained in care: had at least one OAMC visit before September 1, 2012, and had at least 2 visits 90 days or more apart Viral suppression: had at least one OAMC visit, at least one viral load count, and last viral load test <200

21 Women HIV Outcomes Data, 2012 RSR Women: 29% of all RSR clients o Represent 1.8% of the women ages (youth) o Represent 4.7% of the women ages (young adult) Approximately 75.1% of women are at 100% or below FPL o 32.6% of these women are Black More than one-third (38.9%) of women receive Medicaid at some time during the year

22 Women Retained in Care and Virally Suppressed 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 87.8% 86.10% 83.3% 83.5% 80.9% 82.0% 77.5% 76.8% 73.2% 78.8% 70.8% 69.8% 62.3% 50.0% age age White non-hispanic Black non-hispanic Hispanic Medicaid All females 0% Retention in Care Viral Load Suppression

23 Summary of the Ryan White HIV/AIDS Program 2012 RSR RWHAP data remains relatively stable and consistent over the past 3 cycles ( ) Approximately 60% of all RSR clients receive outpatient ambulatory medical care and about 54% receive medical case management Black MSM: 32.4% of all MSM o Retention in care: Young MSM (13-24) are less likely to be retained (74%) o Viral Load Suppression: Black MSM and Young MSM (13-24) are less likely to be suppressed (68%/53%) Women: 29% of all RSR clients o Retention in care: year olds are less likely to be retained (79%) o Viral Load Suppression: and year olds are less likely to be suppressed (62%/50%) along with those on Medicaid (70%) HIV in the South o Lower retention in care and viral suppression rates compared to the rest of the U.S. o Viral Load Suppression: Blacks are less likely to be virally suppressed (68%)

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25 Recommendations to Improve HIV Care Continuum Outcomes 5 Recommendations released December 2, Support, implement and assess innovative models to more effectively deliver care along the care continuum. 2. Tackle misconceptions, stigma and discrimination to break down barriers to care. 3. Strengthen data collection, coordination and use of data to improve health outcomes and monitor use of federal resources. 4. Prioritize and promote research to fill gaps in the knowledge along the HIV care continuum. 5. Provide information, resources, and TA to strengthen the delivery of services along the care continuum, particularly at the state and local levels. 25

26 Interventions for Improving HIV Care Engagement Linkage Case Management (intense, time-limited interaction) Medical Case Management (longitudinal relationship to address unmet needs) Intensive Outreach (time and resource intensive, requires multiple follow-ups) Peer or Para-professional Patient Navigation (shares features with health educators and case managers but no formal training in social work or home agency) Clinic-wide Messaging (posters, brochures, brief messaging low cost with modest improvements) (Mugavero et al. Clin Infect Dis (8): ) 26

27 HAB Next Steps Impacting MAI Analyze more specified data especially related to the care continuum, outcomes, specific populations especially minorities Implement additional data activities to meet the needs of POs, grantees, and other stakeholders to make and encourage datadriven decision making Address data quality and technical support/assistance Support the collection, dissemination and replication of innovative models of accessing, retaining and supporting life-long viral suppression to improve the Care Continuum and health outcomes for minorities

28 Contact Information Harold Phillips Phone: (301)