Positive Living Conference Ft. Walton Beach, Thomas Liberti Chief, Bureau of HIV/AIDS Department of Health March 11, 2011 Tallahassee, 1
The Epidemic in, 2010 60% White Population: 18.8 million (4 th 16% Black in nation) Cumulative AIDS cases: 121,161 (3 rd in nation) Cumulative pediatric AIDS cases: 1,542 (2 nd in nation) Cumulative HIV (not AIDS) cases: 46,795 (since July 1997) Persons living with HIV/AIDS: 97,978 (reported cases) HIV prevalence estimate: 135,000 HIV incidence estimate: 5,550 (2006 est.) 21% Hispanic 3% Other* 30% White 49% Black 19% Hispanic 2% Other* *Other = Asian/Pacific Islanders; American Indians/Alaskan Natives; multi-racial. 2
2010 Population Estimates* and Adult AIDS and HIV Cases by Race/Ethnicity Reported in 2010, AIDS (N=3,459) 19% 2% 2010 Population Estimates* (N=15,837,972) 21% 2% HIV (N=5,187) 22% 1% 15% 29% 25% 54% 62% 48% White Black Hispanic Other 3
Percent of Cases Percent of Adult HIV Cases by Race/Ethnicity and Year of Report, 2001 2010 60 50 40 30 20 White, non-hispanic Black, non-hispanic 10 0 Hispanic 01 02 03 04 05 06 07 08 09 10 Year of Report Comment: The proportion of black HIV cases has decreased by 15% from 2001 to 2010. In contrast, increases were 4 observed among both white (16%) and Hispanic (29%) HIV cases over this same time period.
Number of Deaths 5,000 4,000 3,000 2,000 1,000 0 4142 Resident HIV/AIDS Deaths By Year,, 1994 2009 4336 29% 3093 39% 1879 1547 1651 1809 1658 1714 1742 17141706 1746 Race/Ethnicity 2009 No. rate White Male 258 4.6 White Female 65 1.1 Black Male 438 31.0 Black Female 299 19.7 Hispanic Male 126 6.2 Hispanic Female 34 1.7 Other** 12 2.5 TOTAL 1,232 6.5 1526 1412 18% 13% 7% 13% 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 Year of Death 1232 Rates are expressed as deaths per 100,000 population based on annual Population Estimates, DOH, Office of Planning, Evaluation and Data Analysis. Comment: HIV/AIDS deaths decreased markedly from 1996-1998, associated with the advent of HAART in 1996. A leveling of the trend during 2000-2006 may reflect factors such as viral resistance, late diagnosis of HIV, adherence problems, and lack of access to or acceptance of care. Yearly declines of 13% in 2007, 7% in 2008 and another 13% in 2009 appear to be promising. Racial/ethnic disparities are evident in the death rate data. 5 Source: Office of Vital Statistics and Bureau of HIV/AIDS, death certificates coded to HIV/AIDS as underlying cause.
Counseling & Testing, Number of HIV Tests in Publicly Funded Sites 2001 2002 2003 2004 2005 2006 Whites 110,562 122,558 118,520 114,103 105,316 103,490 Blacks 101,492 107,668 110,509 105,072 106,083 106,042 Hispanics 46,023 51,562 58,543 64,472 73,830 75,329 Total 258,077 281,788 287,572 283,647 285,229 284,861 % Change 2007 2008 2009 2010 2001-2010 Whites 107,566 111,509 113,470 116,021 5% Blacks 126,884 154,493 170,115 182,356 80% Hispanics 79,997 91,338 94,426 95,925 108% Total 314,447 357,340 378,011 394,302 53% 6
AIDS Insurance Continuation Program s AIDS Insurance Continuation Program (AICP) has assisted approximately 8,184 persons through December 2010 in maintaining their healthcare coverage Current enrollment is approximately 2,283 clients Demographics 84% of clients are male 16% of clients are female 65% of clients are white AICP pays premiums up to $750.00, and over the past twelve years, the program obtained nearly $5 in private medical care and services for every dollar spent Past AICP 2009-10 funding was $13,957,968: $6,794,685 in General Revenue and $7,163,283 in Ryan White Current AICP 2010-11 funding is $13,804,903: $6,454,951 General Revenue and $7,349,952 in Ryan White A wait list has been created with 358 applicants as of February 1, 2011. 19% of clients are Hispanic 16% of clients are black 40% of clients are diagnosed as AIDS 54% of clients are diagnosed as HIV or HIV symptomatic Average age of an AICP client is 45 Average monthly premium paid is $463.83 Due to current budget and attrition, since September 2010, approximately 290 applicants have been removed from the waitlist and enrolled in AICP. 7
Trends Affecting AIDS INSURANCE CONTINUATION PROGRAM Cumulative Wait-List 450 416 400 390 353 350 308 300 267 247 250 210 200 162 150 141 124 106 100 70 50 0 Jul-Oct O9 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 8
Waiting List Contributing Factors Ongoing Recession Federal Funding Remaining Flat GR Reduction: $1 Million AICP Waiting List Expansion Of Counseling And Testing NIH Guideline Changes: Early Treatment Increase In Drug Costs Oil Spill Layoffs at Kennedy Space Center (1,100) Increase In Demand For Services 9
Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 331 335 301 330 317 297 367 268 357 372 357 376 1,704 1,560 1,521 1,662 1,662 1,824 1,765 1,559 1,983 1,646 1,776 2,215 Total Enrollments FY 09/10 3,000 2,500 2,000 2,035 1,895 1,822 1,992 1,979 2,121 2,132 1,827 2,340 FISCAL YEAR 09/10 18,022 clients 2,018 2,133 2,591 1,500 1,000 500 0 New Certifications Re Certifications Certifications Reported on April 15, 2010. * For the total number of clients, we considered active clients who picked up at least once during the given timeframe. 10
Apr-10 May-10 367 394 1,909 2,115 Total Enrollments FY 10/11 3000 2500 2,276 2,509 APR JUN 2010 15,226 clients 2000 1500 1000 500 0 New Enrollments Re Enrollments Enrollments Reported on April 15, 2010. * For the total number of clients, we considered active clients who picked up at least once during the given timeframe. 11
Federal Funding Enrollments / Funding $89M $88M $87M $86M $85M $84M $83M $88,022,839 15,732 14,396 $83,621,697 15,569 $83,509,558 18,022 $83,621,697 WAITING LIST IMPLEMENTED *15,490 **$85,188,435 20,000 18,000 16,000 14,000 12,000 10,000 8,000 6,000 4,000 Client Enrollments $82M 2,000 $81M FY06/07 FY07/08 FY08/09 FY09/10 FY10/11 - State Funding $10.5M $10.5M $10.5M $9.5M $9.5M FEDERAL ALLOCATION CLIENTS ENROLLED * Waiting list implemented June 1, 2010. FY10/11 Client Enrollments does not include waiting list numbers. **FY10/11 Federal Funding does not include $6.9 million in Emergency Relief funds and $2.3 million in Supplemental funds. Source: database reported 12/3/2010. Figures shown reflect clients in open status anytime during the given year. 12
Funding Gap MIAMI CONTRACTS $3.5 MIL GAP $20-$25 mil RW PART B $75.6 mil (68.5%) GAP $14.5 mil (13%) SHORTFALL RELIEF $6.9 mil (6%) SUPPLEMENTAL $2.2 mil (2%) PART B SWEEPS $1.7 mil (1.5%) STATE FUNDING $9.5 mil (9%) 13 Reported on January 15, 2010.
Closing the Gap Emergency Relief Funds from HRSA $6.9 million $3 million waiting list requirement Redirect Ryan White Grant Dollars General Revenue Dollars 14
Exploring Other Resources Borrowing from State GR Accessing RW Fund Early Ordering Now, Pay Later Request Assistance of: Part A s Part B s / Consortia Request of HRSA Incur costs using 2011/2012 monies Welvista 15
Resolution (Short-Term) Partnership NASTAD Fair Pricing Coalition Pharmaceutical Industry Welvista Non Profit Organization Located in South Carolina Specialty Pharmacy: 17 yrs experience Single Point of Access for WL clients Short-Term Fix (limited time only) 16
Transitioned to Welvista Proposed Clients Transitioned to Welvista: 5912 % 100 100% TOTAL CLIENTS 90 TRANSITIONED TO WELVISTA 80 70 60 9883 60% REMAINING IN 50 40 5912 40% 30 20 3971 10 0 TOTAL CLIENTS TRANSITIONED TO WELVISTA REMAINING IN 17 Source: Database. Reported on January 24, 2011.
The Transition WELVISTA Projected date for transition February 1, 2011 60 day supply of medications Re-transition: April 1, 2011 Objective: Clients continue to receive medications from CHD seamlessly 18
Future FY 2011/2012 Ensuring continuity of service Realignment of budget Medicare Part D TrOOP Drug rebates Additional funds from Congress Part B supplemental fund Supplemental Partnership Planning Collaboration 19
Ryan White Flat Funding 2007 2008 2009 2010 Part A 69,791,744 70,817,429 67,503,982 72,984,428 Part B 116,325,376 116,146,263 116,269,183 118,435,571** Part C 10,009,713 9,713,246 7,526,095 7,335,918* Part D 7,019,701 7,093,539 7,522,963 6,629,567* Part F 2,854,951 2,854,951 8,006,179* 7,448,947* Total 206,001,485 206,625,428 206,828,402 212,804,431 ** Part B includes MAI and Supplemental funds. * Assuming level-funding
Major Issues in 2011-2012 1. Ongoing state budget challenges 2. Impact of health reform on public health programs 3. Development of a national HIV/AIDS strategy 4. Testing Counseling Linkage and Treatment 5. Use of new media and Internet-based strategies 6. Increased push towards integrated and/or holistic programs 7. More state and local HIV/AIDS workforce challenges 8. Prevention fatigue vs. PrEP 21