Federal AIDS Policy Partnership March 29, 2017 Laura Cheever, MD, ScM Associate Administrator HIV/AIDS Bureau (HAB) Health Resources and Services Administration (HRSA)
HIV/AIDS Bureau Vision and Mission Vision Optimal HIV/AIDS care and treatment for all. Mission Provide leadership and resources to assure access to and retention in high quality, integrated care, and treatment services for vulnerable people living with HIV/AIDS and their families. 2
Ryan White HIV/AIDS Program Provides comprehensive system of HIV primary medical care, medications, and essential support services for low-income people living with HIV More than half of people living with diagnosed HIV in the United States more than 500,000 people receive care through the Ryan White HIV/AIDS Program Funds grants to states, cities/counties, and local community based organizations Recipients determine service delivery and funding priorities based on local needs and planning process Payor of last resort statutory provision: RWHAP funds may not be used for services if another state or federal payer is available 3
Ryan White HIV/AIDS Program Parts Parts A (Cities), B (States), C (Community based organizations), and D (Community based organizations for women, infants, children, and youth) Services include: Medical care, medications, and laboratory services Clinical quality management and improvement Support services including case management, medical transportation, and other services Part F Services Clinician training, dental services, and dental provider training Development of innovative models of care to improve health outcomes and reduce HIV transmission among hard to reach populations 83.4% of Ryan White HIV/AIDS Program clients were virally suppressed in 2015, exceeding national average of 54.7% 4
HIV/AIDS Bureau Priorities National Goals to End the HIV Epidemic/President s Emergency Plan For AIDS Relief (PEPFAR) 3.0 Leadership Partnerships Integration Data Utilization 5
HIV/AIDS Bureau Priorities National Goals to End the HIV Epidemic/President s Emergency Plan For AIDS Relief (PEPFAR) 3.0: Maximize HRSA HAB expertise and resources to operationalize National Goals and PEPFAR 3.0 Leadership Partnerships Integration Data Utilization 6
HIV/AIDS Bureau FY16 Accomplishments: National Goals/PEPFAR 3.0 (Technical Assistance) SMAIF: Center for Engaging Black MSM Across the Care Continuum His Health and Well Versed websites launched Fall 2016 7
HIV/AIDS Bureau FY16/17 Investments: National Goals/PEPFAR 3.0 SPNS Dissemination of Evidence-Informed Interventions to Improve Health Outcomes Along the HIV Care Continuum (DEII) Developing Four evidence-informed Care and Treatment Interventions (CATI) for linkage and retention Based on evidence informed interventions: SPNS Jail, SPNS Buprenorphine, SPNS Outreach, and SMAIF Re-Engagement and Retention initiatives Using Evidence Informed Interventions to Improve Health Outcomes among People Living with HIV Improving HIV health outcomes for transgender women Improving HIV health outcomes for black men who have sex with men (MSM) Integrating behavioral health with primary medical care for PLWH Identifying and addressing trauma among PLWH 8
HIV/AIDS Bureau FY16 Accomplishments: National Goals/PEPFAR 3.0 Strengthening and Improving the HIV Care Continuum within RWHAP Part A Jurisdictions Cooperative Agreement Focused on recipients developing collaborative partnerships and relationships among multiple sources of HIV prevention and care planning, service provision, and State/local resources for improving outcomes along the HIV care continuum Five topic domains were created to form Learning Collaboratives: data access and coordination, identification and implementation of target interventions, identifying and implementing evidence-based/informed interventions, linkages to care, and health care implementation changes to HIV care systems. 9
HIV/AIDS Bureau FY16/17 Investments: National Goals/PEPFAR 3.0 SMAIF: Building Care and Prevention Capacity: Addressing the HIV Care Continuum in Southern Metropolitan Areas Increase capacity to improve health outcomes for minority MSM, youth, cisgender and transgender women, and people who inject drugs Ryan White HIV/AIDS Program Part A Planning Council and Transitional Grant Area Planning Body Technical Assistance (TA) Cooperative Agreement 10
HIV/AIDS Bureau FY16/17 Investments: National Goals/PEPFAR 3.0 (Evaluation) Building Futures: Supporting Youth Living with HIV (evaluation study) Identify barriers and best practices to support youth living with HIV accessing RWHAP funded services Assessing client factors with detectable viral load (evaluation study) Identify differences between PLWH who are virally suppressed vs. those who are not Models of care study Evaluate the impact of different models of HIV care 11
HIV/AIDS Bureau Priorities National Goals to End the HIV Epidemic/ President s Emergency Plan For AIDS Relief (PEPFAR) 3.0 Leadership: Enhance and lead national and international HIV care and treatment through evidence-informed innovations, policy development, health workforce development, and program implementation Partnerships Integration Data Utilization 12
HIV/AIDS Bureau FY16 Accomplishments: Leadership PLWH Leadership Expert Panel Convened diverse panel of PLWH to discuss leadership qualities and how to cultivate leaders SMAIF: Leadership Training for People of Color Living with HIV Support increased engagement of transgender women of color living with HIV in leadership opportunities and support national leadership training SMAIF: Improving Access to Care Using Community Health Workers to Improve Linkage and Retention in HIV Care Increase the use of community health workers to strengthen the health care workforce and improve access to health care and health outcomes for racial and ethnic minority PLWH 13
HIV/AIDS Bureau FY16 Accomplishments: Leadership (2) HIV Specialist August 2016 special issue, HRSA Workforce Study Articles on the HIV clinician workforce - supply of and demand for HIV clinicians & services Articles describing characteristics of RWHAP providers Available online: www.aahivm.org 14
HIV/AIDS Bureau FY16/FY 17 Activities: Leadership (3) Retention Measure Expert Panel Key Issues Discussed: Identifying the goals of the retention measures Alignment with National HIV/AIDS Strategy and other measures Alignment at the national, state, local, and provider level Viral suppression as a measure of retention in HIV care National Quality Forum Endorsement of Existing Measures Retention, Viral Suppression, Antiretroviral prescription Includes electronic specification 15
HIV/AIDS Bureau FY17 Investments: Leadership (4) Resilient and Responsive Health Systems (RRHS) Initiative Democratic Republic of Congo (DRC), Liberia, Sierra Leone, and South Sudan Support the implementation of countries national health strategies and recovery plans to respond to emerging epidemics, to prevent, manage, and control HIV and other diseases, and to improve population health outcomes 16
HIV/AIDS Bureau Priorities National Goals to End the HIV Epidemic/ President s Emergency Plan For AIDS Relief (PEPFAR) 3.0 Leadership Partnerships: Enhance and develop strategic domestic and international partnerships internally and externally Integration Data Utilization 17
HIV/AIDS Bureau FY16 Accomplishments: Partnerships HIV Health Improvement Affinity Group Support state collaborations between public health and Medicaid programs to improve rates of sustained virologic suppression among Medicaid and CHIP enrollees who are living with HIV 18
HIV/AIDS Bureau FY16 Accomplishments: Partnerships (2) Technical Assistance for RWHAP Parts A & B to Support Integrated HIV Planning Implementation Support activities related to the CDC/HRSA Integrated HIV Prevention and Care Plan submissions Funding to encourage a streamlined approach to HIV planning and promote effective local and state decision making to develop systems of prevention and care 19
HIV/AIDS Bureau FY16 Accomplishments: Partnerships (3) HIV Care & Housing Using Data Integration to Improve Health Outcomes along HIV Care Continuum Promotes integration and coordination of HIV and housing services using information technology to Improve entry, engagement, retention in care for HIV positive homeless & unstably housed PLWH with mental illness and substance abuse disorders Ryan White HIV/AIDS Program Clients (non-adap), by Housing Status, 2015 United States and 3 Territories a a Guam, Puerto Rico, and the U.S. Virgin Islands. Source: HRSA. Ryan White HIV/AIDS Program Annual Client-Level Data Report 2015. Does not include clients served by the AIDS Drug Assistance Program. 20
HIV/AIDS Bureau Priorities National Goals to End the HIV Epidemic/ President s Emergency Plan For AIDS Relief (PEPFAR) 3.0 Leadership Partnerships Integration: Integrate HIV prevention, care, and treatment in an evolving health care environment Data Utilization 21
HIV/AIDS Bureau FY16 Accomplishments: Integration Curing Hepatitis C Virus (HCV) in the Ryan White HIV/AIDS Program (RWHAP) To better understand successes, barriers and costs related to HCV treatment among PLWH who receive services through the RWHAP SMAIF funded SPNS: Jurisdictional Approach to Curing Hepatitis C among HIV/HCV Co-infected People of Color funds three RWHAP Part A jurisdictions and up to two RWHAP Part B jurisidictions to increase HCV screening, care, and treatment systems for HIV/HCV coinfected people of color The National Clinician Resource Center s scope of work was expanded and supported with additional funding to create training materials to educate clinicians on screening and treatment of HIV/HCV coinfection 22
HIV/AIDS Bureau Priorities National Goals to End the HIV Epidemic/ President s Emergency Plan For AIDS Relief (PEPFAR) 3.0 Leadership Partnerships Integration Data Utilization: Use data from program reporting systems, surveillance, modeling, and other programs, as well as results from evaluation and special projects efforts to target, prioritize, and improve policies, programs, and service delivery 23
HIV/AIDS Bureau FY16 Accomplishments: Data Utilization Annual publication of national RWHAP client-level data collected through the Ryan White HIV/AIDS Program Services Report (RSR) National focus on data for program monitoring and evaluation RSR data enable access to Ryan White HIV/AIDS Program client-level information Data from 50 states, the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands 5 years of data: 2011 2015 Data are not Part-specific all tables include all clients served, regardless of the RWHAP funding stream Report does not include specific services rendered or information about the AIDS Drug Assistance Program (ADAP) 24
HIV/AIDS Bureau FY16 Accomplishments: Data Utilization (2) HAB developed new contracts/evaluation studies Assessing Client Factors Associated with Detectable Viral Loads; Assessing Models of Care within the Ryan White HIV/AIDS Program; and Utilizing HIV Research Network Data for Studies to Understand and Improve Health Outcomes in Persons Living with HIV. 25
HIV/AIDS Bureau FY17 Investments: Data Utilization Ryan White HIV/AIDS Program (RWHAP) Implementation Center for HIV Clinical Quality Improvement The purpose of this program is to assist RWHAP recipients and subrecipients with implementing clinical quality improvement methodologies and concepts Integration of Oral Health and Primary Care TA to RWHAP Recipients Contract 26
27 HIV/AIDS Bureau FY17 Investments: Data Utilization (2) Link client-level data in Ryan White Services Report (RSR) over time Link client-level data in RSR to client-level data in ADAP Data Report (ADR) Field test electronic clinical quality measures
2015 RWHAP Client-Level Data Report Highlights 28
2015 RWHAP Client-Level Data Report What s New Eligible scope Addition of PLWH and Eligible Metropolitan Areas (EMA)/Transitional Grant Areas (TGA) tables Gender identity: two-step method Transmission risk categories New classification for transgender clients: sexual contact Data displayed separately by gender 29
Select Demographic Characteristics of Clients Served by the Ryan White HIV/AIDS Program 2015 United States and 3 Territories a a Guam, Puerto Rico, and the U.S. Virgin Islands. Source: HRSA. Ryan White HIV/AIDS Program Annual Client-Level Data Report 2015. Does not include clients served by the AIDS Drug Assistance Program. 30
Clients Served by the Ryan White HIV/AIDS Program by Age Group, 2011 to 2015 United States and 3 Territories a a Guam, Puerto Rico, and the U.S. Virgin Islands. Source: HRSA. Ryan White HIV/AIDS Program Annual Client-Level Data Report 2015. Does not include clients served by the AIDS Drug Assistance Program. 31
Clients Served by the Ryan White HIV/AIDS Program by Health Care Coverage, 2015 United States and 3 Territories a a Guam, Puerto Rico, and the U.S. Virgin Islands. Source: HRSA. Ryan White HIV/AIDS Program Annual Client-Level Data Report 2015. Does not include clients served by the AIDS Drug Assistance Program. 32
Health Outcomes of Clients Served by the Ryan White HIV/AIDS Program
Percentage of facilities providing services Services Provided by RWHAP-Funded and Non-RWHAP-Funded Outpatient Facilities: Medical Monitoring Project (MMP) 2009-2012 100% 90% 80% 70% 60% 50% 64% 49% 76% 82% 59% 53% 60% 71% 40% 30% 20% 10% 18% 34% 12% 9% 15% 30% 29% 11% 22% 22% 0% Mental Health Substance Abuse Treatment Dental Care Case Management RWHAP-Funded Adherence Counseling Interpreter Services Non-RWHAP-Funded Transportation Assistance Nutritionist/ Dietician Risk Reduction Counseling Source: Weiser J, Beer L, Frazier EL, Patel R, Dempsey A, Hauck H, Skarbinski J. Service delivery and patient outcomes in Ryan White HIV/AIDS Program-funded and -nonfunded health care facilities in the Unites States. JAMA Intern Med 2015:4095. 34
Percentage of patients with viral suppression Percentage of Virally Suppressed Clients by Health Care Coverage and Ryan White HIV/AIDS Program Assistance: MMP 2009-2012 100% 90% 80% 70% 76% 81% 71% 76% 76% 78% 79% 76% 60% 50% 40% 30% 20% 10% 0% Private Medicaid Medicare Medicare + Medicaid Non-RWHAP Payer Non-RWHAP Payer + RWHAP Source: Bradley, H, Mattson C, Beer L, Huang P, Shouse, R. Luke; for the Medical Monitoring Project. Increased antiretroviral therapy prescription and HIV viral suppression among persons receiving clinical care for HIV infection. AIDS 2016;30(13):2117 24. 35
Viral Suppression among Clients Served by the Ryan White HIV/AIDS Program 2010 2015 United States and 3 Territories a The Centers for Disease Control and Prevention estimates that in the U.S., 54.7% of people diagnosed with HIV are virally suppressed. (Source: Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data United States and 6 dependent areas 2014. HIV Surveillance Supplemental) Viral suppression: 1 OAMC visit during the calendar year and 1 viral load reported, with the last viral load result <200 copies/ml. a Guam, Puerto Rico, and the U.S. Virgin Islands. Source: HRSA. Ryan White HIV/AIDS Program Annual Client-Level Data Report 2015. Does not include clients served by the AIDS Drug Assistance Program. 36
Viral Suppression among Clients Served by the Ryan White HIV/AIDS Program by State, 2010 2015 United States and 3 Territories a IN 2015 83.4% VIRALLY SUPPRESSED IN 2010 69.5% VIRALLY SUPPRESSED 4 Viral suppression: 1 OAMC visit during the calendar year and 1 viral load reported, with the last viral load result <200 copies/ml. a Guam, Puerto Rico, and the U.S. Virgin Islands. Source: HRSA. Ryan White HIV/AIDS Program Annual Client-Level Data Report 2015. Does not include clients served by the AIDS Drug Assistance Program.
Viral Suppression among Clients Served by the Ryan White HIV/AIDS Program by Age Group, 2010 2015 United States and 3 Territories a % virally suppressed 100 90 80 70 60 50 40 30 20 10 0 <13 13 24 25 34 35 44 45 54 55 64 65 2010 2011 2012 2013 2014 2015 Viral suppression: 1 OAMC visit during the calendar year and 1 viral load reported, with the last viral load result <200 copies/ml. a Guam, Puerto Rico, and the U.S. Virgin Islands. Source: HRSA. Ryan White HIV/AIDS Program Annual Client-Level Data Report 2015. Does not include clients served by the AIDS Drug Assistance Program. 38
39 HAB Reports and Other Resources Find the report and other resources online: https://hab.hrsa.gov/data
Thank You! Laura Cheever, MD, ScM Associate Administrator HIV/AIDS Bureau (HAB) Health Resources and Services Administration (HRSA) Email: LCheever@hrsa.gov Web: hab.hrsa.gov Twitter: twitter.com/hrsagov Facebook: facebook.com/hhs.hrsa 40