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2010-2011 Ryan White Services Report Data . CAPT Tracy Matthews Acting Director, Division of Policy and Data E. Amaka Nwankwo-Igomu Chief, Data Management Branch U.S. Department of Health and Human Services Health Resources and Services Administration HIV/AIDS Bureau

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2010 2011 ryan white services report data

2010-2011 Ryan White Services Report Data

CAPT Tracy Matthews

Acting Director, Division of Policy and Data

E. Amaka Nwankwo-Igomu

Chief, Data Management Branch

U.S. Department of Health and Human Services

Health Resources and Services Administration

HIV/AIDS Bureau

February 5, 2014

objectives
Objectives
  • At the end of this presentation, participants will be able to:
    • Describe the Ryan White HIV/AIDS Program (RWHAP) and the HIV epidemic in the United States
    • Discuss Ryan White Services Report (RSR) data results
    • Identify the impact RWHAP has had on the HIV epidemic
    • Identify planned future analyses using RSR data
presentation overview
Presentation Overview
  • HIV Epidemiology
  • RWHAP Background
  • RSR Background
  • Program Reach
  • RSR Demographics
  • RWHAP Funded Services
  • Summary and Future Data
overview
Overview
  • CDC estimates that 1,148,200 persons ages 13 years and older are living with HIV infection; 207,600 (18.1%) are unaware of their infection (Source: CDC Fact Sheet HIV in the United States: At A Glance, February 2013)
  • At the end of 2010, an estimated 888,921 adults and adolescents were living with diagnosed HIV infection in the United States and six dependent areas

(Source: CDC slide set, Epidemiology of HIV Infection through 2011)

about the ryan white hiv aids program
About the Ryan White HIV/AIDS Program
  • The Ryan White HIV/AIDS Program (RWHAP) provides HIV-related services to more than half a million people each year
  • First enacted in 1990 as the Ryan White CARE (Comprehensive AIDS Resources Emergency) Act
  • Amended and reauthorized four times: in 1996, 2000, 2006, and 2009
about the ryan white hiv aids program1
About the Ryan White HIV/AIDS Program
  • Largest Federal program focused exclusively on HIV/AIDS care
  • Through a number of programs, called Parts, RWHAP works with cities, states, hospitals, community health centers and other organizations
  • For individuals living with HIV/AIDS who have:
    • No health insurance (public or private)
    • Have insufficient health care coverage
    • Lack financial resources to get the care they need for their HIV disease
rsr data background
RSR Data Background
  • In 2009, outpatient ambulatory medical care (OAMC), medical case management (MCM) and case management (CM) providers were required to report client-level data for the first time
  • In 2010, all providers were required to report client-level data
    • Ryan White Services Report (RSR)
  • The Ryan White Data Report (RDR) was retired in 2010
  • RSR refers to all RWHAP “client-level data”
rsr background
RSR Background
  • Data are reported annually during submission period
    • Calendar year data reported
  • The HIV/AIDS Bureau needed to develop a data management process for client-level data
    • Six stage process
rsr data management process1
De-duplication

Probabilistic record linking approach

Unique eUCIs are considered unique

Uses several demographic data elements

Felligi-Sunter model used to assign each record pair a score based on the demographic data elements

Threshold for accepting or rejecting match is established

RSR Data Management Process
rsr data the details
RSR Data - The Details

Important things to keep in mind:

  • This is a new dataset and as such is not considered to be mature
    • 2011 data are preliminary
    • Data quality issues such as high missing/unknown values
    • Reflects data reported but may not fully reflect services provided
overview1
Overview
  • During calendar year 2011, an estimated 553,999 individuals received at least one RWHAP-funded service in calendar year (Source: preliminary Ryan White Services Report data, CY 2011)
  • Based on CDC estimates, in the United States, RWHAP is serving 48% of estimated persons living with HIV infection (n= 1,148,200) and 62% of estimated persons living with diagnosed HIV infection (n=888,921)
slide17
Gender of Adults and Adolescents Living with Diagnosed HIV Infection as of the End of 2010 and RWHAP Clients, Calendar Year 2011

HIV Epidemiology source: CDC Slide set, Epidemiology of HIV Infection through 2011. Gender represents adult and adolescent cases living as of 12/31/2010.

Ryan White HIV/AIDS Program source: RSR preliminary 2011 data. Gender represents clients who received at least one

RWHAP-funded service in calendar year 2011.

slide18
Race/Ethnicity of Adults and Adolescents Living with Diagnosed HIV Infection as of the End of 2010 and RWHAP Clients, Calendar Year 2011

HIV Epidemiology source: CDC Slide set, Epidemiology of HIV Infection by Race/Ethnicity through 2011. Race/ethnicity represents adult and adolescent cases living as of 12/31/2010.

RWHAP source: RSR preliminary 2011 data. Race/ethnicity represents clients who received at least one RWHAP-funded service in calendar year 2011.

ryan white services report 2010 2011 gender of clients served
Ryan White Services Report, 2010 & 2011Gender of Clients Served

N = 553,766

N = 555,762

*Less than 1% of clients served were transgender.

Gender was unknown or missing for 413 clients in 2010 and 233 clients in 2011.

ryan white services report 2010 2011 race ethnicity of clients served
Ryan White Services Report, 2010 & 2011Race/Ethnicity of Clients Served

Race/ethnicity is unknown or missing for 13,100 clients in 2010 and 13,807 clients in 2011. Race and ethnicity required for all clients regardless of services received.

ryan white services report 2010 2011 age of clients served
Ryan White Services Report, 2010 & 2011Age of Clients Served*

Birth year is missing for 220 clients in 2010 and 13 clients in 2011. Birth year required for all clients regardless of services received.

ryan white services report 2010 2011 client payer source
Ryan White Services Report, 2010 & 2011Client Payer Source

N = 466,819

N =429,256

Payer source is unknown or missing for 78,463 clients in 2010 and 45,918 clients in 2011. Payer source is required for clients who received any core medical service or non-medical case management services.

ryan white services report 2010 2011 housing status for clients served
Ryan White Services Report, 2010 & 2011Housing Status For Clients Served

Housing status is unknown or missing for 60,346 clients in 2010 and 43,441 clients in 2011. Housing status is required for clients who received outpatient ambulatory medical care, medical case management, non-medical case management, or housing services.

ryan white services report 2010 2011 hiv status of clients served
Ryan White Services Report, 2010 & 2011HIV Status of Clients Served

HIV status is unknown or missing for 4,150 clients in 2010 and 4,919 clients in 2011. HIV status is required for clients who received outpatient ambulatory medical care, medical case management, or non-medical case management services.

ryan white services report 2010 2011 annual household income for clients served
Ryan White Services Report, 2010 & 2011Annual Household Income for Clients Served

N = 376,816

N =416,653

Annual household income is unknown or missing for 76,134 clients in 2010 and 49,743 clients in 2011.

top 10 services used by year
Top 10 Services Used, By Year

*Core Medical Services

2010 ryan white services report rsr number of clients served and visits for core medical services
2010 Ryan White Services Report (RSR)Number of Clients Served and Visits for Core Medical Services
2011 ryan white services report rsr number of clients served and visits for core medical services
2011 Ryan White Services Report (RSR)Number of Clients Served and Visits for Core Medical Services
ryan white services report 2010 2011 percentage of clients served by core medical service
Ryan White Services Report, 2010 & 2011Percentage of Clients Served By Core Medical Service

Fewer than 1% of clients received the following services: home health care, home and community-based case, and hospice.

ryan white services report 2010 2011 percentage of clients receiving support services
Ryan White Services Report, 2010 & 2011 Percentage of Clients Receiving Support Services*

*Fewer than 1% of clients received the following services: childcare, developmental assessment, linguistics, permanency planning, rehabilitation, respite care, and substance abuse treatment, residential.

summary of the ryan white hiv aids program
Summary of the Ryan White HIV/AIDS Program
  • Compared to national surveillance data, the RWHAP serves a higher proportion of:
    • Women
    • Racial/Ethnic Minorities
  • RWHAP serves almost half (48%) of estimated persons living with HIV infection (n= 1,148,200)
  • Approximately 62% of estimated persons living with diagnosed HIV infection (n=888,921) are RWHAP clients
state profiles overview

State Profiles Overview

State-level information related to the Ryan White HIV/AIDS Program

Data sources:

Health Resources and Services Administration

Census Bureau (Poverty and Health Insurance data)

Centers for Disease Control and Prevention (CDC) (HIV/AIDS Surveillance data)

state profiles content
State Profiles Content
  • Section A — State Overview
  • Section B — HIV/AIDS Epidemic 
  • Section C — Program Grantees and Funding 
  • Section D — Provider Characteristics
  • Section E — Client Characteristics  
  • Section F — Services  
  • Section G — Clinical Data NEW!
  • Section H — AIDS Drug Assistance Program  
  • Section I — Oral Health NEW!
  • Section J — HHS Indicators NEW!
  • Section K — National HIV/AIDS Strategy NEW!
future next steps1
Future/Next Steps
  • 2014 Upcoming Data Releases
    • RSR 2012 Preliminary Data
    • Continuum of HIV care among Ryan White HIV/AIDS Program clients—United States, 2010 and 2011 (Doshi, R. et al. In Progress)
  • National HIV/AIDS Strategy and Health and Human Services Indicators
hrsa hab hiv care continuum initial concepts
HRSA/HAB HIV Care Continuum: Initial Concepts

Cheever L. Clinical Infectious Diseases 2007;44:1500-2.

cdc stages of care 2009 national hiv surveillance system medical monitoring project
CDC Stages of Care – 2009 National HIV Surveillance System & Medical Monitoring Project

CDC. HIV in the United States: Stages of Care. July 2012.

Hall HI, Frazier EL, Rhodes P, et al. JAMA Internal Medicine. Jun 17 2013:1-7.

retention in hiv care and viral suppression ryan white services report 2010 and 2011
Retention in HIV Care and Viral SuppressionRyan White Services Report, 2010 and 2011

Retention in HIV care

Numerator: At least 2 HIV care visits at least 90 days apart during the calendar year

Denominator: HIV+, RWHAP-funded HIV care, visit dates available

Viral suppression

Numerator: HIV-1 RNA <200 copies/ml at the most recent check during the calendar year

Denominator: HIV+, RWHAP-funded HIV care, visit dates & viral load available

contact information
Amaka Nwankwo-Igomu

301-443-6561

enwankwo-igomu@hrsa.gov

Contact Information