Factors Associated with HIV Viral Load Suppression among HIV-positive Adults in Care in Washington...
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![Page 1: Factors Associated with HIV Viral Load Suppression among HIV-positive Adults in Care in Washington State in 2009 Council of State and Territorial Epidemiologists.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649de95503460f94ae470d/html5/thumbnails/1.jpg)
Factors Associated with HIV Viral Load Suppression among HIV-positive Adults
in Care in Washington State in 2009
Council of State and Territorial Epidemiologists Annual Conference
June 4, 2012Omaha, Nebraska
Tom Jaenicke, MPH, MBA, MESWashington State Department of Health
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Outline for today
• Overview of the Medical Monitoring Project (MMP)
• Results from 2009 data collection cycle–Descriptive statistics–Focus on factors associated with HIV
viral suppression• Conclusions
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Medical Monitoring Project (MMP)
• MMP is a stratified complex sample survey with three stages: state, facility and individual patients
• Provides much clinical and behavioral data– Health outcomes– How patients interact with the care system– Barriers to care– Behaviors that affect health outcomes– Behaviors that affect transmission
• Is a primary source for providing HIV viral load data for measuring National HIV/AIDS Strategy progress
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MMP Data Collection
• Annual cycle – ‘Population Definition Period’ – January through
April of the calendar year– ‘Surveillance Period’ – 12 months before the
interview (or attempt to contact if no interview)• Two primary methods of collecting data– Lengthy and in-depth interview with patient– Medical record abstraction (MRA)
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MMP Topic Areas• Demographics• Access to care• HIV treatment and adherence• Sexual behavior• Drug and alcohol use• Prevention activities• Mental health• Health conditions and preventive therapy• Gynecological and reproductive history
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Challenges
• Significant logistical challenges associated with sampling, data collection and transfer
• CDC provides direction to 16 states, six large cities and one U.S. territory, some of which consider it surveillance, others research
• Facilities and providers are involved with contacting patients and providing access to medical records
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MMP weighted data• Centers for Disease Control and Prevention (CDC)
responsible for weighting data• Peer-reviewed article in near future• For 2009 data, 9 strata, 64 clusters• Separate weights for separate datasets – Medical record
• Nine weights, frequency of each ranges from 1 to 113
– Interview• Five weights, frequency of each ranges from 2 to 89
• Weighted data provide population estimates
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Washington MMP participants compared to persons reported
to Washington core surveillance
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WA MMP participants similar to persons reported to core surveillance
![Page 10: Factors Associated with HIV Viral Load Suppression among HIV-positive Adults in Care in Washington State in 2009 Council of State and Territorial Epidemiologists.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649de95503460f94ae470d/html5/thumbnails/10.jpg)
WA MMP participants similar to persons reported to core surveillance (cont.)
![Page 11: Factors Associated with HIV Viral Load Suppression among HIV-positive Adults in Care in Washington State in 2009 Council of State and Territorial Epidemiologists.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649de95503460f94ae470d/html5/thumbnails/11.jpg)
WA MMP participants similar to persons reported to core surveillance (cont.)
![Page 12: Factors Associated with HIV Viral Load Suppression among HIV-positive Adults in Care in Washington State in 2009 Council of State and Territorial Epidemiologists.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649de95503460f94ae470d/html5/thumbnails/12.jpg)
Antiretroviral (ARV) Use
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ARV use
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ARV use during past 12 months (from medical record)
Odds Ratio = 12.4 (3.3 – 45.8)
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Currently on ARVs (from interview)
Odds Ratio = 25.4 (6.7 - 96.4)
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Ever taken ARVs (from interview)
Odds Ratio = 15.2 (3.8 - 61.0)
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Drug holiday during past year (from interview)
Odds Ratio = 3.7 (1.5 - 9.3)
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Drug and Alcohol Abuse
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Drug and alcohol abuse
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Substance abuse, other than alcohol(from medical record)
No substance abuse vs. 3 or more substances,Odds Ratio = 6.4 (2.2 – 18.1)
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Alcohol abuse(from medical record)
Odds Ratio = 2.8 (1.4 – 5.6)
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Illicit drug use(from interview)
Odds Ratio = 2.4 (1.4 – 4.3)
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Income
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Income
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Income(from interview)
Odds Ratio = 1.8 (1.2 – 2.7)
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Access to Services
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Access to services• Service gap = person claimed to have needed the service,
but was unable to get it• Services include:
– Case management, counseling, ADAP, medication reminders, peer support, dental, mental health, substance abuse counseling, SSDI, domestic violence services, housing, meals, home health services, transportation, childcare, interpreter
• Percent of respondents with gap for each service ranged from 1% to 17%
• Total service gap for individual participants ranged from zero to five
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Access to services
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Access to services(from interview)
Odds Ratio = 4.7 (2.0 – 11.0)
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Summary of Associations
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Significant associations
• Among 250 participants with a Surveillance Period Visit Form (SPVF) and Medical History Form (MHF), there were 40 who did not have an HIV viral load test during the Surveillance Period.
• There were Standard Interview forms completed for 180 participants. Of these 180, there were 24 who did not have an HIV viral load test during the Surveillance Period.
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Strength of significant associations between viral suppression and various factors
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Strength of significant associations between viral suppression and various factors
![Page 34: Factors Associated with HIV Viral Load Suppression among HIV-positive Adults in Care in Washington State in 2009 Council of State and Territorial Epidemiologists.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649de95503460f94ae470d/html5/thumbnails/34.jpg)
Strength of significant associations between viral suppression and various factors
![Page 35: Factors Associated with HIV Viral Load Suppression among HIV-positive Adults in Care in Washington State in 2009 Council of State and Territorial Epidemiologists.](https://reader036.fdocuments.us/reader036/viewer/2022062407/56649de95503460f94ae470d/html5/thumbnails/35.jpg)
Other associations between viral suppression and various factors
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Conclusions• MMP is a complex survey that provides a wealth of
medical and behavioral information about HIV-positive people in care
• Two major components include interview and medical record abstraction
• HIV viral load suppression among persons in care is associated most strongly with ARV use, also with drug and alcohol use, income and access to support services
• Coming soon: demonstration project of sampling from eHARS rather than through three stages
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Acknowledgements• Community and provider advisors:– Mark Garrett, Dr. Brad Roter, Dr. Julie Dombrowski
• Public Health – Seattle & King County:– Elizabeth Barash, Susan Buskin, Shirley Zhang, Winnie Alston,
Lexa Moongrace• Washington State Department of Health:– Maria Courogen, Leslie Pringle, Elizabeth Mack, Katie
Heidere, Shawn McBrien, Susan Bosse• MMP Team at the Centers for Disease Control and
Prevention, especially our project officer, Dr. Linda Beer
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Questions?