Using Data to Improve Linkage to Care
Debbie Wendell, PhD, MPH Louisiana STD/HIV Program
Louisiana STD/HIV Program
How can data be used to improve programs?
• Where are the biggest gaps in the HIV continuum of care?
• Are there race, gender or age disparities? • How quickly are clients getting linked to
care? • Are clients retained in care? • How does my agency compare to others?
How do we measure linkage, retention and viral suppression?
• Use CD4/VL results as a proxy for an HIV-related medical visit
o All HIV-related test results are reportable in Louisiana
o Most are reported electronically on a daily basis
• Measurement standards o Linkage: Was a person newly-diagnosed with HIV
linked to HIV-related medical care within 90 days?
o Retention: Did a person living with HIV have 2 or more care visits within a 12 month period?
o Viral Suppression: Was the most recent VL <=200?
HIV Continuum of Care Louisiana, 2013
100%
69%
54% 49%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Persons living with HIV In HIV care Retained in HIV care Viral suppression (<=200)
Perc
enta
ge
18,199
9,774
12,536
8,831
70% of PLWH in care were virally suppressed
Louisiana STD/HIV Program
Percent Retained in Care among PLWH by Region, Louisiana, 2013
Louisiana STD/HIV Program
52%
60% 60%
54%
46% 51%
46% 51%
53%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Pe
rce
nta
ge
Region
Louisiana STD/HIV Program
Percent Virally Suppressed among PLWH in Care by Region, Louisiana, 2013
Louisiana STD/HIV Program
68% 71%
75% 75% 71% 71% 68%
72% 76%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Pe
rce
nta
ge
Region
Louisiana STD/HIV Program
HIV Continuum of Care by Race/Ethnicity Louisiana, 2013
100% 100% 100%
70%
45%
70%
54%
35%
55%
46%
35%
58%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Black Hispanic White
Perc
enta
ge
PLWH
In HIV care
Retained in care
Viral suppression
66% of PLWH in care were virally
suppressed
77% of PLWH in care were virally
suppressed
82% of PLWH in care were virally
suppressed
N = 12,442
N = 693
N = 4,861
Louisiana STD/HIV Program
HIV Testing by Site Type Louisiana, 2013
Total Number of Tests
(% of Tests)
Number of Positive Results
% Positivity Total
Positives
Number of New
Positives
% Positivity New
Positives
Total 95,656 1,069 1.1% 532 0.6%
Parish health unit 36,347 (38%) 226 0.6% 146 0.4%
Emergency department 19,484 (20%) 235 1.2% 130 0.7%
Correctional facility 16,385 (17%) 275 1.7% 27 0.2%
Community-based org 15,701 (16%) 279 1.8% 198 1.3%
Community health clinic 4,206 (4%) 45 1.1% 25 0.6%
Substance abuse clinic 2,805(3%) 5 0.2% 2 0.7%
School/college 728 (1%) 4 0.5% 4 0.5%
Linkage to Care within 90 Days Louisiana, 2007 -2014
67% 70% 70%
73% 74% 78% 79%
83%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2007 2008 2009 2010 2011 2012 2013 2014
Year of Diagnosis
National HIV/AIDS Strategy Objective: 85%
Louisiana STD/HIV Program
Linkage to Care within 90 Days by Region, 2013
Louisiana STD/HIV Program
78% 74%
86%
78%
90% 87%
74%
83% 85%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Pe
rce
nta
ge
Region
National HIV/AIDS Strategy Objective: 85%
Louisiana STD/HIV Program
Linkage to Care – New Positives By Site Type, Louisiana, 2013
Number of New
Positive Results
Number Linked to
Care within 90 Days
% Linked to Care within
90 Days
Total 532 365 69%
Community-based org 198 138 70%
Parish health unit 146 85 58%
Emergency department 130 111 85%
Correctional facility 27 12 44%
Community health clinic 25 17 69%
Substance abuse clinic 2 0 0%
School/college 4 2 50%
Time to Linkage to Care New Positives - CBOs, Louisiana, 2013
0
10
20
30
40
50
0-7 8-15 16-30 31-45 46-90 91-180 181-270 >270
Days to Entry into Care Louisiana STD/HIV Program
Linkage to Care within 90 Days New Positives - CBOs, Louisiana, 2013
79%
100%
54%
81% 80%
57%
84%
70%
60%
100% 100%
0%
20%
40%
60%
80%
100%
A B C D E F G H I J K
CBO Louisiana STD/HIV Program
National HIV/AIDS Strategy Objective: 85%
Linkage to Care – New Positives By Gender and Race/Ethnicity, CBOs, 2013
Number of New
Positive Results
Number Linked to
Care within 90 Days
% Linked to Care within
90 Days
Total 198 138 70%
Female 30 16 53%
Male 168 122 73%
African American/Black 118 73 62%
Hispanic/Latino 6 6 100%
White 68 55 81%
Linkage to Care – New Positives By Age Group, CBOs, 2013
Number of New
Positive Results
Number Linked to
Care within 90 Days
% Linked to Care within
90 Days
Total 198 138 70%
16-24 years old 65 48 74%
25-44 years old 99 68 69%
>=45 years old 33 21 64%
Initial CD4 and Viral Load CBOs, 2013
• CD4 count o Range: 6 - 1,169 o Median: 448 o Average: 439 o 28 clients had a CD4 count <=200 (meet AIDS case
definition)
• Viral load o Range: <20 – 5,589,140 o Median: 37,080 o Average: 164,125 o 8 clients had a VL<=200 (i.e., virally suppressed)
HIV Continuum of Care - 2014 CBO – New Positives Diagnosed in 2013
100%
76%
60% 56%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
New Positives Dx in 2013
In HIV care Retained in HIV care Viral suppression (<=200)
Perc
enta
ge
198
118
150
111
74% of persons in care were virally suppressed
Louisiana STD/HIV Program
Evaluating Linkage to Care
• How do you evaluate linkage/retention in care at your agency?
• Do you collect any data to look at linkage to care?
• What are the data gaps? • How can SHP help provide you useful data?
Questions?
For more information: Debbie Wendell, PhD, MPH STD/HIV Program Louisiana Office of Public Health (504) 568-7474 [email protected]
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