Data Trends:
FPAR & HIV Prevention
Project
OPA/OFP HIV Prevention Project
Annual Technical Support Conference
June 12, 2007
Presented by
Kelly Morrison Opdyke, MPH
Cicatelli Associates Inc.
Learning Objectives

Describe key findings from the 2005 Family
Planning Annual Report (FPAR)
 Review epidemiology of HIV/AIDS in relation to
Title X users
 Examine national and regional OPA HIV
Prevention Project data trends
 Compare trends in FPAR and HIV Prevention
Project data with national trends
Family Planning Annual Report

The only source of annual, uniform reporting by
all Title X service grantees

Enables Title X administrators and grantees to:





Monitor program performance
Comply with federal accountability rules
Guide strategic and financial planning
Estimate impact of Title X-supported activities on key
reproductive health outcomes
Published reports available online from OPA:
http://opa.osophs.dhhs.gov/titlex/ofp_references.html
FPAR 2005: User Demographics

5,002,961 family planning users





95% female, 5% male
66% below 100% of federal poverty level (FPL)
60% uninsured
58% under age 25
48% racial and/or ethnic minorities
FPAR 2005: Users by Age Group
Distribution of family planning users by age
(Females: N=4,740,168
Males: N=262,793)
40%
35%
30%
25%
20%
15%
10%
5%
0%
Females
Males
<15
1517
1819
2024
2529
3034
Age in years
3539
4044
>44
FPAR 2005: Users by Race/Ethnicity
Distribution of Family Planning Users by
Race/Ethnicity
Asian
2%
Black/African
American, not
Hispanic
19%
American
Indian/Alaska
Native
1%
Native
Hawaiian/Other
Pacific Islander
1%
White, not
Hispanic
49%
Hispanic/Latino
(All Races),
24%
More than one
race
1%
Unknown or NR
3%
N=5,002,961
FPAR 2005: HIV Testing

HIV test volume increased by 14% in 2005

607,974 confidential HIV tests


519,221 tests among females (85% of all tests)
88,753 tests among males (15% of all tests)

1,114 positive confidential tests (0.18%)

13,349 anonymous HIV tests
FPAR 2005: STD and HIV Testing
Percent of family planning users tested
(Females: N=4,740,168 Males: N=262,793)
60%
50%
49%
46%
50%
46%
40%
34%
27%
30%
20%
15%
10%
11%
0%
Chlamydia
Gonorrhea
Females
*Confidential HIV Tests Only
Syphilis
Males
HIV*
HIV/AIDS among Women
Nature of the epidemic
 Women of color (especially African American
women) are the hardest hit
 Younger women are more likely to get HIV
 AIDS is a common killer, second only to cancer
and heart disease for women
Most common modes of transmission
 Having sex with a man who has HIV
 Sharing injection drug works (needles, etc.)
Source: CDC HIV/AIDS among Women Fact Sheet, March 2007
HIV/AIDS among Women

Since 1985 the proportion of estimated AIDS
cases diagnosed among women has more than
tripled, from 8% in 1985 to 27% in 2004.

In 2004, women of color accounted for 80% of
all women estimated to be living with AIDS;
black women made up 64% of this total.
Source: CDC HIV/AIDS among Women Fact Sheet, March 2007
HIV/AIDS among Youth
Nature of the epidemic
 13% of the persons diagnosed with HIV or AIDS
in 2004 were age 13-24 years
 Young people of racial/ethnic minorities are at
increased risk for infection through sexual risk
behavior (heterosexual and MSM)
Risk Factors
 Earlier age at sexual initiation
 Higher STD rates
Source: CDC HIV/AIDS among Youth Fact Sheet, June 2006
HIV/AIDS Diagnoses by Age
Distribution of new HIV/AIDS diagnoses by age
(N=38,730)
40%
35%
30%
25%
20%
15%
10%
5%
0%
34%
26%
19%
13%
6%
1%
<13
13-24
25-34
35-44
45-54
Age in years
Source: CDC Surveillance 2004
55-64
2%
>64
OPA/OFP Integration of
HIV/AIDS Prevention Project
HIV Prevention Project (HIVPP)
GOAL:
 To supplement existing Title X
grants, in communities with
demonstrated high risk for
HIV/AIDS, to implement or
expand HIV on-site prevention
counseling, testing, and
referral services
Cycle 1: Oct 2001 – Aug 2004
34 projects
8 PHS regions (19 states)
Cycle 2: Sep 2004 – Sep 2007
63 projects
10 PHS regions (27 states)
Number of Projects by Region
18
16
14
12
10
8
6
4
2
0
I
II
III IV V VI VII VIII IX X
Cycle 1
Cycle 2
HIVPP: Outcome Measures

Number of individual HIV counseling sessions
 Number of HIV tests by test mode and type







Confidential v. Anonymous
Standard v. Rapid
Number of positive HIV tests
Number of clients returning for test results and
post-test counseling
Number of positive clients referred for Tx/care
HIV testing by race & ethnicity
HIV testing by gender & age group
HIVPP: Counseling, Testing & Referral
Outcome
Cycle 1:
Oct-01 to Aug-04
N
%
Cycle 2:
Sep-04 to Dec-06
N
%
# counseled
365,461
n/a
391,897
n/a
# tested
187,702
51%
263,623
67%
97,067
53%
169,049
64%
# positive
693
0.37%
692
0.26%
# positives referred for Tx
540
78%
664
96%
# returning for results
HIVPP: Counseling Sessions
Number of Individual HIV Counseling
Sessions Reported per Period
140000
120000
100000
80000
Individual
Counseling
Sessions
60000
40000
20000
0
C1P1 C1P2 C1P3 C1P4 C1P5 C2P1 C2P2 C2P3 C2P4
Cycle 1, Periods 1-5 (Oct-01 to Aug-04) and Cycle 2, Periods 1-4 (Sep-04 to Dec-06)
HIVPP: Counseling Sessions
Average Number of Individual HIV Counseling
Sessions Per Month Per Period
20000
15000
10000
5000
Cycle 1
Cycle 2
Individual
Counseling
Sessions
0
C1P1 C1P2 C1P3 C1P4 C1P5 C2P1 C2P2 C2P3 C2P4
Funding Cycle and Reporting Period
Cycle 1, Periods 1-5 (Oct-01 to Aug-04) and Cycle 2, Periods 1-4 (Sep-04 to Dec-06)
HIVPP: HIV Tests by Period
Number of HIV Tests Reported Per Period
(N=451,971)
100000
80000
60000
Anonymous
Confidential
40000
20000
0
C1P1 C1P2 C1P3 C1P4 C1P5 C2P1 C2P2 C2P3 C2P4
Funding Cycle and Reporting Period
Cycle 1, Periods 1-5 (Oct-01 to Aug-04) and Cycle 2, Periods 1-4 (Sep-04 to Dec-6)
HIVPP: HIV Tests by Test Mode
Average Number of HIV Tests by Test Mode
Per Month Per Period
12000
10000
8000
Anonymous
Confidential
6000
4000
2000
Cycle 1
Cycle 2
0
C1P1 C1P2 C1P3 C1P4 C1P5 C2P1 C2P2 C2P3 C2P4
Funding Cycle and Reporting Period
Cycle 1, Periods 1-5 (Oct-01 to Aug-04) and Cycle 2, Periods 1-4 (Sep-04 to Dec-06)
HIVPP: HIV Tests by Test Type
Average Number of HIV Tests by Test Type
Per Month Per Period
12000
Rapid
Standard
10000
8000
6000
%Rapid
4000
C2P1: 20%
2000
C2P2: 31%
0
C2P3: 41%
C2P1
C2P2
C2P3
Funding Cycle and Reporting Period
Cycle 2, Periods 1-4: Sep-04 to Dec-06
C2P4
C2P4: 46%
HIVPP: Return Rate by Test Type
Percent of Clients Returning for HIV Test Results
by Test Type
120%
96%
100%
80%
60%
64%
55%
40%
20%
0%
Return Rate
Standard
Cycle 2, Periods 2-4: July-05 to Dec-06
Rapid
Total
HIVPP: Testing by Race/Ethnicity
Race/Ethnicity
Tests
Positives
%Pos
Black/African American, not Hispanic
51665
244
0.47%
Hispanic or Latino (All Races)
73552
201
0.27%
American Indian/Alaska Native
1231
2
0.16%
46284
65
0.14%
Asian
3471
3
0.09%
More than one race
1434
1
0.07%
381
0
0.00%
3397
1
0.03%
181415
517
0.28%
White, not Hispanic
Native Hawaiian/Pacific Islander
Unknown or NR
Total
Cycle 2, Periods 2-4: July-05 to Dec-06
HIVPP: Positivity by Race/Ethnicity
Black/African American, not Hispanic
Hispanic or Latino (All Races)
American Indian/Alaska Native
White, not Hispanic
Asian
More than one race
Native Hawaiian/Pacific Islander
0.00
%
Cycle 2, Periods 2-4: July-05 to Dec-06
0.05
%
0.10
%
0.15
%
0.20
%
0.25
%
0.30
%
0.35
%
0.40
%
0.45
%
0.50
%
HIVPP: Testing by Race/Ethnicity
Distribution of HIV Tests vs. HIV Positive Results
by Race/Ethnicity
Tests
Positives
0%
28%
41%
47%
20%
26%
39%
40%
Cycle 2, Periods 2-4: July-05 to Dec-06
60%
13%
80% 100%
Black/AA N-H
Hisp/Latino
White N-H
AI/AN
Asian
>1 race
NH/PI
UK
HIVPP: Testing by Gender
Distribution of HIV Tests vs. HIV Positive Results
by Gender
Tests
20%
80%
Male
Female
Positives
0%
49%
20%
51%
40%
Cycle 2, Periods 1-4: Sep-04 to Dec-06
60%
80%
100%
HIVPP: Testing by Age Group
Distribution of HIV Tests vs. HIV Positive Results
by Age Group
30%
Tests
Positives
0%
18%
19%
20%
40%
Cycle 2, Periods 2-4: July-05 to Dec-06
20%
22%
42%
60%
80%
100%
<15
15-17
18-19
20-24
25-29
30-44
>44
HIVPP: Positivity by Region
0.50%
0.45%
0.40%
0.35%
0.30%
0.25%
0.20%
0.15%
0.10%
0.05%
0.00%
I
II
III
IV
Cycle 2, Periods 1-4: Sep-04 to Dec-06
V
VI
VII
VIII
IX
X
Summary

HIV testing among FP users is increasing
steadily (especially rapid testing)
 Racial/ethnic disparities persist, especially
among Black/African American users
 The HIV positivity rate (>1 per 1,000 tests) in
family planning clinics in most regions appears
to be cost-effective
 HIV prevention strategies should continue to
emphasize the importance of the reduction of
sexual risk behavior to prevent the spread of
infection