FOCUSING RYAN WHITE
SERVICES THROUGH
ANNUAL EVALUATION OF
THE COMPREHENSIVE
STRATEGIC PLAN
Mary Irvine, DrPH, MPH – Director, Research & Evaluation
Graham Harriman, MA, LPC – Director, Care & Treatment
Stephanie Chamberlin, MIA, MPH – Evaluation Specialist,
Research & Evaluation
HIV Care, Treatment and Housing Program
Bureau of HIV/AIDS Prevention and Control
New York City Department of Health and Mental Hygiene
(NYC DOHMH)
Tracking EMA
Progress
A gainst 2009201 2 Comp.
Plan Indicators,
with Data from
2008-2010
PRESENTATION OVERVIEW
 Background and inputs to the Comprehensive Plan
 Overview of data sources used to measure progress
against targets
 Summary of demographics
 Goals 1-4
 Objectives and Indicators for Ryan White and the EMA

Progress towards targets: 2008 -2010
 Goal 5 –update on process
 Highlights of findings
 Discussion
 Exercises/applications to other EMAs (off PowerPoint)
BACKGROUND
 Ryan White legislation mandates that planning councils develop
a comprehensive plan for the delivery of HIV -related services.
 The New York, NY EMA Part A grant covers:
 Five Boroughs of NYC (programs administered by the NYC DOHMH), and
 Three Counties North and East of NYC ( Tri-County)
 Westchester, Rockland, and Putnam Counties
 Programs administered by the Westchester Department of Health (WCDH)
 For 2009-2012, the New York EMA used HRSA guidance, as well
as the 2005-2008 Plan and available indicator data, to develop a
plan that would comply with legislation and meet local needs.
 This presentation focuses on data for 2008 -2010 (calendar years
or grant years, depending on the specific data source used).
 2008-2010 local data were used throughout the process of
developing the 2012-2015 Comprehensive Strategic Plan
 Baseline data (2008) and Year 1 data (2009) were updated for
all data sources to reflect refined methodology in measuring the
indicators, and to ensure comparability between all three years.
INPUTS FOR NY EMA COMP PLAN
 HRSA guidance
 National HIV/AIDS Strategy (applied for 2012-2015 Plan), as well
as other current legislative and programmatic initiatives
 Current NY EMA Comprehensive Strategic Plan documents
 Ongoing EMA planning process (Grantee with Planning Council)
 Data review on current Comprehensive Strategic Plan indicators
 Feedback and draft contributions (September -May) from:
 Planning Council’s Needs Assessment Committee, Integration of Care
Committee and Executive Committee
 Other Planning Council members (in full Council)
 NYC DOHMH and WCDH Staff
 Other NYC DOHMH Reviewers (not directly involved in planning of Ryan
White services), e.g., from the HIV Bureau’s Prevention Program
INPUTS – NATIONAL HIV/AIDS STRATEGY
National HIV/AIDS Strategy (NHAS)
NY EMA Comprehensive Strategic Plan
Decrease the number of new
infections
Increase the number of individuals who
are aware of their HIV status
Facilitate entry into care and
enhance health outcomes
Promote early entry into HIV care &
Promote optimal management of HIV
infection
Diminish HIV-related disparities
and health inequities
Reduce HIV/AIDS health disparities
DATA SOURCES FOR INDICATORS
1.
Required client-level Ryan White data reported by
contractors
a. AIDS Institute Reporting System (AIRS) data for 2008 2010, supplemented by EMR extracts for two agencies
b. eSHARE (new) data combined with AIRS for 2010
c. Allows analysis by Ryan White service category or
combination
d. Limited by providers’ completeness of reporting
e. Limited to NYC programs (no Tri-County data) for these
analyses
DATA SOURCES FOR INDICATORS (CTD.)
2.
HIV/AIDS Surveillance Registry (HSR) data from DOHMH
HEFSP*
a. Includes data from provider reporting forms (PRF) and
electronic laboratory reporting
b. Offers more complete laboratory test data (CD4 counts
and viral loads, also used as proxies for care) than other
available sources
c. Cannot address actual services or treatment received
d. Entails greater reporting lag than other data sources used
e. Represents NYC PLWHA only
* HIV Epidemiology and Field Services Program, Surveillance Unit
DATA SOURCES FOR INDICATORS (CTD.)
3. Rapid testing data from DOHMH HIV Prevention
Program
a. Submitted by all agencies with NYC DOHMH funding
for testing
b. Generally represents tests conducted (test-level vs.
client-level), although Ryan White Part A providers
report client-level data
c. Limited to NYC
 Tri-County data are available from Ryan White programs only,
and are not included in results utilizing the match with the
NYC HIV surveillance registry (HSR)
DATA SOURCES FOR INDICATORS (CTD.)
4.
The Community Health Advisory and Information
Network (CHAIN) Study
a. Is a longitudinal study (conducted by Columbia
University with DOHMH and WCDOH) of PLWHA in NYC
and Tri-County
b. Draws on interviews with persons recruited from
agencies providing social services and/or medical care
(excluding private physicians’ offices)
c. Offers the strengths of comprehensiveness (in topics)
and representativeness of the Part A client population,
as well as the ability to look at planning-relevant
questions over time
d. Covers NYC and Tri-County PLWHA accessing services
DATA SOURCES FOR INDICATORS (CTD.)
5.
The Medical Monitoring Project (MMP)
a. Is a serial cross-sectional study (conducted by NYC
DOHMH HEFSP and CDC) of PLWHA in New York City
b. Draws on interviews with persons recruited from HIV
medical facilities (including private physicians’ offices)
c. Offers the strengths of comprehensiveness (in topics)
and the probability sampling method for
representativeness of PLWHA engaged in medical care
d. Limited to NYC participants (for the datasets available to
NYC DOHMH)
DEMOGRAPHICS – PLWHA 2010
Ryan White
Male
Female
1%
Transgender
34%
65%
EMA
Male
Female
29%
71%
DEMOGRAPHICS – PLWHA 2010
Ryan White
Black
Hispanic
White
Asian
Other
9% 1%4%
35%
51%
EMA
Black
Hispanic White
2% 1%
20%
32%
45%
Asian
Other
DEMOGRAPHICS – PLWHA 2010
Ryan White
< 30 Years
30-49 Years
50+ Years
10%
38%
52%
EMA
< 30 Years
30-49 Years
9%
42%
49%
50+ Years
DEMOGRAPHICS – PLWHA 2010
Ryan White
Bronx
Other
Brooklyn
Queens
9%
6%
Manhattan
Staten Island
4%
29%
25%
27%
EMA
Bronx
Other
Brooklyn
Queens
14%
2%
21%
8%
30%
25%
Manhattan
Staten Island
GOAL 1: INCREASE THE NUMBER OF
INDIVIDUALS WHO ARE AWARE OF THEIR HIV
STATUS
 Objective 1A: To increase the number of individuals receiving
voluntary HIV rapid testing across health care and social
support service provider settings, by 2010 .
Ryan White Indicator
EMA Indicator
A 15% increase from baseline in the A 40% increase from baseline in the
annual total number of unique
total number of HIV rapid tests
individuals receiving an HIV rapid
conducted annually.
test through a Ryan White-funded
program.
Objective 1A: HIV Status
 Ryan White Part A: The number of clients receiving rapid tests climbed from
2008 to 2010 (mostly from 2008 to 2009, with new programs).
2009-2012 Plan Actual
100,000
36,000
59,845
58,554
15%
50,000
2009-2012 Plan Target
-
2008
41,400
2009
2010
2011
 EMA-wide: Analyses indicate a slight reduction in HIV testing EMAwide from 2009 to 2010, but still an overall increase since 2008.
400,000
300,000
200,000
100,000
-
2009-2012 Plan Target
40%
2009-2012 Plan Actual
245,490
2008
343,686
290,011
270,254
2009
2010
2011
GOAL 1: INCREASE THE NUMBER OF
INDIVIDUALS WHO ARE AWARE OF THEIR HIV
STATUS
 Objective 1B: To decrease delayed diagnosis of
HIV, by the end of 2012.
Ryan White Indicator
EMA Indicator
A 12% reduction in the proportion
of newly diagnosed Ryan White
clients who have a concurrent AIDS
diagnosis.
A 12% reduction in the proportion
of new/incident HIV diagnoses that
are concurrent with AIDS diagnoses.
Objective 1B: Concurrent Diagnosis
 Ryan White Part A: Estimates show reduced concurrency for 2009-10, but 2010
concurrency remained higher than in 2008.
2009-2012 Plan Actual
2009-2012 Plan Projection
100%
23%
31%
28%
2008
2009
2010
20%
12%
50%
0%
2011
 EMA-wide: NYC estimates for concurrency are gradually moving in the right direction.
2009-2012 Plan Actual
2009-2012 Plan Projection
50%
23%
23%
22%
2008
2009
2010
12%
100%
20%
0%
2011
Objective 4a: Ryan White - Concurrent Diagnosis
Year:
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
2008
2009
2010 Actual for Ryan White
2010
67%
56%
29%
25%
20%
43%
38%
37%
32%
29%
25%
21% 22%
14%
25%
24%
21%
40%
34%
50%
38%
24%24%
16%
17%
33%33%
33%
22%
20%
38%
28%
24% 25%
8%
0%
Female
Male
<30
GENDER
30-49
50+
Black
Hispanic
AGE GROUP
White
Other
DPHO
RACE/ETHNICITY
Non-DPHO
Missing*
LOCATION
Objective 4a: EMA -Concurrent Diagnosis
Year:
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
2008
2009
2010
2010 Actual for EMA
37%39%37%
25%23%23%
27%26%
23%
25%24%
21%
25%25%23%
26%24%
21%
18%18%19%
Black
Hispanic
White
14%12%12%
Female
GENDER
Male
<30
30-49
AGE GROUP
50+
RACE/ETHNICITY
26%26%23%
25%24%22%
26%23%
22%
Other
DPHO
Non-DPHO
LOCATION
SUMMARY – CONCURRENCY DISPARITIES
 Female Part A clients appeared to have lower concurrency,
but no gender disparity appeared for NYC overall.
 In Part A and NYC overall, older age groups experienced
higher (worse) levels of concurrency.
 In NYC, newly diagnosed whites had lower (better) levels of
concurrency than newly diagnosed individuals in other
racial/ethnic groups.
 For Part A, this difference only appeared for 2010.
 There were no consistent DPHO vs. non -DPHO area of
residence dif ferences for NYC overall or Ryan White.
GOAL 2: PROMOTE EARLY ENTRY INTO AND
CONTINUIT Y OF HIV CARE
 Objective 2A: To increase the number of newly
diagnosed individuals who enter into primary
care within three months of HIV diagnosis, by
2011.
Ryan White Indicator
EMA Indicator
An 8% increase in the proportion of
newly diagnosed clients who show
evidence of accessing primary care
within three months of HIV
diagnosis.
A 5% increase in the proportion of
newly diagnosed individuals who
show evidence of accessing primary
care within three months of HIV
diagnosis.
Objective 2A: Linkage to Care
 Ryan White Part A: Estimates show increased prompt linkage from 2009-2010.
2009-2012 Plan Actual
71%
69%
78%
2008
2009
2010
77%
8%
100%
2009-2012 Plan Target
50%
0%
2011
 EMA-wide: NYC estimates for linkage are gradually moving in the right direction.
2009-2012 Plan Actual
70%
71%
71%
2008
2009
2010
74%
5%
100%
2009-2012 Plan Target
50%
0%
2011
Year:
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
86%
73%73%
70%66%75%
Objective 4B: Ryan White - Linkage to Care
2010 Actual for Ryan White
2009 2010
2008
78% 79%
63%
78%
66%67%
80%
74% 77%
80%
65%66%
80% 78%
69%
75%80%
67%
100%
86%
75%
79%
71%68%
78%
70%70%
80%
71%
0%
Female
Male
<30
GENDER
30-49
50+
Black
Hispanic
AGE GROUP
White
Other
DPHO
RACE/ETHNICITY
Non-DPHO
Missing*
LOCATION
Obective 4B: EMA -Linkage to Care
Year:
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
2008
2009
2010 Actual for EMA
2010
73%75%75%
69%70%70%
72%70%70%
69%74%72%
69%68%74%
67%67%68%
71%73%73%
78%80%76%
85%
72%75%
70%71%72%
71%71%71%
Female
Male
<30
30-49
50+
Black
Hispanic
White
Other
DPHO
Non-DPHO
GENDER
AGE GROUP
RACE/ETHNICITY
LOCATION
SUMMARY – LINKAGE DISPARITIES
 Female Par t A clients and females in NYC overall appeared to do
better on linkage.
 Results for NYC males increased slightly from 2008 -2009 and
held steady from 2009 -2010.
 No clear age pattern emerged; in NYC overall, a higher percentage
of diagnoses among the 50+ led to prompt linkage in 2010, but
those 30-49 fared best in 2009, and those <30 in 2008.
 NYC data overall showed prompt linkage most of ten among white
and “other” racial/ethnic groups, followed by Hispanic and then
black newly diagnosed individuals.
 This pattern loosely fit 2009 Par t A , but did not apply to 2008
and 2010. (Caution: small N!)
 There were no consistent DPHO vs. non -DPHO dif ferences for NYC
overall, except that non -DPHO-area residents stayed at 71%
linkage all three year s, while DPHO -area residents climbed from
70-72%.
GOAL 2: PROMOTE EARLY ENTRY INTO AND
CONTINUIT Y OF HIV CARE
 Objective 2B: To increase retention in HIV care
and treatment, by 2011.
Ryan White Indicator
EMA Indicator
A 30% decrease in the proportion of
clients who show a gap in primary
care of 4 months or longer, at any
time in the 12-month period –
A 20% decrease in the proportion of
PLWHA in the EMA who show a gap
in primary care of 4 months or
longer, at any time in the most
recent 12-month period –
Objective 2B: Retention in Care
 Primary care retention increased from 2008-09 (EMA-wide and Part A*), but
then leveled EMA-wide and decreased slightly in Part A.
*Part A provider reporting underestimates primary care visits experienced.
2009-2012 Plan Actual
100%
62%
2009
2010
70%
2011
EMA-wide
2009-2012 Plan Target
74%
76%
76%
2008
2009
2010
7%
2008
67%
22%
57%
20%
100%
80%
60%
40%
20%
0%
30%
Ryan White
2009-2012 Plan Actual
2009-2012 Plan Target
78%
50%
0%
2011
Objective 4C: Ryan White - Retention in Care
Year:
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
67%
66%
55%
Female
67%
57% 60%
Male
2008
2009
76%
73%
52%
48%
46% 51%
Transgender
68%
67%
67% 59%
66%
65%
62%
61% 60%
56% 62% 56% 59% 55%
57%
<30
GENDER
2010 Actual for Ryan White
2010
30-49
50+
Black
AGE GROUP
Hispanic
White
69%
68%
67%
67%
67%
56% 58% 58%
56%
46% 47%
35%
Other
RACE/ETHNICITY
DPHO
Non-DPHO
Missing*
LOCATION
Objective 4C: EMA -Retention in Care
Year:
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
2008
2009
2010
2010 Actual for EMA
75%78%77%
74%75%75%
67%72%70%
73%74%74%
78%80%80%
73%75%75%
78%80%79%
72%72%72%
76%77%75%
76%78%78%
73%75%75%
Female
Male
<30
30-49
50+
Black
Hispanic
White
Other
DPHO
Non-DPHO
GENDER
AGE GROUP
RACE/ETHNICITY
LOCATION
SUMMARY – RETENTION DISPARITIES
 In NYC overall, female PLWHA had slightly higher retention in care in
2008-10.
Par t A data suggest, if anything, better retention among females in
2010 (and lowest among transgender clients, but the number of
transgender-identified clients is quite small).
 Retention in care increased with age among PLWHA in NYC.
For Par t A , though, 2009 and 2010 seemed to show a marked
increase from 2008 in retention among clients <30, and younger
age groups appeared to have higher retention in 2010 (the reverse
of the NYC result).
 Hispanic PLWHA in NYC had the highest retention in care, followed by
“other,” black , and finally white PLWHA .
Racial/ethnic patterns were less clear for Par t A clients, but black
and Hispanic clients appeared to have higher retention than white
clients in 2009 -2010.
 DPHO-area PLWHA showed greater retention in care each year than
non-DPHO-area PLWHA in NYC, though both groups experienced
increased retention from 2008 -2009 (and then leveled of f).
No clear DPHO/non -DPHO pattern applied to Par t A , but DPHO-area
clients appeared to have better retention in 2010.
GOAL 3: PROMOTE OPTIMAL MANAGEMENT OF
HIV INFECTION.
 Objective 3A: To improve medication
adherence to a rate of 95%, by 2011.
Ryan White Indicator
EMA Indicator
Achievement of 95% or greater
medication adherence among 66%
of MCM clients, meeting minimum
program and treatment criteria.
Achievement of 95% or greater
medication adherence among 50%
of PLWHA on ARVs at last update.
Objective 3A: ART Adherence
 Ryan White Part A: Adherence remained relatively high in CHAIN* (75-83%), but Part A providers
reported under 70% achieving optimal levels (≥95%) in 2008-09, followed by 75% in 2010.
* Filtered to MCM clients at Part A agencies
2009-2012 Plan CHAIN Actual
2009-2012 Plan AIRS/eSHARE Actual
100%
80%
60%
40%
20%
0%
75%
67%
2008
2009-2012 Plan Target
83%
60%
2009
66%
75%
2010
2011
 EMA-wide: Adherence varied by source, with CHAIN and MMP showing different EMA trends,
and CHAIN finding higher percentages achieving optimal levels (≥95%).
2009-2012 Plan CHAIN Actual
2009-2012 Plan MMP Actual
100%
80%
60%
40%
20%
0%
77%
68%
2008
2009-2012 Plan Target
86%
85%
57%
64%
2009
2010
50%
2011
GOAL 3: PROMOTE OPTIMAL MANAGEMENT OF
HIV INFECTION.
 Objective 3B: To increase viral suppression, by
2011.
Ryan White Indicator
EMA Indicator
A 20% increase in the proportion of
MCM clients who have viral loads
documented as counts below 400 or
as “undetectable” viral load (no
count), among those with
documented viral loads in the period,
and meeting minimum expectations
for program engagement.
A 15% increase in the proportion of
PLWHA in the EMA who have viral
loads documented as counts below
400 or as “undetectable” viral load
(no count), among all those with
documented viral loads in the
period.
Objective 3B: Ryan White Viral Load Suppression
 Ryan White Part A: Data showed a slight increase in sustained viral suppression 2008-2009,
but a decrease in 2010. Part A overall results (65%) exceeded Part A MCM (55%) for 2010.
50%
70%
70%
69%
71%
2008
2009
2009-2012 Plan Target
65%
55%
20%
100%
2009-2012 Plan Actual-MCM Programs Only
2010 Actual- All Ryan White Programs
83%
0%
2010
2011
 EMA-wide: Sustained viral suppression has been achieved by a higher percentage of PLWHA in
the EMA each year since 2008 (62%), and reached 70% in 2010.
2009-2012 Plan Actual
2009-2012 Plan Target
100%
62%
66%
70%
2008
2009
2010
15%
50%
71%
0%
2011
Objective 4D: Ryan White - Viral Load Suppression
Year:
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
2008
2009
2010 Actual for Ryan White
2010
77%
75%
74%
73%
72%
72%
72% 69%
71%
71%
69%
69% 68%
68%
67%
67%
67% 69%
66%
65%
65%
65%
64% 71% 66% 64% 72% 69%
63% 68%
63%
62% 70% 68% 65% 67%
58%
56%
51%
Female
Male
Transgender
<30
GENDER
30-49
50+
Black
Hispanic
AGE GROUP
White
Other
DPHO
RACE/ETHNICITY
Non-DPHO
Missing*
LOCATION
Objective 4D: EMA - Viral Load Suppression
Year:
2008
2009
2010 Actual for EMA
2010
100%
80%
60%
40%
59%63%67%
64%67%72%
Female
Male
20%
52%
43%48%
60%63%68%
71%74%78%
58%61%66%
62%65%70%
Black
Hispanic
82%
72%77%
79%
70%76%
White
Other
57%60%64%
65%69%73%
0%
GENDER
<30
30-49
AGE GROUP
50+
RACE/ETHNICITY
DPHO
Non-DPHO
LOCATION
SUMMARY – VIRAL LOAD SUPPRESSION
DISPARITIES
 In NYC, male PLWHA more often had viral suppression.
In Part A , females more often showed viral suppression
than male or transgender clients. (Caution: small
transgender N!)
 Viral suppression increased with age among PLWHA in NYC
and Part A clients (except for apparently equal proportions
in clients <30 and those 30 -49 in 2008).
 White PLWHA in NYC were most often virally suppressed,
followed by “other,” Hispanic, and finally black PLWHA.
There was no clear pattern for Part A clients, though the
same order (between white, Hispanic and black individuals)
seemed to apply for 2009 -2010 only.
 Each year, non-DPHO-area PLWHA more often had sustained
suppression than DPHO-area PLWHA (in NYC and Part A).
GOAL 3: PROMOTE OPTIMAL MANAGEMENT OF
HIV INFECTION.
 Objective 3C: To improve immunological health
(e.g., CD4 count), by 2011.
Ryan White Indicator
EMA Indicator
A 20% increase in the proportion of
MCM clients whose CD4 counts either
remain stable or improve during the
period, and meeting minimum
expectations for program
engagement.
A 15% increase in the proportion of
PLWHA in the EMA whose CD4
counts either remain stable or
improve during the period.
Objective 3C: Immunological Health
 Ryan White Part A: As with viral suppression, this clinical indicator showed an increase from
2008-09 and a drop in 2010.
100%
80%
60%
40%
20%
0%
2009-2012 Plan Projection
82%
84%
2008
2009
71%
99%
20%
2009-2012 Plan Actual
2010
2011
 EMA-wide: PLWHA in the EMA with stable/improving CD4 steadily increased each year.
100%
80%
60%
40%
20%
0%
2009-2012 Plan Projection
79%
82%
84%
2008
2009
2010
91%
15%
2009-2012 Plan Actual
2011
GOAL 3: PROMOTE OPTIMAL MANAGEMENT OF
HIV INFECTION.
 Objective 3D: To decrease HIV-related
hospitalizations of PLWHA by 2011.
Ryan White Indicator
EMA Indicator
- A 25% decrease in the mean
- A 15% decrease in the mean
number of hospitalizations
number of hospitalizations
experienced annually per MCM
experienced annually per
client, AND/OR
PLWHA, AND/OR
- A 25% decrease in the proportion - A 15% decrease in the proportion
of MCM clients who have more
of PLWHA who have more than
than one hospitalization within a
one hospitalization within a 1212-month period.
month period.
Objective 3D: Ryan White Hospitalizations >1
2009-2012 Plan CHAIN Actual
2009-2012 Plan AIRS/eSHARE Actual
2009-2012 Plan Target
100%
4%
5%
5%
2008
2009
2010
25%
50%
3%
0%
2011
Objective 3D: Ryan White Hospitalizations - Average
2009-2012 Plan CHAIN Actual
2009-2012 Plan AIRS/eSHARE Actual
2009-2012 Plan Target
0.50
0.22
0.28
0.32
2008
2009
2010
25%
1.00
0.16
0.00
2011
Objective 3D: EMA Hospitalizations >1
2009-2012 Plan CHAIN Actual
2009-2012 Plan MMP Actual
100%
2009-2012 Target
5%
4%
2008
0%
5%
3%
2009
15%
50%
5%
2%
2010
4%
2011
Objective 3D: EMA Hospitalizations- Average
2009-2012 Plan CHAIN Actual
2009-2012 Target
2009-2012 Plan MMP Actual
0.50
0.26
0.26
0.20
0.00
2008
2009
0.22
15%
1.00
0.22
0.15
2010
2011
GOAL 2: PROMOTE EARLY ENTRY INTO AND
CONTINUIT Y OF HIV CARE
 Objective 2C: To decrease visits to emergency
departments (ED), by 2011.
Ryan White Indicator
EMA Indicator
- A 10% decrease in the mean
- A 5% decrease in the mean
number of ED visits experienced
number of ED visits experienced
annually per MCM client,
annually per PLWHA, AND/OR
AND/OR
- A 5% decrease in the proportion
- A 10% decrease in the proportion
of PLWHA who have more than
of MCM clients who have more
one ED visit within a 12-month
than one ED visit within a 12period.
month period.
Objective 2C: Ryan White Emergency Department Visits >1
100%
2009-2012 Plan CHAIN Actual
2009-2012 Plan AIRS/eSHARE Actual
2009-2012 Plan Target
10%
8%
6%
0%
10%
50%
9%
2008
2009
2010
2011
Objective 2C: Ryan White Emergency Department Visits - Average
1.00
2009-2012 Plan CHAIN Actual
2009-2012 Plan AIRS/eSHARE Actual
2009-2012 Plan Target
0.80
0.40
0.54
10%
0.60
0.48
0.47
0.20
0.29
0.00
2008
2009
2010
2011
Objective 2C: EMA Emergency Department Visits >1
8%
2008
7%
6%
2009
2009-2012 Plan Target
8%
3%
2010
5%
100%
80%
60%
40%
20%
0%
2009-2012 Plan CHAIN Actual
2009-2012 Plan MMP Actual
8%
2011
Objective 2C: EMA Emergency Department Visits - Average
0.50
0.48
0.42
0.26
0.00
2008
2009
2009-2012 Plan Target
0.45
0.37
5%
1.00
2009-2012 Plan CHAIN Actual
2009-2012 Plan MMP Actual
0.16
2010
2011
SUMMARY – ACUTE CARE UTILIZATION
 Part A acute care utilization did not show a clear
trend (if anything, a slight increase in
hospitalizations but decrease in ED visits), but the
source changed in 2010 (from filtered CHAIN
interviews  eSHARE reporting).
 For the EMA, a slight downward trend in acute care
utilization appears for MMP, alongside a stable or
slight downward trend for CHAIN, depending on the
measure (% with >1 event vs. mean #).
GOAL 5: ECONOMIC EVALUATION OF RYAN
WHITE PART A SERVICES
 Building on a prior consultant’s report with recommendations
and the Planning Council feedback from mid -2011, we have:
 Contracted with a consultant from the New York University
Medical Center to conduct preliminary modeling of the local
Ryan White Part A portfolio
 Developed a plan for feasible and progressive cost and
outcome analyses for the next 3 years that will inform
planning discussions
 Identified next steps for more program -specific modeling
ef forts once additional data are available via eSHARE
 Begun drafting a fuller presentation on these ef forts, to be
shared with specific Planning Council committees soon
HIGHLIGHTS FROM 2008-2010 RESULTS
 Ryan White testing programs substantially exceeded targets
by 2009, and approximately 60,000 individuals were rapid tested in 2010. Citywide testing remained below targets.
 Concurrency was slightly reduced Citywide (to 22%); subgroup
analyses suggest delayed diagnosis among older New Yorkers.
 Linkage was slightly improved Citywide (to 71%); subgroup
analyses showed traditional racial/ethnic disparities in NYC.
 Citywide retention in care moved upward and then leveled at
76%, not yet at the 78% target; subgroup analyses suggest
non-traditional disparities, with better retention among
female, DPHO-residing, older and nonwhite PLWHA.
HIGHLIGHTS FROM 2008-2010 RESULTS
(CTD.)
 Citywide and in Ryan White MCM, percentages with optimal
adherence exceeded the targets. (Note: low targets @ 50 -66%)
 Viral suppression nearly reached the 71% target Citywide;
subgroup results reflect traditional health disparities, except
that suppression (like retention in care) did increase with age .
 PLWHA with CD4 stability/improvement increased each year
Citywide, reaching 84% in 2010. Targets for this were set
high, at 91% for the EMA and 99% for Ryan White. (Note:
baselines were unknown when the 2009 -12 Plan was drafted)
 Citywide and Part A results (from dif ferent data sources) have
generally met or improved upon targets for reducing acute
care reliance, with the exception of Ryan White
hospitalizations (still appearing a bit above targeted levels ).
THANK YOU!
Questions?
WORKSHOP EXERCISES
 Local data sources listing and comparison of strengths
 Approaches to measurement of disparities and their reduction
 Ways of honoring the Comprehensive Strategic Plan as a
“living document” – how to integrate changes in the policy
and practice landscape, and changes in the data we receive
 When to ‘drop’ an indicator (or do you just keep adding?)
 Uses of Comprehensive Strategic Plan throughout the year