Julie Dombrowski , MD, MPH Department of Medicine, University of Washington

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Preliminary Results from Out-of-Care Investigations: A Collaborative Project of the Northwest Health Dept. CFAR Consortium. Julie Dombrowski , MD, MPH Department of Medicine, University of Washington HIV/STD Program, Public Health Seattle & King County. - PowerPoint PPT Presentation

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CFAR Supplement Activities

Preliminary Results from Out-of-Care Investigations: A Collaborative Project of the Northwest Health Dept. CFAR Consortium

Julie Dombrowski, MD, MPHDepartment of Medicine, University of WashingtonHIV/STD Program, Public Health Seattle & King County

1Collaborative Out-of-Care AnalysisGoal: Lay the foundation for collaborative research on key steps in the HIV care continuumSpecific Aim: Enhance investigation of previously reported HIV cases to increase accuracy of estimates of retention in care and virologic suppressionCorrect surveillance-based estimates of the number of HIV-diagnosed persons residing in an areaEvaluate the impact of migration on population-level estimates of retention and virologic suppressionHypothesis: Accounting for migration will increase the estimates of the proportion of HIV-infected persons retained in care and with virologic suppression by 25% in all areasAnticipated Future Direction: Region-wide, population-based interventions to improve engagement in carePreliminary DataEveryone completed the work!Very early analysisPlan for manuscript and next steps

Case InvestigationsStateNumber of PLWHANumber of Cases with No CD4 or VL 12 months % Out of Care Before InvestigationAlaska1,13722019%IdahoBoisePocatello1,385

12033737 31% Montana54811020%Multnomah*3,88675619%Washington**(11,142)271524%Wyoming22273%TOTAL17,855***4,18223%*OR State data forthcoming, data shown for 18 month period**Washington data to be presented in more detail separately***Assuming Boise has ~800 patients for the purposes of rough estimationDemographics of No Labs CasesStateMale(%)Race/Ethnicity(%)MSM%Yrs Since DxYrs Since last labNHWNHBHMedianMedianAlaska8560181052133IdahoBoisePocatello81787165931154443101165Montana87856353153Wyoming71430294393TOTAL836911948134.5Final Case DispositionsStateCasesMoved(%)Died(%)In Care(%)Out of Care*(%)Unable to LocateAlaska22056521612IdahoBoisePocatello337376952919317132310Montana1098636131Multnomah756112825Washington271527438219Wyoming7290141443TOTAL41813116*Confirmed or presumedAdjusted Retention Estimates*StateNumber of PLWHA Out of Care Before InvestigationOut of Care After InvestigationAlaska1,13722019%131%IdahoBoisePocatello1,385?8001203373742% 31% 4416%1%Montana54811020%143%Multnomah3,88675619%381%Washington(11,142)271524%5705%Wyoming22273%125% in all areas

QuestionsWhy only 11% out-migration in Multnomah investigations?Did we all handle spontaneous re-engagement the same way?Differentiate out-of-care during surveillance period then re-engaged spontaneously from in-careHow do we interpret the comparison between health department-based and clinic-based?

ImplicationsOut of care Much less common than national estimates suggestWe might be using the wrong criteria to find the target populationData to Care initiatives that focus on persons with no labs may have limited population-level effectFuture directions need to be reassessed

Retention in CareRecent CDC Report from 19 jurisdictionsExamined following metrics:Any care: Engaged or retained, per definition belowEngaged in care: 1 lab in past yearRetained in continuous care: 2 labs/visits 90 days apart in past yearRetained in care, HHS Core Indicator: 1 lab/visit in each 6-month period of a 24 month measurement period with 60 days between the 1st visit in the prior 6 month period and the last visit in the subsequent 6 month periodSource: Cohen S et al, JAIDS 2014; Valiserri et al, Public Health Reports 201311Viral Suppression by Retention Measure, 19 US JurisdictionsSource: Cohen S, et al, JAIDS 2014, Epub ahead of printN%Virally suppressed% of rowvirally suppressedTotal338,959100147,01543.4Any Care214,73463 (of total)147,01568.5Engaged42,36320 (of any care)20,19247.7Retained in continuous care172,37180 (of any care)126,82373.6History of ART initiation and continuing ART use and viral suppression at the end of 2010 among patients who received care at a CNICS clinic in2010 (N=8633)N (% of total)% Ever on ART% on Continuing ART (at end of 2010)% with Viral SuppressionAny Care in 20108633 (100)948970Retained in continuous care (2 visits 3 mo apart)No1396 (16)90*81*55*Yes7237 (84)94*91*73** p

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