Medical Monitoring Project (MMP)National Perspective

A.D. McNaghten, PhD, MHSACenters for Disease Control and Prevention

Division of HIV/AIDS PreventionClinical Outcomes Team

Texas Medical Monitoring Project Meeting – Austin, TXMay 31, 2007

Objectives

• To describe the Medical Monitoring Project (MMP)

• To provide an overview of the MMP at the national level

• To provide an update of MMP project activities and progress

• To discuss how the MMP data will be used

• View some preliminary pilot data

What is MMP?

• New supplemental surveillance project designed to produce nationally representative data on people living with HIV/AIDS who are receiving care in the United States

• Collaborative effort with:– State and local health departments – CDC (Centers for Disease Control and Prevention)– NIH (National Institutes of Health)– HRSA (Health Resources and Services

Administration)

What is MMP?

• Core Surveillance– Gathers basic information everyone reported

with HIV or AIDS• Gender• Age• Race/ethnicity• Mode of HIV exposure

– Provides information on the number of cases and trends in the epidemic

What is HIV Surveillance?

No.

of

case

s and

death

s (i

n t

hou

sand

s)

Year of diagnosis or death

Estimated Number of AIDS Cases, Deaths, and Persons Living with AIDS,1985-2004, United States

Note. Data adjusted for reporting delays.

Pre

vale

nce

(in th

ousa

nds)

0 0

90

400

450

10

20

50

30

100

40

150

50

200

60

250

70

300

80

350

19851986198719881989199019911992199319941995199619971998199920002001200220032004

DeathsPrevalence

AIDS 1993 definitionimplementation

What is HIV Surveillance?

• Supplemental Surveillance– Gathers detailed information on fewer people

• Access to and receipt of clinical care and support services

• Health care seeking and other behaviors

– Helps explain the reasons for the trends

Questions Supplemental Surveillance Data Can Answer

• Are patients receiving care and treatment in accordance with USPHS guidelines?

• Are patients receiving care in public facilities receiving the same quality of care as patients in private facilities?

• What are the barriers to receiving care and services?

• What behaviors are persons who are HIV-infected engaging in?

Origin of MMP• Previous supplemental surveillance projects

– SHAS (Supplement to HIV/AIDS Surveillance)

– ASD (Adult/Adolescent Spectrum of HIV Disease)

• Not representative of people in the United States living with HIV/AIDS

• Both were conducted in a limited number of areas

• Medical Monitoring Project – Interview and medical record data – Representative of HIV-infected people in care

Representative Data• Representative = resembles the

population

• To obtain the most representative data, we would need everyone receiving HIV care in the U.S. to participate

• As a compromise, we will give everyone receiving HIV care in the U.S. a chance to participate

Three Stage Sampling Design

1. National sample of project areas

2. Sample of facilities within each project area

3. Sample of patients within each facility

1st Sampling Stage

State level

• Every state in the country had a chance of being selected

• Chance of selection was proportional to the number of AIDS cases in December 2002

• 20 areas selected– 6 separately funded cities

Sampled Project Areas Medical Monitoring Project

TX

CA

SF

LA County

PR

FL

GAMS

SC

NC

VA

PA

NYS

IN

MI

IL

WACHI

HOU

MA

NJNYC

MD

OR

DEPHIL

TX

High

Moderate

Low

WA

OR

CAIL

FL

MS GA

SC

NC

VA

PA

NY

PR

MI

IN

2nd Sampling StageProvider level

• Every facility providing HIV care in the sampled state had a chance of being selected – ART, CD4, viral load

• Large, medium and small facilities/clinics/practices

• Public/private; HRSA/non• ~40-60 facilities per project

area

3rd Sampling Stage

Patient level

• Every patient in a sampled facility has a chance of being selected– ≥18 years old– HIV+– receiving care

• ~400 patients per project area

Who is involved?

Medical Monitoring Project3 stage sample design

26 Project Areas

>1,000 Facilities

>10,000 Patients

Provider Participation

LocallyLocally, a lead provider assists the health department to– Promote and support the project

• Submit articles in local newsletters• Conduct formal and informal talks with providers

– Assist the health department with recruitment of providers

– Provide advice to the health department

One local provider from each project area is a member of CDC’s National Provider Advisory Board (PAB)

Provider Participation

Nationally• Provider Advisory Board

– Provide input on MMP data collection instruments– Provide technical assistance in development of

provider education materials and recruitment – Enhance local and national investigators’

understanding of the impact of MMP on the HIV-infected and HIV care provider communities

– Guide dissemination of information about MMP within the medical community

Community Participation

LocallyLocal community involvement in MMP is required– Many project areas have their own Community

Advisory Board or use existing community planning groups/boards

– CAB members promote the project and get community and consumer input

One local CAB member from each project area is amember of CDC’s National Community AdvisoryBoard (CAB)

Community Participation

Nationally• Community Advisory Board

– Advocate for the best interests of the community and serve as an important link between MMP staff and patients who participate

– Provide input on MMP data collection instruments– Provide technical assistance in development of

patient education materials and recruitment – Guide the distribution of information about MMP back

to the community to help direct prevention and care

Collaborators

• Centers for Disease Control and Prevention (CDC)

• State and Local Health Departments

• National Institutes of Health (NIH)

• Health Resources and Services Administration (HRSA)

• RAND Corporation

Texas MMP

• Mark Heinzke• Sharon Melville• Sylvia Odem• Jim Philips• Tammy Sajak• Jose Velez

• Laura Armas-Kolostroubis – Lead PAB member

• David Huse– Lead CAB member

How will the MMP data be used?

Data Collection

Interview Modules• Demographics• Access to Health

Care• Adherence• Sexual Behavior• Drug Use Behavior• Access to Prevention

Services

Data Collection

Chart Abstraction• Demographics• Insurance Status• Opportunistic

Illnesses• Antiretroviral Therapy• Laboratory Data• Substance Abuse• Mental Health• Referrals

Confidentiality and Security• MMP data adheres to the same rigorous

confidentiality and security requirements as other HIV/AIDS surveillance data

• Privacy and confidentiality are extremely important and strictly guarded

• Names of patients, providers, and clinics are not sent to CDC

• Information about individual patients, providers or clinics will not be released or used in any reports

• Information can only be accessed by a limited number of staff

Uses of MMP Data

Local• Ryan White reporting requirements• Epi profiles• Evaluation of local prevention programs• Evaluation of resource needs for treatment and care• Information on access to care and prevention servicesNational• Healthy People 2010• Documentation of impact of Ryan White CARE Act-supported

care• Treatment Guidelines

– Evaluation of compliance – Revisions

Counseling session about HIV prevention in the preceding 12 months, MMP Pilot*,

January 2006 – January 2007 (N=432)

18

11

0

2

4

6

8

10

12

14

16

18

20

One-on-one Group session

Perc

ent

age

*Delaware, South Carolina, Texas, Los Angeles County, Philadelphia, Michigan

0

5

10

15

20

25

Per

cen

tag

e

Individual-level Group session

White

Hispanic

Black

Overall 18%

Overall 11%

Counseling session about HIV prevention in the preceding 12 months, by participant’s ethnicity, MMP Pilot*,

January 2006 – January 2007 (N=432)

* Delaware, South Carolina, Texas, Los Angeles County, Philadelphia, Michigan

Prevention Counseling Session in the preceding 12 months, by age in years, MMP Pilot*,January 2006 – January 2007 (N=432)

0

5

10

15

20

25Pe

rcen

tage

One-on-one Group session

18 - 24

25 - 34

35 - 44

45 - 54

55 or older

Overall 18%

Overall 11%

*Delaware, South Carolina, Texas, Los Angeles County, Philadelphia, Michigan

Activities and progress

Data Collection Cycles

• Data collection for MMP is conducted in yearly cycles

• Project area activities will take place each data collection cycle– 2005 cycle collected data on patients in care

in 2005• 2005 cycle to end when interviews for the 2007

cycle begin - May 31, 2007

Data Collection Cycles

• 2007 cycle collects data on patients in care in 2007– Start interviews after May 1, 2007

• Pending OMB clearance

– 2007 cycle will end when data collection for the 2008 cycle begins

Data Collection Cycles

• Delaware• Florida• Houston• Illinois• Los Angeles• Maryland• Michigan

• New Jersey• New York City• Philadelphia• South Carolina• Texas• Washington

13 project areas funded to collect data for the 2005cycle

Interviews and Abstractions2005 Data Collection Cycle

• Interviews– 10 project areas conducted interviews

• DE, HOU, LAC, MD, MI, NJ, PHI, SC, TX, WA

– 814 collected

• Medical record abstractions– 6 project areas conducted abstraction

• HOU, LAC, MI, NJ, TX, WA

– 447 collected

Data Collection Cycles

• California• Chicago• Delaware• Florida• Georgia• Houston• Illinois• Indiana• Los Angeles• Maryland• Massachusetts• Michigan• Mississippi

• Pennsylvania• New Jersey• New York• New York City• North Carolina• Oregon• Philadelphia• Puerto Rico• San Francisco• South Carolina• Texas• Virginia• Washington

26 project areas funded to collect data for the 2007cycle

Progress of 2007 data collection sites (n=26)

MMP activity Completed In Progress

Complete facility frame 25 1

Facility sample selected 25 1

Recruited sampled facilities 13 12

Obtained patient lists 1 23

Patient sample selected 0

Interviewed patients

Abstracted patient records

Medical Monitoring Project (MMP)

Centers for Disease Control and Prevention

Division of HIV/AIDS Prevention

Clinical Outcomes Team

(404) 639-6325

aom5@cdc.gov

http://www.cdc.gov/hiv/topics/treatment/MMP/index.htm

MMP National Surveillance Report

Centers for Disease Control and PreventionDivision of HIV/AIDS Prevention

Clinical Outcomes Team

Informative & Relevant– Consumers

• Capture the experiences of those in care• Describe met and unmet needs

– Clinicians• Paint a broader (representative) picture of HIV progression,

comorbidities, disease management, and care• Demonstrate the quality of care delivered• Help advocate for treatment guidelines

– Community Planning Groups• Demonstrate gaps in services• Help to allocate services/resources locally• Used to guide local prevention programs

– Health policy and public health professionals• Used to forecast resource needs and guide allocation• Inform development of new prevention initiatives

Sylvia Odem

sylvia.odem@dshs.state.tx.us

(512) 533-3053

Suggestions for the National Surveillance Report?