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Health Disparity Calculator for Minneapolis-St. Paul Transitional Grant Area
Who am I?
Matthew KravitzScranton, PA
Lehigh University
Rising Senior
Double Major: Biology & Public Health
Minor: Integrated Business
Definitions and Notes
• Viral suppression: viral load under 200 viral copies per milliliter
• Health disparity: Differences in health outcomes that are linked with systematic economic,
social, or environmental disadvantages
• There are other aspects to inequity, but viral suppression is the focus of the presentation
• Health literacy: The degree to which individuals have the capacity to obtain, process, and
understand basic health information and services needed to make
appropriate health decisions
• 90/90/90 2020 Goal: • Diagnose 90% of all HIV-positive persons
• Provide antiretroviral therapy (ART) for 90% of those diagnosed
• Achieve viral suppression for 90% of those provided ART/retained in care
Population
• Ryan White Clients only
• Transitional Grant Area (TGA): 13 county metro area that Hennepin County`s Ryan White Program is responsible for
• Clients with no viral load excluded
• Groups: Two calculator groupings ran
• Men:• Black African American MSM
• Black African Born Men
• White Non-Hispanic MSM
• Hispanic MSM
• Women:
• Black African American Women• Black African Born Women
• White Non-Hispanic Women
• Hispanic Women
• *Populations less than 100 are too small for release per MDH public re-release policy*• i.e. Transgender, Asian Pacific Islander, etc.
Background
• Developed by Center for Quality Improvement and Innovation (CQII) to provide
assistance to Ryan White HIV/AIDS Program recipients
• CQII: provides technical assistance on quality improvement to Ryan White HIV/AIDS
Program recipients and sub recipients
• Goal: Identify sub-populations experiencing disparities in need of improvement along the
HIV Care Continuum
• Pre-programmed spreadsheet tool
• Works with the end+disparities Collaborative Learning Communities
The Calculator: How Does It Work?
• Center for Quality Improvement and Innovation: provides technical assistance on quality improvement to Ryan White HIV/AIDS Program recipients and sub recipients
• Uses five formulas• Health disparity is determined by thresholds
• Calculator developed by national experts
• Started by third party and adopted by CQII
• Predetermined statistics
Data: Retention in Care 2018
70
75
80
85
90
95
100
Black AfricanAmerican Women
Black African BornWomen
White Non-Hispanic Women
Hispanic Women Hispanic MSM Black AfricanAmerican MSM
White Non-Hispanic MSM
African Born Males
% R
eten
tio
n in
Car
e
2018
• Retention in care is consistent across demographics • Therefore, the calculator focused on viral suppression only
Viral Suppression Rates for Men by Race/Ethnicity: 2014-2018
70
75
80
85
90
95
2014 2015 2016 2017 2018
% S
up
pre
sio
n R
ate
Year
Black African American MSM African Born Men White Non-Hispanic MSM Hispanic MSM Overall
• Viral suppression rate consistently below average: Black African American MSM• Overall, Ryan White is performing better than individuals living with HIV not in Rytan White
• General trend of improving viral suppression rates except for Black African American MSM*2015: Higher percentage of clients missing a viral load*
• Possible explanation for the lower viral suppression rates• Reminder: These are only TGA Ryan White clients and overall is an average of the four groups
Health Disparities Based on Viral Suppression Rates for Men: 2014-2018
• Black African American MSM showed a health disparity• Reminder: These are only Ryan White clients, not all people living with HIV
Black African American MSM
Black African Born Men
White Non-Hispanic MSM Hispanic MSM
2014 84% 84% 90% 92%
2015 76% 85% 88% 90%
2016 82% 91% 92% 89%
2017 80% 91% 92% 94%
2018 80% 90% 92% 93%
Absolute Impact Black African American MSM: 2014-2018
17
3129
38 35
0
5
10
15
20
25
30
35
40
45
2014 2015 2016 2017 2018
# o
f In
div
idu
als
Year
Black African American MSM Linear (Black African American MSM)
• Absolute impact• The number of clients that would be virally suppressed if the health disparity was eliminated• Just a quantitative representation-> not specific individuals
• Increasing number of individuals affected• Increase in clients, but health disparities still remain
• Eliminating disparity -> 35 more clients would be virally suppressed
Effects of Addressing Health Disparity Based on the Viral Suppression of Black, African American (BAA) MSM: 2018
89 90.491.6
80.6
86.3
91.6
74
76
78
80
82
84
86
88
90
92
94
Men Overall Men w/ 50% HealthDisparity Eliminated
Men w/ 100% HealthDisparity Eliminated
BAA MSM w/ 50% Health DisparityEliminated
w/ 100% Health DisparityEliminated
% o
f In
div
idu
als
Vir
ally
Su
pp
ress
ed
Group
Goal 2020: 90%
• Men overall population• Black African American MSM• Black African Born Men• White Non-Hispanic MSM• Hispanic MSM
% %%
%
%
%
Viral Suppression Rates for Women by Race/Ethnicity: 2014-2018
70
75
80
85
90
95
2014 2015 2016 2017 2018
% V
iral
ly S
up
pre
ssed
Year
Black African American Women Black African Born Women White Non-Hispanic Women Hispanic Women Overall
• Black African American Women consistently have lower viral suppression rates*2015: Higher percentage of clients missing a viral load*
• Possible explanation for the lower viral suppression rate• Reminder: These are only TGA Ryan White clients and overall is an average of the four
groups
Health Disparities Based on Viral Suppression Rates for Women: 2014-2018
Black African American Women
Black African Born Women
White Non-Hispanic Women Hispanic Women
2014 84% 88% 87% 90%
2015 81% 86% 85% 92%
2016 84% 90% 87% 91%
2017 86% 92% 88% 93%
2018 86% 92% 91% 93%
• Black African American Women health disparity• Similar to Black African American MSM
Absolute Impact Black African American Women: 2014-2018
13
19
17
15
21
0
5
10
15
20
25
2014 2015 2016 2017 2018
# o
f In
div
idu
als
Year
Black African American Women Linear (Black African American Women)
• Absolute impact• The number of clients that would be virally suppressed if the health disparity was eliminated• Just a quantitative representation-> not specific individuals
• Increasing number of individuals affected• Increase in clients, but health disparities still remain
• Eliminating disparity -> 21 more clients would be virally suppressed
Effects of Addressing Health Disparity Based on the Viral Suppression for Black, African American Women(BAA): 2018
89.590.9
92.1
85.6
88.7
92.2
74
76
78
80
82
84
86
88
90
92
94
Women Overall Women w/ 50% HealthDisparity Elimination
Women w/ 100% HealthDisparity Elimination
BAA Women w/ 50% Health DisparityElimination
w/ 100% Health DisparityElimination
% o
f In
div
idu
als
Vir
ally
Su
pp
ress
ed
%
%
Goal 2020: 90%
• Women overall population• Black African American Women• White Non-Hispanic Women• Black African Born Women• Hispanic Women
%%
%
%
Takeaways
*Utilize calculator as an effective tool to continue monitoring changes in
health disparities*
• Ryan White Program is effective and improving outcomes for all
racial/ethnic groups compared to people living with HIV not in Ryan
White
• However, disparities still exist in the Ryan White program for Black African
American Women & Black African American MSM
Possible Future Evaluation
• Association between Health Literacy and HIV Treatment Adherence
• N=145 with 93% African American Population: Out of state, simply a model!
• Health literacy directly becomes a predictor of poor HIV treatment adherence
• Adherence -> viral suppression
• Unannounced pill checks to check HIV treatment adherence
• Lower health literacy was associated not achieving 85% adherence
• Factors:
• Emotional Distress
• Stigma
• Social Support
*Association not Correlation*
Discussion
• How do we improve viral suppression rates for Black, African Americans in
the MSP-TGA?
Systematic:-Non-representative workforce-HIV criminalization and incarceration-Lack of safety-Funding Inequities-Cultural responsiveness
Social Determinants of Health-Racism-Health Literacy/Access toinfo
Cultural-Stigma-Lack of trust in healthcare-Invisibility with family systems
Historical Trauma-Providers-> White-History with sexuality-PTSD
Previous Discussion Root Cause Ideas
Hennepin County Public Health Department
525 Portland Ave, MC L963
Minneapolis, MN 55415
Matthew Kravitz
