The document discusses using HIV program data to evaluate gaps and disparities in linkage to care. It provides examples of how Louisiana measures linkage, retention, and viral suppression, and presents continuum of care data for the state overall and by region, race/ethnicity, and testing site. Linkage to care rates for newly diagnosed individuals are shown to be improving over time but still vary between regions and community-based organizations. The document encourages evaluating one's own agency's linkage data and identifying opportunities for the State HIV Program to provide more useful data support.

1. Using Data to Improve
Linkage to Care
Debbie Wendell, PhD, MPH
Louisiana STD/HIV Program
Louisiana STD/HIV Program

2. How can data be used to improve
programs?
• Where are the biggest gaps in the HIV
continuum of care?
• Are there race, gender or age disparities?
• How quickly are clients getting linked to
care?
• Are clients retained in care?
• How does my agency compare to others?

3. How do we measure linkage, retention and
viral suppression?
• Use CD4/VL results as a proxy for an
HIV-related medical visit
o All HIV-related test results are reportable in Louisiana
o Most are reported electronically on a daily basis
• Measurement standards
o Linkage: Was a person newly-diagnosed with HIV
linked to HIV-related medical care within 90 days?
o Retention: Did a person living with HIV have 2 or more
care visits within a 12 month period?
o Viral Suppression: Was the most recent VL <=200?

4. HIV Continuum of Care
Louisiana, 2013
100%
69%
54%
49%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Persons living with HIV In HIV care Retained in HIV care Viral suppression
(<=200)
Percentage
18,199
9,774
12,536
8,831
70% of PLWH in care were virally suppressed
Louisiana STD/HIV Program

5. Percent Retained in Care among PLWH
by Region, Louisiana, 2013
Louisiana STD/HIV Program
52%
60% 60%
54%
46%
51%
46%
51%
53%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Percentage
Region
Louisiana STD/HIV Program

6. Percent Virally Suppressed among PLWH in Care
by Region, Louisiana, 2013
Louisiana STD/HIV Program
68%
71%
75% 75%
71% 71% 68%
72%
76%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Percentage
Region
Louisiana STD/HIV Program

7. HIV Continuum of Care by Race/Ethnicity
Louisiana, 2013
100% 100% 100%
70%
45%
70%
54%
35%
55%
46%
35%
58%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Black Hispanic White
Percentage
PLWH
In HIV care
Retained in care
Viral suppression
66% of PLWH in
care were virally
suppressed
77% of PLWH in
care were virally
suppressed
82% of PLWH in
care were virally
suppressed
N = 12,442 N = 693 N = 4,861
Louisiana STD/HIV Program

8. HIV Testing by Site Type
Louisiana, 2013
Total Number of
Tests
(% of Tests)
Number of
Positive
Results
% Positivity
Total
Positives
Number of
New
Positives
% Positivity
New
Positives
Total 95,656 1,069 1.1% 532 0.6%
Parish health unit 36,347 (38%) 226 0.6% 146 0.4%
Emergency department 19,484 (20%) 235 1.2% 130 0.7%
Correctional facility 16,385 (17%) 275 1.7% 27 0.2%
Community-based org 15,701 (16%) 279 1.8% 198 1.3%
Community health clinic 4,206 (4%) 45 1.1% 25 0.6%
Substance abuse clinic 2,805(3%) 5 0.2% 2 0.7%
School/college 728 (1%) 4 0.5% 4 0.5%

9. Linkage to Care within 90 Days
Louisiana, 2007 -2014
67%
70% 70%
73% 74%
78% 79%
83%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2007 2008 2009 2010 2011 2012 2013 2014
Year of Diagnosis
National HIV/AIDS Strategy Objective: 85%
Louisiana STD/HIV Program

10. Linkage to Care within 90 Days
by Region, 2013
Louisiana STD/HIV Program
78%
74%
86%
78%
90%
87%
74%
83%
85%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Percentage
Region
National HIV/AIDS Strategy Objective: 85%
Louisiana STD/HIV Program

11. Linkage to Care – New Positives
By Site Type, Louisiana, 2013
Number of
New
Positive
Results
Number
Linked to
Care within
90 Days
% Linked to
Care within
90 Days
Total 532 365 69%
Community-based org 198 138 70%
Parish health unit 146 85 58%
Emergency department 130 111 85%
Correctional facility 27 12 44%
Community health clinic 25 17 69%
Substance abuse clinic 2 0 0%
School/college 4 2 50%

12. Time to Linkage to Care
New Positives - CBOs, Louisiana, 2013
0
10
20
30
40
50
0-7 8-15 16-30 31-45 46-90 91-180 181-270 >270
Days to Entry into Care
Louisiana STD/HIV Program

13. Linkage to Care within 90 Days
New Positives - CBOs, Louisiana, 2013
79%
100%
54%
81% 80%
57%
84%
70%
60%
100% 100%
0%
20%
40%
60%
80%
100%
A B C D E F G H I J K
CBO
Louisiana STD/HIV Program
National HIV/AIDS Strategy Objective: 85%

14. Linkage to Care – New Positives
By Gender and Race/Ethnicity, CBOs, 2013
Number of
New
Positive
Results
Number
Linked to
Care within
90 Days
% Linked to
Care within
90 Days
Total 198 138 70%
Female 30 16 53%
Male 168 122 73%
African American/Black 118 73 62%
Hispanic/Latino 6 6 100%
White 68 55 81%

15. Linkage to Care – New Positives
By Age Group, CBOs, 2013
Number of
New
Positive
Results
Number
Linked to
Care within
90 Days
% Linked to
Care within
90 Days
Total 198 138 70%
16-24 years old 65 48 74%
25-44 years old 99 68 69%
>=45 years old 33 21 64%

16. Initial CD4 and Viral Load
CBOs, 2013
• CD4 count
o Range: 6 - 1,169
o Median: 448
o Average: 439
o 28 clients had a CD4 count <=200 (meet AIDS case
definition)
• Viral load
o Range: <20 – 5,589,140
o Median: 37,080
o Average: 164,125
o 8 clients had a VL<=200 (i.e., virally suppressed)

17. HIV Continuum of Care - 2014
CBO – New Positives Diagnosed in 2013
100%
76%
60%
56%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
New Positives Dx in
2013
In HIV care Retained in HIV care Viral suppression
(<=200)
Percentage
198
118
150
111
74% of persons in care were virally suppressed
Louisiana STD/HIV Program

18. Evaluating Linkage to Care
• How do you evaluate linkage/retention in
care at your agency?
• Do you collect any data to look at linkage to
care?
• What are the data gaps?
• How can SHP help provide you useful data?

19. Questions?
For more information:
Debbie Wendell, PhD, MPH
STD/HIV Program
Louisiana Office of Public Health
(504) 568-7474
debbie.wendell@la.gov