This document provides a summary of the IHS HIV Program update from May 2012. It includes: 1) An overview of AI/AN HIV epidemiology statistics such as incidence rates, number of people living with HIV, and AIDS diagnoses. 2) A discussion of new resources for the program including a new HIV epidemiology atlas and the IHS HIV/AIDS website. 3) An overview of current IHS HIV/AIDS Program initiatives funded by the Secretary's Minority AIDS Initiative such as enhanced health IT and clinical services. 4) A discussion of program performance measurement based on national HIV screening guidelines and future plans to expand testing and care linkages.

1. IHS HIV Program
Update
May 2012
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2. Discussion Overview
• Programmatic Update
– AI/AN Epidemiology
– New Resources
– IHS HIV/AIDS Program Initiatives
• Where We Are Headed
• Program Performance
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3. Epidemiology
Including CDC-Generated
Statistics
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4. AI/AN HIV Epidemiology
• HIV Estimates, 20091
– Incidence rate : 14.1/100K
– About 26% AI/AN People Living with HIV were estimated
to be unaware of status
• HIV Diagnosis, 20082
– Prevalence (# living with diagnosed HIV infection): 2,387
• AIDS Diagnosis, since 1985
– AI/AN ever diagnosed with AIDS (estimated): 3,7023
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Estimated rates of new HIV infections, 50 U.S. states and the District of Columbia, 2009
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Diagnosis from 40 states and 5 dependent areas, 2008
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All states and 5 dependent areas, 2009
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5. Rates of HIV Infection Diagnosis/ 100K*
(Adults/Adolescents/Children)
*40 states with long-term confidential name-based HIV infection reporting
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Dependent areas not included due to limited census information

6. AI/AN HIV Epidemiology
• HIV diagnosis rate for AI/AN men (18.4 per 100K)
slightly higher than white men (14.8)
• HIV diagnosis rate for AI/AN women (6.6) more than
double the rate for white women (2.4)
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Diagnosis from 40 states only, 2009

7. Proportion of Persons Surviving following an AIDS
Diagnosis 2001-2005
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8. New Resources of Note
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9. Epidemiology Resource
• http://www.cdc.gov/Features/AtlasTool/
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10. 10

11. New Website
• http://www.ihs.gov/hivaids/
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12. AIDS 2012
• IHS presence
• HUB opportunities
– Applications open now
– Applications close on September 15, 2012
– Recorded sessions will be available free of charge
– http://www.aids2012.org/hubs.aspx
• Technical Assistance
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13. IHS HIV/AIDS Program
Initiatives:
Secretary’s Minority AIDS
Initiative Fund
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14. Major IHS HIV Initiatives
• Enhanced Medical Information Technology
• Patient-Centered Delivery of Medical Services/
Enhancing Continuity of Care
• Clinical Capacity Enhancements and Hepatitis
Integration into Care
• Effective Behavioral Interventions
• Media Interventions (esp. youth and LGBT)
• Continued Testing Expansions and Technical
Assistance
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15. IHS HIV Program Partnerships, 2009
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16. Where Are We Headed?
• Effective Behavioral Interventions Outcomes
Dissemination
• Expanded relationships with Tribes and
Communities: Including consultation
• Further expansion of HIV Testing
• Improving linkages to care, engagement in
care
• Improving integration with other IHS
programs and services
• Reporting, monitoring and evaluation of
programs: HHS Streamlining of Metrics
• Further growth of the HIV network in I/T/U 16

17. Program Performance and
Measurement
How are we doing?
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18. 4 Performance Measures
2010
1. HIV Screening of 13-64 y.o.: 7%
2. Prenatal HIV Screening (GPRA): 82%
3. Comprehensive of STI+ patients: 31%
4. Chlamydia screening of sexually active 15-24
y.o. females annually: 26%
All 4 measures based on national guidelines and
recommendations
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19. Reducing Infections: Screening
Number of HIV Tests Performed per Year 2000 - 2010
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20. Impact: GPRA Prenatal HIV Screening
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21. Successful Screening
• Sites understand screening rationale
• Use of standing protocols or clinical
reminders for patients eligible for
screening
• Medical team comfortable offering HIV test
and test results
• Clear responsibility for who offers HIV test
• Clear linkage to care for HIV+
• Generally “provider-endorsed, nurse-
driven”

22. Successful screening
• Replicates exisiting prenatal HIV
screening practices
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23. Reminder/Dialogue Challenges
• Inaccurate
• Too many
• Inflexible

24. Deploying Reminders
(AK site method)
1) Pilot test and refine with 1-2 providers
2) Deploy reminder with all providers
3) Data feedback for providers to teams to see
screening scores (iCare)
4) Delegate screenings away from physicians
5) Each professional only sees a subset of total
reminders
source: Onders et. al. JAMIA [in press]

26. New measure
• HCV screening, once only, birth cohort of
persons born 1945-1965
• Already incorporated in CRS logic as
national indicator
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27. Thank You
Lisa C. Neel, MPH
Program Analyst, HIV Program
IHS Headquarters
801 Thompson Ave, Suite 304B
Rockville, MD 20852
(301) 443-4305
lisa.neel@ihs.gov
http://www.ihs.gov/hivaids/
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