2015 Statewide Orientation Meeting

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