Ryan White Part C Reauthorization:Impact On UW Health HIV Care Program

• 407 new cases of HIV infection were reported in 2007.

• 9,929 cases have been reported since 1983.

• 6,684 cases are classified as AIDS, 3,245 as non-AIDS.

• 3,635 persons reported with HIV infection are known to have died.

• 6,294 persons with HIV infection were presumed to be alive at the end of 2007.

Wisconsin AIDS/HIV Surveillance Data December 31, 2007

Number of persons reported with HIV infection by year of report, Wisconsin, 1990-2007

0

100

200

300

400

500

600

700

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Between 1998 and 2007:Average = 383 cases per year95% Confidence interval=336-430 cases per year

2,588

2,992

3,3523,527

3,6533,810

3,9864,225

4,4304,626

4,844

5,2655,450

5,6565,873

6,0896,294

5,043

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Number of persons reported with HIV infection and presumed alive at year’s end, Wisconsin, 1990-2007

New Cases of HIV Infection Reported

2

4

0

2

00

0

1

3

1

1

0 0

1

2

2

0

1

0

2

3

3

2

0

6

2

0

2

7

1

0

61

0

1

4

1

0

2

3

3

6

80

2

4

3

0

0

16

2

8

15

20

0

2

17

1

0

2

02 0

0

1

0 21

2 0

0

0

166

0-2

3-5

6-10

11-50

50

Cases

Wisconsin AIDS/HIV ProgramWisconsin data, cases reported through December 31, 2007.

UW Health HIV Care ProgramCatchment Area

**

90%

6% 5%2% 1%

47%

36%

15%

1% 1%

0.6

0.4

0.1

0.0 0.00%

25%

50%

75%

100%

White African American Hispanic Asian/PacificIslander

American Indian

WI POPWI HIVUW HIV

57%

37%

14%

1% 1%

UW HIV-18% Women 55% of Women are Minorities

UW HIV Clinic Demographics Compared to WI State Population and WI HIV Demographics

46%

2%6%

31%

15%

0%

25%

50%

75%

100%

MSM MSMIDU IDU Heterosexual Other

2008

UW Health HIV Care Program Risk Groups

Beloit Community

HealthCenter

WisconsinPrisonSystem

Aids Network

WIHIV/AIDSBureau

(RW Part B)

UW Health HIV Care Program

University of Wisconsin Hospitals and Clinics

Satellite Clinic80 Patients

Staff Nurse SocialWorker NA

10 State Prisons130 Patients

Come to UW Clinic

Testing and CounselingPrevention

ADAPPrison Case

ManagerOther Funding

17 Individuals Staff Clinic

2 HIV Infected2 Multi-lingual

CABQA/QI Committee

Multiple SpecialtiesFunds several staff

Contracts UWMF

Medical Case Management

Integration of Services

Increase Access to Services and

Retention

Continuity of Care

Enhanced Independence

Increased Knowledge about

HIV

Ryan White HIV/AIDS Treatment Modernization Act of 2006

Goals

CLIENT

Physicians/PA

Nurse/NAsSocial Worker

Case Managers

Dentists

Treat/Adhere Pharmacists

Mental HealthNutritionist

Data Analyst

Translation Research

Appointment

UW HIV Care Coordination Model

Coordinator

Providers

Coordinator

CoordinatorServices

4 Physicians2 ID

ImmunologistInternist

PA Provider

2 Nurses2 NAs

NA SchedulesReferrals

PsychiatristPsychologist

In Clinic

2 Social Workers

1 is Prison Case

Manager

Administrator

Pain Specialist (MD)

Brochurewww.medicine.wisc.edu/hivuw

UW Health HIV Care Program Total and New and RWII Patients (2008 Thru August)

0

200

400

600

800

1000

2004 2005 2006 2007 2008

Total PatientsNew PatientsRWIII Part C

36% Increase in Total Patients since 2004

UW Health HIV Care Program Total, New and RW Part C Patients (2008 is Thru August)

--

UW Health HIV Care Program Total and New and RWII Patients (2008 Thru August)

0

5000

10000

15000

2004 2005 2006 2007 2008

Total Visits

Case ManagementVisitsNo-Show Rate

2008 Through August—No-Show Rate Doctor Visits

8% 10% 7% 6% 6%

UW Health HIV Care Program Visits (2008 is Thru August)

29%

15%

61%

85%

0%

25%

50%

75%

100%

CD4 <200 CD4<200 All Viral Loads Viral Loads Treated

CD4 Counts (New Patients) and HIV RNA Levels

1998-2000 2005-2007 <50 Viral Load

Prison Case Management

• One of our social workers deals primarily with individuals infected with HIV and incarcerated

• All incarcerated individuals with HIV from the State prisons attend our clinic in the UWHC and have access to all the services in our clinic and the hospital

• The Prison Case Manager coordinates prisoner HIV discharge planning---sets up appointments in the community, assures have meds to time of appointment, etc

• Data for time period January-July 2008--- 31 inmates released– 2 refused release planning– 1 took info only– 20 attended scheduled apt in community– 5 no-shows– 3 either did not have apt yet or release delayed

Challenges with RW—Part C• We continue to grow but our space does not

• As the patient load grows our staff doesn’t—the nurse position especially challenging

• Staff attrition

• Transportation and weather at times a problem in our community

• Dental—hospital dentist is retiring

• State ADAP may go to a waiting list 2011 • The economy