County of Los AngelesDepartment of Public Health

Office of AIDS Programs and Policy

2009 HIV Care and Treatment Service Utili ti Y E d R tUtilization Year End Report

Carlos A. Vega-Matos, M.P.A.gChief, Care Services Division

BackgroundBackground

• Overview of the 2009 HIV Care and Treatment Service Utilization Year End Report

• Reporting period: March 2009 – February 2010

Data source: Casewatch• Data source: Casewatch

• Full report including detailed data sources is availableFull report, including detailed data sources, is available in Commission on HIV meeting packet and on OAPP website: http://www.lapublichealth.org/aids/

HIV/AIDS in Los Angeles County( f 12/31/2009)(as of 12/31/2009)

• Estimated number of PLWH/A: 62,000 – 65,000, ,– PLWA : 24,845– Estimated number of PLWH: 25,000

Estimated number of undiagnosed: 13 000– Estimated number of undiagnosed: 13,000

• PLWHA accessing OAPP-funded Services: 18,545PLWHA accessing OAPP funded Services: 18,545– 39% of all PLWHA in L.A. County– 14,875 (80.2%) had at least 1 medical visit

1 779 (11 9%) were new clients– 1,779 (11.9%) were new clients• 67% accessed medical care

– 1,124 (7.6%) returned to the system of care

Distribution of OAPP-funded Servicesd AIDS Cand AIDS Cases

SPA 1: Antelope Valley

Ryan White Care Services

SPA 2: San Fernando

yCase Management ServicesHousing Services

Medical Case ManagementMedical Nutritional TherapyMental Health Services

$$

$$ $

$$

$

$

$

$

$$

$

$$$

$

$

$

$

$

SPA 3: San Gabriel

SPA 5: WestSPA 4: Metro

Mental Health ServicesMedical OutpatientTreatment Adherence

$

$

$$

$

$

$$ $$ $SPA 5: West

SPA 7: East

SPA 8: South Bay

SPA 6: South2009 HIV/AIDS Cases

$$$

SPA 8: South Bay

< 5 Cases

Gender Distribution of All Ryan White Cli t FY 2009 (N 18 545)Clients, FY 2009 (N=18,545)

1.8%

14.6%<0.1%

83.6%

Male Female Transgender Other/Unknowng

Race/Ethnicity of All Ryan White ClientsFY 2009 (N 18 545)FY 2009 (N=18,545)

60%47.9%

24 9%30%

40%

50%

Clie

nts

24.9% 23.1%

3 2% 0 % %10%

20%

30%

rcen

t (%

)

3.2% 0.5% 0.4%0%Pe

Age Group Distribution of All R Whit Cli t FY 2009 (N 18 545)Ryan White Clients, FY 2009 (N=18,545)

0%10%20%30%40%50%

26.1%

0%10%20%30%40%50%

≥50Percent Clients A

23.5%

39.3%

30-39

40-49

Age G

rou

3 2%

7.2%

19 24

25-29

up (years)

0.8%

3.2%

≤18

19-24

HIV/AIDS Status of All R Whit Cli t FY 2009 (N 18 545)Ryan White Clients, FY 2009 (N=18,545)

31.8%

0.4% HIV+, Not AIDS

HIV+, AIDS Status Unknown

CDC Defined AIDS

12.0%55.8%Unknown

Primary Medical Insurance Status of All R Whit Cli t FY 2009 (N 18 545)Ryan White Clients, FY 2009 (N=18,545)

61 2%70%

61.2%

50%

60%

ents

30.6%

20%

30%

40%

erce

nt C

li

5.4%1.7% 1.1%

0%

10%

20%Pe

0%Private Public No

InsuranceOther Unknown

Primary Medical InsurancePrimary Medical Insurance

Distribution of All Ryan White Clients by F d l P t L l FY 2009Federal Poverty Level, FY 2009

Percent Clients

64.4%

0%20%40%60%80%

Equal to or below FPL

26.0% 101-200% of FPL

Federal P

6.0%

2.2%

201-300% of FPL

301-400% of FPL

Poverty Le

1.2%

0 2%

>400% of FPL

Unknown

evel (FPL

0.2% Unknown L)

Proportion of Clients in Ryan White Medical Care Who Had No Health Insurance and Who Lived At or Below Federal

Poverty Level, FY 2007 - 2009

65.6%67.5%2009

66.0%66.8%2008

no insurance

61.2%63.6%2007

income at or below FPL

55.0% 60.0% 65.0% 70.0%Percent Clients Receiving Medical Care

Ryan White Clients Who Were Homeless, FY 2007 2009FY 2007-2009

8.0%6.9% 7.0%

6.2%6.0%

7.0%

clie

nts

4.0%

5.0%

otal

RW

c

Homeless Clients

1 0%

2.0%

3.0%

Perc

ent t

0.0%

1.0%

2007 2008 2009Year

Distribution of Clients by Race/Ethnicity among Homeless, Recently-Incarcerated, and All Clients,y , ,

FY 2009

60%

9% %

45.5

%

47.9

%

50%

60%

ents Homelessness (n=1,152)

28.8

% 35.9

31.6

%

22.8

% 29.3

%

24.9

%

23.1

%30%

40%

erce

nt C

lie

Incarceration History (n=1,795) All Clients (N=18,545)

1% 4% 5%

2

2% %

2

2% % 5%10%

20%

Pe ( , )

2.1

1.4

<0.5

1.2

1.13. 0.5 %

<0.5

0%White African American Latino Asian Pacific

IslanderNative American Other/Unknown

Patterns of Service UtilizationTable 2.2. Services Accessed by All Ryan White Clients, FY 2009

Type of Ryan White Services N %yp yAll Clients 18,545 100.0

Medical Outpatient* 14,875 80.2Psychosocial Case Management 4 180 22 5Psychosocial Case Management 4,180 22.5Oral Health Care 2,967 16.0Nutrition Support 2,576 13.9Mental Health Psychotherapy 2,345 12.6M di l C M t 2 093 11 3Medical Case Management 2,093 11.3Mental Health Psychiatry 1,917 10.3Substance Abuse Services - Residential 428 2.3Home-based Case Management 387 2.1gResidential Services 381 2.1Substance Abuse Services - Outpatient 52 0.3Hospice Services & Skilled Nursing Services 5 <0.1

Data Source: Casewatch FY 2009 (March 2009 - February 2010)*Received at least 1 medical visit within the year

AcknowledgementsAcknowledgements

• OAPP partners with many County and community-based p y y yagencies to provide HIV care and treatment services. We extend our sincere thanks to these partners for the services and data they providedservices and data they provided.

Thanks also to staff of OAPP’s Office of Planning• Thanks also to staff of OAPP s Office of Planning, Financial Services Division, and Clinical Services Division for their assistance in the development of this document

Authors and ContributorsAuthors and Contributors

• Juhua Wu, Care Grants and Planning Manager• Chi-Wai Au, HRSA Grants Analyst• Min Kim, Research Analyst• Jose Gomez, Data Management & Quality Assurance• Jacqueline Rurangirwa, Epidemiologist• Khrystyne Fong, Fiscal Grants Manager• Angela Boger Section Manager Care Services• Angela Boger, Section Manager, Care Services• Terina Keresoma, Section Manager, Care Services

For additional information please contact J h W t (213) 351 8150Juhua Wu at (213) 351-8150

Office of AIDS Programs and Policy600 S th C lth A 10th Fl600 South Commonwealth Ave., 10th Floor

Los Angeles, CA 90005Phone (213) 351-8000

http://www lapublichealth org/aids/http://www.lapublichealth.org/aids/