Data Trends:Data Trends:FPAR & HIV Prevention FPAR & HIV Prevention

ProjectProject

OPA/OFP HIV Prevention ProjectOPA/OFP HIV Prevention ProjectAnnual Technical Support ConferenceAnnual Technical Support Conference

June 12, 2007June 12, 2007

Presented byPresented byKelly Morrison Opdyke, MPHKelly Morrison Opdyke, MPH

Cicatelli Associates Inc.Cicatelli Associates Inc.

Learning ObjectivesLearning Objectives

Describe key findings from the 2005 Family Describe key findings from the 2005 Family Planning Annual Report (FPAR)Planning Annual Report (FPAR)

Review epidemiology of HIV/AIDS in relation to Review epidemiology of HIV/AIDS in relation to Title X usersTitle X users

Examine national and regional OPA HIV Examine national and regional OPA HIV Prevention Project data trendsPrevention Project data trends

Compare trends in FPAR and HIV Prevention Compare trends in FPAR and HIV Prevention Project data with national trendsProject data with national trends

Family Planning Annual ReportFamily Planning Annual Report The only source of annual, uniform reporting by The only source of annual, uniform reporting by

all Title X service granteesall Title X service grantees

Enables Title X administrators and grantees to:Enables Title X administrators and grantees to: Monitor program performanceMonitor program performance Comply with federal accountability rulesComply with federal accountability rules Guide strategic and financial planningGuide strategic and financial planning Estimate impact of Title X-supported activities on key Estimate impact of Title X-supported activities on key

reproductive health outcomesreproductive health outcomes

Published reports available online from OPA:Published reports available online from OPA:http://opa.osophs.dhhs.gov/titlex/ofp_references.htmlhttp://opa.osophs.dhhs.gov/titlex/ofp_references.html

FPAR 2005: User DemographicsFPAR 2005: User Demographics

5,002,961 family planning users5,002,961 family planning users 95% female, 5% male95% female, 5% male 66% below 100% of federal poverty level (FPL)66% below 100% of federal poverty level (FPL) 60% uninsured60% uninsured 58% under age 2558% under age 25 48% racial and/or ethnic minorities48% racial and/or ethnic minorities

FPAR 2005: Users by Age GroupFPAR 2005: Users by Age Group

Distribution of family planning users by age (Females: N=4,740,168 Males: N=262,793)

0%5%

10%15%20%25%30%35%40%

<15 15-17

18-19

20-24

25-29

30-34

35-39

40-44

>44

Age in years

FemalesMales

FPAR 2005: Users by Race/EthnicityFPAR 2005: Users by Race/EthnicityDistribution of Family Planning Users by

Race/ Ethnicity

More than one race1%

American Indian/ Alaska

Native1%

Asian2%

Unknown or NR3%

Black/ African American, not

Hispanic19% Native

Hawaiian/ Other Pacific Islander

1%

White, not Hispanic

49%

Hispanic/ Latino (All Races),

24%

N=5,002,961

FPAR 2005: HIV TestingFPAR 2005: HIV Testing

HIV test volume increased by 14% in 2005HIV test volume increased by 14% in 2005

607,974 confidential HIV tests607,974 confidential HIV tests 519,221 tests among females (85% of all tests)519,221 tests among females (85% of all tests) 88,753 tests among males (15% of all tests)88,753 tests among males (15% of all tests)

1,114 positive confidential tests (0.18%)1,114 positive confidential tests (0.18%)

13,349 anonymous HIV tests13,349 anonymous HIV tests

FPAR 2005: STD and HIV TestingFPAR 2005: STD and HIV Testing

Percent of family planning users tested(Females: N=4,740,168 Males: N=262,793)

46% 46%

15%11%

49% 50%

27%

34%

0%

10%

20%

30%

40%

50%

60%

Chlamydia Gonorrhea Syphilis HIV*

Females Males

*Confidential HIV Tests Only

HIV/AIDS among WomenHIV/AIDS among Women

Nature of the epidemicNature of the epidemic Women of color (especially African American Women of color (especially African American

women) are the hardest hitwomen) are the hardest hit Younger women are more likely to get HIVYounger women are more likely to get HIV AIDS is a common killer, second only to cancer AIDS is a common killer, second only to cancer

and heart disease for womenand heart disease for women

Most common modes of transmissionMost common modes of transmission Having sex with a man who has HIVHaving sex with a man who has HIV Sharing injection drug works (needles, etc.)Sharing injection drug works (needles, etc.)

Source: CDC HIV/AIDS among Women Fact Sheet, March 2007

HIV/AIDS among WomenHIV/AIDS among Women

Since 1985 the proportion of estimated AIDS Since 1985 the proportion of estimated AIDS cases diagnosed among women has more than cases diagnosed among women has more than tripled, from 8% in 1985 to 27% in 2004.tripled, from 8% in 1985 to 27% in 2004.

In 2004, women of color accounted for 80% of In 2004, women of color accounted for 80% of all women estimated to be living with AIDS; all women estimated to be living with AIDS; black women made up 64% of this total.black women made up 64% of this total.

Source: CDC HIV/AIDS among Women Fact Sheet, March 2007

HIV/AIDS among YouthHIV/AIDS among Youth

Nature of the epidemicNature of the epidemic 13% of the persons diagnosed with HIV or AIDS 13% of the persons diagnosed with HIV or AIDS

in 2004 were age 13-24 yearsin 2004 were age 13-24 years Young people of racial/ethnic minorities are at Young people of racial/ethnic minorities are at

increased risk for infection through sexual risk increased risk for infection through sexual risk behavior (heterosexual and MSM)behavior (heterosexual and MSM)

Risk FactorsRisk Factors Earlier age at sexual initiationEarlier age at sexual initiation Higher STD ratesHigher STD rates

Source: CDC HIV/AIDS among Youth Fact Sheet, June 2006

HIV/AIDS Diagnoses by AgeHIV/AIDS Diagnoses by Age

Distribution of new HIV/ AIDS diagnoses by age(N=38,730)

1%

13%

26%

34%

19%

6%2%

0%5%

10%15%20%25%30%35%40%

<13 13-24 25-34 35-44 45-54 55-64 >64

Age in years

Source: CDC Surveillance 2004

OPA/OFP Integration of OPA/OFP Integration of HIV/AIDS Prevention ProjectHIV/AIDS Prevention Project

HIV Prevention Project (HIVPP)HIV Prevention Project (HIVPP)

GOAL:GOAL: To supplement existing Title X To supplement existing Title X

grants, in communities with grants, in communities with demonstrated high risk for demonstrated high risk for HIV/AIDS, to implement or HIV/AIDS, to implement or expand HIV on‑site prevention expand HIV on‑site prevention counseling, testing, and counseling, testing, and referral servicesreferral services

Cycle 1: Oct 2001 – Aug 2004Cycle 1: Oct 2001 – Aug 200434 projects34 projects8 PHS regions (19 states)8 PHS regions (19 states)

Cycle 2: Sep 2004 – Sep 2007Cycle 2: Sep 2004 – Sep 200763 projects63 projects10 PHS regions (27 states)10 PHS regions (27 states)

Number of Projects by Region

02468

1012141618

I II III IV V VI VII VIII IX X

Cycle 1 Cycle 2

HIVPP: Outcome MeasuresHIVPP: Outcome Measures

Number of individual HIV counseling sessionsNumber of individual HIV counseling sessions Number of HIV tests by test mode and typeNumber of HIV tests by test mode and type

Confidential v. AnonymousConfidential v. Anonymous Standard v. RapidStandard v. Rapid

Number of positive HIV testsNumber of positive HIV tests Number of clients returning for test results and Number of clients returning for test results and

post-test counseling post-test counseling Number of positive clients referred for Tx/careNumber of positive clients referred for Tx/care HIV testing by race & ethnicityHIV testing by race & ethnicity HIV testing by gender & age groupHIV testing by gender & age group

HIVPP: Counseling, Testing & ReferralHIVPP: Counseling, Testing & Referral

OutcomeOutcome Cycle 1:Cycle 1:

Oct-01 to Aug-04Oct-01 to Aug-04

N %N %

Cycle 2: Cycle 2:

Sep-04 to Dec-06Sep-04 to Dec-06

N %N %

# counseled# counseled 365,461365,461 n/an/a 391,897391,897 n/an/a

# tested# tested 187,702187,702 51%51% 263,623263,623 67%67%

# returning for results# returning for results 97,06797,067 53%53% 169,049169,049 64%64%

# positive# positive 693693 0.37%0.37% 692692 0.26%0.26%

# positives referred for # positives referred for TxTx

540540 78%78% 664664 96%96%

HIVPP: Counseling SessionsHIVPP: Counseling Sessions

Number of Individual HIV Counseling Sessions Reported per Period

0

20000

40000

60000

80000

100000

120000

140000

C1P1 C1P2 C1P3 C1P4 C1P5 C2P1 C2P2 C2P3 C2P4

IndividualCounselingSessions

Cycle 1, Periods 1-5 (Oct-01 to Aug-04) and Cycle 2, Periods 1-4 (Sep-04 to Dec-06)

HIVPP: Counseling SessionsHIVPP: Counseling Sessions

Average Number of Individual HIV Counseling Sessions Per Month Per Period

0

5000

10000

15000

20000

C1P1 C1P2 C1P3 C1P4 C1P5 C2P1 C2P2 C2P3 C2P4

Funding Cycle and Reporting Period

IndividualCounselingSessionsCycle 1 Cycle 2

Cycle 1, Periods 1-5 (Oct-01 to Aug-04) and Cycle 2, Periods 1-4 (Sep-04 to Dec-06)

HIVPP: HIV Tests by PeriodHIVPP: HIV Tests by Period

Number of HIV Tests Reported Per Period(N=451,971)

0

20000

40000

60000

80000

100000

C1P1 C1P2 C1P3 C1P4 C1P5 C2P1 C2P2 C2P3 C2P4

Funding Cycle and Reporting Period

AnonymousConfidential

Cycle 1, Periods 1-5 (Oct-01 to Aug-04) and Cycle 2, Periods 1-4 (Sep-04 to Dec-6)

HIVPP: HIV Tests by Test ModeHIVPP: HIV Tests by Test Mode

Average Number of HIV Tests by Test ModePer Month Per Period

0

2000

4000

6000

8000

10000

12000

C1P1 C1P2 C1P3 C1P4 C1P5 C2P1 C2P2 C2P3 C2P4

Funding Cycle and Reporting Period

AnonymousConfidential

Cycle 1 Cycle 2

Cycle 1, Periods 1-5 (Oct-01 to Aug-04) and Cycle 2, Periods 1-4 (Sep-04 to Dec-06)

HIVPP: HIV Tests by Test TypeHIVPP: HIV Tests by Test Type

Average Number of HIV Tests by Test TypePer Month Per Period

0

2000

4000

6000

8000

10000

12000

C2P1 C2P2 C2P3 C2P4

Funding Cycle and Reporting Period

RapidStandard

Cycle 2, Periods 1-4: Sep-04 to Dec-06

%Rapid

C2P1: 20%

C2P2: 31%

C2P3: 41%

C2P4: 46%

HIVPP: Return Rate by Test TypeHIVPP: Return Rate by Test Type

Percent of Clients Returning for HIV Test Resultsby Test Type

55%

96%

64%

0%

20%

40%

60%

80%

100%

120%

Return Rate

Standard Rapid Total

Cycle 2, Periods 2-4: July-05 to Dec-06

HIVPP:HIVPP: Testing by Race/Ethnicity Testing by Race/Ethnicity

Race/EthnicityRace/Ethnicity TestsTests PositivesPositives %Pos%Pos

Black/African American, not HispanicBlack/African American, not Hispanic 5166551665 244244 0.47%0.47%

Hispanic or Latino (All Races)Hispanic or Latino (All Races) 7355273552 201201 0.27%0.27%

American Indian/Alaska NativeAmerican Indian/Alaska Native 12311231 22 0.16%0.16%

White, not HispanicWhite, not Hispanic 4628446284 6565 0.14%0.14%

AsianAsian 34713471 33 0.09%0.09%

More than one raceMore than one race 14341434 11 0.07%0.07%

Native Hawaiian/Pacific IslanderNative Hawaiian/Pacific Islander 381381 00 0.00%0.00%

Unknown or NRUnknown or NR 33973397 11 0.03%0.03%

TotalTotal 181415181415 517517 0.28%0.28%

Cycle 2, Periods 2-4: July-05 to Dec-06

HIVPP:HIVPP: Positivity by Race/Ethnicity Positivity by Race/Ethnicity

0.00%

0.05%

0.10%

0.15%

0.20%

0.25%

0.30%

0.35%

0.40%

0.45%

0.50%

Native Hawaiian/Pacific Islander

More than one race

Asian

White, not Hispanic

American Indian/Alaska Native

Hispanic or Latino (All Races)

Black/African American, not Hispanic

Cycle 2, Periods 2-4: July-05 to Dec-06

HIVPP:HIVPP: Testing by Race/Ethnicity Testing by Race/Ethnicity

Distribution of HIV Tests vs. HIV Positive Results by Race/ Ethnicity

47%

28%

39%

41%

13%

26%

0% 20% 40% 60% 80% 100%

Positives

TestsBlack/ AA N-HHisp/ LatinoWhite N-HAI/ ANAsian>1 raceNH/ PIUK

Cycle 2, Periods 2-4: July-05 to Dec-06

HIVPP: Testing by GenderHIVPP: Testing by Gender

Distribution of HIV Tests vs. HIV Positive Results by Gender

49%

20%

51%

80%

0% 20% 40% 60% 80% 100%

Positives

Tests

MaleFemale

Cycle 2, Periods 1-4: Sep-04 to Dec-06

HIVPP:HIVPP: Testing by Age Group Testing by Age Group

Distribution of HIV Tests vs. HIV Positive Results by Age Group

18%

30%

19%

20%

42%

22%

0% 20% 40% 60% 80% 100%

Positives

Tests<1515-1718-1920-2425-2930-44>44

Cycle 2, Periods 2-4: July-05 to Dec-06

HIVPP: Positivity by RegionHIVPP: Positivity by Region

0.00%

0.05%

0.10%

0.15%

0.20%

0.25%

0.30%

0.35%

0.40%

0.45%

0.50%

I II III IV V VI VII VIII IX X

Cycle 2, Periods 1-4: Sep-04 to Dec-06

SummarySummary HIV testing among FP users is increasing HIV testing among FP users is increasing

steadily (especially rapid testing)steadily (especially rapid testing) Racial/ethnic disparities persist, especially Racial/ethnic disparities persist, especially

among Black/African American usersamong Black/African American users The HIV positivity rate (>1 per 1,000 tests) in The HIV positivity rate (>1 per 1,000 tests) in

family planning clinics in most regions appears family planning clinics in most regions appears to be cost-effectiveto be cost-effective

HIV prevention strategies should continue to HIV prevention strategies should continue to emphasize the importance of the reduction of emphasize the importance of the reduction of sexual risk behavior to prevent the spread of sexual risk behavior to prevent the spread of infectioninfection