Texas Medical Monitoring Project (MMP) Meeting Omni Austin Hotel at Southpark Thursday, May 31, 2007

1. Texas Medical Monitoring Project (MMP) MeetingOmni Austin Hotel at SouthparkThursday, May 31, 2007 a multi-stage probability sample of HIV infected adults in care

2. Current TX-MMP Team: • Sharon K. Melville, Principal Investigator • Tammy Sajak, Co-Principal Investigator • Sylvia Odem, Project Coordinator • Mark Heinzke, Data Manager • Jim Phillips, Data Collector • Jose Velez, Data Collector

3. Medical Monitoring Project Goals • Provide local and national estimates for the population in care for HIV • Determine health-related behaviors and access to and use of prevention and support services • Gain knowledge of care and treatment provided • Examine variations of factors by geographic area and patient characteristics

4. First Stage – States and Cities Selected 20 states & 6 cities sampled AIDS prevalence (probability proportionate to size – S, M, L) Texas and Houston – two large sites Chicago New York San Francisco Philadelphia LA County Large Houston Medium Small Puerto Rico

6. Second Stage – Facility SamplingFinding HIV Care Facilities • There was no existing list of facilities providing HIV care • Obtained list of all possible facilities from HARS, ELR and ADAP • Needed to call all possible facilities

7. Contacted 860 & 196 facilities 160 & 107Facilities Provide HIV Care Get estimated patient load per year (EPL) (S, M, L) 181 & 107Facilities Provide HIV Care 2006/2007 2005 27 & 21 Facilities Selected 47 & 21 Facilities sampled by RAND 17 & 9Facilities agree to participate 33 so far & 21 Facilities to participate Texas: 2005 – 27 of 160 providers selected; 2006/2007 – 47 of 181 providers selectedHouston: 2005 – 21 of 107 providers selected; 2006/2007 – 21 of 107 providers selected Second Stage – HIV Care Providers Selected

10. Patient Sampling • Collect list of de-identified patients seen during the previous specified time period from selected facilities • Clean lists of any duplicates and combine with other facilities • Submit complete list to RAND for sampling

11. Facilities that agree to participate 33 so far & 21 Facilities to Submit Patient Lists. 17 & 9 Facilities Submit Patient Lists 2005 2006/2007 8,645 & 3,574Patients Collected Greater than 20,000 & 10,000 Patients to be Collected 150 & 150 Patients Sampled by RAND 400 & 400 Patients to be Sampled by RAND Texas: 2005 – 8,645 Total Patients, 150 Sampled. 2006/2007 – >20,000 Total Patients, 400 Sampled Houston: 2005 – 3,574 Total Patients, 100 Sampled. 2006/2007 - >10,000 Total Patients, 400 Sampled Third Stage – Patients Selected

12. Validity of MMP Data If 100% of Project Areas, 75% of Facilities, and 75% of patients from each facility are enrolled, the overall response rate is 1.0 * .75 *.75 =.56 or 56% Important because facilities can’t be substituted for non- participating facilities A facility that refuses to participate has refused participation for all its patients

13. Representativeness of Data The MMP multi-stage sampling method will provide data that is representative at local, state and national levels of: • HIV infected adults in care • Their Behaviors • Adherence; sexual; drug use; care-seeking • Clinical outcomes • Treatment; CD4 and viral load; opportunistic illnesses • Type and quality of care received • Met and unmet needs for HIV care and prevention services

14. Patient Interview • Demographics • Access to Health Care • Adherence • Unmet Needs • Sexual Behaviors • Drug Use Behaviors • Local Questions Module

15. Medical Chart Abstraction • Demographics • Insurance Status • Opportunistic Illnesses • Antiretroviral Therapy • Laboratory Data • Substance Abuse/Mental Health • Referrals to other facilities/services

16. Local Questions Module • Captures the health needs and services of local communities • Based on consumer, provider, stakeholder and community input Examples: • HIV care and testing during/after pregnancies • Use of complementary medications • Race/ethnicity of sex partners • Alternative sources to obtain HIV medications • Crossing the borders to receive care or meds

17. Electronic data collection • Handheld Assisted Personal Interview (HAPI) • Pocket PCs • Computer Assisted Personal Interview (CAPI) • Laptops • Medical Record Abstraction (MRA) Application

18. Electronic Data Collection Advantages • Entry of data at time of administration of interview • No separate data entry (time and costs) • Data quality • Eliminates skip pattern errors • Automatic entry/calculation of certain variables • Simplifies review/standardization of survey • Clean data available almost immediately • No/minimal data cleaning

19. Patients Eligible for Interview • Patients HIV+ 18 years of age or older • Patients with HIV seen at the sampled facility during the patient definition period (3 month time period)

20. Records Eligible for Abstraction • Records of interviewed patients at the facility from which they were recruited • Records from other facilities at which they received HIV care during the surveillance period

21. Time Periods Covered by Medical Record Abstraction Surveillance period form X X Date of interview 12 months

22. Time Periods Covered by Medical Record Abstraction Medical History Form Surveillance period form X X X Date of interview 1st HIV-related visit 12 months

23. Medical History Form • Clinical information from the period prior to the SP • Have important background information to understand the course of events. • May need to visit other facilities if the client received care from multiple facilities.

24. Surveillance Period (visit) Form • Information collected includes all visits that occurred during the surveillance period • Abstraction from eligible sites (in addition to one from which patient was recruited) • Abstractors will use one form for each visit the patient had during the surveillance period

25. 2005 Interview & Chart Abstraction Summary • Interviews Completed – 86 • Chart Abstractions Completed - 87