The Aging HIVinfected Population: Variations in Service Use by Age among Ryan White CARE Act Clients

1
The Aging HIV-infected Population Variations in
Service Use by Age among Ryan White CARE Act
Clients

• U.S Department of Health Human Services
  (HHS)Health Resources and Services
  Administration (HRSA)HIV/AIDS Bureau, Division
  of Science and PolicyAugust 29, 2006Katherine
  McElroy, MPH, MSW

2
Background

• Americans over age 45 account for an increasing
  percentage of the HIV/AIDS population
• Factors attributing to the increased incidence of
  HIV in this age group include
• Development and adoption of effective therapies
  patients are living longer with the disease
• Limited information exists regarding HIV
  knowledge and behavior among older adults
• Stereotypes of older adults as not sexually
  active
• Older adults may be less likely to talk about sex
  with their provider

3
Estimated Number of AIDS Diagnoses by Age,
2000-2004
CDC HIV/AIDS Surveillance Report, 2004
4
Estimated Number of Persons Living with HIV/AIDS
Diagnosis by Age, 2001-2004
CDC HIV/AIDS Surveillance Report, 2004
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HIV and the Elderly The Issue

• Older persons living with HIV/AIDS face a myriad
  of medical care issues including
• Treatment of their HIV disease
• Complications and side effects of treatment
• Other health problems related to aging

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Question

• How will the demand on medical and health care
  services be satisfied, in light of the increasing
  population of older (50) HIV-infected
  individuals ?

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CARE Act Programs Serving Older Adults

• Program data reveal that CARE Act grantees and
  their providers are serving an increasingly
  larger proportion of aging clients
• Across the CARE Act programs, the proportion of
  clients served age 45 years or older increased by
  17 percent from 2002 to 2004

8
Ryan White CARE Act Title II Percentage
Distribution of Duplicated Clients Served by
Age, 2002-2004
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Question

• Is there variation in service use by age
• among Ryan White CARE Act clients?

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Data Source

• 2004 Client-Level Demonstration Project Data
• 24 Community-based EIS sites

• Catholic Healthcare West/C.A.R.E. Program/St.
  Mary Med. Ctr.
• Family Health Centers of San Diego, Inc.
• West Co. Health Ctr/Russian River Health Center
• Unconditional Love, Inc.
• Albany Area Primary Health/Rural HIV Model
• University of Iowa
• Howard Brown Health Center
• University of Louisville Research Foundation
• Charity Hospital Medical Center of LA at New
  Orleans
• Fenway Community Health Center
• Chase-Brexton Health Services/Baltimore
  Consortium
• Southeast Mississippi RHI, Inc.

• St. Joseph's Hospital Medical
  Center/Comprehensive Care Ctr. for HIV Services
• Camino de Vida
• Northern Nevada H.O.P.E.S.
• Albany Medical College AIDS Program/Mid-Hudson
  HIV Care Center
• Brooklyn Hospital Center
• N.Y.U. Medical Center/Dept. of Pediatrics/Lower
  NY Consortium
• University Hospital of Cleveland
• Hahnemann University Ambulatory Care Services
• University of Pittsburgh
• Harris County Hospital District
• Planned Parenthood Center of El Paso, Inc
• University of Wisconsin, Madison

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Limitations

• Convenience sample sites self-selected to apply
  for funding
• Not representative of all CARE Act grantees and
  their providers

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Study Sample

• All clients with known HIV status
• N 26,881
• HIV (not AIDS) (N11,405 )
• HIV (AIDS unknown) (N1,823 )
• AIDS (N11,986 )
• Negative or unknown (N1,451)

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Client Demographics
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Stage of HIV Disease by Age
p lt .001
Does not include 9,710 cases (924 HIV Negative,
527 unknown, 8,259 missing age)
15
Service Use Mean Number of Services Used by
Age and HIV Status
p lt .001
age data was missing for 9,477 cases
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Service Use Percent of Clients Using Key Health
Care Services
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Mean Number of Visits by Service Type and Age
p lt .001 p lt .001 p lt .001 p lt .001
p lt .001
18
Mean Number of Visits by Service Type and
AgeStage of Disease HIV (not AIDS)
p lt .001 p lt .001 p lt .001 p lt .001
p lt .001
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Mean Number of Visits by Service Type and
AgeStage of Disease HIV (AIDS unknown)
p lt .001 NS p lt .001
NS p .066
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Mean Number of Visits by Service Type and
AgeStage of Disease HIV (CDC-defined AIDS)
p lt .001 p lt .001 p lt .001
NS p lt .001
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Overall Findings

• On average, clients 45 years and older with HIV
  and CDC-defined AIDS utilized a significantly
  higher number of visits for key health care
  services
• Older clients had significantly higher mean
  number of visits for medical care than younger
  clients regardless of the stage of disease
• While clients utilized mental health services
  less than other services, older clients had a
  much higher number of visits than younger clients
• Clients with CDC-defined AIDS had higher average
  number of visits than those with HIV (not AIDS)

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Conclusions

• Increased service utilization among older persons
  living with HIV Particularly, medical care and
  case management services is reflective of an
  increasing demand for services among this
  population
• When assessing older HIV clients, incorporate
  prevention efforts and education

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Conclusions

• Consideration by HIV services community and
  medical care providers in particular, of the
  rising incidence of HIV in people over age 45 is
  essential in order to effectively treat
  concurrent medical and health conditions.
• HIV/AIDS therapies/regimens adherence
• Confidentiality
• Social Support
• Nondiscrimination

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Questions or Comments

• Katherine McElroy, MPH, LSW
• HRSA/HAB/DSP
• 5600 Fishers Lane
• Rockville, MD 20857
• Room 7-74
• [phone]
• kmcelroy_at_hrsa.gov