Area and Population Characteristics

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Area and Population Characteristics

• Scott Holmberg, MD, MPH (RTI)
• For the Area and Population
• Characteristics Panel

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Area Characteristics Panel

• Jill Ashman (HRSA)
• Matthew Bramlett (NCHS)
• Celia Gabrel (HRSA)
• Jo Ann Hilger (NYC)
• Scott Holmberg (RTI)
• Andy Jordan (HRSA)
• Faye Malitz (HRSA)

• Kathleen McDavid (CDC)
• Chuck Nelson (US Census Bureau)
• David Rein (RTI)
• Ebony Ross (HSR)
• Mona Scully (NYS)
• Pat Sweeney (CDC)
• Ella Tardy (Miss.)

Non-voting coordinators
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Underlying Considerations in Arriving at a
Severity-of-Need (SON) Index

• Actual HIV/AIDS prevalence and incidence would
  be critical to any determination of SON
• Measures of poverty and/or lack of HIV services
  would also be critical to any SON index and
• These would be relatively easy to obtain given
  US Census, CDC, HRSA, and other available
  datasets (just kidding)

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Area Characteristics variables panelists
priority scores, where 1 (most important)- 5
(least important)

• HIV/AIDS Disease Prevalence 1.08
• Poverty Rate
  1.69
• Uninsured Rate
  1.77
• Access to Primary Care Providers 2.62
• Median Income
  2.62
• Unemployment Rate 3.08
• HRSA Supported Clinics 3.38
• STI Burden
  4.08

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Defining the issues turned out to be a lot easier
than resolving them.
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We considered three general categories of area
characteristics that would determine need

• Burden of diseaseactual AIDS and HIV cases
• Health infrastructurehow well could an area
  accommodate HIV/AIDS patients and
• Poverty and other indices of need (how many
  HIV/AIDS patients needed but could not get care).

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General formula that underlay our thinking

• Severity of Need
• A function of the number of HIV cases-- minus
  those already cared for-- times medical need
  (cost)

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Burden of Disease

• How many persons with HIV infection or AIDS
  will need care?

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Burden of DiseaseVariables suggested for
inclusion

• ? Prevalence of HIV/AIDS disease
• (score, 1.08)
• ? Prevalence of Chlamydia and
• NGU infections (score, 4.08)

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Burden of Disease AIDS Cases only
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Burden of Disease AIDS and HIV Cases, as
reported to CDC
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Burden of Disease AIDS/HIV Cases, adjusted for
states without, or with recent, HIV reporting
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Burden of Disease Chlamydia and non-gonococcal
urethritis (NGU) reporting
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Thought question

• Which of these potential systems would you use?
• AIDS only
• AIDS and HIV
• AIDS and HIV, adjusted for localities without
  HIV reporting
• Chlamydia/NGU reports

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SON Area Characteristics Working Group
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Our Groups Decision

• We recommended counting all cases reported
  through CDCs national AIDS and HIV reporting
• An important caveat the final arbiters may
  decide to use an adjustment for the minority of
  states with recent or no HIV reporting systems.

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Next variable for considerationHealth
infrastructure

• Area capabilities to care for current HIV/AIDS
  cases
• Difficult, as there is no direct measurement of
  this (such as surveillance or census data).

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Health Infrastructure Variables suggested
for inclusion

• ? Access to primary care providers
• (score, 2.62)
• ? HRSA supported clinics and providers
• (score, 3.38)

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Areas ability to provide HIV care for those
needing it
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Areas ability to provide HIV care for those
needing it
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Variables considered for possible inclusion in an
HIV/AIDS SON index
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Final Area Characteristic considered poverty

• The problem with this variable was the many
  different but comparable (co-linear) measures
  of poverty in an area

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Poverty and census characteristics Variables
suggested for inclusion

• ? Percent below 100 federal poverty level
  (score, 1.69)
• ? Percent with no health insurance (score, 1.77)
• ? Percent unemployed (score, 3.08)
• ? Median household income (score, 2.62)
• ? Population size

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Variables considered for possible inclusion in an
HIV/AIDS SON index

• Consumer Price Index

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Issues

• Group consensus good on the vast
• majority of issues
• Larger, recurrent issues
• How to count AIDS/HIV cases potentially needing
  care under RW Care act
• Some measures are of the same parameter (eg,
  several variables are linked to poverty)which is
  best?
• Political realities.