HIV/AIDS
PROGRAMS
Programs
included in this section are:
Ryan
White HIV/AIDS Treatment Modernization Act of
2006
# |
Key
Outcomes* |
FY
2004
Actual |
FY
2005
Actual |
FY
2006 |
FY
2007 |
FY
2008
Target |
FY
2009
Target |
Out-Year
Target |
Target |
Actual |
Target |
Actual |
Long-Term
Objective 1: Expand the capacity of the health
care safety net. |
16.1 |
Number
of racial/ethnic minorities and the number of
women served by Ryan White HIV/AIDS-funded programs.
(Baseline
– 2005) |
|
412,000/
195,000 |
|
|
|
|
|
|
2014:
422,300/
199,875 |
16.
I.
A.1 |
Proportion
of racial/ethnic minorities in Ryan White HIV/AIDS-funded
programs served.
(exceeding
their representation in national AIDS prevalence
data reported by the CDC) |
DNAa |
72% |
5
percentage
points
above
CDC
datab |
72% |
5
percentage
points
above
CDC
data
|
Oct-08 |
5
percentage
points
above
CDC
data
|
5
percentage
points
above
CDC
data
|
|
16.
I.
A.2 |
Proportion
of women in Ryan White HIV/AIDS-funded programs
served.
(exceeding
their representation in national AIDS prevalence
data reported by the CDC) |
33% |
33% |
5
percentage
points
above
CDC datab
|
33% |
5
percentage
points
above
CDC data
|
Oct-08 |
5
percentage
points
above
CDC data
|
5
percentage points above CDC data
|
|
Long-Term
Objective 2: Expand the availability of health
care, particularly to underserved, vulnerable,
and special needs populations. |
16.2 |
Reduce
deaths of persons due to HIV infection to 3.1
per 100,000 people.
(Baseline
– 2003: 4.7 per 100,000) |
|
|
|
|
|
|
|
|
2014:
3.1
per
100,000 |
# |
Key
Outputs* |
FY
2004 Actual |
FY
2005
Actual |
FY
2006 |
FY
2007 |
FY
2008 Target/ Est. |
FY
2009 Target/ Est. |
Out-Year
Target/ Est. |
Target/
Est. |
Actual |
Target/
Est. |
Actual |
16.
II.
A.1 |
Number
of AIDS Drug Assistance Program (ADAP) clients
served through State ADAPs annually. |
DNAa |
147,187 |
131,880c |
157,988 |
143,339c |
Jan-09 |
158,739c |
158,887 |
|
16.
II.
A.2 |
Number
of persons who learn their serostatus from Ryan
White HIV/AIDS Programs. |
553,569 |
572,397 |
583,845 |
Feb-08 |
572,397d |
Feb-09 |
572,397d |
572,397 |
|
16.
II.
A.3 |
Percentage
of HIV-positive pregnant women in Ryan White
HIV/AIDS Programs who receive anti-retroviral
medications. |
DNAa |
85.3% |
86.3% |
Feb-08 |
87.3% |
Feb-09 |
88.3% |
89.3% |
|
Long-Term
Objective: Promote effectiveness of health
care systems. |
16.3 |
Ryan
White HIV/AIDS Program-funded HIV primary medical
care providers will have implemented a quality
management program and will meet two “core”
standards included in the October 10, 2006 “Guidelines
for the Use of Antiretroviral Agents in HIV-1
Infected Adults and Adolescents.
(Baseline
– 2005) |
|
63.7% |
|
|
|
|
|
|
2014:
90%e |
16.
III.
A.1 |
Percentage
of Ryan White HIV/AIDS Program-funded primary
medical care providers that have implemented
a quality management program. |
DNAa |
85.7% |
70% |
88.6% |
90.7%d |
Aug-08 |
93.2%d |
95.7% |
|
16.
III.
A.2. |
Proportion
of new Ryan White HIV-infected clients who are
tested for CD4 count and viral load. |
DNAa |
CD4-83.2%
Viral
load-79.3% |
CD4-80%
Viral
load-75% |
CD4-84.9%
Viral
load-82.5% |
CD4-85.2%
Viral
load-81.3% |
Aug-08 |
CD4-86.2%
Viral
load-82.3% |
CD4-87.2%
Viral
load-83.3% |
|
Efficiency
Measure |
16.E |
Amount
of savings by State ADAPs participation in cost-savings
strategies on medications.f |
$143.5M |
$275M |
2
percent over FY 05 |
Apr-08 |
1
percent over FY 06e |
Apr-09 |
1
percent over FY 07e |
1
percent over FY 08 |
|
|
Appropriated
Amount
($
Million) |
$2,044.9 |
$2,073.3 |
|
$2,061.3 |
|
$2,137.8 |
$2,166.8 |
$2,167.9 |
|
Notes:
a
DNA = Data not available. Due to the aggregate nature
of the CADR data and the way the race/ethnicity questions
are currently phrased, the proportion of racial/ethnic
minorities served by the Ryan White HIV/AIDS Program
can not be calculated for 2002-2004.
b
CDC’s data for comparison is not available as of this
writing.
c
The FY 06 target is based on number of persons
served at least one quarter of the year, rather than
number of persons served annually. The FY 07 and
FY 08 targets differ from those shown in the FY 08
Congressional Justification to reflect actual funding
levels.
d
The FY 07 and FY 08 targets differ from those
shown in the FY 08 Congressional Justification because
targets were reset in the FY 07
PART reassessment.
e
This target was established during the PART
reassessment, and therefore differs from previously
reported targets.
f
Cost-saving strategies are defined as rebates,
third party reimbursements, and direct negotiations
with pharmaceutical companies.
*
During the FY 07 PART reassessment of the Ryan White
HIV/AIDS Program, minor changes were made in the wording
of some measures.
INTRODUCTION
The
Ryan White HIV/AIDS Program’s performance measures
are tied to HRSA’s overall goals, which serve as the
performance management framework for the Program.
The measures allow the Program to track progress
toward reaching these goals. Specific performance
measures are linked to the following HRSA goals:
Improve Access to Health Care by expanding the
capacity of the health care safety net; Improve Health
Outcomes by expanding the availability of health care,
particularly to underserved, vulnerable, and special
needs populations; Improve the Quality of Health Care;
and Improve the Public Health and Health Care Systems.
Several
cross-cutting long-term and annual measures have been
identified to use in assessing the Ryan White HIV/AIDS
Program’s performance. Because these goals are related
to the program as a whole, rather than to specific
Parts, they are presented in aggregate below. This
is followed by additional Part-specific measures.
Performance
measure information is used by the program to identify
potential policy issues, to share best practices,
for providing accountability for results, to assess
training needs of Project Officers in order to assure
better monitoring of grantee performance, and to evaluate
the effectiveness of the program and activities and
the resources spent on conducting them.
The
Ryan White HIV/AIDS Program uses various strategies
to achieve the performance goals including targeting
resources to address the unmet care and treatment
needs of persons living with HIV/AIDS who are uninsured
or underinsured and therefore unable to pay for HIV/AIDS
health care and vital health-related support services;
assuring patient adherence and compliance (e.g., through
patient education and follow-up); directing outreach
and prevention education and testing to populations
at disproportionate risk for HIV infection; tailoring
health care and related services to populations known
to have delayed care seeking behaviors (e.g. varying
hours, care offered in various sites, linguistically
and culturally appropriate service provision); and
assuring that appropriate services are being provided
in areas of greatest need, including where there are
high rates of HIV infection, rural areas, and in communities
with health disparities. In many instances, the Program
collaborates with other Federal, State and local providers
who conduct HIV testing to encourage them to refer
clients who test positive to Ryan White HIV/AIDS Programs
for treatment.
DISCUSSION
OF RESULTS AND TARGETS
Long-Term
Objective: Expand the Capacity of the Health Care
Safety Net
16.1.
Number of racial/ethnic minorities and the number
of women served by Ryan White HIV/AIDS-funded programs.
(Baselines
- 2005: 412,000/195,000; Targets - 2014: 422,300/199,875)
16.I.A.1.
Proportion of racial/ethnic minorities in Ryan White
HIV/AIDS-funded programs served. (exceeding their
representation in national AIDS prevalence data reported
by the CDC)
Despite
the reduction seen in overall AIDS mortality, annual
incidence data show that the proportion of AIDS cases
among racial/ethnic minorities continues to increase.
In addition, benefits provided by new combination
drugs (anti-retrovirals/protease inhibitors/HAART)
have not uniformly reduced the disparities in incidence
of AIDS among racial/ethnic minorities. The proportion
of racial/ethnic minorities served by the Ryan White
HIV/AIDS Program was selected as a measure demonstrating
progress toward the program’s goal to improve access
to health care among individuals infected with HIV/AIDS
by increasing utilization for traditionally underserved
populations.
Ryan
White HIV/AIDS-funded programs serve a significantly
higher proportion of racial/ethnic minorities than
the target, which is five percentage points higher
than the representation of racial/ethnic minorities
among all AIDS cases in the Nation, as reported by
CDC. The proportion of Ryan White clients who were
racial/ethnic minorities in 2005 was 72%, compared
to the 64.1% of CDC-reported AIDS cases. Seventy-two
percent (72%) of clients served in Ryan White HIV/AIDS-funded
programs in FY 06 were racial/ethnic minorities.
(The CDC AIDS data for comparison is not available
as of this writing.) The FY 09 target for the proportion
of racial/ethnic minorities served by the Ryan White
HIV/AIDS Program continues to be 5 percentage points
above CDC data for the same period.
16.I.A.2.
Proportion of women in Ryan White HIV/AIDS funded-programs
served.
(exceeding
their representation in national AIDS prevalence data
reported by the CDC)
Despite
the reduction seen in overall AIDS mortality, annual
incidence data show the proportion of AIDS cases among
women continues to increase. In addition, benefits
provided by combination drugs (anti-retrovirals/protease
inhibitors/HAART) have not uniformly reduced the disparities
in incidence of AIDS among women. The proportion
of women served by the Ryan White HIV/AIDS Program
was selected as measure demonstrating progress toward
the program’s goal to improve access to health care
among individuals infected with HIV/AIDS by increasing
utilization for traditionally underserved populations.
The
Ryan White HIV/AIDS-funded programs are serving a
significantly higher proportion of women than the
target, which is five percentage points higher than
the representation of women among all AIDS cases in
the Nation, as reported by CDC. In 2005, 33% of persons
served by the Ryan White HIV/AIDS Program were women,
compared to 24% of CDC-reported AIDS cases. The proportion
of women served by the Ryan White HIV/AIDS Program
in 2006 was 33%. (The CDC AIDS data for comparison
is not available as of this writing.) The FY 09 target
for the proportion of women served by the Ryan White
HIV/AIDS Program is 5 percentage points above CDC
data for the same period.
Long-Term
Objective: Expand the Availability of Health Care,
Particularly to Underserved, Vulnerable, and Special
Needs Populations
16.2.
Deaths due to HIV infection below 3.1 per 100,000
people.
(Baseline
- 2003: 4.7 per 100,000; Target - 2014 3.1 per 100,000)
16.II.A.1.
Number of AIDS Drug Assistance Program (ADAP) clients
served through State ADAPs annually.
The
number of ADAP clients served through State ADAPs
annually was selected as a measure demonstrating progress
toward the program’s goal to improve health outcomes
among individuals with HIV/AIDS who are underserved
by increasing availability and utilization of essential
medications. Many clients are enrolled in ADAP only
temporarily while they await acceptance into other
insurance programs, like Medicaid.
In
2006, the AIDS Drug Assistance Program (ADAP) served
157,988 clients through State ADAPs. This can not
be compared with the FY 06 target because the actual
performance is based on a revised measure using annual
data and the target is based on a previous measure
based on quarterly utilization. The number of ADAP
clients served through State ADAPs annually in 2006
was 10,801 persons above the 2005 results. The FY
09 target for clients served through State ADAPs is
158,887. The Program’s marginal cost model corroborates
the projected target for number of ADAP clients served
in 2009. (See section below on “Targets Substantially
Exceeded or Not Met.”)
16.II.A.2.
Number of persons who learn their serostatus from
Ryan White HIV/AIDS Programs.
The
number of individuals who learn their serostatus from
the Ryan White HIV/AIDS Programs was selected as a
measure demonstrating progress toward achieving the
program’s goal to improve health outcomes for individuals
infected with HIV/AIDS by increasing access to services.
Knowing one’s HIV status helps prevent the spread
of HIV. Additionally, early diagnosis and treatment
can vastly improve the quality and length of life.
In
FY 05, the Ryan White HIV/AIDS Program provided 572,397
persons confirmation of their serostatus, exceeding
the target by 7,757. This represents an increase
of 18,828 persons and a 3.4% increase compared to
FY 04. Ryan White HIV/AIDS Program dollars are used
for HIV testing only when HIV testing is not otherwise
available. The FY 09 target for persons learning
their serostatus from Ryan White HIV/AIDS Programs
is 572,397.
16.II.A.3.
Percentage of HIV positive pregnant women in Ryan
White HIV/AIDS Programs who receive Anti-Retroviral
Medications.
The
percentage of HIV positive pregnant women in Ryan
White HIV/AIDS Programs who received anti retroviral
medications was selected as a measure demonstrating
progress toward achieving the Program’s goal to improve
health outcomes for individuals infected with HIV/AIDS
by increasing access to services to reduce perinatal
transmission. Approximately 100,000 childbearing-aged
women in the United States are infected with human
immunodeficiency virus (HIV), and an estimated 7,000
infants are born to HIV-positive mothers each year.
In the United States, the rate of perinatal transmission
of HIV among mothers who do not receive antiretroviral
therapy is 25%- 30%. The transmission risk can be
reduced to below 8% when pregnant women receive antiretroviral
medications.
In
FY 05, the Ryan White HIV/AIDS Program provided 85.3%
of HIV-positive pregnant women in Ryan White HIV/AIDS
Programs with anti-retroviral medications. This was
the baseline number and therefore targets were not
set for this year. The FY 09 target for the percentage
of HIV-positive pregnant women in Ryan White HIV/AIDS
programs receiving anti-retroviral medication is 89.3%.
Long-Term
Objective: Promote Effectiveness of Health Care Systems
16.3
Ryan White HIV/AIDS Program-funded HIV primary medical
care providers will have implemented a quality management
program and will meet two “core” standards included
in the October 10, 2006 “Guidelines for the Use of
Antiretroviral Agents in HIV-1-Infected Adults and
Adolescents.”
(Baseline
- 2005: 63.7%; Target - 2014 90%)
16.III.A.1.
Percentage of Ryan White HIV/AIDS Program-funded primary
medical care providers that will have implemented
a quality management program.
A
major goal of the Ryan White HIV/AIDS Program is to
improve the quality of care that its clients receive.
The number of Ryan White HIV/AIDS Program-funded grantees
that implement a quality management program was selected
as a key performance measure because having a quality
management program is essential to continued quality
improvement.
By
FY 06 88.6% of medical care providers had implemented
a quality management program. This exceeded the target
by 18.6 percentage points. Additionally, the FY 06
results represent a growth by 2.9 percentage points
over the FY 05 data which indicated that 85.7% of
primary care providers had implemented a quality management
program. The FY 09 target for the measure is 95.7%.
16.III.A.2.
Proportion of new Ryan White HIV/AIDS Program HIV-infected
clients who are tested for CD4 count and viral load.
The
proportion of new Ryan White HIV/AIDS Program HIV-infected
clients that are tested for CD4 count and viral load
was selected as a good measure demonstrating progress
toward the program goals to improve quality of health
care for individuals infected with HIV/AIDS.
In
2006, the Ryan White HIV/AIDS Program provided CD4
count testing to 84.9% of new clients and Viral Load
testing to 82.5% of these new clients. This exceeded
the target for CD4 tests by 4.9 percentage points
and exceeded the target of new clients receiving Viral
Load testing by 7.5 percentage points. This performance
has improved over the FY 05 baseline of 83.2% of new
clients receiving CD4 counts and 79.3% of new clients
receiving viral load testing. The FY 09 target for
CD4 is 87.2% and Viral Load is 83.3%.
16.E.
Amount of savings by State ADAPs participation in
cost-savings strategies on medications.
Cost-containment
strategies are important as more clients are seeking
treatment with dramatic increases in the cost of new
treatments, and rapidly changing standards of care.
This challenges ADAPs to contain costs at the same
time they are asked to expand access. As a result,
ADAPs have taken a number of steps to stretch dollars.
These include changing the system used to purchase/distribute
drugs, seeking larger price discounts or rebates on
drugs (e.g., through participation in the Section
340B Drug Discount Program), third party reimbursement,
and direct negotiations with pharmaceutical companies.
ADAP’s
savings strategies on medications resulted in a savings
of $76 million in 2002, $92.5 million in 2003, and
$143.5 million is 2004. In 2005 the ADAP program
had cost-savings on medications of $275 million, exceeding
the target by $128.7 million. The FY 09 target for
ADAP cost savings is 1 percent over the FY 08 results.
TARGETS
SUBSTANTIALLY EXCEEDED OR NOT MET
Measure:
Number of AIDS Drug Assistance Program (ADAP) clients
served through State ADAPs annually.
FY
06 Target: 131,808 clients
FY
06 Result: 157,988 clients
A
major reason that the target was exceeded is that
Medicare Part D, which covers the cost of prescription
drugs for eligible persons, was implemented in 2006.
ADAP clients who are eligible for Medicare Part D
had some of their prescription drug costs covered
by Medicare. Another reason is State ADAPs’ purchase
of private health insurance for clients to cover the
cost of HIV/AIDS medications. Both of these initiatives
yield “savings” that permit more persons to be served
by ADAP programs. It should also be noted that the
target is related to clients served at least one quarter
of the year, whereas the result is clients served
annually.
The
Ryan White HIV/AIDS Program has adjusted future ADAP
targets to reflect the performance in FY 06. The
Program continues to promote use of cost-saving strategies
by ADAP grantees.
The
impact of this result is that more people, primarily
low-income persons who have limited or no access to
needed medications, had access to essential medications
to treat their disease and/or prevent the serious
deterioration in health arising from their HIV disease.
HIV
Emergency Relief Grants (Part A)
# |
Key
Outcomes |
FY
2004 Actual |
FY
2005 Actual |
FY
2006 |
FY
2007 |
FY
2008
Target |
FY
2009
Target |
Target |
Actual |
Target |
Actual |
Long
– Term Objective: Promote Effectiveness of
Health Care Services |
17.
III.
A.1 |
Proportion
of women that receive PAP screening. |
35.8% |
38% |
Baseline
plus 1.5% |
40.8% |
Baseline
plus 1.5% |
Oct-08 |
Baseline
plus 1.5% |
Baseline
plus 1.5% |
17.
III.
A.2 |
Proportion
of clients that receive TB skin tests. |
28% |
54% |
1.5%
over FY 05 |
52.5% |
Sustain
FY 06 |
Oct-08 |
Sustain
FY 07 |
Sustain
FY 08 |
# |
Key
Outputs |
FY
2004 Actual |
FY
2005
Actual |
FY
2006 |
FY
2007 |
FY
2008 Target/ Est. |
FY
2009 Target/ Est. |
Target/
Est. |
Actual |
Target/
Est. |
Actual |
Long
– Term Objective: Expand the Capacity of the
Health Care Safety Net |
17.
I.
A.1. |
Number
of visits for health-related care (primary medical,
dental, mental health, substance abuse, rehabilitative,
and home health) to a level that approximates
inclusion of new clients. |
3.11
M |
3.18
M |
2.91
M |
2.47
M |
2.91
M |
Jan-09 |
2.47
Ma |
2.44
M |
|
Appropriated
Amount
($
Million) |
$615.0 |
$610.1 |
|
$603.6 |
|
$604.0 |
$627.1 |
$619.4 |
Notes:
a
This FY 08 target was changed from that shown in the
FY 08 Congressional Justification to be consistent
with recent performance.
DISCUSSION
OF RESULTS AND TARGETS
Long
– Term Objective: Promote Effectiveness of Health
Care Services
17.III.A.1.
Proportion of women that receive PAP screening.
Cervical
Intraepithelial Neoplasia (CIN) refers to cellular
changes in the cervix, thought to be precursors of
cervical cancer that can be detected with PAP screening.
Researchers conclude that HIV+ women are three times
as likely as HIV negative women to have CIN. Women
with HIV are more likely to develop cervical cancer
than other women. The possibility increases to 30
times as likely if a woman has HIV and HPV, the human
papilloma virus.
In
FY 06, the Part A program provided 40.8% of women
served with PAP screening. This fell short of the
target of 47.4 by 6.6 percentage points. The proportion
of women receiving PAP screening had increased from
35.8% in 2004 to 38% in 2005 and the 2006 result shows
another increase. The FY 09 target is baseline plus
1.5% or 47.4% of women receiving PAP screening. (See
section below on “Targets Substantially Exceeded or
Not Met.”)
17.III.A.2.
Increase the proportion of clients that receive TB
skin tests.
Latent
TB is much more likely to become active TB in someone
with HIV. TB is an AIDS-defining condition. The
CDC recommends HIV-infected persons get tested for
TB, with a TB Skin Test (TST). There are a number
of instances where annual TB testing for HIV-infected
individuals is not supported. For instance, 10-15%
of HIV-infected individuals who already have TB are
not receiving annual TB skin tests. Additionally,
persons who have documented false positive TB skin
test results and those that have a current skin rash
that interferes with reading the test results are
not given annual TB skin tests.
In
FY 06, the Part A program provided 52.5% of clients
with TB skin tests. This fell short of the target
by 3 percentage points. There has been a rise in
the proportion of clients receiving TB skin testing
from 28% in FY 04 and 54% in FY 05. Patient outreach
and follow-up are among the strategies grantees use
to achieve targets. The FY 09 target is to sustain
FY 08 results.
Long
– Term Objective: Expand the Capacity of the Health
Care Safety Net
17.I.A1.
Number of visits for health-related care (primary
medical, dental, mental health, substance abuse, rehabilitative,
and home health) to a level that approximates inclusion
of new clients.
The
number of visits provided for health-related services
was selected as a measure demonstrating progress toward
the program goal to improve access to health care
and related services for individuals infected with
HIV/AIDS by increasing availability of and access
to care.
In
FY 06, 2.47 million visits were reported by 56 Part
A Eligible Metropolitan Area (EMA) grantees and Transitional
Grant Areas (TGAs). This number fell short of the
target by 440,000 and was 710,000 visits less than
the previous year. The FY 09 target for visits for
health-related care is 2.44 million visits. More
than 1,500 providers of funded and eligible services
provided health care and related supportive services
to hundreds of thousands of persons living with HIV/AIDS.
(See section below on “Targets Substantially Exceeded
or Not Met.”)
TARGETS
SUBSTANTIALLY EXCEEDED OR NOT MET
Measure:
Proportion of women that receive PAP screening.
FY
06 Target: 47.4% (Baseline, 45.9% plus 1.5%)
FY
06 Result: 40.8%
The
proportion of women that receive PAP screening has
continued to increase over time with 35.8% of women
receiving PAP screening in FY 04, 38% in FY 05 and
40.8% in FY 06. The proportion of women receiving
PAP screening in FY 06 fell below the target for a
variety of reasons including: the PAP screening results
are not documented in the patient chart, the PAP results
in the chart may not be entered in the data base used
to report performance data to the Program, the PAP
screenings are done at locations other than HIV Clinics,
and the reluctance of patients to have PAP screening.
The
Program has initiated a special initiative to improve
the PAP screening rates. The initiative includes
providing technical assistance through the National
AETC and the National Quality Center to HIV medical
providers, providing Project Officers with the tools
to understand the PAP screening data that grantees
submit, and follow up with grantees regarding identifying
barriers and improving reporting.
While
the FY 06 target was not met, the Program has been
successful in increasing, each year, the proportion
of clients receiving PAP testing. Cervical cancer
can often be prevented or detected in its earliest
stages through effective screening with a PAP smear
and avoidance of known risk factors. This accentuates
the importance of routine gynecological care, which
includes PAP smears for HIV-infected women. The impact
of annual improvements in this result is that HIV-related
morbidity is improved and essential information is
available to inform treatment decisions.
Measure:
Number of visits for health-related care (primary
medical, dental, mental health, substance abuse, rehabilitive,
and home health) to a level that approximates inclusion
of new clients.
FY
06 Target: 2.91 million visits
FY
06 Result: 2.47 million visits
The
number of visits for health-related care (primary
medical, dental, mental health, substance abuse, rehabilitative,
and home health) to a level that approximates inclusion
of new clients has continued to decrease annually
and the FY 06 number of visits fell below the target
by 440,000 visits. There has been a declining trend
in client visits is the past years as follows. In
FY 04 there were 3.11 million health-related care
visits reported and FY 05 produced 3.18 million visits.
The decrease in visits may be the result of fewer
Part A providers and fewer clients served, and the
impact of health care inflation.
The
Ryan White HIV/AIDS Program has adjusted future targets
to reflect the performance in FY 06. Patient outreach
and follow-up are among the strategies grantees use
to achieve targets.
While
the target was not met, the visits provided by the
Part A programs indicate that many low-income, uninsured
and underinsured people affected by HIV/AIDS had access
to care and support services delivered in eligible
metropolitan areas and transitional grant areas.
HIV
Care Grants to States (PART B)
# |
Key
Outputs |
FY
2004 Actual |
FY
2005
Actual |
FY
2006 |
FY
2007 |
FY
2008 Target/ Est. |
FY
2009 Target/ Est. |
Target/
Est. |
Actual |
Target/
Est. |
Actual |
Long
– Term Objective: Expand the Capacity of the
Health Care Safety Net |
18.
I.
A.1. |
Number
of visits for health-related care (primary medical,
dental, mental health, substance abuse, rehabilitative,
and home health) to a level that approximates
inclusion of new clients. |
2.28M |
2.34M |
1.56M |
1.88M |
1.56M |
Jan-09 |
2.14
Ma |
2.28
M |
|
Appropriated
Amount
($
Million) |
$1,085.9 |
$1,121.8 |
|
$1,119.7 |
|
$1,195.5 |
$1,195.2 |
$1,209.5 |
Notes:
a
This FY 08 target was changed from that shown
in the FY 08 Congressional Justification to be consistent
with recent performance.
DISCUSSION
OF RESULTS AND TARGETS
Long
– Term Objective: Expand the Capacity of the
Health Care Safety Net
18.I.A.1.
Number of visits for health-related care (primary
medical, dental, mental health, substance abuse, rehabilitative,
and home health) to a level that approximates inclusion
of new clients.
The
number of visits for health-related care (primary
medical, dental, mental health, substance abuse, rehabilitative,
and home health) was selected as the best measure
demonstrating progress toward the program’s goal to
increase access to health care and related services
for individuals with HIV/AIDS by increasing availability
of and access to care.
In
FY 06, Part B programs provided 1.88 million visits.
The actual performance for FY 05 exceeded the target
by 340,000 visits. Patient outreach and follow-up
are among the strategies grantees use to achieve targets.
The FY 09 target of visits for health-related care
is 2.28 million visits.
HIV
Early Intervention Services (PART C)
# |
Key
Outputs |
FY
2004 Actual |
FY
2005
Actual |
FY
2006 |
FY
2007 |
FY
2008 Target/ Est. |
FY
2009 Target/ Est. |
Target/
Est. |
Actual |
Target/
Est. |
Actual |
Long
– Term Objective: Expand the Availability of
Health Care, Particularly to Underserved, Vulnerable,
and Special Needs Populations |
19.
II.
A.1 |
Number
of people receiving primary care services under
Early Intervention Services programs. |
212,471 |
216,591 |
158,346 |
Mar-08 |
158,346 |
Mar-09 |
216,591a |
216,591 |
|
Appropriated
Amount
($
Million) |
$197.2 |
$195.6 |
|
$193.5 |
|
$193.7 |
$198.8 |
$198.8 |
Notes:
a
This FY 08 target was changed from that shown
in the FY 08 Congressional Justification to be consistent
with recent performance.
DISCUSSION
OF RESULTS AND TARGETS
Long
– Term Objective: Expand the Availability of
Health Care, Particularly to Underserved, Vulnerable,
and Special Needs Populations
19.II.A.1.
Number of people receiving primary care services under
Early Intervention Services programs.
The
number of individuals receiving primary care services
through the Early Intervention Services program was
selected as the best measure demonstrating progress
toward achieving the program’s goal to improve health
outcomes for individuals infected with HIV/AIDS by
increasing access to these services.
In
FY 05, Part C Early Intervention Program served 216,591
clients, exceeding the targeted goal by 37%, and representing
an increase of 2% in new clients served compared to
FY 04. The FY 09 target for persons receiving primary
care under Early Intervention Services programs is
216,591. (See section below on “Targets Substantially
Exceeded or Not Met.”)
TARGETS
SUBSTANTIALLY EXCEEDED OR NOT MET
Measure:
Number of people receiving primary care services under
Early Intervention Services.
FY
05 Target: 158,346 clients
FY
05 Result: 216,591 clients
The
FY 05 result of 216,591 persons receiving primary
care services under Early Intervention Services program
is consistent with the previous trends in FY 04 of
212,471, in FY 03 of 191,229 and 172,422 in FY 02.
The FY 05 result was below the target because the
target was set as a result of an earlier, subsequently
revised, target setting method.
FY
08 and 09 targets have been adjusted upwards to reflect
the current program achievement.
The
target was exceeded for the number of people receiving
primary care services under the EIS program. Key
strategies used by grantees in achieving targets include
patient outreach and follow-up. The results of surpassing
the target is that more people gained assess to ongoing
medical, oral health, nutritional, psychosocial, and
other treatment for HIV-positive individuals; laboratory,
x-ray and other diagnostic tests; and medical case
management to help patients access care and remain
in treatment.
HIV
Children, youth, Women, and their families Grants
(Part
D)
# |
Key
Outputs |
FY
2004 Actual |
FY
2005
Actual |
FY
2006 |
FY
2007 |
FY
2008 Target/ Est. |
FY
2009 Target/ Est. |
Target/
Est. |
Actual |
Target/
Est. |
Actual |
Long
– Term Objective: Expand the Availability of
Health Care, Particularly to Underserved, Vulnerable,
and Special Needs Populations |
20.
II.
A.1 |
Number
of female clientsa provided comprehensive
services, including appropriate services before
or during pregnancy, to reduce perinatal transmission.
|
48,800 |
52,306 |
32,772 |
49,701 |
32,772 |
Jan-09 |
52,306b |
52,306 |
|
Appropriated
Amount
($
Million) |
$73.1 |
$72.5 |
|
$71.7 |
|
$71.8 |
$73.7 |
$73.7 |
Notes:
a
Female clients counted are age 13 and above.
b
This FY 08 target was changed from that shown in the
FY 08 Congressional Justification to be consistent
with recent performance.
DISCUSSION
OF RESULTS AND TARGETS
Long
– Term Objective: Expand the Availability of Health
Care, Particularly to Underserved, Vulnerable, and
Special Needs Populations
20.II.A.1.
Number of female clients provided comprehensive services,
including appropriate services before or during pregnancy,
to reduce perinatal transmission.
The
number of female clients receiving comprehensive services,
including appropriate services before or during pregnancy
to reduce perinatal transmission, was selected as
the best way to measure demonstrating progress toward
the Part D program’s goal to improve health outcomes
for HIV-infected children, adolescents, women and
families through increasing utilization of care among
this traditionally underserved population.
Part
D served 52,306 female clients in 2005 and 48,800
female clients in 2004. In FY 2006, Part D provided
49,701 females with comprehensive services, including
appropriate services before and during pregnancy,
to reduce perinatal transmission. This number exceeds
the FY 2006 target by 16,929 clients. The FY 09 target
for female clients served in Part D programs is 52,306
female clients. (See section below on “Targets Substantially
Exceeded or Not Met.”)
TARGETS
SUBSTANTIALLY EXCEEDED OR NOT MET
Measure:
Number of female clients provided comprehensive services,
including appropriate services before or during pregnancy,
to reduce perinatal transmission.
FY
06 Target: 32,772 female clients
FY
06 Result: 49,701 female clients
The
FY 06 result of 49,701 female clients provided comprehensive
services, including appropriate services before or
during pregnancy, to reduce perinatal transmission
is consistent with the previous trends in FY 05 of
52,306, in FY 04 of 48,800. The FY 06 result was
above the target although the target was set as a
result of an earlier, subsequently revised, target
setting method.
The
Ryan White HIV/AIDS Program has adjusted future targets
to reflect the recent trends in performance. Key
strategies used by grantees in achieving targets include
patient outreach and follow-up.
The
target was exceeded for the number of female clients
receiving services under Part D. The results of surpassing
the target is that more female clients gained assess
to services including primary and specialty medical
care, psychosocial services, logistical support and
coordination, and outreach and case management.
AIDS
Education and Training Programs (PART F)
# |
Key
Outcomes |
FY
2004 Actual |
FY
2005
Actual |
FY
2006 |
FY
2007 |
FY
2008 Target/ Est. |
FY
2009 Target/ Est. |
Target/
Est. |
Actual |
Target/
Est. |
Actual |
Long
– Term Objective: Increase Collaborative Efforts
to Improve the Capacity and Efficiency of the
Public Health and Health Care Systems |
21.
V.
B.1 |
Proportion
of racial/ethnic minority health care providers
participating in AETC training intervention
programs. |
44% |
43% |
43% |
Mar-08 |
43% |
Mar-09 |
43% |
43% |
|
Appropriated
Amount
($
Million) |
$35.3 |
$35.0 |
|
$34.6 |
|
$34.7 |
$34.1 |
$28.7 |
DISCUSSION
OF RESULTS AND TARGETS
Long
– Term Objective: Increase Collaborative Efforts
to Improve the Capacity and Efficiency of the Public
Health and Health Care Systems
21.V.B.1.
Proportion of racial/ethnic minority health care providers
participating in AETC training intervention programs.
To
increase proportion of racial/ethnic minority health
care providers participating in AETC training intervention
programs was selected to demonstrate progress toward
improvements in the public health and health care
system by providing the education and training in
HIV care to the health care workforce serving medically
underserved populations. A training intervention
is defined as an interaction between a health care
provider and an AETC trainer for the purposes of receiving
clinical consultation or other types of training related
to the provision of HIV/AIDS related health care services.
In
FY 05, the proportion of racial/ethnic minority health
care providers participating in the AETC training
interventions programs was 43% meeting the target.
The AETC program provided training interventions to
44% racial/ethnic minorities in 2004. The FY 09 target
for proportion of racial/ethnic minority health care
providers training in AETC programs is 43%.
Dental
Reimbursement and community partnership Programs (PART
F)
# |
Key
Outputs |
FY
2004 Actual |
FY
2005
Actual |
FY
2006 |
FY
2007 |
FY
2008 Target/ Est. |
FY
2009 Target/ Est. |
Target/
Est. |
Actual |
Target/
Est. |
Actual |
Long
– Term Objective: Promote Access to Health
Insurance and Maximize Use of Available Reimbursements
for Health Care Services |
22.
I.
D.1. |
Number
of persons for whom a portion/ percentage of
their unreimbursed oral health cost were reimbursed. |
30,598 |
31,050 |
26,500 |
34,394 |
30,600 |
Apr-08 |
34,394a |
34,394 |
|
Appropriated
Amount
($
Million) |
$13.3 |
$13.2 |
|
$13.1 |
|
$13.1 |
$12.9 |
$12.9 |
Notes:
a
This FY 08 target was changed from that shown
in the FY 08 Congressional Justification to be consistent
with recent performance.
DISCUSSION
OF RESULTS AND TARGETS
Long
– Term Objective: Promote Access to Health Insurance
and Maximize Use of Available Reimbursements for Health
Care Services
22.I.D.1.
Number of persons for whom a portion/percentage
of their unreimbursed oral health costs were reimbursed.
As
the rate of HIV-related mortality slows, the number
of people living with HIV who are in need of continuing
and regular oral health services continues to grow.
The number of persons for whom a portion of their
unreimbursed oral health costs were reimbursed was
selected as the best measure demonstrating progress
toward the program’s goal to improve access to health
care for those HIV infected individuals who require
oral health services but are without the financial
means to afford them.
In
2006, the Dental Reimbursement Program awards met
42.3% of the total non-reimbursed costs reported by
68 participating institutions in support of oral health
care. These institutions reported providing care
to 34,394 HIV-positive individuals, for whom no other
funded source was available. This number exceeded
the goal by 7,894 individuals or 29.8%. This represents
a 10.8% increase from FY 05 for persons whom a portion/percentage
of their unreimbursed oral health costs were reimbursed.
The FY 09 target for number of persons being reimbursed
for oral health care is 34,394 persons.
In
FY 05, the demographic characteristics of patients
who were cared for by institutions participating in
the DRP were: 33.3% women, 61.6% minority. Therefore,
the DRP served a higher proportion of women than the
representation of women among all AIDS cases in the
nation, as reported by CDC. CDC reports 24% of AIDS
cases in 2005 were among women and 64.1% of AIDS cases
were among racial/ethnic minorities.
|