Transcript Massachusetts DPH Bureau of HIV/AIDS 2012 Update

Massachusetts Department of Public Health
Office of HIV/AIDS
2012 Update
Project ABLE Annual Meeting
October 26, 2012
General Updates in the
Office of HIV/AIDS
OHA/BID Activities and Events
• Massachusetts Integrated Prevention and Care
Committee (MIPCC), November 2012
• Implementation of Electronic Lab Reporting
(ELR) effective January, 2012
• 4th Generation HIV assay at State Lab
• National HIV/AIDS Strategy—State Plan
meeting, March 13th, 2013
OHA Changes
•
•
•
•
•
•
•
•
Prevention and Screening
Integrated testing across HIV, STI and HCV
Client Health Services
HIV/Infectious Disease Correctional Health
HIV/Infectious Disease policy efforts
Contract Management
Capacity Building
27% decline in the number of OHA staff over the past
eight years
Massachusetts HIV/AIDS Epidemic at
a Glance
• As of September 1, 2012 a cumulative total
of 31,153 MA residents have been
diagnosed and reported with HIV/AIDS
– 18,408 MA residents are currently living with
HIV/AIDS
– An additional 2,393 MA residents living with
HIV/AIDS were first diagnosed in another state
• 649 new diagnoses reported in 2010
• 669 new diagnoses (preliminary) reported in
2011
Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 9/1/12
National Estimates of Unmet Need
• CDC now estimates that 18% of HIV infected
persons nationwide are not aware of their HIV
status.
• OHA is able to estimate that as of January 1st,
2012 approximately 4,692 people living in
Massachusetts are infected with HIV and are
not aware of their HIV status.
Trends in HIV Infection and Death among People Reported
with HIV/AIDS by Year: Massachusetts, 2000–2011
1,400
Number of Diagnoses and Deaths
1,200
Diagnosis of
HIV Infection
1,000
800
600
Death
400
200
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Year
Note: 2011 Death data are preliminary
Data Source: MDPH HIV/AIDS Surveillance Program; Data as of 9/1/12
People Diagnosed with HIV Infection Within the Years 2008–2010
by Gender: Massachusetts
Female
27%
Male
73%
N=1,994
Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 1/1/12
People Diagnosed with HIV Infection Within the Years 2008–2010
by Race/Ethnicity: Massachusetts
Other
3%
Hispanic/Latino
25%
White
39%
Black
33%
N=1,994
Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 1/1/12
People Diagnosed with HIV Infection Within the Years 2008–2010
by Exposure Mode: Massachusetts
MSM/IDU Other
1%
Injection Drug 3%
Use
9%
Presumed
Heterosexual
Sex
11%
Male-to-Male
Sex
40%
Heterosexual
Sex
13%
Undetermined
24%
Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 1/1/12
People Diagnosed with HIV Infection within the Years 2008–2010 by
Race/Ethnicity and Place of Birth: Massachusetts
100%
8%
<1%
35%
Percent of Total Diagnoses
80%
51%
60%
92%
33%
<1%
40%
48%
20%
32%
0%
White NH, N=768
Black NH, N=659
Hispanic/Latino, N=500
Race/Ethnicity
US
Puerto Rico/US Dependency
Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 1/1/12
Non-US
Trends in new HIV diagnoses
A declining epidemic across
populations
People Diagnosed with HIV Infection by Race/Ethnicity and
Year of Diagnosis1: Massachusetts, 2001–2010
600
Number of Diagnoses
500
400
White NH
300
Black NH
Hispanic
200
100
Other/Unknown
0
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Year
1 Reflects
year of diagnosis for HIV infection among all individuals reported with HIV infection, with or without an AIDS diagnosis.
Data Source: MDPH HIV/AIDS Surveillance Program; NH = Non-Hispanic; Data as of 1/1/12
Individuals Diagnosed with HIV Infection by Exposure Mode and
Year of Diagnosis: Massachusetts, 2001–2010
350
HIV Diagnoses
300
MSM
250
200
NIR
IDU
150
Pres. HTSX
HTSX
100
50
MSM/IDU
Other
0
2001
2002
2003
2004
2005
2006
2007
Year of Diagnosis
Data Source: MDPH HIV/AIDS Surveillance Program; Data as of 1/1/12
2008
2009
2010
Men Diagnosed with HIV Infection with Male-to-Male Sex as
the Exposure Mode by Race/Ethnicity and Year of Diagnosis1:
Massachusetts, 2001–2010
300
Number of Diagnoses
250
White NH
200
150
100
50
Hispanic
Black NH
0
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Year
1 Reflects
year of diagnosis for HIV infection among all individuals reported with HIV infection, with or without an AIDS diagnosis.
Data Source: MDPH HIV/AIDS Surveillance Program; NH = Non-Hispanic; Data as of 1/1/12
HIV/AIDS Epidemiology of New
Infections—Geographic Analysis
Top ten cities in Massachusetts with the greatest number of HIV
infection diagnoses within the years 2008–2010
Rank City
1
Boston
536
% of total
(N=1,994)
28%
2
Springfield
97
5%
2
Worcester
97
5%
3
Brockton
63
3%
4
Lowell
59
3%
5
Cambridge
52
3%
6
Lawrence
51
3%
7
Lynn
42
2%
8
Waltham
37
2%
9
Fall River
36
2%
9
Provincetown
36
2%
Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 1/1/12
No.
Ten cities/towns1 in Massachusetts with the highest average
annual rate of HIV infection diagnoses, 2008–2010
Rank City
1
Average No.
Average Rate per
100,000
1
Provincetown
12.0
348.4
2
Boston
178.7
32.0
3
Holyoke
10.3
25.1
4
Everett
8.0
21.6
5
Brockton
21.0
20.9
6
Lawrence
17.0
20.8
7
Waltham
12.3
20.7
8
Springfield
32.3
20.7
9
Malden
11.3
20.0
10
Lowell
19.7
18.6
Cities with fewer than 10 total HIV diagnoses from 2008–2010 are excluded
Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 1/1/12
Massachusetts—City of Boston
• Among 2008–2010 HIV diagnoses in Massachusetts the city
of Boston accounts for:
– 28% of all diagnoses (N=536, ranked 1st)
– 31% of diagnoses among MSM (N=244, ranked 1st)
– 19% of diagnoses among IDU (N=35, ranked 1st)
– 34% of diagnoses among Black NH individuals (N=227,
ranked 1st)
– 22% of diagnoses among Hispanic/Latino individuals
(N=109, ranked 1st)
Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 1/1/12
People diagnosed with HIV Infection within the years 2008–
2010 in the city of Boston by neighborhood
Brighton Allston Charlestown
1%
West/North 2%
1%
End/Downtown
South End
3%
Hyde Park
14%
4%
Homeless
4%
S. Boston
4%
Roslindale
4%
S. Dorchester
13%
Mattapan
6%
Jamaica Plain
5%
N. Dorchester
13%
E. Boston
6%
Roxbury
9%
Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 1/1/12
Back Bay
9%
N=536
Massachusetts—City of Worcester
• Worcester is tied with Springfield as the 2nd highest
number of 2008–2010 HIV diagnoses among cities in
Massachusetts and accounts for:
– 5% of all diagnoses (N=97, ranked 2nd)
– 2% of diagnoses among MSM (N=16, ranked 5th, tied
with Somerville)
– 11% of diagnoses among IDU (N=15, ranked 2nd)
– 7% of diagnoses among Black NH individuals (N=44,
ranked 3rd)
– 6% of diagnoses among Hispanic/Latino individuals
(N=30, ranked 4th)
Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 1/1/12
Massachusetts—City of Springfield
• Springfield is tied with Worcester as the 2nd highest
number of 2008–2010 HIV diagnoses among cities in
Massachusetts and accounts for:
– 5% of all diagnoses (N=97, ranked 2nd)
– 4% of diagnoses among MSM (N=29, ranked 3rd)
– 10% of diagnoses among IDU (N=19, ranked 2nd)
– 5% of diagnoses among Black NH individuals (N=31,
ranked 4th)
– 10% of diagnoses among Hispanic/Latino individuals
(N=52, ranked 2nd)
Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 1/1/12
Top ten cities in Massachusetts with the greatest number
of people living with HIV/AIDS on 12/31/11
Rank
City
1
Boston
5,296
% of total
(N=18,170)
29%
2
Springfield
1,031
6%
3
Worcester
940
5%
4
Lowell
510
3%
5
New Bedford
457
3%
6
Brockton
434
2%
7
Cambridge
414
2%
8
Lawrence
413
2%
9
Lynn
391
2%
10
Provincetown
329
2%
Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 1/1/12
No.
Hepatitis C Overview
Massachusetts
HIV and Hepatitis C in Massachusetts
• Of all Massachusetts residents diagnosed
and reported with HIV/AIDS
– 4,215 (14%) are co-infected with hepatitis C
– 26,015 (86%) are infected with HIV only
• 649 new HIV diagnoses reported in 2010
– 77 (12%) are co-infected with hepatitis C (same
for males and females)
– 572 (88%) are infected with HIV only
Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 1/1/12
Proportion of People Diagnosed with HIV Infection in 2010 Co-Infected
with Hepatitis C by Race/Ethnicity: Massachusetts
Percent Co-Infected with Hep C
30%
20%
16%
13%
10%
12%
8%
0%
White (nonHispanic)
Black (nonHispanic)
Hispanic/Latino
Mass. Total
Race/Ethnicity
Note: Patients diagnosed with HIV infection first outside of MA are NOT excluded because Hepatitis C diagnosis was made in MA
Data Source: MDPH HIV/AIDS Surveillance Program, data as of 9/1/12
Percent Co-Infected with Hep C
Proportion of People Diagnosed with HIV Infection in 2010 Co-Infected
with Hepatitis C by Health Service Region: Massachusetts
50%
42%
40%
30%
21%
20%
11%
9%
10%
13%
10%
3%
n
Pr
is
o
es
te
rn
W
t
So
ut
he
as
or
th
ea
st
N
t
M
et
ro
w
es
en
tr
al
C
B
os
to
n
0%
Health Service Region
Note: Patients diagnosed with HIV infection first outside of MA are NOT excluded because Hepatitis C diagnosis was made in MA
Data Source: MDPH HIV/AIDS Surveillance Program, data as of 9/1/12
HIV/AIDS Epidemiology of Emerging
Populations — MSM and Women
MSM Diagnosed with HIV Infection Within the Years 2008–2010 by
Race/Ethnicity: Massachusetts
Other, N=32
4%
Hispanic/
Latino, N=141
18%
Black, N=121
15%
White, N=495
63%
N=789
Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 1/1/12
MSM and Non-MSM Males Diagnosed with HIV Infection
Within the Years 2008–2010 by Age at Diagnosis:
Massachusetts
50-59
11%
60+
3%
0-19
3%
60+
7%
20-29
27%
0-19
3%
20-29
13%
50-59
19%
30-39
24%
40-49
31%
30-39
25%
40-49
34%
MSM, N=789
Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 1/1/12
All Other Males,
N=1,453
MSM Diagnosed with HIV Infection within the Years 2008–2010 by
Age at Diagnosis and Race/Ethnicity: Mass.
Percent
13-24
100%
25+
90%
84%
77%
80%
70%
60%
40%
30%
23%
20%
16%
10%
0%
White
Black NonHispanic/Latino
Hispanic
Race/Ethnicity
Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 1/1/12
Mass. Total
Women Diagnosed with HIV Infection Within the Years 2008–2010
by Race/Ethnicity: Massachusetts
White NonHispanic, 18%
Other, 2%
Black NonHispanic, 52%
Hispanic/Latin
a, 27%
N=541
Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 1/1/12
Women Living with HIV/AIDS by Race/Ethnicity: Massachusetts
Other, 2%
White NonHispanic, 26%
Black NonHispanic, 44%
Hispanic/Latin
a, 28%
N=5,253
Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 1/1/12
Women Diagnosed with HIV Infection within the Years 2008–2010
by Age at Diagnosis and Race/Ethnicity: Mass.
Percent
24 and under
100%
92%
87%
25+
90%
89%
80%
60%
40%
20%
13%
8%
11%
10%
0%
White
Black NonHispanic/Latina
Hispanic
Race/Ethnicity
Data Source: MDPH HIV/AIDS Surveillance Program, Data as of 1/1/12
Mass. Total
Fiscal Projections
State Fiscal Year 2014
Proportion of FY ’13 Contract Allocations
by Service Type (all sources)
CT
C
H
e..
.
Cl
ien
t
P&
S
H
D
AP
40
35
30
25
20
15
10
5
0
FY13 Office of HIV/AIDS Funding by Service Category
State Funds
Retained Revenue
Federal
Total
Percentage
-
5,264,751.69
18,942,502.33
27%
-
164,048.00
164,048.00
0%
961,762.93
1%
15,794,578.72
23%
1,334,831.00
2%
23,548,126.19
34%
Direct Services
Client Health Services
Minority AIDS Initiative
13,677,750.64
-
Corrections to Community
Reintegration
861,762.93
-
100,000.00
Prevention and Screening
12,082,740.00
-
$3,711,838.72
Rapid Test, Risk Reduction Supplies &
Syringe Disposal Kiosks
1,033,512.00
-
301,319.00
HDAP
1,893,375.48
7,500,000.00
$14,154,750.71
Training and Public Information
700,681.47
-
516,493.28
1,217,174.75
2%
Evaluation
357,735.00
-
873,176.28
1,230,911.28
2%
-
245,000.00
245,000.00
0%
25,331,377.68
63,438,935.20
91%
Quality Management
Total Direct Services
30,607,557.52
7,500,000.00
Administrative Services
0%
Personnel
329,990.59
-
Operations
279,361.89
-
Consultant Services including SWCAB
479,083.00
Other Department Support
4,367,593.65
6%
$589,539.27
868,901.16
1%
-
-
479,083.00
1%
405,030.00
-
-
405,030.00
1%
Total Administrative Services
1,493,465.48
-
4,627,142.33
6,120,607.81
9%
Total Funding
32,101,023.00
29,958,520.00
69,559,543.00
100%
7,500,000.00
4,037,603.06
FY2012-FY2016 CDC Calendar Year Funding
Loss Ranges
PART A
Award Ranges
Funding Loss Range
% Loss Range
FY2012
6,551,478.00
FY2013- Low
5,231,100.00
FY2014- Low
4,732,700.00
FY2015- Low
4,483,600.00
FY2016- Low
4,234,400.00
FY2013- High
5,781,700.00
FY2013-min
FY2013 Max
% loss- min
% loss Max
(769,778.00)
(1,320,378.00)
12%
20%
(498,400.00)
(550,800.00)
10%
10%
(249,100.00)
(275,400.00)
5%
5%
(249,200.00)
(275,400.00)
6%
6%
FY2014- High
5,230,900.00
FY2015- High
4,955,500.00
FY2016- High
4,680,100.00
CDC Losses Across State Fiscal Years
SFY13
Award Ranges
SFY14
min
max
min
max
(384,889)
(660,189)
(384,889)
(660,189)
(249,200)
(275,400)
SFY15
min
max
(249,200)
(275,400)
(124,550)
(137,700)
SFY16
min
max
(124,550)
(137,700)
(124,600)
(249,150)
SFY17
min
max
(137,700)
(124,600)
(137,700)
(275,400)
(124,600)
(137,700)
FY2012
6,551,478.00
FY2013- Low
FY2013- High
5,231,100.00
5,781,700.00
FY2014- Low
FY2014- High
4,732,700.00
5,230,900.00
FY2015- Low
FY2015- High
4,483,600.00
4,955,500.00
FY2016- Low
FY2016- High
4,234,400.00
4,680,100.00
(384,889)
(660,189)
(634,089)
(935,589)
(373,750)
(413,100)
FY13 Update
HDAP Costs by Program Category
– Full-Pay- $5,166,048
– Co-Pay- $4,098,203
– CHII -$9,994,102
• HDAP is stable in FY13
Fiscal “Big” Picture
SFY14 Projections
• Projected CDC losses in 12-1201, Year 2 of
the Cooperative Agreement 1/2013-12/2013
• Projected HRSA losses in upcoming grant
year, 4/2013-3/2014 due to allocation
methodology
• Projected losses due to sequestration in CDC
and HRSA, effective early CY 2013
• State FY14 budget, current funding $32.1
million
CDC Projected Reductions
• CY2012 reductions were absorbed in SFY12 (Jan June 2012) and SFY13 (July – Dec 2012) investments
• CY2013 losses will be absorbed in SFY14
investments (July – Dec 2013)
• Projected loss in CDC CY2013 is up to $1.3 million.
– $634,000 – 935,500 will be absorbed in SFY14
– Sequestration might add another $500K reduction
• Total CDC loss in SFY14 as high as ~$1.4 million,
including projected impacts of sequestration
Projected HRSA Reductions
• Funding methodology based on name-based HIV case reports
only is applied in 2013 award
• Historically we received partial credit for code-based HIV
cases
• ~10% of Massachusetts cases (HIV only) do not have a namebased report
• Projected up to $2 million reduction in the Massachusetts
HRSA Part B award to the state
– $1.5 million to HDAP
– $500,000 to services (base)
– Sequestration might add another $2 million reduction
• Potential HRSA losses of ~$4 million, including projected
impacts of sequestration
Time frame
•
•
•
•
•
•
•
January 2013, CDC award
April 2013, HRSA award
Jan-March sequestration impacts
June 2013, state FY14 budget
Impact of reductions may be substantial
Losses will effect OHA administration
Both Prevention and Care investments will be
impacted
Thank you
H. Dawn Fukuda
Office of HIV/AIDS
[email protected]
(617) 624-5303