Epidemiological Profile of HIV/AIDS in Minnesota

Ryan White CARE Act Services in Minnesota 2011

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This section of the profile provides a description of people who use the Ryan White HIV/AIDS Program services in Minnesota, both within the TGA (Part A and Part B) and Greater Minnesota (Part B), and quantifies the unmet need for primary medical care.

Data Sources

The data presented in this section comes primarily from two sources, the enhanced HIV/AIDS Reporting System (eHARS) and the Minnesota CAREWare system used by all agencies providing Part A, Part B, ADAP and state-funded HIV services.

Since almost all Ryan White services are dependent on financial eligibility, it should not be expected that everyone living with HIV/AIDS in Minnesota would be eligible and/or receiving Ryan White services. Therefore, surveillance data should not be used as the standard by which services are measured, but as an additional piece of the puzzle in describing HIV/AIDS care in Minnesota.

Overview of Ryan White in Minnesota

The number of clients utilizing Ryan White services has steadily grown from 1,771 in 1996 to 4,213 in 2013. Additionally, over the past three years, several of the funded services have seen increases in the number of people being served. Essential care services are those services considered necessary to address care needs, and essential access are services that help people gain access to HIV care and support services.

Comparison of Epi and Utilization Data

While the center of the epidemic in Minnesota is the Minneapolis-St. Paul TGA, there are people living with HIV/AIDS in 95% of Minnesota counties. In 2013, 4,213 people utilized Ryan White Services in Minnesota, compared to 7,723 people living with HIV/AIDS in Minnesota.

Gender

Males comprise the majority of those living with HIV/AIDS in Minnesota, accounting for 76% of all cases. A similar distribution is seen among those receiving services, with males accounting for 71% of clients and females accounting for 28%. Transgender persons make up about 1% of those receiving services (data not shown).

Age

Persons ages 40-55 account for the most (48%) of those receiving services. Adolescents and young adults (ages 13–24) account for 4% of those receiving services. The age distribution of those receiving services is similar to those living with HIV/AIDS. People ages 40-55 account for 49% of those living with HIV/AIDS and adolescents and young adults account for 4% (data not shown).

Mode of Exposure

There are also significant differences in the mode of exposure distribution of those living with HIV/AIDS in the TGA and greater Minnesota. While MSM account for 53% of those living with HIV/AIDS in the TGA, they only account for 39% in Greater Minnesota.

Mode of exposure for those receiving Ryan White services also differs for people residing in the TGA and those residing in Greater Minnesota. MSM account for 46% of those receiving services in the TGA compared to 31% in Greater Minnesota. Injection drug use accounts for 5% of cases in the TGA compared to 7% in Greater Minnesota.

 

Race/Ethnicity

There are significant differences in the racial/ethnic distribution between those living with HIV/AIDS in the TGA and Greater Minnesota. While Whites account for the majority of cases in both areas, people of color make up 48% of cases in the TGA compared to 37% in Greater Minnesota.

As with surveillance data, there are racial/ethnic differences between those receiving services in the TGA and Greater Minnesota. White people account for 31% people receiving Ryan White services in the TGA compared to 45% in Greater Minnesota. Additionally, Blacks (includes African-born) account for 38% of those receiving services in the TGA compared to 23% in Greater Minnesota.

living cases by mode and location

ryan white by race, greater mn

Geography

The table below shows that the proportion of people receiving services in Greater Minnesota is larger than those receiving services in the TGA. However, based on the numbers of people served, the majority of people accessing Ryan White services live in the TGA (85%) compared to 15% in Greater Minnesota. In addition, less than 1% of people receiving services have unknown counties of residence, and less than 1% reside in other states.

Table 1. Number of People Receiving Ryan White CARE Act Services and Living Cases of HIV/AIDS, Minnesota 2013
  Number Receiving Services* Number in SurveillanceŦ Percentage Receiving Services

Greater MN

614

1,161

53%

13-County TGA

3,599

6,519

55%

* Includes 10 cases from Pierce and St. Croix counties.
Ŧ Does not include 48 cases with unknown residence.

 

Services Received in 2013

In 2013, the service category of Medical Case Management was the most utilized, with 3,020 clients (72% of total clients) accessing case management services. Medical Transportation Services was the next most utilized service with 1,616 clients (38% of total clients), followed by the AIDS Pharmaceutical Assistance Program (ADAP) with 1,526 clients (36% of total clients), and Outpatient/Ambulatory Care with 1,476 clients (35% of total clients). The next most used services were Meals Service, Emergency Financial Assistance, and Case Management (non-medical), with 1,452; 1,146; and 921 clients, respectively.

While Ryan White funds in many states are primarily used to pay for primary medical care for people living with HIV/AIDS, Minnesota has historically been fortunate enough to provide extensive access to health insurance through public programs. Additionally, several clinics and hospitals throughout Minnesota have had a tradition of providing extensive charitable care for HIV/AIDS. This has reduced the need to use Ryan White Part A and B funds to support primary medical care, and allowed the dollars to be used to create a comprehensive system of support services. However, due to the rise in health care costs, hospitals and clinics are cutting back on the amount of charitable care provided, which may signal a change in the way in which Part A and B funds will be spent in Minnesota in the future.

ryan white services

ryan white services

 

Characterizing Unmet Need for Primary Care Among HIV Positive People

The definition of unmet need for primary medical care is: “An individual with HIV or AIDS is considered to have an unmet need for care (or to be out of care) when there is no evidence that s/he has received any of the following three components of HIV primary medical care during a defined 12-month time frame: (1) viral load testing, (2) CD4 count, or (3) provision of anti-retroviral therapy (ART).” (1)

(1) HRSA/HAB definition of unmet need

MDH calculated an estimate of unmet need using data in eHARS to determine the number of people living with HIV/AIDS as of December 31, 2013 and how many of those individuals had received a CD4 or viral load test in 2013. MDH was able to gather additional data from conducting reviews of patient records at HCMC.

By December 31, 2013 there were 7,723 persons living with HIV/AIDS in Minnesota. Using the methodology described above, we are able to estimate that of those, the number not receiving primary medical care for their HIV is 2,309 or 30% of people living with HIV/AIDS in Minnesota. The table below shows the number of people living with HIV/AIDS who are in and out of care by race, gender and mode of exposure.

The Minnesota communicable disease reporting rule was amended in June 2011 to require the reporting of all CD4 and viral load results. This will greatly improve the completeness of data contained within eHARS and will allow MDH to provide more accurate estimates of the number of people who are in care in the future.

Demographic Characteristics of Out of Care PLWHA in Minnesota, 2013
 
Number
In Surveillance
Number
In Care
Number
Out of Care
Percent
Out of Care
Race*
 
 
 
 
White, not Hispanic
3,901
2,850
1051
27%
Black, not Hispanic
2,745
1,859
879
32%
African American
1,703
1,154
549
32%
African-born
1,042
705
337
32%
Hispanic
665
408
257
39%
American Indian
132
103
29
22%
Asian/Pacific Islander
140
91
49
35%
Multiple Races
123
100
23
19%
Gender**
 
 
 
 
Male
5,908
4,100
1,808
31%
Female
1, 815
1,314
501
28%
Mode of Exposure
 
 
 
 
MSM
3,936
2,829
1,107
28%
IDU
416
271
145
35%
MSM/IDU
387
258
129
33%
Heterosexual contact
1,720
1,240
480
28%
Mother with HIV
99
80
19
19%
Other/hemophilia/blood transfusion
34
25
9
26%
Unspecified risk
1,131
711
420
37%
Total
7,723
5,414
2,309
30%
*Excludes individuals of unknown race
** Does not include transgender individuals

 

Summary of Ryan White CARE Act Services in Minnesota

More people than ever are living with HIV/AIDS and utilizing Ryan White services in Minnesota. The number of people utilizing services has steadily grown from 1,771 clients in 1996 to 4,213 2013 — a 138% increase.

As with the epidemic, in 2013, men accounted for the majority of those served (71%), White people  accounted for the greatest proportion of people served, accounting  40% of all served followed by black and African-born persons at 37%. the majority (85%) of persons served lived in the TGA.

There are racial/ethnic and mode of exposure differences among those being served in the TGA and in Greater Minnesota. While Whites account for 50% of those being served in Greater Minnesota, they account for 39% in the TGA. Similarly, while MSM account for 36% of those being served in the TGA, they account for 27% in Greater Minnesota.

Updated Thursday, February 05, 2015 at 03:50PM