clinical news & resources
Evaluating Gaps in HIV Care and Treatment: The Medical Monitoring Project
By Jacek Skarbinski, MD
Team Lead, Clinical Outcomes Team, Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention
The Medical Monitoring Project (MMP) is a supplemental surveillance system that produces nationally representative estimates of behaviors, clinical outcomes, and quality of care for adults living with HIV who are receiving care in the United States (1). It was created in 2004 in response to an Institute of Medicine (IOM) recommendation for the Centers for Disease Control and Prevention (CDC) and the Health Resources and Services Administration (HRSA) to coordinate efforts to more accurately measure the delivery of and the need for prevention and care services. MMP has been identified by the IOM as a key data source to assess our interventional strategies and guide our approach to the provision of HIV care (2).
1) Clinicians should know that the data used to monitor the HIV epidemic are supplied by surveillance programs. By working with public health departments that conduct surveillance, clinicians can play an important role in collecting the data used to direct HIV policy.
2) Clinicians can support HIV surveillance programs such as the Medical Monitoring Project (MMP) by recommending that their patients participate in the data collection process.
MMP is implemented by state and local health departments in collaboration with the CDC, and is currently conducted in 16 states, one U.S. territory, and six U.S. cities (3). MMP is a cross-sectional survey conducted annually since 2007. Every year, participating state and local health departments select a random sample of approximately 400 adult patients from HIV care facilities in each jurisdiction. Patients who provide informed consent participate in an interview and have their medical records abstracted. All data are kept confidential. Additional information about MMP is available at: http://www.cdc.gov/hiv/topics/treatment/mmp/index.htm. MMP data are used by HIV prevention community planning groups, Ryan White CARE Act planning councils, HIV care providers, and others to improve HIV services and outcomes.
A CDC report published in December 2011 and based in part on MMP data showed that only 41 percent of the 1.2 million people living with HIV were retained in care (4). Among all persons retained in care, 89 percent had been prescribed antiretroviral therapy (ART), of whom 77 percent had a suppressed viral load. Among the 92 percent of whites, 89 percent of Hispanics or Latinos, and 86 percent of blacks or African Americans who were prescribed ART, 84 percent of whites and 79 percent of Hispanics or Latinos had documented viral suppression, compared with 70 percent of blacks or African Americans. The differences in rates of viral suppression may reflect health-care providers' perceptions of patients' probability of adherence, differences in insurance coverage, cost of ART, or other factors associated with adherence, all of which can be ascertained by MMP surveillance.
With respect to prevention, 45 percent of persons in MMP received prevention counseling from their provider during the preceding year, ranging from 36 percent among persons aged ≥55 years to 73 percent among persons aged 18–24 years. By race/ethnicity, 54 percent of blacks or African Americans and 52 percent of Hispanics or Latinos received prevention counseling, compared with 29 percent of whites. These surveillance data indicate that more effort is needed to eliminate disparities among the subgroups monitored.
You can support MMP by allowing your patients the opportunity to participate if your facility is selected. If your patients are selected for an interview, encourage them to be a part of this national effort to improve health outcomes and quality of care for people living with HIV.
1. McNaughten AD, Wolfe MI, Onorato I, et al. Improving the representativeness of behavioral and clinical surveillance for persons with HIV in the United States: the rationale for developing a population-based approach. PLoS ONE. 2007;6:e550.
2. Institute of Medicine. Monitoring HIV care in the United States: Indicators and data systems. 2012. Available at: http://www.iom.edu/Reports/2012/Monitoring-HIV-Care-in-the-United-States.aspx
3. CDC. Clinical and behavioral characteristics of adults receiving medical care for HIV infection - Medical Monitoring Project, United States, 2007. MMWR. September 2, 2011 / 60(SS11);1-20.
4. CDC. Vital Signs: HIV prevention through care and treatment - United States. MMWR. December 2, 2011 / 60(47);1618-1623.
For information on Prevention with Positives including downloadable Prevention IS Care resource tools, go to the HIVMA homepage http://www.hivma.org/Home.aspx and click on our rotating feature box, “Act Against AIDS”: Also available online: http://www.cdc.gov/PreventionISCare
Figure 1: Number and percentage of HIV-infected persons engaged in selected stages of the continuum of HIV care — United States
The figure above shows the number and percentage of HIV-infected persons engaged in selected stages of the continuum of HIV care in the United States. CDC synthesized these findings to determine the number of persons in selected categories of the continuum of HIV care, and estimated that 328,475 (35 percent) of 941,950 persons diagnosed with HIV (or 28 percent of all 1,178,350 persons with HIV) in the United States are virally suppressed.
Reprinted with permission from: CDC. Vital Signs: HIV prevention through care and treatment - United States. MMWR. December 2, 2011 / 60(47);1618-1623.