Every five years, Ryan White Care (RWC) requires its programs to prepare new plans to adjust to the changing epidemic. Biomedical advances, such as PrEP and Treatment as Prevention, have changed how people understand HIV. It has become difficult to separate HIV Prevention from Treatment. Florida’s RWC programs have submitted their new five-year plans. This article summarizes Miami-Dade County’s five-year HIV plan for 2017-2021.
The epidemic in Miami-Dade
Only 13.2 percent of Florida’s population lives in Miami-Dade County. Yet Miami-Dade has 23.7 percent of all people living with HIV (PLWH) in Florida. Miami-Dade exceeds all other counties in the number of its annual newly diagnosed HIV cases. While 23 percent of Florida identifies as Latino, 67 percent of Miami-Dade does.
Miami-Dade reports data separately for Haitians and Blacks. About 11 percent of PLWH in Miami-Dade in 2015 identified as Haitian, 5 percent male and 6 percent female. Only 17 percent of people in Miami-Dade identify as non-Haitian Black. In contrast, 41 percent of the PLWH in Miami-Dade identify as non-Haitian Black.
Challenges and Goals
Miami-RWC found three major challenges in its Continuum of Care: linkage, retention, and viral suppression. Specific groups of clients varied in linkage, retention in care, and viral suppression. This indicates a need for changes directed towards specific client groups.
Miami-RWC linked 85 percent of its clients to care within 90 days of diagnosis. This exceeded its goal in its previous plan by 5 percentage points. In its 2017-2021 plan, Miami-RWC set a more ambitious goal. Its new goal is to link at least 80 percent of its clients to care within 30 days of diagnosis.
Miami-RWC retained 60 percent of its clients in care. In contrast, Florida retained 66 percent of its RWC clients in care. Miami-RWC defines “retention in care” as “a PLWHA having at least two medical encounters at least 90 days apart during a 12-month period.”
While Miami-RWC overall retained 60 percent of its clients in care, it varied by specific client groups. Miami-RWC retained less than 60 percent of clients in care among Whites, Blacks, women, clients under 35, clients over 65, and intravenous drug users. It retained more than 60 percent of its clients among Latinos, Haitians, transgender people, and gay/bi men, and clients between the ages of 35 and 64.
Miami-RWC has reported that 67 percent of its clients have a suppressed viral load. While Miami-RWC labeled this as a “problem,” Florida had only 59 percent.
While Miami-RWC overall had 67 percent of its clients with a suppressed viral load, it varied by specific client groups. Less than 67 percent had achieved a suppressed viral load among Blacks, women, clients under 35, clients over 65, heterosexuals, and intravenous drug users. More than 67 percent had achieved a suppressed viral load among Whites, Latinos, Haitians, males, gay/bi men, and clients between the ages of 35 and 64.
Among client groups, the percent of clients with viral suppression frequently exceeded the percent retained in care. Only one client group, those younger than 25, had lower levels of viral suppression than of retention in care. Logically, however, the percent retained in care should exceed the percent virally suppressed. Possibly, clients with stable rates of viral suppression contact providers less often
Miami-RWC has set ambitious goals for itself. As the political context changed in November, those goals may be more elusive than before. RWC still needs ambitious goals. And people, particularly those served by RWC, need to monitor progress towards those goals and to hold these programs accountable.
To read the full report, visit http://www.floridahealth.gov/diseases-and-conditions/aids/prevention/_documents/community_mobalization/florida-integrated-hiv-prevention-care-plan-09-29-16v2.pdf, Miami-Dade data is on pages 308-351.
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