Table 3.
Provision of care among HIV care facilities and the proportion of persons receiving HIV care by care characteristics—Medical Monitoring Project Facility Survey 2021, United States.
| HIV care facility characteristics | Proportion of persons receiving HIV care by facility characteristics | ||||||
|---|---|---|---|---|---|---|---|
| n | % | 95% CI | n | % | 95% CI | ||
| Total | 455 | 100 | 4100 | 100 | |||
| What are the barriers to offering new patients an appointment with an HIV care provider within 1 business day of an initial request? | Patient preference | 217 | 50.4 | (45.3–55.5) | 1991 | 51.5 | (45.1–57.8) |
| Insufficient provider capacity to see rapid entry patients | 223 | 55.5 | (50.5–60.5) | 1626 | 45.4 | (40.4–50.4) | |
| Patients lack documents required for facility enrollment | 83 | 18.6 | (14.7–22.5) | 975 | 23.3 | (18.0–28.6) | |
| Patients lack documents required for Ryan White HIV/AIDS Program enrollment | 69 | 12.1 | (9.1–15.0) | 803 | 19.4 | (15.5–23.4) | |
| Facility administration is not committed to rapid enrollment | 10 | 2.6* | (1.0–4.3) | 42 | 0.9 | (0.6–1.2) | |
| Other staff are not committed to rapid enrollment | 8 | 1.6* | (0.4–2.7) | 51 | 1.3* | (0.5–2.2) | |
| Which of these documents are required for scheduling the first appointment with an HIV care provider? | Proof of income | 122 | 21.8 | (17.9–25.6) | 1326 | 32.9 | (29.6–36.2) |
| Proof of residence | 129 | 24.1 | (20.1–28.1) | 1348 | 33.2 | (29.7–36.7) | |
| Government-issued identification | 164 | 35.9 | (31.1–40.6) | 1417 | 37.3 | (34.6–40.0) | |
| Result of a test for tuberculosis (PPD or IGRA) | 28 | 5.6 | (3.4–7.8) | 318 | 7.3 | (4.6–10.0) | |
| Positive HIV antibody or detectable viral load | 247 | 51.5 | (46.6–56.4) | 2405 | 62.2 | (56.1–68.3) | |
| CD4 lymphocyte count result | 90 | 19.2 | (15.3–23.0) | 904 | 23.0 | (20.5–25.5) | |
| None of the above | 134 | 32.3 | (27.7–37.0) | 1016 | 27.9 | (23.7–32.1) | |
| Which of the following patients are routinely able to obtain a 30-day supply of antiretroviral medication on the day of their first visit with an HIV care provider? | All patients | 274 | 72.9 | (68.1–77.7) | 2555 | 66.1 | (60.9–71.3) |
| Patients with no prescription coverage, e.g. by using a pharmaceutical patient assistance program or funds designated for this purpose | 359 | 94.7 | (92.2–97.2) | 3541 | 93.5 | (90.8–96.2) | |
| Patients without results of baseline laboratory tests | 308 | 82.1 | (78.0–86.2) | 3016 | 77.7 | (73.9–81.4) | |
| Which of these are barriers to patients obtaining a 30-day supply of antiretroviral therapy on the day of the first HIV care provider visit? | Patient preference | 41 | 10.0 | (6.9–13.1) | 440 | 11.3 | (9.0–13.6) |
| Prescription not given because test results are not available | 81 | 19.5 | (15.5–23.5) | 725 | 20.0 | (16.3–23.7) | |
| Delay getting medication paid for | 65 | 17.1 | (13.2–21.0) | 556 | 14.0 | (11.9–16.2) | |
| Antiretroviral starter packs are not available to be given to patients | 52 | 12.6 | (9.2–16.0) | 497 | 12.5 | (9.6–15.3) | |
| Lack of trained staff to submit patient assistance program applications for free antiretrovirals | 10 | 3.0* | (1.2–4.9) | 50 | 1.1 | (0.6–1.7) | |
| Patient cannot afford copayment | 41 | 10.8 | (7.5–14.0) | 399 | 9.9 | (7.3–12.5) | |
| Providers are not committed to immediate antiretroviral initiation | 16 | 4.1 | (2.1–6.2) | 117 | 3.3 | (2.2–4.4) | |
| Facility administration is not committed to immediate antiretroviral initiation | 7 | 1.5* | (0.3–2.8) | 76 | 6.3 | (3.0–9.5) | |
| Lack of a standardized protocol for all clinicians to follow | 14 | 3.6 | (1.7–5.5) | 193 | 5.1 | (2.3–8.0) | |
| Have any providers provided HIV clinical care for patients via remote conferencing? | Yes | 366 | 82.0 | (78.1–85.9) | 3301 | 87.3 | (84.4–90.2) |
| Have any patients received HIV clinical care from outside HIV providers via remote conferencing during a visit (in-person or virtual) at your facility? | Yes | 118 | 27.0 | (22.6–31.5) | 987 | 27.6 | (22.5–32.8) |
| Have any providers received HIV clinical consultation or mentoring from outside providers via remote conferencing, e.g., HIV ECHO? | Yes | 156 | 34.1 | (29.4–38.8) | 1520 | 38.9 | (34.0–43.9) |
| Have any providers provided HIV clinical consultation or mentoring for outside providers via remote conferencing, e.g., HIV ECHO? | Yes | 174 | 36.9 | (32.1–41.6) | 1823 | 45.6 | (41.6–49.6) |
| Does the facility use data to systematically monitor retention in care of all HIV patients? | Yes | 342 | 71.0 | (66.4–75.7) | 3214 | 83.6 | (78.8–88.5) |
| Which types of data does the facility use to monitor retention in care? | Internal data (e.g., electronic health record or billing data) | 312 | 65.6 | (60.8–70.5) | 2941 | 77.6 | (72.8–82.3) |
| Health department surveillance data | 112 | 20.6 | (16.8–24.4) | 1139 | 28.2 | (24.4–32.0) | |
| CAREWare | 143 | 24.2 | (20.3–28.1) | 1573 | 37.5 | (29.9–45.1) | |
| Pharmacy refill data | 176 | 37.8 | (33.0–42.5) | 1703 | 43.7 | (37.7–49.7) | |
| Does the facility collaborate with the state or local health department to identify or contact patients who are out of care, e.g., by providing clinic data or contact information to the health department? | Yes | 340 | 72.6 | (68.0–77.2) | 3016 | 78.1 | (72.3–83.8) |
| Does the facility send patient reminders before all provider appointments? | Yes | 415 | 92.4 | (89.7–95.2) | 3648 | 96.3 | (95.5–97.1) |
| Which of these patient reminders are routinely used at the facility? | Text, email, or patient portal message | 317 | 70.4 | (65.8–75.0) | 2948 | 76.0 | (72.1–80.0) |
| Automated phone calls | 239 | 52.0 | (47.1–57.0) | 2194 | 58.1 | (51.7–64.5) | |
| Live phone calls | 330 | 71.2 | (66.6–75.8) | 2918 | 77.7 | (72.0–83.4) | |
| Letter | 134 | 27.9 | (23.5–32.2) | 1253 | 33.9 | (28.8–38.9) | |
| Does the facility follow-up on all missed appointments? | Yes | 379 | 83.9 | (80.2–87.7) | 3244 | 85.0 | (80.3–89.8) |
| With which methods does the facility follow-up on missed appointments? | Text, email, or patient portal message | 209 | 44.8 | (39.9–49.7) | 1799 | 48.4 | (44.6–52.2) |
| Automated phone calls | 82 | 16.5 | (13.0–20.1) | 541 | 14.5 | (11.6–17.4) | |
| Live phone calls | 342 | 75.4 | (71.1–79.8) | 2923 | 77.1 | (70.4–83.7) | |
| Letter | 210 | 44.0 | (39.2–48.9) | 1807 | 47.1 | (42.7–51.6) | |
| Outreach in the field by a facility employee | 119 | 23.0 | (19.1–27.0) | 1249 | 30.7 | (26.5–35.0) | |
| Is there a pharmacy at the same geographic location as the facility (onsite)? | Yes | 244 | 53.8 | (48.9–58.7) | 2422 | 62.9 | (57.4–68.4) |
| Does the facility have direct access to information about prescription fulfillment and pick-up by patients? | Yes | 283 | 59.1 | (54.2–64.0) | 2662 | 69.8 | (66.2–73.5) |
| Does the facility notify patients of all missed prescription pickups? | Yes | 146 | 29.3 | (24.9–33.7) | 1511 | 38.4 | (32.2–44.7) |
| With which methods does the facility notify patients of missed prescription pick-ups? | Text, email, or patient portal message | 89 | 17.7 | (14.0–21.3) | 780 | 20.3 | (15.2–25.5) |
| Automated phone calls | 50 | 9.7 | (6.9–12.5) | 476 | 12.3 | (9.8–14.8) | |
| Live phone calls | 126 | 24.9 | (20.8–29.0) | 1348 | 34.1 | (28.0–40.2) | |
| Letter | 32 | 6.2 | (4.0–8.5) | 254 | 7.8 | (3.8–11.9) | |
Notes: PPD, purified protein derivative; IGRA, interferon-gamma release assay; Numbers are unweighted, percentages are weighted.
*
Estimates are unstable and should be viewed with caution.