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HomeMy WebLinkAboutMINUTES - 10221991 - IO.5 1.0'-5 TO: BOARD OF SUPERVISORS E' :; Contl'a -_ Costa FROM: INTERNAL OPERATIONS COMMITTEE October 14, 1991 County DATE: spq_coui+�t SUBJECT: STATUS REPORT ON THE COUNTY'S AIDS PROBLEM AND RESPONSE. THERETO SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATIONS• 1. Accept this status report on the AIDS problem in Contra Costa County and the steps which are being taken by the County to respond to the problem. 2. Request the Health Services Director to continue to report to the Internal , Operations Committee on, approximately a quarterly "basis on the status of the AIDS problem in this County and on the steps which are being taken to address the problems. For this purpose, remove this matter as a referral to our Committee and instead refer this issue to the 1992 Internal Operations Committee. BACKGROUND: On May 7, 1991, the Board of Supervisors received and approved our last periodic report on the subject of communicable diseases. On October 14, 1991; our Committee met with Dr. Wendel Brunner and Francine Wise and reviewed the attached report specifically on the status of the AIDS epidemic in Contra Costa County. Dr. Brunner particularly called attention to the differences between Contra ' Costa County and Alameda County in terms of the manner in which each county conducts surveillance of AIDS cases. While Alameda County simply complies with the law by passively recording cases which are reported by physicians, Contra Costa County conducts an active surveillance program. This involves CONTINUED ON ATTACHMEXPS YES SIGNATURE: RECOMMENDATION OF COUNTY AD R RECOMMENDATIO OF BOARD COMMITTEE APPROVE O SIGNATURE(%:: ER SUNNE WRIGHT McPEAK ACTION OF BOARD ON October 22, 19 9 APPROVED AS RECOMMENDED �r OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE UNANIMOUS(ABSENT ) AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. CC: ATTESTED OCT 2 2 1991 Please see Page 2. PHIL BATCHELOR,CLERK OF THE BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR BY DEPUTY M382 (10/8$) I.O.-5 actively reviewing medical charts for evidence of AIDS symptoms and reviewing death certificates for evidence of AIDS which may not have been diagnosed. This is important. both in order to know the true extent of the disease in the County and also because much federal funding is based on the size of the AIDS caseload. The different attitudes toward surveillance between the two counties has resulted in statistics which indicate that Contra Costa County' s AIDS caseload is growing whereas Alameda County' s caseload is falling. We do not believe that this reflects anything so much as a difference in surveillance patterns. Dr. Brunner also reminded our Committee that the federal government has changed the definition of an AIDS case to include those individuals with a CD4 T-cell count of 200 or fewer per cubic millimeter of blood. This change in the definition of an AIDS case is expected to increase the AIDS caseload here and elsewhere in the United States by perhaps 50% to 75%. We have asked the Health Services Department to try to identify the number of cases which meet this new definition separately so that we can account accurately for what we anticipate will be a substantial jump in the number of cases- and determine how many are due solely to this change in definition. As is clear from the attached report, AIDS continues. to be a major public health problem in this County, as elsewhere, and continues to grow among IV drug users. AIDS continues to be a . significant problem among women of child. bearing age because of the risk that they will pass the infection onto their babies, as was the case with four women in 1990. We are asking the Health Services Department to continue to provide the 1992 Internal Operations Committee with approximately quarterly reports on caseload, services being provided, directions the disease appears to be taking and steps which are being taken to prevent the spread of the disease. cc: County Administrator Health Services Director Wendel Brunner, M.D. , Public .Health Director Francine Wise, Public Health Contra The Board of Supervisors Costa Health Services Department Tom Powers,1st District County Nancy C.Fanden,2nd District ��J Robert 1.Schroder,3rd District 6 OFFICE OF THE DIRECTOR Sunne Wright McPeak,4th District Mark Finucane,Director Tom Torlakson,5th District -� Administrative Offices V °S en Street County Administrator x,. .. 20 AllMartinez,Cenia 94553 Phil Batchelor �o, "� (415)646-4416 County Administrator rTA coi is�1 October 9, 1991 To: Internal Operations Commit Board of Su rvisors From: Mark Finucane, Direcfor ealth Services Department by Wendel Brunner, M. D. Subject: Quarterly Report on Status of AIDS AIDS Cases in Contra Costa As of October 6, 1991, 670 persons have been diagnosed with AIDS in Contra Costa. Five of those are pediatric cases; 42 are women. Of the adult cases, 32%, (almost one-third) are now people of color with 21% being African Americans, 10% Latinos and one percent Asians or Pacific Islanders. Sixteen percent of the men diagnosed now report some history of injection drug use while 48% of the women diagnosed report a history of drug use. Seventy-five percent of the'cases are homosexual or bisexual men without a history of injection drug use. In a recent review of AIDS cases in East County, we learned that of the 654 cases reported, 16% (103) were in East County, which is slightly higher than the proportion of the population which resides in East County (13.5%) Of these cases the percentage of women with AIDS is higher than any other region, 9.7% as compared to Central County (3.4%) and West County (9.3%) Of the 103 cases in East County, 15.5% are Latino compared to 8.3% in Central County and.9.3% in West County. Looking at risk factors, 25.5% of the cases in East County reported some intravenous drug use, either with or without homosexual activity. In West County, 24.3% of the case had drug use as a risk factor compared to 9.5% of AIDS cases in Central County. It is also disturbing to note that three of the five pediatric AIDS cases in the county have been from east county. Status of AIDS Presented to Internal Operations Committee Contra Costa County Board of Supervisors October 14, 1991 Page 2 As the figure at right demonstrates, Central although case numbers are clearly higher in �C�co my Central County, the rate of increase in cases N in East County almost directly parallels that in Central County. 70 ----------------------------------------------------------------------------- •• ------------------------------------------------------------------- -------- With funding the Board approved for so ----------------------------------------------------------- ................. Communicable Disease programs earlier this year, the AIDS Program was able to 40 ----------------------------------------- ----------------------------------- hire a bilingual health educator, Dinorah ,• ------------------------------ ---------------------------------------------- Barton-Antonio. Dinorah began work for the AIDS Program in August: Her focus is 20-1.................. ....................................... .............. AIDS education programs in East and Cen- ,o ....... .---................................. ............................ tral County with a special emphasis on the Latino population. Lou LM an i••• i• It is estimated that approximately —Rog Co +G'`n'Co. 3,000 people in Contra Costa County are infected with HIV. Of this number, 1,200 (40%) are thought to reside in Central County, 1,030 (34.3%) in West County and 770 (25.6%) in East County. Using existing AIDS cases to project the level of HIV infection, there are at least 120 Latinos with HIV infection and approximately 75 women infected in East County (these numbers could overlap). However, the proportions of both Latinos and women with AIDS have been increasing each year, leading us to believe that these estimates are low. Statewide Seroprevalence Study of Childbearing Women Last week the State announced its findings from Statewide blinded seroprevalence studies of women giving birth in the State for the period July through September 1990. As the chart below demonstrates, the rate of infection of women fluctuates over time. We clearly continue to have a problem of infection rates among,women and will continue to address that problem through Healthy Start clinics, through Hospital and Clinics, and through the AIDS Program's prevention and education programs. Status of AIDS Presented to Internal Operations Committee Contra Costa County Board of Supervisors October 14, 1991 Page 3 HIV Seroprevalence Among Childbearing Women in Contra Costa County 1988-90 30- 27.6 25------------------------------------- ................................... 20.:................................... .... ............................... ------------..................... .... ................ ------- ................ ............ .... .... .... 6.6 .... .... ........ .... 1988 1989 1990 Infected per 10,000 Statewide, the 1990 rate of 7.0 per 10,000 is slightly higher than the 1989 rate of 6.4 per 10,000, but somewhat lower than the 1988 rate of 7.4. The rate remains high for African American mothers. Mothers between the ages of 25 and 29 have the highest rate statewide. This year Contra Costa ranked third highest in HIV seroprevalence with a rate of 12.3 cases per 10,000. Four women of 3,245 women giving birth in Contra Costa were found to be infected with HIV. All four were African American women. Status of AIDS Presented to Internal Operations Committee Contra Costa County Board of Supervisors October 14, 1991 Page 4 Centers for Disease Control Expected to Issue Revised AIDS Definition In April 1992, the Centers for Disease Control is expected to add to the current list of conditions which comprise,the current AIDS case definition, anew criteria which will include any HIV positive person with a CD4 T-cell count of 200 or fewer per cubic millimeter of blood. The CD4 count is a test of immune system functioning. An estimate from the National Center for Infectious Diseases estimates that the broader definition could add 150,000 to 200,000 people to the nation's AIDS case load. We expect that the number of AIDS cases among county residQ tints may increase by 50-75%. In response to the expected change, the AIDS Program has begun to inform physi- cians and other health care providers to modify their reporting guidelines and to begin to request T-cell count on all HIV-infected patients. The AIDS Program has an aggressive surveillance program not only because reporting of AIDS cases is required by law, but also because we are eager for persons who have been diagnosed to be aware of existing services. Funding decisions from the State and Federal government are also made, in part, on AIDS case data. Contra Costa HIV/AIDS Consortium The Consortium which was created in response to Title II of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990 recently agreed to issue two requests for proposals for the following services in Contra Costa County: Case Management Services $34,000 Resource/Case Management Coordination $50,060 As mandated by the State, if funding was not found elsewhere, the Consortium was required to cover the Health Resources and Service Administration's AIDS Service Demon- stration Project for the six month period (October 1, 1991 - March 31, 1992). That funding currently supports HIV case management (primarily in West County) operated by the AIDS Program. The Consortium_considered proposals and received input from the proposers and is in the process of creating contracts with three community-based organizations in the county to provide services. Pittsburg Preschool Coordinating Council and Familias Unidas of Richmond are each being funded'$17,000 to provide a .5 FTE social work/case management program. The Contra Costa County AIDS Task.Force will receive $20,060 for vouchers for food, transportation and emergency housing to be distributed to agencies providing services to people with HIV in our county. The AIDS Task Force will also be funded $30,000 for a Status of AIDS Presented to Internal Operations Committee Contra Costa County Board of Supervisors October 14, 1991 Page 5 .75 FTE case management/resource coordinator. The county will continue for six months to provide the case management formerly funded through the HRSA AIDS Service Demon- stration Project. Alameda/Contra Costa HIV Health Planning Council As I have previously reported to the Board, in 1992 Contra Costa County, as a part of the Oakland Metropolitan Statistical Area, will be eligible for Title I monies from the CARE Act. Our share of those monies will probably be between $300,000 - $500,000. The Congress has not yet determined the appropriation. The decision making body over the use of Title I funds is the HIV Health Planning Council. As directed by the Board last April, I have now appointed members of that Council. Our nine members are as follows: Bill Bond - representing gay man of color Genoveva Calloway - representing the mental health community Deborah Card - representing health care providers Jan Diamond - representing hospitals Alan Johnson - representing gay men Art McDermott -.representing community-based organizations Jim Schexnayder - representing social service agencies Michele Washington - a non-elected community leader Eugene Richards, Acting Director of the HIV/AIDS Services Division from Alameda County, and Rusty Keilch, Director of our AIDS Program, will co-chair the Council. Surveillance As you know, physicians in California (and in.all States) are required by law to report AIDS cases. Cases are reported for epidemiological purposes so that the disease can be monitored for the purposes of health planning and disease investigation. Case counts are also used to determine funding in some State and Federal HIV/AIDS programs. And, at the human level, cases need to be known so that people who have been diagnosed can be told of services that exist to assist them and their loved ones. In our AIDS Program, we do aggressive active surveillance of AIDS cases. The primary method of active surveillance practice is reviewing medical charts for clues that a patient may have received or may be eligible to receive an AIDS diagnosis. Our surveillance team also reviews death records and assists infection control nurses and others who are Status of AIDS Presented to Internal Operations Committee Contra Costa County Board of Supervisors October 14, 1991 Page 6 known to serve AIDS patients in making reporting simple and direct. At five of the twelve hospitals in the county, we now conduct active surveillance. Passive surveillance implies waiting for physicians to report cases. Currently in Alameda County, very little active surveillance of AIDS cases is practiced. Dr. Brunner has recently met with Alameda County's Assistant Health Services Director, to discuss regional surveillance activities. Alameda County's practices are of concern to us because.the Ryan White CARE Act funds from the Federal government come to the Alameda/Contra Costa metropolitan statistical area (MSA) and are based a formula which includes actual cases and incidence of cases in the area. We obviously want to assure that our MSA receives the amount of funding that truly reflects the extent of the AIDS problem in our area. The table below reflects the changes in the ratio of cases in the two counties since 1988. While the data could reflect a major shift in cases away from Alameda and into Contra Costa County, we suspect that the date reflects a difference in the surveillance activities in the two counties. AIDS Case ratio-Alameda&Contra Costa Counties by year of diagnosis(in fir) 100 f0 7L 4 74.7 ` f0 srx 47 44 Ji 23A UJ is - e 1900 1919 19'90 1991 M A1..6 ®Contra Cwt. 1991 cues as of 9124!91 We will continue to pursue with Alameda County the importance of active surveil- lance to assure that our area receives funds that adequately reflect the extent of the epidemic in our counties.