needs change at different phases of ACA implementation. MMP data are reflective of the experiences of patients who receive care in a variety of settings, public and private, and whose care is covered by a variety of payers, including Medicaid, Medicare, the Ryan White HIV/AIDS Program, and private insurance, among others. This makes MMP a useful source of data to track care utilization and quality in different care organizational models and the distribution of health coverage among people with HIV during and following implementation of the ACA.

Although MMP provides a promising basis upon which to build, the committee raised a number of concerns about its current ability to generate nationally representative data, including concerns about MMP’s current response rate and its representation of vulnerable populations. Although MMP’s response rate has improved over time, the overall patient response rate for 2010, the most recent year for which data are available, was 56 percent. Another concern is that MMP does not currently include people who have a diagnosis of HIV infection but who are not in care, many of whom stand to benefit from provisions of the ACA that will improve access to health care coverage. Adolescents (ages 13-17) are also excluded by design, leaving a gap in representative data on health care coverage and utilization for this age group. It is also important to ensure adequate representation of populations, such as immigrants, people who are homeless or unstably housed, people with mental and substance abuse disorders, and people who flow in and out of the corrections system, who are more likely to experience gaps in health care coverage and care.

Expansion of MMP to include new populations is likely to generate the need for additional staffing resources. Substantial resources and expertise are also required to achieve adequate response rates, including from vulnerable populations, and to support data collection, analysis, and dissemination activities. Training and technical support for staff in the 23 MMP project areas will continue to be critical to the success of the project. It is important that funding for MMP is commensurate with these activities.

Recommendation 2. By 2015, the Centers for Disease Control and Prevention (CDC) should improve the Medical Monitoring Project (MMP) to ensure higher response rates and increased sample representativeness. CDC should expand MMP to include representative numbers of HIV-diagnosed individuals not in care, adolescents, and those in the criminal justice system and take particular care to ensure adequate representation of vulnerable populations, including, but not limited to immigrants; individuals who are homeless or unstably housed; and people with mental or substance use disorders.

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