The committee encourages CDC to continue to test strategies for improving MMP sample completion and representation of vulnerable populations of people with HIV who are not in care. Such strategies might include using the National HIV Surveillance System (NHSS) for participant sampling; using a dual-frame sampling approach that combines medical facility-based sampling to identify individuals in care and NHSS-based sampling to identify individuals not in care; implementing real-time sampling within select facilities; and extending the time period for participant recruitment and data collection.

Recommendation 3. The Office of National AIDS Policy and the Department of Health and Human Services should use the Medical Monitoring Project, once improved, to obtain nationally representative data on health care coverage and utilization for people with HIV.

Historically, priorities for HIV surveillance have shifted with changes in the distribution of HIV burden among people living with HIV, new knowledge about transmission risk, clinical indicators of health for people with HIV, HIV treatment guidelines, and other factors. Surveillance priorities inevitably will continue to shift within the context of the ACA. Similarly, new questions may emerge over time with respect to access to and receipt of quality care by people with HIV as the ACA is implemented. For example, researchers and policy makers may want to gather information on reasons for changes in care quality consequential to shifts in care coverage and the range of benefits available to people with HIV. A mechanism should be established for periodic evaluation of MMP to ensure that data collected are responsive to changes in the HIV epidemic and ACA-related informational needs.

Recommendation 4. The Department of Health and Human Services should convene and fund a multidisciplinary task force responsible for designing improvements in the Medical Monitoring Project and for ensuring that it remains responsive to changes in the epidemic and the health care environment.

Although designed to be nationally representative, the MMP does not collect data on individuals with HIV in all U.S. states and territories. Similarly MMP is not designed to provide an in-depth look at care coverage and utilization within coverage sources of particular importance for HIV-infected individuals. Data from Medicaid and the Ryan White HIV/AIDS Program, because they are captured for all states and territories, can serve as useful sources of state-level information on care coverage and utilization to supplement findings from MMP. Medicaid and the Ryan White HIV/

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