DEFINITION FOR "UNMET NEED"

HAB has developed a definition for unmet need (specific to those who are not in care and know their HIV status) (see Section V, chapter 6 for more detail). Its purpose is to help programs meet legislative requirements of the CARE Act Amendments of 2000 to focus on assessing their needs.

Unmet need is the need for HIV-related health services by individuals with HIV disease who are aware of their HIV status but are not receiving regular primary health care. Primary health care includes:

• Medical evaluation and clinical care that is consistent with Public Health Service guidelines, including CD4 cell monitoring, viral load testing, antiretroviral therapy, prophylaxis and treatment of opportunistic infections, malignancies, and other related conditions
• Oral health care
• Outpatient mental health care
• Outpatient substance abuse treatment
• Nutritional services, and
• Specialty medical care referrals.

Primary medical care is medical evaluation and clinical care that is consistent with U.S. Public Health Service guidelines for the treatment of HIV/AIDS. Such care must include access to antiretrovirals and other drug therapies, including prophylaxis and treatment of opportunistic infections and combination antiretroviral therapies. [It is the first of the list of services included above in the primary heath care definition.]

Other primary health care includes HIV-related health services other than primary medical care—oral health care, outpatient mental health care, outpatient substance abuse treatment, nutritional services; and specialty medical care referrals.

Non-medical supportive services are other services that contribute to PLWH accessing and remaining in primary medical care.

"In care" means receiving primary medical care for HIV disease that is consistent with U.S. Public Health Service Treatment Guidelines. Persons who are accessing other health-related services and/or support services but are not receiving primary medical care are not considered to be "in care."

DEFINITIONS FOR "SERVICE GAPS"

Because your needs assessment will help the planning body set service priorities and advise the grantee about how best to meet those priorities, your needs assessment will need to address not only the unmet need for primary health care but also other service needs—referred to as service gaps to distinguish them from unmet needs.

Service gaps are all service needs not currently being met for all PLWH except for the need for primary health care for individuals who know their status but are not in care. Service gaps include additional need for primary health care for those already receiving primary medical care ("in care"). They also include the need for supportive services for individuals not receiving primary medical care ("not in care").

Service gaps may occur because no services are currently available or because available services are either not appropriate for or not accessible to the target population. For example, a service area that includes Latino PLWH with limited English proficiency but lacks Spanish-English bilingual case managers may have a service gap for bilingual case management services. A rural service area that has a high incidence of injection drug use but lacks substance abuse services may have a lack of residential treatment facilities.

TYPES OF NEEDS ASSESSMENT DATA

Needs assessment data can be secondary source data (existing information that is obtained and used, such as epidemiologic data) or primary source data (information collected by the grantee, planning body, or applicant through such methods as surveys, interviews, and focus groups). Secondary and primary source data can be quantitative (numerical information, such as epidemiologic data) and/or qualitative (descriptive or narrative information, such as focus group input).

COLLABORATION BETWEEN PREVENTION AND CARE:
OPPORTUNITIES AND CHALLENGES

Needs assessment represents a promising area for collaboration between CARE Act planning bodies, funded through the HRSA/HAB and HIV Prevention Community Planning Groups (CPGs) funded through CDC. Beneficial collaboration might include:

• Preparation and presentation of an epidemiologic profile. Data on AIDS cases, HIV cases, and co-morbidities are of similar importance in both prevention and care planning. These data are typically compiled by the same State or local health department, which may find it more efficient to compile them once a year for both users. Data needs are not identical, however. For example, the number of PLWH at various stages of illness is needed for care but not for prevention planning. Regional collaboration may be complicated by differences in service area boundaries. As a result, some collaborating groups use a single profile, while others work together to compile and present data of common interest. Then each entity individually obtains additional data that meet its specific needs. (The epidemiology section in this guide provides information about a HRSA/CDC initiative to encourage the development of joint epidemiologic profiles for prevention and care.)
• Preparation of a resource inventory. A resource inventory that catalogues available prevention and care services—including a description of services provided, clients served, and funding levels and sources—is needed by both prevention and care planners. Sharing of mailing lists can be the beginning of collaboration on such an inventory. A joint provider survey can be conducted to obtain data needed by either or both groups, with shared data analysis responsibility. The CARE Act body analyzes information needed only for care planning; the prevention group analyzes data needed only for prevention planning.