Purpose Of The Database And Study Design: The AAR provides standardized data regarding providers and clients participating in Titles I or II of the Ryan White CARE Act for administrative and fiscal monitoring purposes. The Resource Allocation Report provides data on the amount of funds allocated for various types of health and support services. Title I of the CARE Act provides formula and supplemental grants to Eligible Metropolitan Areas (EMAs) that are disproportionately impacted by the HIV epidemic. Grants are awarded to the chief elected official of the city or county that administers the health agency providing services to the greatest number of HIV positive individuals in the EMA. Title II of the Ryan White CARE Act provides formula grants to States, the District of Columbia, Puerto Rico, and eligible US territories to fund health care and support services for HIV positive individuals. The goal of the AAR is to provide uniformly collected data that shows what populations are being reached and what types and amounts of services are being provided. The AAR is designed to provide information on the number and characteristics of clients who are served by agencies funded by Titles I or II, the types and amount of services they receive, and the agencies from which they receive those services. The Resource Allocation Report supplements the AAR by identifying funds allocated to different types of services, aggregated at the grantee level.
Nature Of The Data Collected: Cross-sectional administrative data
Unit Of Analysis: Providers or programs receiving Titles I or II funds
Data Collection Methods: Providers are required to submit AAR reports annually using standardized reporting forms. The Standard AAR is completed by most providers and includes service counts for contracting agencies and their subcontractors. Providers either submit hardcopy aggregate reports or electronically stored data obtained from their automated files. Title II grantees must report summary fiscal and client data for the ADAPs using the AIDS Pharmaceutical Assistance Program AAR. Local providers that implement pharmaceutical assistance programs must also complete these data. Providers are responsible for developing a data collection system that reports all required data, including unduplicated client counts. Providers are responsible for obtaining and reporting AAR data from subcontractors, completing their aggregate reports, and submitting them to the grantee. Health Insurance Continuation Programs (HICP) must complete a HICP AAR. Titles I or II grantees are responsible for collecting AARs from their providers and subcontractors on a calendar year basis. They must also prepare the AIDS Pharmaceutical Assistance and HICP AARs. The grantees are responsible for ensuring compliance with AAR reporting requirements and providing training and technical assistance to contract providers. Grantees must edit the AARs for completeness and accuracy and forward them to HAB in March of each year. HAB disseminates aggregate data to each grantee and produces national tabular data that summarizes the submissions of grantees. Grantees are required to submit Resource Allocation Reports twice annually by fiscal year, using an Office of Management and Budget (OMB) approved form to report on anticipated allocations 90 days after grant award and then final allocations with their final grant progress report.
General Attributes: AAR data have been submitted by grantees for the period between 1994 and 1999. Summary AAR reports have been completed through 1998, with 1999 data to be available by Fall 2000. A total of 51 Title I grantees and 54 Title II grantees currently submit AAR forms. Resource Allocation Reports were instituted in FY 1996 as a requirement of OMB and approved as a revised AAR. Summary reports and trend analyses have been completed for FY 1996 to 1999. A total of 51 Title I grantees and 54 Title II grantees currently submit Resource Allocation Reports as a condition of grant award and as part of their final progress report.
Major Data Constructs And Key Data Elements: AAR data provided by grantees include provider information (for agencies receiving funds to deliver direct services), the type and units of service provided, and summary client demographic data. The AAR collects data on all clients who receive at least one service in a calendar year that is eligible for Title I or II funding. Resource allocation data can be used to provide amounts, percentages, and trends in increases/decreases of the use of Title I and II funds for various service categories.
Strengths And Weaknesses Of The Study Design And Database: Data are aggregated at the grantee level. Clients often use more than one provider and patient level files with a unique client ID are not submitted to the grantee. Most providers report all services and clients eligible for Titles I or II funding, not just services and clients funded by the Ryan White CARE Act. Although this strategy provides a more complete assessment of the HIV-related services delivered by Ryan White CARE Act providers, the data report over estimates the number of individuals served by Titles I or II. Resource allocation data provide an aggregate description of the use of funds, but they do not represent the actual expenditure of funds by providers.
Gaps In The Data Collected And Factors Leading To The Gaps: In addition to duplicate counts of patients by multiple providers, longitudinal person-based clinical data are not collected. Clinical outcomes cannot be linked to interventions due to lack of longitudinal databases. Provider performance and quality data are inadequately recorded.
Feasibility Of Linking With Other Databases: The provider data reported in the AAR might be linked to other databases. Client data are reported in the aggregate and cannot be linked due to the lack of unique identifiers. A cross-Title AAR prototype is in development.
Process To Access The Database And Contact Person: This is not a database accessible to the public. For more information on the AAR contact: John Milberg, Deputy Branch Chief, HRSA HAB Office of Science and Epidemiology at (310) 443-6560. For the information on the Resource Allocation Report contact: Richard Conviser, PhD, Chief, Evaluation Branch, HRSA HAB Office of Science and Epidemiology at (310) 443-6560
HIV/AIDS Bureau, Trends in Ryan White CARE Act Title I and II Allocations for HIV Services: FY 1996-1999. Rockville: HRSA, 2000.
HIV/AIDS Bureau. 1997 Annual Administrative Report: Ryan White CARE Act Title I and Title II National Data Tables. Rockville: HRSA, 1999.
HIV/AIDS Bureau. 1996 Annual Administrative Report: Ryan White CARE Act Title I and Title II National Data Tables. Rockville: HRSA, 1998.
McKinney MM, Wieland MK, Bowen GS, et al. States’ responses to Title II of the Ryan White CARE Act. Public Health Report. 108(1): 4-11, 1993.
Bowen GS, Marconi K, Kohn S, Bailey DM, et al. First year of AIDS services delivery under Title I of the Ryan White CARE Act. Public Health Reports. 107(5): 491-499, 1992.