hiv care continuum, georgia, united states, 2011 presented to american public health association,...
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HIV Care Continuum, Georgia, United States, 2011Presented to American Public Health Association, Annual Meeting
Presented by Deepali Rane, MBBS, MPH, Epidemiologist Date: 4th November, 2013
Outline• Overview of HIV statistics Georgia statewide
• Define and describe the HIV care continuum methodology
• Describe the HIV care continuum for persons living with and new diagnoses of HIV infection
• Discuss the HIV care continuum in Georgia by demographic characteristics and transmission category
Epidemic of HIV infection, Georgia, 1995 to 2011
Late testers=Persons diagnosed with stage 3, AIDS within one year of HIV diagnosis
Georgia Care Continuum Methodology, Persons Living With HIV infection (PLWH), 2011
• Adults and adolescents are those aged >= 13 years• Diagnosed by 09/30/2011 (Western Blot or Viral Load [VL]) ,
including those missing race, sex, and/or transmission category• Living as of 12/31/2012• Current address within Georgia• Engaged in care >= 1 CD4 or VL in 2012• Retained in care >= 2 CD4 or VL at least 3 months apart in 2012• Viral suppression (VS) = VL<200 copies/ml in most recent VL• All percentages are percent of total number of persons
diagnosed with HIV
Adults and adolescents living with HIV infection, Georgia, 2011
Series10
20
40
60
80
100100
54
38 39
Diagnosed Engaged Retained Viral suppression
Perc
ent
N=46,495
Adults and adolescents >= age 13, diagnosed by 09/30/2011, living 12/31/2012, Georgia = 46,495Engaged in care >= 1 CD4 or VL in 2012Retained in care >= 2 CD4 or VL at least 3 months apart in 2012Viral suppression (VS) = VL<200 copies/ml Note: All percentages are proportion of total number of persons living with HIV infection
Adults and adolescents living with HIV, by sex,
Georgia, 2011
Adults and adolescents >= age 13, diagnosed by 09/30/2011, living 12/31/2012 Georgia = 46,495Engaged in care >= 1 CD4 or VL in 2012Retained in care >= 2 CD4 or VL at least 3 months apart in 2012Viral suppression (VS) = VL<200 copies/ml Excludes 270 cases for whom sex was not reportedNote: All percentages are proportion of total number of persons living with HIV infection in each category
Male Female0
20
40
60
80
100
54 55
38 3739 38
Diagnosed Engaged Retained Viral suppression
Perc
en
t
N=34,510
N=11,715
Adults and adolescents living with HIV, by race/ethnicity, Georgia, 2011
Black Hispanic/Latino White Other*/ Unknown0
20
40
60
80
100
54 51 55 57
36 3542 4036 37
45 43
Diagnosed Engaged Retained Viral suppression
Perc
en
t
N= 30,150 N= 2,282 N= 9,382 N= 4,681
Adults and adolescents >= age 13, diagnosed by 09/30/2011, living 12/31/2012, Georgia = 46,495Engaged in care >= 1 CD4 or VL in 2012Retained in care >= 2 CD4 or VL at least 3 months apart in 2012Viral suppression (VS) = VL<200 copies/ml *American Indian/Alaska Native, Asian and Native Hawaiian/Pacific Islander groups together constitute <2% of adults living with HIV in Georgia and are grouped with those of mixed or unknown race/ethnicityNote: All percentages are proportion of total number of persons living with HIV infection in each category
Adults and adolescents living with HIV infection by current age (years),
Georgia, 2011
13-24 25-34 35-44 45-54 55+0
102030405060708090
100
5853 56 56
50
35 3338 40 37
30 3139 42 40
Diagnosed EngagedRetained Viral suppression
Perc
en
t
N= 1,814 N= 7,789 N= 11,665 N= 15,915 N= 9,312
Adults and adolescents >= age 13, diagnosed by 09/30/2011, living 12/31/2012, Georgia = 46,495Engaged in care >= 1 CD4 or VL in 2012Retained in care >= 2 CD4 or VL at least 3 months apart in 2012Viral suppression (VS) = VL<200 copies/ml Note: All percentages are proportion of total number of persons living with HIV infection in each category
Adult and adolescent males living with HIV,
by transmission category*, Georgia, 2011
MSM IDU MSM/IDU HET Other0
20
40
60
80
100
56
4352 53 55
3931
37 34 394031 36 37 42
Diagnosed Engaged Retained Viral suppression
Perc
en
t
N= 24,935 N= 2,583 N= 2,428N= 2,022 N= 2,541
Adult and adolescent males >= age 13, diagnosed by 09/30/2011, living 12/31/2012, Georgia = 34,510Engaged in care >= 1 CD4 or VL in 2012Retained in care >= 2 CD4 or VL at least 3 months apart in 2012Viral suppression (VS) = VL<200 copies/ml*Multiple imputation is used to estimate number of persons in each transmission category. Note: All percentages are proportion of total number of persons living with HIV infection in each category
Adult and adolescent females living with HIV, by transmission category*,
Georgia, 2011
HET IDU Other0
20
40
60
80
100
57 5445
37 3731
39 3731
Diagnosed EngagedRetained Viral suppression
Perc
en
t
N= 8,420 N= 2,452 N= 842
Adult and adolescent females >= age 13, diagnosed by 09/30/2011, living 12/31/2012, Georgia = 11,715Engaged in care >= 1 CD4 or VL in 2012 Retained in care >= 2 CD4 or VL at least 3 months apart in 2012Viral suppression (VS) = VL<200 copies/ml *Multiple imputation is used to estimate number of persons in each transmission categoryNote: All percentages are proportion of total number of persons living with HIV infection in each category
Georgia Care Continuum Methodology, New Diagnoses of HIV infection, Georgia, 2011
• Adults and adolescents are those aged >= 13 years• Diagnosed between 01/01/11 -12/31/11• Alive at least 15 months after diagnosis• Residence at diagnosis and current address within
Georgia• Excludes 52 persons deceased within 15 months of diagnosis• Linked to care = CD4 or VL within 3 months of
diagnosis , excluding date of diagnosis• Engaged in care >= 1 CD4 or VL 4-15 months after
diagnosis• Retained in care >= 2 CD4 or VL at least 3 months
apart 4-15 months after diagnosis• Viral suppression (VS) = VL<200 copies/ml in most recent
viral load• All percentages are percent of total number of persons
diagnosed with HIV
HIV Care Continuum Methodology
Confirmatory Diagnosis
Date
Months 0-3 after diagnosis
Months 4-15 after diagnosis
CD4 or Viral Load
CD4 or Viral Load
CD4 or Viral Load
This person is:• Linked YES• Engaged YES • Retained YES• Virally suppressed YES
Last viral load <200 copies/ml
Adults and adolescents diagnosed with HIV infection, Georgia, 2011
Diagnosed only0
102030405060708090
100100
6266
46 45
DiagnosedLinked to careEngaged in careRetained in careViral sup-pression
Perc
en
t
Adults and adolescents >= age 13, diagnosed 01/01/11 -12/31/11, Georgia = 2,885Linked to care = CD4 or VL within 3 months of diagnosis Engaged in care >= 1 CD4 or VL 4-15 months after diagnosisRetained in care >= 2 CD4 or VL at least 3 months apart 4-15 months after diagnosisViral suppression (VS) = VL<200 copies/ml in most recent viral load = 1307Note: All percentages are proportion of total number of persons diagnosed with HIV
Adults and adolescents diagnosed with HIV infection, by sex, Georgia,
2011
Males Females0
20
40
60
80
100
616665 67
46 4544 48
Diagnosed Linked to care Engaged in care Retained in care Viral suppression
Perc
en
t
Adults and adolescents>= age 13, diagnosed 01/01/11 - 12/31/11, Georgia =2,869Excludes 16 persons for whom sex was not reported Linked to care = CD4 or VL within 3 months of diagnosis Engaged in care >= 1 CD4 or VL 4-15 months after diagnosisRetained in care >= 2 CD4 or VL at least 3 months apart 4-15 months after diagnosisViral suppression (VS) = VL<200 copies/ml in most recent viral load Note: All percentages are proportion of total number of persons diagnosed with HIV infection in each category
N=2,214 N=655
Adults and adolescents diagnosed with HIV infection, by race/ethnicity,
Georgia, 2011
Black Hispanic/Latino White Other/unknown0
102030405060708090
100
62
72 71
5765
70 7364
4453 54
4538
56 54 54
Diagnosed Linked to care Engaged in careRetained in care Viral suppression
Perc
en
t
N=1,616 N=144 N=271 N=854
Adults and adolescents >= age 13, diagnosed 01/01/11 - 12/31/11, Georgia = 2,885Linked to care = CD4 or VL within 3 months of diagnosis Engaged in care >= 1 CD4 or VL 4-15 months after diagnosisRetained in care >= 2 CD4 or VL at least 3 months apart 4-15 months after diagnosisViral suppression (VS) = VL<200 copies/ml in most recent viral load Other/Unknown include American Indian/Alaska Native, Asian, Native Hawaiian/Pacific Islanders and equal <2% of new diagnosesNote: All percentages are proportion of total number of persons diagnosed with HIV infection in each category
Adults and adolescents diagnosed with HIV infection, by age (years), Georgia,
2011
13-24 25-34 35-44 45-54 55+0
20
40
60
80
100
57 5965 68 67
62 66 67 6964
3946 47
5247
3443
50 54 52
Diagnosed Linked to care Engaged in care Retained in care
Perc
en
t
Adults and adolescents >= age 13, diagnosed 01/01/11 - 12/31011, Atlanta = 2,885Linked to care = CD4 or VL within 3 months of diagnosis Engaged in care >= 1 CD4 or VL 4-15 months after diagnosisRetained in care >= 2 CD4 or VL at least 3 months apart 4-15 months after diagnosisViral suppression (VS) = VL<200 copies/ml most recent viral load Note: All percentages are proportion of total number of persons diagnosed with HIV infection in each category
N=655 N=786 N=649 N=537 N=258
Adult and adolescent males diagnosed with HIV infection,
by transmission category*, Georgia, 2011
MSM IDU MSM/IDU HET Other0
20
40
60
80
100
6167 67
75
5865
6067 71
65
46 44 42 45 4839 40 39
4858
Diagnosed Linked to care Engaged in careRetained in care Viral suppression
Perc
en
t
N=1386 N=36N=68 N=101 N=623
Adult and adolescent males >= age 13, diagnosed 01/01/11 - 12/31/11, Georgia = 2214Linked to care = CD4 or VL within 3 months of diagnosis Engaged in care >= 1 CD4 or VL 4-15 months after diagnosisRetained in care >= 2 CD4 or VL at least 3 months apart 4-15 months after diagnosisViral suppression (VS) = VL<200 copies/ml in most recent viral load *Multiple imputation was used to re-distribute transmission category where missingNote: All percentages are proportion of total number of persons diagnosed with HIV infection in each category
Adults and adolescent females diagnosed with HIV infection, by transmission category*,
Georgia, 2011
IDU HET Other0
102030405060708090
100
7571
50
74 71
5552 50
32
5450
42
Diagnosed Linked to care Engaged in care Retained in care Viral suppression
Perc
en
t
Adults and adolescent females >= age 13, diagnosed 01/01/11 - 12/31/11, Georgia = 655Linked to care = CD4 or VL within 3 months of diagnosis Engaged in care >= 1 CD4 or VL 4-15 months after diagnosisRetained in care >= 2 CD4 or VL at least 3 months apart 4-15 months after diagnosisViral suppression (VS) = VL<200 copies/ml in most recent viral load *Multiple imputation was used to re-distribute transmission category where missingNote: All percentages are proportion of total number of persons diagnosed with HIV infection in each category
N=81 N=411 N=163
The HIV Care Continuum can help…
• Focus our efforts for linkage, retention and viral suppression
• Identify groups at increased risk for dropping out of each step in the continuum
• Monitor our progress in improvement of linkage, retention, and viral suppression
• Identify disparities not only in prevalence but in care
• Evaluate efforts addressing specific populations with low viral suppression
• Monitor efforts in improving viral suppression in specific counties, census tracts, zip codes and facilities
• Encourage improvement in surveillance data completeness (race, sex, transmission category)
Limitations
• Incomplete reporting • Missing data for race/ethnicity, sex, and current
address • Lack of transmission category information• Multiple imputation use to redistribute risk when
missing• Definition of heterosexual transmission (sexual
contact with a known HIV infected partner or person with increased risk, i.e., MSM or IDU)
• Missing laboratory reports may lead to underestimation of engagement, retention and viral suppression
• Laboratory measures may be a poor proxy for engagement and retention in HIV care
Questions?
Contact information:Deepali Rane, MBBS, [email protected] Department of Public HealthHIV/AIDS Epidemiology ProgramSuite 14-4662 Peachtree St NWAtlanta GA 30303404-657-2600
For more information on HIV Surveillance, Georgia, visithttp://dph.georgia.gov/georgias-hivaids-epidemiology-surveillance-section
For information on HIV Prevention, Georgia visithttp://dph.georgia.gov/hiv-prevention-program