hiv care continuum new diagnoses, 2011, atlanta eligible metropolitan area (ema)
DESCRIPTION
HIV Care Continuum New Diagnoses, 2011, Atlanta Eligible Metropolitan Area (EMA). Persons with HIV Engaged in S elected S tages of the Continuum of Care, United States. 82. 66. Percent. 37. 33. 25. Hall et al . XIX International AIDS Conference, 2012 - PowerPoint PPT PresentationTRANSCRIPT
HIV Care Continuum New Diagnoses, 2011,
Atlanta Eligible Metropolitan Area (EMA)
Diagnosed
Linke
d to ca
re
Retained in
care
Prescribed ART
Viral S
uppression
0102030405060708090
100
Persons with HIV Engaged in Selected Stages of the Continuum of Care, United States
Perc
ent
82
66
37 3325
Hall et al. XIX International AIDS Conference, 2012ART, antiretroviral therapy
Care Continuum Methodology, New HIV Diagnoses, 2011, Atlanta EMA* • 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 in Atlanta Eligible Metropolitan Area (EMA),
current address in Georgia• Excludes 26 persons deceased within 15 months of diagnosis• Linked to care = CD4 or VL within 3 months of diagnosis , excluding
CD4 or VL drawn on day 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• Estimated percentage prescribed ART derived from MMP sample • Viral suppression (VS) = VL<200 copies/ml in most recent viral load• All percentages are percent of total number of persons diagnosed
with HIV
*EMA: Bartow, Paulding, Carroll, Coweta, Fayette, Spalding, Henry, Newton, Rockdale, Gwinnett, Walton, Barrow, Forsyth, Cherokee, Pickens, DeKalb, Fulton, Clayton, Cobb and Douglas counties.
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
HIV Care Continuum Methodology
HIV 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
HIV Care Continuum Methodology
HIV Confirmatory
Diagnosis Date
Months 0-3 after diagnosis
Months 4-15 after diagnosis
CD4 or Viral Load
This person is• Linked YES• Engaged YES• Retained NO• Virally suppressed YES
• “Engaged in care” is minimal engagement that indicates the person “touched” the medical system at least once during that 12 month period
Last viral load undetectableCD4 or Viral Load
HIV Care Continuum Methodology
HIV Confirmatory
Diagnosis Date
Months 0-3 after diagnosis
Months 4-15 after diagnosis
CD4 or Viral Load
This person is• Linked NO• Engaged YES• Retained YES• Virally suppressed NO
• If no viral load done, it is assumed to be not suppressed
CD4 done but no viral load done
Adults and adolescents diagnosed with HIV infection, Atlanta EMA, 2011
Diagnosed only0
102030405060708090
100 100
60 66
47 46DiagnosedLinked to careEngaged in careRetained in careViral suppression
Perc
ent
Adults and adolescents >= age 13, diagnosed 01/01/11 -12/31/11, Atlanta EMA = 1923Linked 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 = 788Note: all percentages are proportion of total number of persons diagnosed with HIV in categoryExcludes 26 cases deceased as of 03/31/13
Adults and adolescents diagnosed with HIV infection, by race, Atlanta EMA 2011
Black Hispanic/Latino White Other/unknown0
102030405060708090
100
5870 68
626471 73 68
44
58 5647
38
56 57 55
Diagnosed Linked to care Engaged in careRetained in care Viral suppression
Perc
ent
N=1,067 N=101 N=160 N=595
Adults and adolescents >= age 13, diagnosed 01/01/11 - 12/31/11, Atlanta EMA = 1923Linked 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 American Indian/Alaska Native, Asian, and Native Hawaiian/Other Pacific Islanders combined equal <2% of new diagnoses and are included in Other/Unknown
Adult and adolescent males diagnosed with HIV infection, by race, Atlanta EMA 2011
Black Hispanic/Latino White Other/unknown0
102030405060708090
100
54
71 67 626374 72 71
42
60 5751
34
56 57 58
Diagnosed Linked to care Engaged in careRetained in care Viral suppression
Perc
ent
N=828 N=80 N=138 N=493
Adult and adolescent males >= age 13, diagnosed 01/01/11 - 12/31/11, Atlanta EMA = 1539 Linked to care = CD4 or VL within 3 months of diagnosis Retained 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 American Indian/Alaska Native, Asian, and Native Hawaiian/Other Pacific Islanders combined equal <2% of new diagnoses and are included in Other/Unknown
Adult and adolescent females diagnosed with HIV infection, by race, Atlanta EMA
2011
Black Hispanic/Latino White Other/unknown0
102030405060708090
100
69 67 6856
7062
73
5552 52 50
31
5057 55
43
Diagnosed Linked to care Engaged in careRetained in care Viral suppression
Perc
ent
N=231 N=21 N=22 N=98
Adult and adolescent females >= age 13, diagnosed 01/01/11 - 12/31/11, Atlanta EMA = 372Linked to care = CD4 or VL within 3 months of diagnosis Retained 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 American Indian/Alaska Native, Asian, and Native Hawaiian/Other Pacific Islanders combined equal <2% of new diagnoses and are included in Other/Unknown
Adults and adolescents diagnosed with HIV infection, by age (years),
Atlanta EMA 2011Age at
diagnosis (years)
N LinkedN (%)
Engaged N (%)
Retained N (%)
Viral suppressio
nN (%)
13-24 420 211 50% 255 61% 155 37% 138 33%25-34 561 326 58% 367 65% 264 47% 239 43%
35-44 442 290 66% 307 69% 218 49% 233 53%45-54 345 232 67% 245 71% 190 55% 188 54%55+ 155 101 65% 103 66% 77 50% 83 54%
Adults and adolescents >= age 13, diagnosed 01/01/11 -12/31/11, Atlanta EMA = 1923Linked 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 percent of total number of persons diagnosed with HIV in categoryExcludes 26 cases deceased as of 03/31/13
Adults and adolescents diagnosed with HIV infection, by
age, Atlanta EMA, 2011
13-24 25-34 35-44 45-54 55+0
20406080
100
5058
66 67 6561 65 69 71 66
3747 49 55 50
3343
53 54 54
Diagnosed Linked to care Engaged in careRetained in care Viral suppression
Perc
ent
Adults and adolescents >= age 13, diagnosed 01/01/11 - 12/31011, Atlanta EMA = 1923Linked 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 percent of total number of persons diagnosed with HIV in category
N=420 N=561 N=442 N=345 N=155
Transmission category definitions
• Multiple imputation was used to re-distribute transmission category where missing
• MSM = Male to male sexual contact• IDU = Injection drug use• MSM/IDU = Male to male sexual contact and injection drug
use• HET = Heterosexual contact with a person known to have, or
to be at high risk for, HIV infection• Other = hemophilia, blood transfusion, perinatal exposure,
and risk factor not reported or not identified
Adult and adolescent males diagnosed with HIV infection, by transmission category*,
Atlanta EMA 2011Transmission
categoryN Linked
N (%)Engaged N (%)
Retained N (%)
Viral suppressio
nN (%)
MSM 961 544 57% 626 65% 435 45% 376 39%IDU 42 28 67% 27 64% 22 52% 18 43%MSM/IDU 25 16 64% 17 68% 11 44% 11 44%HET 58 40 69% 38 66% 28 48% 24 41%Other 453 281 62% 319 70% 233 51% 267 59%
Adult and adolescent males >= age 13, diagnosed 01/01/11 -12/31/11, Atlanta EMA = 1539Linked 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 missing*MSM = Male to male sexual contact IDU = Injection drug useMSM/IDU = Male to male sexual contact and injection drug useHET = Heterosexual contact with a person known to have, or to be at high risk for, HIV infectionOther = hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified
Adult and adolescent males diagnosed with HIV infection, by transmission category*, Atlanta
EMA, 2011
MSM IDU MSM/IDU HET Other0
20406080
100
5767 64 69
6265 64 68 6370
4552
44 47 5139 43 44 40
59
Diagnosed Linked to care Engaged in careRetained in care Viral suppression
Perc
ent
N=961 N=25N=42 N=58 N=453
Adult and adolescent males >= age 13, diagnosed 01/01/11 - 12/31/11, Atlanta EMA = 1539Linked 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 missing*MSM = Male to male sexual contact IDU = Injection drug useMSM/IDU = Male to male sexual contact and injection drug useHET = Heterosexual contact with a person known to have, or to be at high risk for, HIV infectionOther = hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified
Adult and adolescent females diagnosed with HIV infection, by transmission category*,
Atlanta EMA 2011
Transmission category
N LinkedN (%)
Engaged N (%)
Retained N (%)
Viral suppressio
nN (%)
IDU 48 35 73% 35 73% 26 54% 27 56%HET 232 159 69% 162 69% 122 53% 119 52%Other 92 50 54% 47 51% 24 26% 36 39%
Adult and adolescent females >= age 13, diagnosed 01/01/11 -12/31/11, Atlanta EMA = 372Linked 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 missing*IDU = Injection drug useHET = Heterosexual contact with a person known to have, or to be at high risk for, HIV infectionOther = hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified
Adults and adolescent females diagnosed with HIV infection, by transmission category*,
Atlanta EMA, 2011
IDU HET Other0
102030405060708090
100
73 69
54
73 69
5154 53
26
56 52
39
Diagnosed Linked to care Engaged in care Retained in care Viral suppression
Perc
ent
Adults and adolescent females >= age 13, diagnosed 01/01/11 - 12/31/11, Atlanta EMA = 372Linked 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 missing*IDU = Injection drug useHET = Heterosexual contact with a person known to have, or to be at high risk for, HIV infectionOther = hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified
N=48 N=232 N=92
Adult and adolescent Black MSM* diagnosed with HIV infection, by age
(years), Atlanta EMA 2011Age at
diagnosis (years)
N** LinkedN (%)
Engaged N (%)
Retained N (%)
Viral suppressio
nN (%)
13-24 254 113 44% 152 60% 87 34% 64 25%25-34 262 139 53% 164 63% 115 44% 92 35%35-44 110 70 64% 76 69% 52 47% 45 41%45-54 72 49 68% 50 69% 41 57% 35 49%55+ 27 15 56% 13 48% 9 33% 8 30%
Adults and adolescent males >= age 13, diagnosed 01/01/11 -12/31/11, Atlanta EMA = 725Linked 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 redistribute transmission category when missing*MSM = men who have sex with men**N = estimated number of persons in that category
Adult and adolescent Black MSM diagnosed with HIV infection, by age,
Atlanta EMA, 2011
13-24 25-34 35-44 45-54 55+0
20
40
60
80
100
4453
64 685660 63
69 69
4834
44 4757
3325
3541
49
30
Diagnosed Linked to care Engaged in careRetained in care Viral suppression
Perc
ent
N= 255 N= 267 N= 112 N= 74 N= 27
Adult and adolescent males >= age 13, diagnosed 01/01/11 - 12/31011, Atlanta EMA = 725Linked 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 in category
The HIV Care Continuum can help us…
• 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 some specific facilities• Encourage improvement in surveillance data completeness
(race, sex, transmission category)
Stage of HIV disease at diagnosis
• Stage at diagnosis is defined by the first CD4 done within 3 months of diagnosis
Stage 1 = CD4 >=500Stage 2 = CD4 200-499Stage 3 = CD4 <200 or OI
• Stage at diagnosis is unknown if no CD4 done within 3 months of diagnosis
Stage of disease by earliest CD4 count within 3 months of HIV diagnosis, adults and
adolescents, Atlanta EMA, 2011
Stage 1 CD4
>=500
Stage 2 CD4 200-
499
Stage 3 CD4 <200
Stage unknown
0
0.1
0.2
0.3
0.4
0.5
15%22% 19%
43%
Perc
ent
Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1923CD4<200 = Stage 3 disease (AIDS)Stage unknown = no CD4 within 3 months of diagnosisExcludes 26 cases deceased as of 03/31/13
N=292 N=426 N=364 N=841
Stage of disease by earliest CD4 count within 12 months of HIV diagnosis, adults
and adolescents, Atlanta EMA, 2011
Stage 1 CD4
>=500
Stage 2 CD4 200-
499
Stage 3 CD4 <200
Stage unknown
0
0.1
0.2
0.3
0.4
0.5
17%
27%22%
35%
Perc
ent
Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1923CD4<200 = Stage 3 disease (AIDS)Stage unknown = no CD4 within 12 months of diagnosisExcludes 26 cases deceased as of 03/31/13
N=332 N=511 N=416 N=664
Number and proportion of adults and adolescents by stage at diagnosis by earliest
CD4 count within 3 and 12 months after diagnosis, by age, Atlanta EMA, 2011
Age at diagnos
is (years)
N*Stage 1
CD4>500Stage 2
CD4 200-499Stage 3
CD4 <200Stage
Unknown CD4 Missing
3 mos.N (%)
12 mos.
N (%)
3 mos.N (%)
12 mos.
N (%)
3 mos.N (%)
12 mos.
N (%)
3 mos.N (%)
12 mos.N (%)
13-24 420 54 (13)
72 (17)
95 (23) 122 (29)
36 (9) 47 (11)
235 (56)
179 (43)
25-34 561 81 (14)
92 (16)
112 (20)
137 (24)
99 (18)
117 (21)
269 (48)
215 (38)
35-44 442 59 (13)
64 (14)
110 (25)
128 (29)
97 (22)
110 (25)
176 (40)
140 (32)
45-54 345 63 (18)
67 (19)
76 (22) 87 (25)
94 (27)
104 (30)
112 (32)
87 (25)
55+ 155 35 (23)
37 (24)
33 (21) 37 (24)
38 (25)
38 (25)
49 (32) 43 (28)Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1923CD4<200 = Stage 3 disease (AIDS)Stage Unknown = no CD4 within 3 or 12 months of diagnosisN = total number in this categoryExcludes 26 cases deceased as of 03/31/13
Stage of disease by earliest CD4 count within 3 months of HIV diagnosis, adults and
adolescents, by age (years), Atlanta EMA 2011
13-24 25-34 35-44 45-54 55+0
102030405060
13 14 13 18 2323 20 25 22 219
18 2229 25
5648
4032 32
Stage 1 CD4>=500Stage 2 CD4 200-499
Age at diagnosis (years)
Perc
ent
N= 420 N= 442N= 561 N= 345 N= 155
Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1923CD4<200 = Stage 3 disease (AIDS) Stage Unknown = no CD4 within 3 months of diagnosis
Stage of disease by earliest CD4 count within 12 months of HIV diagnosis, adults and
adolescents, by age (years), Atlanta EMA, 2011
13-24 25-34 35-44 45-54 55+0
102030405060
17 16 1419
2429
2429 25 24
1121 25
3025
4338
3225 28
Stage 1 CD4>=500 Stage 2 CD4 200-499Stage 3 CD4 <200 Stage Unknown
Age at diagnosis (years)
Perc
ent
N= 420 N= 561 N= 442 N= 345 N= 155
Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1923CD4<200 = Stage 3 disease (AIDS)Stage Unknown = no CD4 within 12 months of diagnosis
Number and proportion of adults and adolescents by stage at diagnosis by
earliest CD4 count within 3 and 12 months after diagnosis, by race/ethnicity, Atlanta
EMA, 2011Race/
Ethnicity
N**Stage 1
CD4>500Stage 2
CD4 200-499Stage 3
CD4 <200Stage
Unknown CD4 Missing
3 mos.N (%)
12 mos.
N (%)
3 mos.N (%)
12 mos.
N (%)
3 mos.N (%)
12 mos.N (%)
3 mos.N (%)
12 mos.
N (%)
Black, 1067
132 (12)
160 (15)
223 (21)
283 (27)
233 (22)
274 (26)
479 (45)
350 (33)
Hispanic/ Latino
101 12 (12) 13 (13) 26 (26) 30 (30) 32 (32) 33 (33) 31 (31) 25 (25)
White 160 31 (19) 33 (21) 39 (24) 49 (31) 36 (23) 40 (25) 54 (34) 38 (24)
Other*/ Unknown
595 117 (20)
126 (21)
138 (23)
149 (25)
63 (11) 69 (12) 277 (47)
251 (42)
Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1923CD4<200 = Stage 3 disease (AIDS)Stage Unknown = no CD4 within 3 or 12 months of diagnosis*American Indian/Alaska Native, Asian and Native Hawaiian/Pacific Islander groups together constitute <1% of adults diagnosed with HIV in Georgia, 2011 and are grouped with other/unknown race/ethnicity** N = total number in this categoryExcludes 26 cases deceased as of 03/31/13
Stage of disease by earliest CD4 count within 3 months of HIV diagnosis, adults and
adolescents, by race/ethnicity, Atlanta EMA 2011
Black Hispanic/Latino White Other*/Unknown
0
10
20
30
40
50
12 1219 2021
26 24 2322
3223
11
45
31 34
47
Stage 1 CD4 >500 Stage 2 CD4 200-499Stage 3 CD4 <200 Stage Unknown
Perc
ent
Adults >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1923CD4<200 = Stage 3 disease (AIDS)Stage Unknown = no CD4 within 3 months of diagnosis*American Indian/Alaska Native, Asian and Native Hawaiian/Pacific Islander groups together constitute <1% of adults diagnosed with HIV in Georgia, 2010 and are grouped with Unknown race/ethnicity
N=1067 N=101 N=160 N=595
Stage of disease by earliest CD4 count within 12 months of HIV diagnosis, adults and
adolescents, by race/ethnicity, Atlanta EMA, 2011
Black Hispanic/Latino White Other*/Unknown
0102030405060
15 1321 21
27 30 312526
3325
12
3325 24
42
Stage 1 CD4 >500 Stage 2 CD4 200-499Stage 3 CD4 <200 Stage Unknown
Perc
ent
N=1067 N=101 N=1610 N=595
Adults >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1923CD4<200 = Stage 3 disease (AIDS)Stage Unknown = no CD4 within 12 months of diagnosis*American Indian/Alaska Native, Asian and Native Hawaiian/Pacific Islander groups together constitute <1% of adults diagnosed with HIV in Georgia, 2010 and are grouped with other/unknown race/ethnicity
Number and proportion of adults and adolescents by stage at diagnosis by earliest
CD4 count within 3 and 12 months after diagnosis, by sex, Atlanta EMA, 2011
Sex N*Stage 1
CD4>500Stage 2
CD4 200-499Stage 3
CD4 <200Stage
Unknown CD4 Missing
3 mos.N (%)
12 mos.
N (%)
3 mos.N (%)
12 mos.N (%)
3 mos.N (%)
12 mos.
N (%)
3 mos.N (%)
12 mos.
N (%)Male 1539 241 (16) 275
(18)320 (21)
394 (25)
272 (18)
317 (21)
696 (45) 553 (36)
Female
372 50 (13) 56 (15) 95 (26) 116 (31)
88 (24) 95 (26) 139 (37) 105 (28)
Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA - 1911CD4<200 = Stage 3 disease (AIDS)Stage Unknown = no CD4 within 3 or 12 months of diagnosis*N = total number in this categoryExcludes 12 cases for which sex was not reportedExcludes 26 cases deceased as of 03/31/13
Stage of disease by earliest CD4 count within 3 months of HIV diagnosis, adults and adolescents, by sex, Atlanta EMA,
2011
Male Female0
102030405060
16 1321
2618
24
4537
Stage 1 CD4 >500 Stage 2 CD4 200-499Stage 3 CD4 <200 Stage Unknown
Perc
ent
Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1911CD4<200 = Stage 3 disease (AIDS)Stage Unknown = no CD4 within 3 months of diagnosisExcludes 12 cases for which sex was not reported
N=1539 N=372
Stage of disease by earliest CD4 count within 12 months of HIV diagnosis, adults
and adolescents, by sex, Atlanta EMA, 2011
Male Female0
102030405060
18 1525
3121
2636
28
Stage 1 CD4 >500 Stage 2 CD4 200-499Stage 3 CD4 <200 Stage Unknown
Perc
ent
1539 N=372
Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1911CD4<200 = Stage 3 disease (AIDS)Stage Unknown = no CD4 within 12 months of diagnosisExcludes 12 cases for which sex was not reported
Number and proportion of adult and adolescent males by stage at diagnosis by earliest CD4 count within 3 and 12
months after diagnosis, by transmission category*, Atlanta EMA, 2011
Trans-mission categor
y
N**Stage 1
CD4>500Stage 2
CD4 200-499
Stage 3CD4 <200
Stage Unknown
CD4 Missing3 mos.N (%)
12 mos.N (%)
3 mos.N (%)
12 mos.
N (%)
3 mos.N (%)
12 mos.
N (%)
3 mos.N (%)
12 mos.
N (%)
MSM 961 127 (13)
153 (16) 206 (21)
259 (27)
184 (19)
223 (23)
444 (46)
327 (34)
IDU 42 5 (12) 5 (12) 6 (14) 8 (19) 19 (45)
20 (48) 12 (29) 9 (21)
MSM/IDU 25 4 (16) 5 (20) 5 (20) 5 (20) 6 (24) 6 (24) 11 (44) 9 (36)
HET 58 7 (12) 8 (14) 10 (17)
11 (19)
24 (41)
25 (43) 18 (31) 14 (24)
Other 453 98 (22)
105 (23) 103 (23)
111 (25)
40 (9) 43 (9) 212 (47)
194 (43)
Adult and adolescent males >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1539CD4<200 = Stage 3 disease (AIDS) Stage Unknown = no CD4 within 3 or 12 months of diagnosisMultiple imputation was used to re-distribute transmission category where missing*MSM = Male to male sexual contact IDU = Injection drug useMSM/IDU = Male to male sexual contact and injection drug useHET = Heterosexual contact with a person known to have, or to be at high risk for, HIV infectionOther = hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified**N = total number in this category
Stage of disease by earliest CD4 count within 3 months of HIV diagnosis, adult and adolescent males, by transmission category*, Atlanta EMA,
2011
MSM IDU MSM/IDU HET Other 0
10
20
30
40
50
13 1216
12
222114
20 1723
19
45
20
41
9
46
29
44
31
47
CD4 >500 CD4 200-499 CD4 <200 Stage Unknown
Perc
ent
N=58 N=453
Adult and adolescent males >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1539CD4<200 = Stage 3 disease (AIDS) Stage Unknown = no CD4 within 3 months of diagnosisMultiple imputation was used to re-distribute transmission category where missing*MSM = Male to male sexual contact IDU = Injection drug useMSM/IDU = Male to male sexual contact and injection drug useHET = Heterosexual contact with a person known to have, or to be at high risk for, HIV infectionOther = hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified
N=961 N=42 N=25
Stage of disease by earliest CD4 count within 12 months of HIV diagnosis, adult and adolescent males, by transmission category*, Atlanta EMA,
2011
MSM IDU MSM/IDU HET Other 0102030405060
16 1220
142327
19 20 192523
48
24
43
9
34
21
36
24
43
CD4 >500 CD4 200-499 CD4 <200 Stage Unknown
Perc
ent
N=961 N=42 N=25 N=58 N=453
Adult and adolescent males >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1539CD4<200 = Stage 3 disease (AIDS) Stage Unknown = no CD4 within12 months of diagnosisMultiple imputation was used to re-distribute transmission category where missing*MSM = Male to male sexual contact IDU = Injection drug useMSM/IDU = Male to male sexual contact and injection drug useHET = Heterosexual contact with a person known to have, or to be at high risk for, HIV infectionOther = hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified
Number and proportion of adult and adolescent females by stage at diagnosis by earliest CD4 count within 3 and 12 months after diagnosis, by transmission category*, Atlanta EMA, 2011
Trans-mission categor
y
N**Stage 1
CD4>500Stage 2
CD4 200-499Stage 3
CD4 <200Stage
UnknownCD4 Missing
3 mos.N (%)
12 mos.
N (%)
3 mos.N (%)
12 mos.
N (%)
3 mos.N (%)
12 mos.N (%)
3 mos.N (%)
12 mos.
N (%)
HET 232 29 (13) 34 (15) 60 (26) 77 (33) 63 (27) 70 (30) 80 (34) 52 (22)
IDU 48 6 (13) 8 (17) 12 (25) 15 (31) 15 (31) 15 (31) 15 (31) 11 (23)
Other 92 15 (16) 15 (16) 23 (25) 25 (27) 10 (11) 10 (11) 44 (48) 42 (46)Adults and adolescent females >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA =372 CD4<200 = Stage 3 disease (AIDS) Stage Unknown = no CD4 within 3 or 12 months of diagnosisMultiple imputation was used to re-distribute transmission category where missing*HET = Heterosexual contact with a person known to have, or to be at high risk for, HIV infectionIDU = Injection drug useOther = hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified** N = total number in this category
Stage of disease by earliest CD4 count within 3 months of HIV diagnosis, adult and adolescent
females, by transmission category*, Atlanta EMA, 2011
HET IDU Other0
102030405060
13 13 1626 25 2527 31
11
34 31
48
CD4 >=500 CD4 200-499 CD4 <200 Stage Unknown
Perc
ent
Adult and adolescent females >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 372CD4<200 = Stage 3 disease (AIDS) Stage Unknown = no CD4 within 3 months of diagnosisMultiple imputation was used to re-distribute transmission category where missing*HET = Heterosexual contact with a person known to have, or to be at high risk for, HIV infectionIDU = Injection drug useOther = hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified
N=232 N=48 N=92
Stage of disease by earliest CD4 count within 12 months of HIV diagnosis, adult and adolescent females,
by transmission category*, Atlanta EMA, 2011
HET IDU Other0
10
20
30
40
50
15 17 16
33 312730 31
11
22 23
46
CD4 >=500 CD4 200-499 CD4 <200 Stage Unknown
Perc
ent
N=232 N=48 N=92
Adult and adolescent females >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 372CD4<200 = Stage 3 disease (AIDS) Stage Unknown = no CD4 within 12 months of diagnosisMultiple imputation was used to re-distribute transmission category where missing*HET = Heterosexual contact with a person known to have, or to be at high risk for, HIV infectionIDU = Injection drug useOther = hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified
Limitations• Incomplete reporting • Missing data for race/ethnicity, sex, and complete
address at diagnosis• Lack of transmission category information• Estimation using multiple imputation 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• CD4 within 3 and 12 months of diagnosis yields
high unknown stage in Atlanta EMA
Uncertainties• Populations for which data are missing
may be fundamentally different• How to obtain data for transgender
category• How to improve completeness of reporting• Data on ART use• Understanding barriers to ART adherence• Prioritizing further research
Viral suppression on most recent viral load, by stage of disease by earliest CD4 within 12
months of HIV diagnosis, adults and adolescents, Atlanta EMA, 2011
Stage 1 CD4
>=500
Stage 2 CD4 200-
499
Stage 3 CD4 <200
Stage unknown
00.10.20.30.40.50.60.7
50% 54%63%
26%
Perc
ent
Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1923CD4<200 = Stage 3 disease (AIDS)Stage unknown = no CD4 within 3 months of diagnosis
N=332 N=511 N=416 N=664
For information on HIV prevention visithttp://dph.georgia.gov/hiv-prevention-program
For more information on HIV surveillance in Georgia, visithttp://dph.georgia.gov/georgias-hivaids-epidemiology-surveillance-section