Evaluating the National HIV/AIDS Strategy with Surveillance Data H. Irene Hall, PhD, FACE Chief, HIV Incidence and Case Surveillance Branch 2011 National HIV Prevention Conference August 15, 2011 National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of HIV/AIDS Prevention
Outline Outcome measures of the National HIV/AIDS Strategy Surveillance data collection Preliminary data Conclusion
National HIV/AIDS Strategy Reducing New HIV Infections Increasing Access to Care and Improving Health Outcomes for People Living with HIV Reducing HIV-Related Health Disparities
Reducing New HIV Infections Lower the annual number of new infections by 25 percent Reduce the HIV transmission rate, which is a measure of annual transmissions in relation to the number of people living with HIV, by 30 percent Increase from 79 percent to 90 percent the percentage of people living with HIV who know their serostatus
Increasing Access to Care and Improving Health Increase the proportion of newly diagnosed patients linked to clinical care within three months of their HIV diagnosis from 65 percent to 85 percent Increase the proportion of Ryan White HIV/AIDS Program clients who are in continuous care (at least 2 visits for routine HIV medical care in 12 months at least 3 months apart) from 73 percent to 80 percent A benchmark for surveillance?
Reducing HIV-Related Health Disparities Increase the proportion of HIV diagnosed gay and bisexual men with undetectable viral load by 20 percent Increase the proportion of HIV diagnosed Blacks with undetectable viral load by 20 percent Increase the proportion of HIV diagnosed Latinos with undetectable viral load by 20 percent
HIV Surveillance Measures of HIV morbidity and mortalityHIV Infection HIV diagnosis (1st positive confidential test) 1st CD4 Count 1st Viral Load Test 1st CD4 Count <200 1st Drug (IMM-AIDS) Resistance test AIDS-OI Death Entry to care Retention in care and viral suppression
HIV Case Surveillance Information Flow People with HIVSources of Reports Local Health Dept Dissemination HIV Local BulletinsHospital Practitioners Report CDC Semiannual ReportPrivate Practitioners HIV Web Sites 2001Public Clinics Region X Public Information Data SetLaboratories Surveillance Slide Set Active Case Finding State Health Dept CDC 7,738 74,353
National HIV SurveillanceData Year2008: confidential, name-based HIV reporting in allstates2011: all states included inestimates of HIV diagnoses
National HIV Incidence Surveillance WA CHI MA NYS CT MI NYCSF CO IN NJPhil CA VA DC NC LA AZ SC Cty MS AL TX LA FL HOU
Areas with Laws and Regulations forReporting all CD4 and Viral Load Values VT NH MA RI CT NJ DE MD DC Laboratory reporting (laws and regulations) Not all values All values, specified All values, not specified Puerto Rico Virgin Islands, U.S.
National HIV/AIDS Strategy Implementation Plan VA, CMS, HRSA, CDC, SAMHSA and NIH will jointly consider and issue a report of strategies to encourage providers to collect and report standardized viral load and CD4 data from infected individuals within populations at greatest risk for HIV infection. CDC will identify which States and localities collect CD4 and viral load data HRSA and CDC will convene a consultation with clinical providers and community-based organizations to develop recommendations for gathering and reporting necessary data to calculate community viral load CDC, in consultation with States, will provide technical assistance to localities, particularly those with a heavy disease burden, to collect necessary data to calculate community viral load
National HIV/AIDS Strategy Implementation Plan CDC will release a report on suggestions for border states to help improve HIV surveillance and prevention interventions among migrant communities CDC will provide State health departments with greater concentrations of AAPI or AI/AN populations with recommendations on effective HIV surveillance activities for these small populations HHS OS will coordinate among HHS agencies to mine existing databases to explore associations between HIV infection and social determinants of health
HIV Incidence 2006-2009, United States60,00050,000 56,000 (49,100-69,200)40,000 48,600 47,800 48,100 (42,400-54,700) (41,800-53,800) (42,200-54,000)30,00020,00010,000 0 2006 2007 2008 2009 Prejean (2011) Estimated HIV Incidence in the United States, 2006–2009. PLoS ONE 6(8): e17502. doi:10.1371/journal.pone.0017502
Estimated AIDS Diagnoses, Deaths, Persons Living with an AIDSDiagnosis and Persons Living with HIV Infection (Diagnosed and Undiagnosed) Among Adults and Adolescents – United States, 1981 - 2008 80 1,200 AIDS Diagnoses 1,100 70 Deaths 1,000 No. of Diagnoses and Deaths Living with an AIDS Diagnosis 60 900 Living with HIV infection 800 50 (thousands) (thousands) Prevalence 700 40 600 500 30 400 20 300 200 10 100 0 0 1984 1988 1993 2002 1981 1982 1983 1985 1986 1987 1989 1990 1991 1992 1994 1995 1996 1997 1998 1999 2000 2001 2003 2004 2005 2006 2007 2008 Year MMWR 2011;60:689-693.
Annual Transmission Rates per 100 Persons Living with HIV, 1977–2006Holtgrave . Updated Annual HIV Transmission Rates in the United States, 1978-2006. JAIDS 2009;50(2):236-38.
Estimated Number of Adults and Adolescents Living with HIVInfection (Diagnosed and Undiagnosed) and Percent Undiagnosed – United States, 1985 - 2008 1,200,000 No. living with undiagnosed HIV infection 100.0 No. living with diagnosed HIV infection Percent undiagnosed 1,000,000 80.0 800,000 60.0 Number Percent 600,000 40.0 400,000 20.0 200,000 0 0.0 2002 2003 2004 2005 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2006 2007 2008 Year
Linkage to Care and Continuous Care Data from 13 areas with mandatory laboratory reporting of HIV-related tests and reporting to national HIV surveillance 82% of persons diagnosed in 2009 linked to care within 3 months -- NHAS 85 percent Poster No. 083M. Mahle et al. Using HIV Surveillance-based Indicators to Monitor the National HIV/AIDS Strategy, 13 U.S. Jurisdictions Persons living with HIV in 2009 in continuous care – NHAS 80% Track B Session B04 . Hall et al. Retention in Care of HIV-Infected Adults and Adolescents in 13 U.S. Areas
Reducing HIV-Related Health Disparities Data from 13 areas with mandatory laboratory reporting of HIV- related tests and reporting to national HIV surveillance Persons living with HIV in 2009 Viral suppression (≤400 copies/mL) among those in care, vs. NHAS undetectable viral load 77% among MSM 65% among blacks/African Americans 74% among Hispanics/Latinos • vs. 81% among whites NHAS – increase by 20 percent Poster No. 083M. Mahle et al. Using HIV Surveillance-based Indicators to Monitor the National HIV/AIDS Strategy, 13 U.S. Jurisdictions
Conclusion Of 9 outcome measures in the National HIV/AIDS Strategy, 8 can be measured with surveillance data However, there is a need to Support and strengthen HIV … surveillance activities: There is a need to support existing surveillance methods to identify populations at greatest risk that need to be targeted for HIV prevention services.
Thank youThe findings and conclusions in this report are those of the authors and do not necessarily represent the official position o fthe Centers for Disease Control and Prevention. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of HIV/AIDS Prevention