Transcript of "Using HIV Incidence Surveillance Data to Examine Racial/Ethnic Disparities in HIV Testing Behaviors Among YMSM in Los Angeles County"
Using HIV Incidence Surveillance Data to Examine Racial/Ethnic Disparities in HIV Testing Behaviors Among YMSM in Los Angeles CountyS Nakelsky, V Hu, E Kahn, Z Sheng, L Taylor, T Bingham HIV Epidemiology Program Los Angeles County Department of Public Health
Overview• Background• Study population• Methods – Core HIV Surveillance System – HIV Incidence Surveillance System• Results – New HIV cases diagnosed – HIV testing behaviors and frequency by race/ethnicity – HIV incidence estimates for all MSM• Conclusions and recommendations
Background• CDC testing recommendations: – At least annual HIV testing for those at high risk• MSM in LAC are not adhering to guidelines: – Concurrent HIV and AIDS diagnoses (13%) – 24% diagnosed with AIDS within 6 months of HIV – 2008 NHBS-MSM2 data (mean= 12.1 months) – New indicator: testing and treatment history data collected for HIV Incidence Surveillance
Why young MSM?• The majority (~84%) of people diagnosed with HIV annually in LAC are MSM.• In 2008, MSM aged 13-29 years were the group most frequently diagnosed with HIV.• Identifying strategies to increase HIV diagnosis and to decrease transmission in YMSM will have a large impact on LAC’s epidemic.
Methods• Data were obtained from existing HIV surveillance systems• Eligibility for analysis: – 13-29 years of age – Diagnosed in 2008 – Resided in LAC at the time of diagnosis – Reported sex with males as a risk factor• Denominators for rates assumed 4% of males aged 13-29 years were MSM
Data Sources (1)• Enhanced HIV/AIDS Reporting System (EHARS) – Age – Race/ethnicity – Mode of transmission – HIV diagnosis date – Proportion of cases diagnosed with AIDS within 6 months of HIV diagnosis (late detection)
Data Sources (2)• HIV Incidence Surveillance – Uses statistical methods to estimate # of new infections among those who do and don’t test – Serologic Testing Algorithm for Recent HIV Seroconversion (STARHS) • Remnant sera of new HIV diagnoses tested with BED assay to estimate # of cases acquiring HIV in 12 months – HIV testing and treatment history • History of previous negative test results • Date of most recent negative test result • Time between last negative and first positive test
Results: Overview of YMSM in LAC, 2008• 563 MSM aged 13-29 years were newly diagnosed with HIV• Latinos represented the largest number of new diagnoses among YMSM• Rates of new HIV diagnoses: – 31 per 1,000 for Blacks – 10 per 1,000 for Whites – 9 per 1,000 for Latinos
Proportion of YMSM inLos Angeles County by Race, 2008 Total Population New HIV Diagnoses Black, Other Other, 9.0% 7.8% 12.0% BlackWhite, White 26.3%23.1% 21.0% Latino, 55.9% Latino 44.9%
Late Detection% diagnosed with AIDS within 6 months of HIV Diagnosis20%15% 18.3% 17.4% 15.3%10%5%0% Black (n=148) Latino (n=253) White (n=118)
STARHS Results by Race70% Recent60% 63% 63% Longterm50% 50% 50%40% 37% 37%30%20%10%0% Black (n=78) Latino (n=116) White (n=50)
First Time versus Repeat Testers by Race 100% 80% 60% 74% 87% 89% 40% Repeat Tester New Tester 20% 26% 13% 11% 0% Black (n=82) Latino White(n=64) (n=151)Latino vs. Black p=0.02; Latino vs. White p=0.01
Months between Last Negative and First Positive Test by Race 16Mean Number of Months 14 12 14 10 13 8 6 9 4 2 0 Black (n=70) Latino (n=106) White (n=56) White vs. Latino p=0.02; white vs. black p=0.04
Months since Last HIV Test by Race, YMSM enrolled in 2008 NHBS 15Mean Number of Months 13 11 9 12.8 12.6 10.8 7 5 3 1 Black Latino White
Estimated HIV Incidence Rates for all MSM in LAC, 2008 18 16 16 14 11 12 10 9Rate per 1,000 10 8 8 7 6 4 2 0 Black Latino 13-29 30-39 40-49 White Age Race 17
Summary• STARHS results indicate <50% of YMSM adhere to annual HIV testing recommendations• Frequency of HIV testing varies by race/eth. – Latino YMSM reported highest: • Average months between last negative and first positive • Proportion of new HIV diagnoses at first test – Black YMSM reported lower testing frequency compared with White YMSM• Black YMSM are disproportionately impacted – Findings observed in both surveillance systems 18
Limitations• Establishing HIS within LAC has proven challenging• HIS data for 2008 are marginally complete – Of the men diagnosed with non-AIDS HIV, 244 (51%) had a STARHS result available – 435 cases (71%) had some but not all testing history data elements available
Conclusions• HIS provides additional insight for monitoring HIV testing behaviors and rate of new infections• In LAC, all YMSM—but especially Blacks and Latinos—would benefit from increased HIV testing to detect new infections
Moving Forward• Future research should focus on identifying specific barriers (e.g., stigma, access, acceptable modes) to HIV testing among YMSM• Revised testing recommendations, social marketing campaigns, and other approaches must consider racial/ethnic differences in testing norms and HIV incidence rates to support more appropriate testing intervals
Thank You! For more information contact: Shoshanna NakelskyHIV Incidence Surveillance Coordinator email@example.com 213.351.8154 22
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