Chicago's HIV Epidemic, Continuum of Care and Targets to Reach

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Prevention and Care Framework and Priorities …

Prevention and Care Framework and Priorities
Epidemiology of HIV in the EMA
HIV continuum of care in the Chicago EMA – linkage to care, engaged in care and viral suppression
Reaching the NHAS goals

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  • 1. Chicago’s HIV Epidemic, Continuum of Care and Targets to ReachChicago Department of Public Health NHAS Goals CAHISC – Data Day Nanette Benbow Chicago Department of Public Health August 3, 2012 Rahm Emanuel Bechara Choucair, MD Mayor Commissioner
  • 2. Overview • Prevention and Care Framework and PrioritiesChicago Department of Public Health • Epidemiology of HIV in the EMA – Description of Those at Risk of HIV – Prevalence of HIV in high risk populations • Characteristics of People Aware of their status • Characteristics of those newly diagnosed • Characteristics of those unaware of their status • HIV continuum of care in the Chicago EMA – linkage to care, engaged in care and viral suppression • Reaching the NHAS goals Rahm Emanuel Bechara Choucair, MD Mayor Commissioner CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 08/2012
  • 3. National HIV/AIDS StrategyReduce new HIV infections– Lower the annual number of new infections by 25%– Reduce HIV transmission by 30%– Increase the percentage of people living with HIV who knowtheir serostatus from 79% to 90%Increase access to care and improve health outcomes for people living with HIV– Increase the proportion of newly diagnosed patients linked toclinical care from 65% to 85%– Increase the proportion of Ryan White HIV/AIDS Program clientswho are in continuous care from 73% to 80%– Increase the number of Ryan White clients with permanent housing from 82% to 86%Reduce HIV-related health disparities– Improve access to prevention and care for all Americans– Increase the proportion of HIV-diagnosed gay and bisexual men, Blacks and Latinos with undetectable viral load by 20% CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 08/2012
  • 4. CDC – High Impact Prevention: Maximizing Limited Resources for HIV Prevention • Proven HIV Prevention Interventions – HIV testing and linkage to care – Antiretroviral therapy – Access to condoms and sterile syringes – Prevention programs for people living with HIV and their partners – Prevention programs for people at high risk of HIV infection – Substance abuse treatment – Screening and treatment for other sexually transmitted infections – Pre-exposure prophylaxis PrEP for select populations
  • 5. Test and Treat – Treatment as Prevention CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 02/2012
  • 6. HRSA Continuum of EngagementNot in Care Fully engagedUnaware Aware of May be Entered HIV In and out Fully of HIV HIV receiving medical of HIV engaged status status other medical care but care or in HIV care but not dropped out infrequent medical HIV care user care Cheever. Clin Infect Dis 2007;44:1500-1502
  • 7. The Continuum of HIV Care – Gardner CascadeStacy M. Cohen, MPH, Michelle M. Van Handel, MPH, Bernard M. Branson, MD, Janet M. Blair, PhD, H. Irene Hall, PhD, Xiaohong Hu, MS, Linda J. Koenig, PhD, Jacek Skarbinski, MD,Angie Tracey, Jonathan Mermin, MD, Linda A. Valleroy, PhD. Vital Signs: HIV prevention through care and treatment—United States. MMWR 2011;60(47):1618–1623.
  • 8. Epidemiology of HIV in the EMAChicago Department of Public Health Rahm Emanuel Bechara Choucair, MD Mayor Commissioner
  • 9. HIV Prevalence and Awareness of HIV Infection, National HIV Behavioral Surveillance (NHBS), Chicago MSM IDU HET MSM 2008 2009 2010 2011 n=523 n=527 n=514 n=453HIV prevalence 17.4% 5.5% 1.2% 20.9%Unaware of 50% 48% 50% 24%infection CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 08/2012
  • 10. Unrecognized HIV Infection by Race, NHBS Chicago 2011 Total Unaware HIV + 2009 HIV + # # (%) (%)Black 46 16 35 66White 35 3 9 23Hispanic 14 4 27 50Total 95 23 24 50 CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 08/2012
  • 11. HIV Risk Behaviors, Past 12 months, NHBS Chicago MSM IDU HETUnprotected vaginal sex -- 71% 89%Unprotected anal sex 52% 24% 32%Shared syringes -- 24% --Shared injection equipment -- 51% --Tested for HIV infection in 12 64% 49% 33%mo prior to interviewParticipated in HIV 23% 18% 9%behavioral interventionAccess to Free Condoms 82% 75% 44% CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 08/2012
  • 12. People Living and Diagnosed with HIV and AIDS, Chicago, 1992-2010 CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 08/2012
  • 13. Changes in the HIV Epidemic,Chicago EMA, 2000-2010, as of 6/12 CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 08/2012
  • 14. HIV Infection Transmission Category Percent Distribution in Large Cities in the US, 2007 CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 07/2012
  • 15. People Living with HIV* in 2010 by Select Characteristic, Chicago EMA, as of 6/12*N = 27,533 CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 08/2012
  • 16. 2010 HIV Infection Diagnoses* in the EMA by Select Characteristic, as of 6/12*N = 1,402 CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 07/2012
  • 17. Subpopulations with the Largest Numbers ofNew HIV Infection Diagnoses, Chicago EMA, 2005 & 2010, as of 6/12
  • 18. Trends in Male HIV Infection Diagnoses by Race/Ethnicity, Chicago EMA, 2000-2010, as of 6/12 CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 08/2012
  • 19. Trends in HIV Infection Diagnoses by Mode of Transmission, Chicago EMA, 2000-2010, as of 6/12 CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 08/2012
  • 20. Trends in Female HIV Infection Diagnoses by Race/Ethnicity, Chicago EMA , 2000-2010, as of 6/12 CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 08/2012
  • 21. Trends in HIV Infection Diagnoses inMSM by Race/Ethnicity, Chicago EMA, 2000-2010, as of 6/12 CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 08/2012
  • 22. Trends in HIV Infection Diagnoses by Age, Chicago EMA, 2000-2010, as of 6/12 CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 08/2012
  • 23. Trends in HIV Infection Diagnoses in MSM by Age, Chicago EMA, 2000-2010, as of 6/12 CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 08/2012
  • 24. Trends in HIV Infection Diagnoses Among Black MSM by Age, Chicago EMA, 2000-2010, as of 6/12 CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 08/2012
  • 25. Current HIV Continuum of Care, Chicago EMA, 2010 as of 6/2012Test Link & Treat Prevent CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 08/2012
  • 26. Chicago Department of Public Health Testing Rahm Emanuel Bechara Choucair, MD Mayor Commissioner
  • 27. HIV-related Services among MSM Aware of HIV+ MSM who know their status (n=72) their Infection, Chicago 2011, NHBS Black (n =30) White (n =32) Hispanic (n =10) (%) (%) (%)Diagnosed in past 2 years 60 34 50At diagnosis – partner 57 38 33services offeredTested for STI, past year 65 72 90 67 84 70Vaccinated for Hep A/B CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 08/2012
  • 28. Ever Tested for HIV Before 1st Positive Result, Chicago, MMP 2011 Local Questions CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 08/2012
  • 29. Main Reason for Never Being Tested for HIV Before the 1st Positive Result, MMP 2011 Local Questions*missing responses excluded CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 08/2012
  • 30. A) Late TestersPeople who are diagnosed with HIV as wellas AIDS in the same calendar year.
  • 31. Percent Distribution by Select Characteristics in 2010, Chicago EMA, as of 6/12 Late Testers
  • 32. B) People Unaware of Status Using CDC 2009 Estimate of 18%
  • 33. Estimates of People Unaware of Their Status, Chicago EMA, 2010 Percent 2009 National # Unaware Distribution of Estimates of % Using National Estimated 2010 Prevalence Unaware Estimates UnawareMale 21,561 19% 5,058 82%Female 5,972 15% 1,079 18%Black 13,656 19% 3,287 57%White 7,701 15% 1,338 23%Hispanic 4,782 20% 1,173 20%MSM 15,651 21% 4,135 68%IDU-male 2,695 10% 299 5%IDU-female 1,763 9% 170 3%MSM/IDU 1,582 9% 158 3%HRHC-male 1,386 24% 447 7%HRHC-female 3,976 18% 849 14%Total 27,533 18% 6,085 100% CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 08/2012
  • 34. % Distribution of People Unaware and Unaware of Their Status by Select Characteristics, Chicago EMA, 6/12 Unaware CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 08/2012
  • 35. HIV Continuum of Care in the Chicago EMAChicago Department of Public Health Rahm Emanuel Bechara Choucair, MD Mayor Commissioner
  • 36. Chicago Department of Public Health Linkage to Care Rahm Emanuel Bechara Choucair, MD Mayor Commissioner
  • 37. Linkage - Percentage of HIV Diagnoses Linked to Care, Chicago EMA, 2010 CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 08/2012
  • 38. Percentage Linked to Care within 12 months of Diagnosis by SelectCharacteristics, Chicago EMA, 2009 CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 08/2012
  • 39. Main Reason for Selecting Care Location Chicago, MMP 2011 Local Questions*missing response excluded CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 08/2012
  • 40. Chicago Department of Public Health Access/Retention in Care Rahm Emanuel Bechara Choucair, MD Mayor Commissioner
  • 41. HIV Care among MSM Aware of their HIV+ MSM who know their status (n=72) Infection, Chicago 2011, NHBS Black (n =30 ) White (n = 32) Hispanic (n =10 ) (%) (%) (%)Seen doctor for HIV care 100 97 100Currently on ART 80 91 80 2008 43 83 79Know CD4 count 100 94 100Know Viral Load 97 91 80 CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 08/2012
  • 42. Retained in Care - Percentage of People in Care, Chicago EMA, 2009, as of 3/12 CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 08/2012
  • 43. Percentage of PLWHA in 2010 with UnmetNeed* by Select Characteristics, Chicago EMA, as of 8/11*No laboratory reports of a CD4, VL or indication of being on ART CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 08/2012
  • 44. First Entered Into Medical Care System for HIV, Chicago, MMP 2011 Local Questions # % Medical evaluation at the time of diagnosis 34 17 Appointment scheduled for medical evaluation at the time of diagnosis 44 22 Referral for doctor given 47 23 Self motivated 66 32 Family or friend motivated 6 3 Other 6 3 Total 204**missing response excluded CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 08/2012
  • 45. Providers Office Reminders Chicago, MMP 2011 Local Questions (for scheduled appointments)*missing responses excluded CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 08/2012
  • 46. Care Interrupted, Chicago, MMP 2011 Local Questions•19% (38/205) had their care interrupted for a period of morethan 6 months consecutively at least one time since beingdiagnosed •56% only once •44% two or more times•Reasons provided for most recent time: •Drinking or using drugs •Missed appointment(s) •Didn’t have enough money or health insurance •Had other responsibilities •Felt good •Dissatisfied with care from provider•60% said there were no attempts made by provider at themost recent occurrence to restart their care CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 08/2012
  • 47. Chicago Department of Public Health Prescription on ART and Viral Suppression Rahm Emanuel Bechara Choucair, MD Mayor Commissioner
  • 48. PLWHA in Care, Chicago MMP, 2009 Among those prescribed ART, most recent HIV viral load test indicating Prescription of ART† <=200 copies/mL† weighted % (95% CI) weighted % (95% CI) Age** 18-29 87 (71-100) 86 (67-100) 30-49 81 (74-88) 82 (73-90) 50+ 88 (81-94) 87 (81-92) Sex Male 89 (84-94) 85 (79-91) Female 69* (58-80) 79 (66-93) Race/Ethnicity Black or African American 81 (75-88) 80 (74-87) Hispanic or Latino 81 (68-95) 80 (65-95) White 92 (84-100) 100 (100-100) Other 100 (100-100) 43 (0-86) Sexual risk behavior^§ Men who have sex with men (MSM) 90 (85-96) 90 (84-95) Black MSM 89 (81-98) 86 (78-95) Hispanic MSM 89 (73-100) 83 (66-99) White MSM 92 (83-100) 100 (100-100) Young MSM (18-29) 92 (77-100) 87 (63-100) Men who have sex with women only (MSW) 84 (73-94) 71 (57-84) Women who have sex with men (WSM) 71* (59-82) 79 (66-93) Total 84 (80-89) 84 (78-90)*Significant p<.05 CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 08/2012
  • 49. Indicators of Care Among Ryan White Ambulatory Care Part A Clients*, Chicago EMA, July 2010-June 2011 NHAS Target: Increase % of RW clients engaged in care to 80%*N=11,220; Engaged in care= 2 CD4/VL at least 3 months apart CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 08/2012
  • 50. Current State and FutureChicago Department of Public Health Outcomes Rahm Emanuel Bechara Choucair, MD Mayor Commissioner
  • 51. 5-Year Chicago EMA Targets if NHAS Goals are Reached CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 08/2012
  • 52. For every 100 people estimated to beliving with HIV in the Chicago EMA….. CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 08/2012
  • 53. Conclusions• There has been considerable progress in getting people tested earlier, aware of their status and linked to care across all demographic and risk groups• The characteristics of those aware of the their status is not that different from those unaware, thus, similar targeting efforts can be used across the continuum – focus on reducing disparities• The percent of people on ART varies by demographic and risk groups and has increased among MSM participating in NHBS• Success in reaching NHAS goals in the EMA will require coordination and collaboration between public and private institutions/agencies providing prevention and care services CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 08/2012
  • 54. How To Connect With Us