• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
E:\uncovering the effect of co morbidities on the houston syphilis outbreak and the hiv epidemic through epidemiological analysis and data mapping-final
 

E:\uncovering the effect of co morbidities on the houston syphilis outbreak and the hiv epidemic through epidemiological analysis and data mapping-final

on

  • 781 views

 

Statistics

Views

Total Views
781
Views on SlideShare
781
Embed Views
0

Actions

Likes
0
Downloads
2
Comments
0

0 Embeds 0

No embeds

Accessibility

Upload Details

Uploaded via as Adobe PDF

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    E:\uncovering the effect of co morbidities on the houston syphilis outbreak and the hiv epidemic through epidemiological analysis and data mapping-final E:\uncovering the effect of co morbidities on the houston syphilis outbreak and the hiv epidemic through epidemiological analysis and data mapping-final Presentation Transcript

    • Uncovering the Effect of Co-morbidities on the Houston Syphilis Outbreak and the HIV Epidemic through Epidemiological Analysis and Data Mapping 17th Texas HIV/STD Conference Biru Yang; Hickmon Friday; Riju Stephen; Amanda Kubala; Lupita Thornton; Michael Thomas; M. Aaron Sayegh Deborah Banerjee HIV/STD Surveillance Program Community Health Statistics Program Bureau of HIV/STD & Viral Hepatitis Prevention
    • Collaboration Epidemiologist/Biostatistician Sr. Health Planner/STD Data Manager HIV/STD Surveillance Program STD Prevention Program Bureau of Epidemiology Bureau of HIV/STD & Viral Hepatitis Office of Surveillance and PHP Division Disease Prevention & Control Division GIS Analyst Community Health Statistics Program Office of Surveillance and PHP Division
    • Houstonians living with HIV/AIDS significantly contributed to and were affected by the 2007/2008 Syphilis Outbreak.
    • Outline • Collaboration • Study Objectives • Epidemiological Trend • Houston Syphilis Outbreak • Data matching • Data mapping • Conclusions • Limitations • Future Directions • Questions?
    • Biological Significance of Syphilis and HIV Co-morbidity The deadly duo • Co-morbid STDs increase susceptibility of acquiring and transmitting HIV 2 to 5 fold • Relapse of syphilis infection is more likely in the HIV-positive patient [Journal of the American Osteopathic Association, 2004 Nusbaum,M.R et al. ] [Lancet Infect.Dis., 2004, Lynn,W.A et al. ]
    • Public Health Significance of Syphilis and HIV Co-morbidity Timing of Diagnoses Among the People with Co-Morbidity Same Time 38% Syphilis Diagnosis • 62% still had First 14% unprotected sex HIV Diagnosis 3 months after their First 48% HIV or Syphilis diagnoses.
    • Objectives 1. To evaluate the effect of co-morbidities on the 2007-2008 Houston Syphilis Outbreak using epidemiological analysis 2. To emphasize the utility of spatial data analysis to public health events
    • Epidemiological Trend
    • Data Sources • HIV/AIDS data stored in the HIV/AIDS Reporting System (eHARS) • All STD data maintained in the Sexually Transmitted Disease Management Information System (STD*MIS)
    • HIV Cases by Diagnosis Year in Houston/Harris Co., TX 1999-2007 1600 1400 1433 1444 1423 1417 1200 1206 Number of Cases 1193 1159 1145 1147 1000 800 600 400 200 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 HIV Diagnosis Year
    • Trend of New HIV Diagnosis and HIV-Syphilis Co-Morbidity (n=11,567) in Houston/Harris Co., TX 1999-2007 1600 4% 4% 3% 5% 1400 5% 6% 6% 7% 8% 1200 Number of Cases 1000 HIV and Syphilis 800 HIV Only 600 400 200 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 HIV Diagnosis Year
    • Primary, Secondary and Early Latent Syphilis Cases by Diagnosis Year in Houston/Harris Co., TX 1999-2007 900 800 700 Number of Syphilis Cases Early Latent Syphilis 600 Secondary Syphilis Primary Syphilis 500 400 300 200 100 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 Syphilis Diagnosis Year
    • Trend of New Syphilis Diagnosis and HIV-Syphilis Co-Morbidity (n=3,490) in Houston/Harris Co., TX 1999-2007 900 24% 800 700 600 26% Number of Cases 500 HIV and Syphilis 30% 22% 400 22% Syphilis Only 6% 300 23% 9% 8% 200 100 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 Syphilis Diagnosis Year
    • Houston Syphilis Outbreak
    • 2007-2008 Houston Syphilis Outbreak • Outbreak: Number of cases exceed the expected number based on outbreak thresholds • Multiple outbreak thresholds • Exceeded outbreak threshold in June 2007
    • 2007-2008 Houston Syphilis Outbreak P & S Syphilis Thresholds: City-wide Race Total White Afr. Am. Hispanic Other Unk Mean # of cases/month (36 months) 24.5 6.8 12.4 5.1 0.2 0.1 Standard Deviation (36 months) 8.1 2.6 7.3 2.3 0.4 0.2 Warning Level (Mean + 1 SD) 32.6 9.5 19.7 7.4 0.6 0.3 Rapid Response Level (Mean + 2 SD) 40.6 12.1 26.9 9.8 1.0 0.5 Most Mar-07 30 9 15 6 0 0 Recent Apr-07 33 7 20 5 0 1 Data May-07 40 8 24 7 1 0 Jun-07 55 7 36 11 1 0 Possible Mar-07 Problem Apr-07 Warning Warning single Areas May-07 Warning Warning single Jun-07 RR! RR! RR! single
    • Number of Cases 0 10 20 30 40 50 60 May-04 Jun-04 Jul-04 Aug-04 Sep-04 Oct-04 Nov-04 Dec-04 * 2007 includes cases diagnosed and entered into STD*MIS through July 23rd Jan-05 Feb-05 Mar-05 Apr-05 May-05 Jun-05 Jul-05 Aug-05 Sep-05 Oct-05 Nov-05 Dec-05 Jan-06 Feb-06 Mar-06 Houston/Harris Co. Apr-06 Month of Diagnosis May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06 Total P&S Cases in the Past Three Years Nov-06 Dec-06 Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07
    • Number of Cases 0 5 10 15 20 25 May-04 30 Jun-04 Jul-04 Aug-04 Sep-04 Oct-04 into STD*MIS through July 23rd Nov-04 Dec-04 Jan-05 Feb-05 Mar-05 * 2007 includes cases diagnosed and entered Apr-05 May-05 Jun-05 Jul-05 Aug-05 Sep-05 Oct-05 Nov-05 Dec-05 Jan-06 Feb-06 Mar-06 Apr-06 Month of Diagnosis May-06 Years, Houston/Harris Co. Jun-06 Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Total P&S Cases Among MSM in the Past Three Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07
    • Houston Syphilis Outbreak Response Plan • Enhanced surveillance – Weekly analysis of early Syphilis cases – Geographic mapping of cases by screening sites or by risk factors • Disease investigation and follow-up activities – Syphilis interviews and partner elicitation/notification • Outreach screening and education efforts – Increased Syphilis testing or referral for testing in high-risk individuals – Increased education/information about Syphilis for targeted populations • Community involvement – Mobile unit screenings in collaboration with community partners • Improved diagnostic and treatment methods – Expanded Syphilis Prophylaxis Treatment Protocol – Provider visit surveys
    • Houston Syphilis Outbreak Response Plan Participants • Bureau chief of • Field operations (DIS) HIV/STD prevention • Mobile clinic staff • STD program • Syphilis Elimination manager Advisory Committee • Surveillance • Community-based • Syphilis elimination organizations coordinator • Community leaders • Public health advisor- special projects coordinator
    • Syphilis Outbreak Response Effort • Expanded prophylaxis treatment protocol • Targeted activities for enhanced surveillance • CBO’s and community mobilization • Syphilis rapid response mobile STD clinic
    • Disease Burden • Houston ranks 2nd in the nation • 53% of early cases were detected in the P&S stages in 2007 • P&S Syphilis increased by 28% in January through June of 2007 compared to the same period in 2006 • Approximately 1/3 of Houstonians with new Syphilis infections in 2007 were also HIV positive
    • Population & Geographic Areas • MSM between 20-39 years old • Individuals who engage in anonymous sex • Individuals who exchange sex for drugs or money
    • Geographic Areas of Interest Area A Area B Area C
    • Data Matching
    • Matching Software: Link King • Free software • Browser-based • SAS application but no SAS experience is needed • Allow manual review • Random sample validation http://www.the-link-king.com/
    • Inclusion Criteria HARS • 13 years and older at HIV diagnosis • Houston/Harris county residents STD-MIS • Primary and Secondary Syphilis • Diagnosed in 2007 and 2008 • 13 years and older at Syphilis diagnosis • Houston/Harris county residents
    • Matching Results in Houston/Harris Co., TX 35,995 records 833 records (eHARS) (STD*MIS) 1983-2010 2007-2008 263 linkages Among 833 Syphilis cases, 246 (30%) had an HIV diagnosis before or during the Syphilis Outbreak
    • Demographics of People with HIV-Syphilis Co-Morbidities (n=246) in Houston/Harris Co., TX 2007-2008 By Sex By Age Group Female 30-39 5% 30% 20-29 50% Male 95% 40-49 11% 13-19 7% 50+ • Most of the HIV-Syphilis co-morbidity were in young men between 20-39 years old
    • Demographics of People with HIV-Syphilis Co-Morbidities (n=246) in Houston/Harris Co., TX 2007-2008 By Race/Ethnicity • African Americans Hispanic 22% accounted for 54% of the co-morbidity Black 54% White 22% Other 2%
    • Risk Factors of People with HIV-Syphilis Co-Morbidities (n=246) in Houston/Harris Co., TX 2007-2008 By Risk Group IDU MSM/IDU 4% 3% Heterosex 9% Risk Not Identified 4% • MSM accounted MSM 80% for 80% of the co-morbidity
    • Data Mapping
    • Average Rates of HIV by Zip Codes (1999-2008) Area A Area B Area C
    • Average Rates of Syphilis by Zip Codes (1999-2008) Area A Area B Area C
    • Comparison: Average Rates of HIV and Syphilis by Zip Codes (1999-2008) Area A Area A Area B Area B Area C Area C HIV Syphilis
    • Spatial Distribution of Syphilis Cases in Houston/Harris Co., TX 2001-2005 2001 2002 2003 2005 2004
    • Spatial Distribution of Syphilis Cases in Houston/Harris Co., TX 2006 Male Female
    • Spatial Distribution of Syphilis cases (n=833) in Houston/Harris Co., TX 2007-2008
    • Spatial Distribution of HIV-Syphilis Co-morbid cases (n=246) in Houston/Harris Co., TX 2007-2008
    • Education
    • Linguistic Isolation
    • Poverty
    • Location of Facilities/Providers where Syphilis Diagnoses occurred Area A Area B Area C
    • Mobile clinic visits vs. HIV cases in Houston/Harris Co., TX 2007 Area A Area B Area C 0 -5 6 - 15 16 - 27 28 - 40 41 - 95 Height= Mobile clinic outreach frequency
    • Mobile clinic visits vs. HIV cases in Houston/Harris Co., TX 2008 Area A Area B Area C 0 -5 6 - 15 16 - 27 28 - 40 41 - 95 Height= Mobile clinic outreach frequency
    • Conclusions • Most of the HIV+ individuals who contracted Syphilis during the Outbreak were – African American – Aged 20-39 at HIV diagnosis – MSM – Living in the same area where the Syphilis outbreak occurred
    • Conclusions • Houston Syphilis Outbreak Response Plan outlines coordinated efforts between the health department and community partners to reduce the outbreak episodes • Data mapping helped the Outbreak Response target activities for enhanced surveillance and continued follow-up
    • Take Home Message Houstonians living with HIV/AIDS significantly contributed to and were affected by the 2007/2008 Syphilis Outbreak.
    • Limitations • Incomplete addresses • Only included one syphilis diagnosis • Limited behavior information
    • Future Directions • Collaborations • Investigate the syphilis re-infection rate among HIV+ • Design better intervention strategies to focus at HIV+ individuals • Evaluate the effect of education, linguistic isolation and poverty on Co-morbidities
    • Acknowledgements The HDHHS HIV/STD Surveillance Program The HDHHS HIV/STD Prevention Program The Community Health Statistics Program Bureau of Epidemiology Adelowale Awosika-Olumo, Bureau Chief Bureau of HIV/STD & Viral Hepatitis Prevention Marlene McNeese-Ward, Bureau Chief Sources of Support: This study was supported by Cooperative Agreements. Its contents are solely the responsibility of the authors and do not represent the official views of the funding agencies
    • References • [Journal of the American Osteopathic Association, 2004 Nusbaum,M.R. ; Wallace,R.R.; Slatt,L.M.; Kondrad,E.C. Sexually transmitted infections and increased risk of co- infection with human immunodeficiency virus] • [Lancet Infect.Dis., 2004, Lynn,W.A.; Lightman,S. Syphilis and HIV: a dangerous combination]
    • Thank you!! Biru Yang, PhD, MPH HIV Epidemiologist Bureau of Epidemiology Houston Department of Health and Human Services Tel: 713-794-9181 E-mail: Biru.Yang@cityofhouston.net
    • Questions?