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Annual Epidemiological Presentation, 2017 - Kathleen Brady, PDPH

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Kathleen Brady of the PDPH presented the annual report on the HIV epidemic in Philadelphia at the February 2017 meeting of the Philadelphia Ryan White Part A Planning Council.

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Annual Epidemiological Presentation, 2017 - Kathleen Brady, PDPH

  1. 1. HIV in Philadelphia Kathleen A. Brady, MD Medical Director/Medical Epidemiologist AIDS Activities Coordinating Office Philadelphia Department of Public Health Office of HIV Planning Epi Update February 9, 2017
  2. 2. THE HIV CARE CONTINUUM
  3. 3. HIV Care Continuum Adapted from Eldred et al AIDS Patient Care STDs 2007;21(Suppl1):S1-S2 Cheever LW Clin Infect Dis 2007;44:1500-2 Not in HIV Care Engaged in HIV Care Unaware of HIV infection Aware of HIV infection (not in care) Receiving some medical care but not HIV care Entered HIV care but lost to follow-up Cyclical or intermittent user of HIV care Fully engaged in HIV care
  4. 4. CDC HIV Continuum Measures  Aligns with NHAS 2020 indicator definitions  Represents the best available data for measuring progress  Uses National HIV Surveillance System (NHSS) data which meet the NHAS indicator data source criteria – Timely and routine – Can stratify by demographic characteristics – Prioritized data sources that are available at the state level to allow states ability to monitor progress toward Strategy goals in their jurisdictions  Uses different denominators for each measure
  5. 5. Calculation of Indicators  Prevalence of diagnosed HIV – United States – Numerator: Persons aged ≥13 years living with diagnosed HIV infection year-end 2013 – Denominator: Persons aged ≥13 years living with diagnosed or undiagnosed HIV infection year-end 2013 (derived using back- calculation)  The following indicators only use data from areas with complete reporting of CD4 and viral load test results to CDC (32 states and the District of Columbia): – Linkage to care (within 1 month) – Retention in care – Viral suppression
  6. 6. Diagnosed Infection among Persons Aged ≥13 Years Living with Diagnosed or Undiagnosed HIV Infection, by Sex, 2013—United States Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. Estimates were derived by using back- calculation on HIV data for persons aged ≥13 years at diagnosis in the 50 states and the District of Columbia.
  7. 7. Diagnosed Infection among Persons Aged ≥13 Years Living with Diagnosed or Undiagnosed HIV Infection, by Age, 2013—United States Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. Estimates were derived by using back- calculation on HIV data for persons aged ≥13 years at diagnosis in the 50 states and the District of Columbia.
  8. 8. Unaware Estimates by Select Demographic Groups, Philadelphia, 2014 Demographic Group % Unaware (95% CI) Sex Female 4.7% (0.0 %-9.8%) Male 7.7% (3.8%-11.2%) Race/Ethnicity Black 8.5% (4.3%-12.4%) Hispanic 4.4% (0%-11.4%) White/Other 5.2% (0.1%-12.2%) Mode of Transmission Heterosexual 9.5% (9.0%-19.1%) IDU (including MSM/IDU) 0.0% (0.0%-2.2%) MSM 9.2% (4.0%-15.0%) Total 7.0% (4.0% – 10.4%) Source: PDPH, AIDS Activities Coordinating Office, 2016
  9. 9. EMA Concurrent HIV/AIDS 29.7% 29.1% 26.1% 24.9% 23.5% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 2011 2012 2013 2014 2015 Philly PA Counties NJ Counties EMA
  10. 10. Concurrent HIV/AIDS, 2014 - 2015 Year 2014 2015 Non-concurrent Concurrent HIV/AIDS Non-concurrent Concurrent HIV/AIDS N Col % N Col % N Col % N Col % Total 444 78.0% 125 22.0% 433 80.5% 105 19.5% Sex Female 89 74.2% 31 25.8% 95 80.5% 23 19.5% Male 35 79.1% 94 20.9% 338 80.5% 82 19.5% Race/ Ethnicity Black 294 76.2% 92 23.8% 312 80.0% 78 20.0% Hispanic 63 88.7% 8 11.3% 66 86.8% 10 13.2% White 70 80.5% 17 19.5% 46 82.1% 10 17.9% Asian 10 76.9% * 23.1% * 45.5% 6 54.5% Multi-race * 50.0% * 50.0% * 50.0% * 50.0% Other/Unk * 75.0% * 25.0% * 100.0% 0 0.0% Source: PDPH, AIDS Activities Coordinating Office, 2016
  11. 11. Concurrent HIV/AIDS, 2014 - 2015Year 2014 2015 Non-concurrent Concurrent HIV/AIDS Non-concurrent Concurrent HIV/AIDS N Col % N Col % N Col % N Col % Age at HIV Dx 0-12 * 100.0% 0 0.0% * 100.0% 0 0.0% 13-19 31 93.9% * 6.1% 33 97.1% * 2.9% 20-24 101 91.8% 9 8.2% 96 95.0% * 5.0% 25-29 77 88.5% 10 11.5% 81 88.0% 11 12.0% 30-39 89 74.2% 31 25.8% 101 78.3% 28 21.7% 40-49 62 63.9% 35 36.1% 57 64.8% 31 35.2% 50+ 83 68.6% 38 31.4% 63 68.5% 29 31.5% Transmission Risk MSM 247 84.9% 44 15.1% 253 83.2% 51 16.8% IDU 33 82.5% 7 17.5% 27 90.0% * 10.0% Heterosexual 153 68.0% 72 32.0% 142 75.1% 47 24.9% MSM/IDU 6 100.0% 0 0.0% * 50.0% * 50.0% Pediatric * 100.0% 0 0.0% * 100.0% 0 0.0% No Risk Reported * 66.7% * 33.3% 8 72.7% * 27.3% Source: PDPH, AIDS Activities Coordinating Office, 2016
  12. 12. Calculation of Indicators  Linkage to care – Numerator: Persons aged ≥13 years who were diagnosed during 2014 and who had ≥1 viral load (VL) or CD4 test within 1 month of HIV diagnosis – Denominator: Persons aged ≥13 years who were diagnosed during 2014 (32 states and the District of Columbia)
  13. 13. Linkage to HIV Medical Care within 1 Month after HIV Diagnosis during 2014, among Persons Aged ≥13 Years, by Sex—32 States and the District of Columbia Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. Linkage to HIV medical care was defined as having a CD4 or VL test ≤1 month after HIV diagnosis.
  14. 14. Linkage to HIV Medical Care within 1 Month after HIV Diagnosis during 2014, among Persons Aged ≥13 Years, by Transmission Category—32 States and the District of Columbia Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. Linkage to HIV medical care was defined as having a CD4 or VL test ≤1 month after HIV diagnosis. Heterosexual contact is with a person known to have, or be at high risk for, HIV infection. MSM, male-to-male sexual contact; IDU, injection drug use
  15. 15. 2011 2012 2013 2014 2015 Linkage 30 Days 75 75 72 77 81 Linkage 90 Days 81 81 78 82 91 0 20 40 60 80 100 Percentage(%) Care Continuum Measures Source: Philadelphia Department of Public Health, AIDS Activities Coordinating Office Philadelphia Linkage to Care Indicators, 2011-2015
  16. 16. Calculation of Indicators  Retention in care – Numerator: Persons aged ≥13 years with ≥2 tests (CD4 or VL) at least ≥3 months apart in 2013 – Denominator: Persons aged ≥13 years who were diagnosed by year-end 2012 and alive at year-end 2013 (32 states and the District of Columbia)  Viral suppression – Numerator: Persons aged ≥13 years with <200 copies/mL on their most recent VL test in 2013 – Denominator: Persons aged ≥13 years who were diagnosed by year-end 2012 and alive at year-end 2013 (32 states and the District of Columbia)
  17. 17. Retention in HIV Medical Care and Viral Suppression among Persons Aged ≥13 Years Living with Diagnosed HIV Infection, by Sex, 2013—32 States and the District of Columbia Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. Retained in medical care was defined as ≥2 tests (CD4 or VL) ≥3 months apart in 2013. Viral suppression was defined as <200 copies/mL on the most recent VL test in 2013.
  18. 18. Retention in HIV Medical Care and Viral Suppression among Persons Aged ≥13 Years Living with Diagnosed HIV Infection, by Transmission Category, 2013—32 States and the District of Columbia Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. Retained in medical care was defined as ≥2 tests (CD4 or VL) ≥3 months apart in 2013. Viral suppression was defined as <200 copies/mL on the most recent VL test in 2013. Heterosexual contact is with a person known to have, or be at high risk for, HIV infection. MSM, male-to-male sexual contact; IDU, injection drug use
  19. 19. 2011 2012 2013 2014 2015 Retention* 47 51 52 52 53 Suppression* 44 49 50 53 56 0 20 40 60 80 100 Percentage(%) Care Continuum Measures *Significant increase between 2011 and 2015 (p<0.0001) Philadelphia Diagnosis-Based HIV Care Continuum, 2011-2015 Source: Philadelphia Department of Public Health, AIDS Activities Coordinating Office
  20. 20. 87% 75% 49% 48% 0% 20% 40% 60% 80% 100% HIV-Diagnosed Linked to Care (2015 New Cases) In HIV Care during 2015 Suppressed VL (<200copies/mL) US Prevalence-Based HIV Care Continuum, 2013 Source: Philadelphia Department of Public Health, AIDS Activities Coordinating Office
  21. 21. 93% 91% 49% 52% 0% 20% 40% 60% 80% 100% HIV-Diagnosed Linked to Care (2015 New Cases) In HIV Care during 2015 Suppressed VL (<200copies/mL) 19,280 488/538 10,173 10,758 Philadelphia Prevalence-Based HIV Care Continuum, 2015 Source: Philadelphia Department of Public Health, AIDS Activities Coordinating Office
  22. 22. US* Philadelphia** Number 87 Diagnosed 75 Are linked to HIV care 49 Stay in HIV care 48 Have a very low amount of virus in their body Number 93 Diagnosed 91 Are linked to HIV care 49 Stay in HIV care 52 Have a very low amount of virus in their body For every 100 people living with HIV: *2013 Data **2015 Data
  23. 23. HIV PREVALENCE
  24. 24. Newly Diagnosed HIV Cases, Deaths, and Living HIV Cases by Year Philadelphia, 2008-2015 928 897 739 694 737 634 569 538523 513 550 473 434 497 349 312 18640 19237 19525 19157 19832 19564 19494 19280 15000 16000 17000 18000 19000 20000 0 500 1000 1500 2000 2008 2009 2010 2011 2012 2013 2014 2015 Newly Diagnosed Deaths Living HIV Cases Source: PDPH, AIDS Activities Coordinating Office, 2016
  25. 25. Rates of Adults and Adolescents Living with Diagnosed HIV Infection, by Area of Residence, Year-end 2014 — United States and 6 Dependent Areas N = 970,319 Total Rate: 360.0 Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. Data are based on address of residence as of December 31, 2014 (i.e., most recent known address).
  26. 26. Persons Living with HIV/AIDS by Census Tract, Philadelphia, 2015 Source: PDPH, AIDS Activities Coordinating Office, 2016
  27. 27. Comparison of HIV Prevalence in the US and Philadelphia Philadelphia EMA • 26,807 PLWH as of 12/2015 – 482.6/100,000 population – 1,263.4/100,000 in Philadelphia • 57.9% black, 15.0% Latino, 22.8% white • 70.9% male • 48.8% current age >50 and 24.6% 40-49 • MSM – 35.5%, IDU – 21.3%, Heterosexual – 34.8% • Majority of cases among blacks, regardless of risk United States • 955,081 as of 12/2014 – Rate 299.5/100,000 population • 42.4% black, 20.8% Latino, 31.4% white • 75.6% male • 44.9% current age >50 and 27.6% 40-49 • MSM – 53.3%, IDU – 13.7%, Heterosexual – 25.8% • Highest rates of HIV in the Northeast US Sources: PDPH, AIDS Activities Coordinating Office, 2016 https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2015-vol-27.pdf
  28. 28. Proportion of Philadelphia Residents Diagnosed and Living with HIV by Race/Ethnicity and Sex, 2015 2.9% 2.3% 1.1% 1.1% 0.9% 0.2% 0.0% 1.0% 2.0% 3.0% 4.0% 5.0% Black Males Hispanic Males Black Females White Males Hispanic Females White Females Overall Prevalence 1.3% Epidemic Level 1.0% Source: PDPH, AIDS Activities Coordinating Office, 2016
  29. 29. Proportion of Philadelphia EMA Residents Diagnosed and Living with HIV by Race/Ethnicity and Sex, 2015 2.9% 2.3% 1.1% 1.1% 0.9% 0.2% 1.0% 0.6% 0.5% 0.1% 0.4% 0.0% 1.0% 0.8% 0.5% 0.2% 0.4% 0.0% 0.5% 1.0% 1.5% 2.0% 2.5% 3.0% 3.5% Black Males Hispanic Males Black Females White Males Hispanic Females White Females Philly PA counties NJ Counties
  30. 30. HIV/AIDS Prevalence per 100,000 Population by Race and Transmission Group, 2015
  31. 31. HIV DIAGNOSES
  32. 32. Newly Diagnosed HIV Cases, Deaths, and Living HIV Cases by Year Philadelphia, 2008-2015 928 897 739 694 737 634 569 538523 513 550 473 434 497 349 312 18640 19237 19525 19157 19832 19564 19494 19280 15000 16000 17000 18000 19000 20000 0 500 1000 1500 2000 2008 2009 2010 2011 2012 2013 2014 2015 Newly Diagnosed Deaths Living HIV Cases Source: PDPH, AIDS Activities Coordinating Office, 2016
  33. 33. Rates of Diagnoses of HIV Infection among Adults and Adolescents, by Area of Residence, 2015 — United States and 6 Dependent Areas N = 39,920 Total Rate: 14.7 Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. Data for the year 2015 are preliminary and based on 6 months reporting delay.
  34. 34. Persons Diagnosed with HIV (regardless of AIDS status) by Census Tract, Philadelphia, 2015 Source: PDPH, AIDS Activities Coordinating Office, 2016
  35. 35. Newly Diagnosed HIV United States, 2014 • 44,073 estimated cases • 80.7% male at birth • 43.7% black, 24.3% Hispanic, 26.9% white • 22.0% among 13-24 year olds 66.5% 6.1% 24.1% 2.7%0.4%0.2% Mode of Transmission MSM IDU HET MSM/IDU Pediatric NIR Source: http://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv- surveillance-report-us.pdf
  36. 36. Newly Diagnosed HIV Philadelphia, 2015 • 538 Newly Diagnosed cases • 78.0% male at birth • 72.4% black, 14.1% Hispanic, 10.4% white • 25.0% among 13-24 year olds 56.5% 5.5% 35.1% 0.4%0.5% 2.0% Mode of Transmission MSM IDU HET MSM/IDU Pediatric NIR Source: PDPH, AIDS Activities Coordinating Office, 2016
  37. 37. Newly Diagnosed HIV Disease by Age at Diagnosis (regardless of HIV status) 41 33 222 269 232 197 193 129 111 97 88 127 133 113 121 92 34 33 44 129 120147151 154 164 114 0 50 100 150 200 250 300 2010 2011 2012 2013 2014 2015 Year NumberofCases 13-19 20-29 30-39 40-49 50+
  38. 38. Newly Diagnosed HIV Disease by Race/Ethnicity (regardless of HIV status) 105 93 68 87 56 486 508 474 386 390 91 114 69 71 76 0 100 200 300 400 500 600 2010 2011 2012 2013 2014 2015 Year NumberofCases White AfrAm Hispanic
  39. 39. Newly Diagnosed HIV Disease by Sex at Birth (regardless of AIDS status) 0 100 200 300 400 500 600 2010 2011 2012 2013 2014 2015 Year NumberofCases HIV Female HIV Male
  40. 40. 41 Newly Diagnosed HIV Disease by Mode of Transmission (regardless of AIDS status) 286 300 70 83 40 40 30 250 8 6 11 304 291 322 189 225 313313 30 9 0 50 100 150 200 250 300 350 2010 2011 2012 2013 2014 2015 Year NumberofCases MSM IDU HetSx NIR
  41. 41. Rates of Newly Diagnosed HIV/AIDS per 100,000 population, Philadelphia 2011-2015
  42. 42. Newly Diagnosed HIV (Non-AIDS) for 2015, Philadelphia EMA EMA Total N=596 EMA % Phila N=433 % PA N=85 % NJ N=78 % Race/Ethnicity White, non-Hispanic 98 16.4 10.6 42.4 20.5 Black, non-Hispanic 399 66.9 72.1 48.2 59.0 Hispanic 87 14.6 15.2 8.2 17.9 Asian/Pacific Islander 7 1.2 1.4 1.2 0.0 American Indian/Alaskan Native <6 0.2 0.2 0.0 0.0 Multi-Race <6 0.3 0.5 0.0 0.0 Gender Male 449 70.2 75.5 72.9 76.9
  43. 43. Newly Diagnosed HIV (Non-AIDS) for 2015, Philadelphia EMA EMA Total N=596 EMA % Phila N=433 % PA N=85 % NJ N=78 % Age <13 years <6 0.3 0.8 0.0 0.0 13 - 19 years 38 6.4 7.6 2.4 3.8 20-24 years 128 21.5 22.2 16.5 23.1 25-29 years 121 20.3 18.7 18.8 30.8 30-39 years 127 21.3 23.3 15.3 16.7 40-49 years 79 13.3 13.2 17.6 9.0 50+ years 101 16.9 14.5 29.4 16.7
  44. 44. Newly Diagnosed HIV (Non-AIDS) for 2015, Philadelphia EMA EMA Total N=596 EMA % Phila N=433 % PA N=85 % NJ N=78 % Mode of Transmission Men who have sex with men (MSM) 326 54.7 58.4 44.7 4.9 Injection drug users (IDU) 39 6.5 6.2 5.9 9.0 MSM/IDU <6 0.3 0.2 1.2 0.0 Heterosexuals 207 34.7 32.8 41.2 38.5 Other/hemophilia/blood transfusion 0 0.0 0.0 0.0 0.0 Perinatal exposures <6 0.7 0.5 0.0 0.0 Risk not reported or identified 20 5.0 1.8 7.1 7.7
  45. 45. HIV INCIDENCE
  46. 46. 2014 Local Estimate of HIV Incidence • Local estimate of 299 new HIV infections in 2014 in adults and adolescents (95% CI, 205- 393) • Significant reduction since 2012 – 618 estimated HIV infections (95% CI, 419-817) Source: PDPH, AIDS Activities Coordinating Office, 2016
  47. 47. HIV Incidence Trends by Demographic Groups 0 200 400 600 800 1000 1200 2006 2007 2008 2009 2011 2012 2013 2014 Total Age 13-24 Male Black MSM Source: PDPH, AIDS Activities Coordinating Office, 2016
  48. 48. Estimated Incidence Rates - 2014 Population Population in 2010 (13 +) ESTIMATED Incidence Estimate, 2014 Estimated Case Rate per 100,000 95% CI lower bound 95% CI upper bound MSM 233,550 196 584.2 363.6 801.8 IDU 26,400 33 125.0 22.7 223.5 HET 269,231* 70 26.0 12.3 39.7 *Includes persons >13 living in poverty Data Source: PDPH/AACO HIV Incidence Surveillance Program, 2016
  49. 49. SPECIAL POPULATIONS
  50. 50. Annual Retention, Annual Viral Suppression, and Durable Viral Suppression by Ryan White Care, 2010-2014 52.8 63.3 46 19.2 27.8 20.4 0 20 40 60 80 100 Annual Retention in Care* Annual Viral Suppression* Durable Viral Suppression* Percent(%) Ryan White Non-Ryan White *p<0.0001 Source: Philadelphia Department of Public Health, 2016
  51. 51. Philadelphia HIV Care Continuum 2015 0% 20% 40% 60% 80% 100% Diagnosed Linked In Care Retained in Care Prescribed ART Virally Suppressed ALL PLWHA MSM of Color AA Men Youth 13-24 AA Women Transgender Source: PDPH, AIDS Activities Coordinating Office, 2016
  52. 52. Philadelphia HIV Care Continuum 2015 0% 20% 40% 60% 80% 100% ALL PLWHA MSM of Color AA Men Youth 13-24 AA Women Transgender Diagnosed Linked In Care Retained in Care Prescribed ART Virally Suppressed Source: PDPH, AIDS Activities Coordinating Office, 2016
  53. 53. Questions

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