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Epidemiology Update: Disparities in the HIV Continuum of Care

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Dr. Kathleen Brady of the AIDS Activities Coordinating Office presented this epidemiologic update to the Philadelphia EMA HIV Integrated Planning Council on February 9, 2018.

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Epidemiology Update: Disparities in the HIV Continuum of Care

  1. 1. Epidemiology Update Disparities in the HIV Continuum of Care Kathleen A. Brady, MD Philadelphia Department of Public Health AIDS Activities Coordinating Office February 9, 2018
  2. 2. Overview 1 HIV Continuum of Care 2 Priority Populations 3 Trends in Disparities 4 Geographic Disparities 5 Conclusions
  3. 3. HIV Continuum of Care
  4. 4. Why a Continuum? • For individuals living with HIV to fully benefit from antiretroviral therapy, they need to: • Know that they are HIV positive • Be engaged in regular HIV care • Receive and adhere to effective ART • Various obstacles, or barriers, contribute to gaps in testing and care • An individual’s care status can fluctuate, moving forwards or backwards
  5. 5. Parts of the HIV Continuum • HIV-Diagnosed/ Unaware estimates • Linkage to HIV medical care (within 90 days of HIV diagnosis) • Retention in HIV medical care (≥2 labs at least 90 days apart in a year) • Viral load suppression (<200 copies/mL)
  6. 6. Newly Diagnosed HIV, Philadelphia 2016 Populations Most Affected Rates of Newly Diagnosed HIV/AIDS per 100,000 Population by Year of Diagnosis and Risk Group
  7. 7. Priority Populations
  8. 8. Priority = HIV Continuum Disparities • Higher rates of new HIV diagnoses/transmissions • Lower rates of HIV status awareness • Lower rates of retention in medical care • Lower rates of viral load suppression 8
  9. 9. Priority Populations, Philadelphia EMA 2018 • Racial/Ethnic minority youth (ages 13-24) • Transgender persons who have sex with men (TSM) • MSM of color ≥25 years of age • Heterosexual men of color • Women of color • Persons who inject drugs (PWID)
  10. 10. Racial/Ethnic Minority Youth (ages 13-24), 2016 91.6 87.3 50.1 54.9 48.6 83.7 59 53.1 0 20 40 60 80 100 Percent Diagnosed Linked to Care Retained in Care Virally Suppressed EMA Minority Youth Note: • High rates of new infections • Very low rates of awareness • Higher rate of retention in care • Lower rate of viral suppression
  11. 11. Transgender persons who have sex with men (TSM), 2016 91.6 87.3 50.1 54.9 82.9 70 69.5 65.2 0 20 40 60 80 100 Percent Diagnosed Linked to Care Retained in Care Virally Suppressed EMA TSM Note: • High rates of new infections • Lower rate of awareness • Lower rate of linkage to care • Higher rates of retention in care and viral suppression • *limited data*
  12. 12. MSM of color ≥25 years of age, 2016 91.6 87.3 50.1 54.9 88.1 92 48.6 54 0 20 40 60 80 100 Percent Diagnosed Linked to Care Retained in Care Virally Suppressed EMA MSM ≥25 Note: • High rates of new infections • Low rates of awareness • No disparities in care
  13. 13. Heterosexual men of color, 2016 91.6 87.3 50.1 54.9 90.7 82.4 43.6 51.2 0 20 40 60 80 100 Percent Diagnosed Linked to Care Retained in Care Virally Suppressed EMA HET Men of Color Note: • Disparity in rate of new HIV diagnoses • Lower rate of retention in care • Lower rate of viral suppression
  14. 14. Women of color, 2016 91.6 87.3 50.1 54.9 94.2 75.4 50.7 53.2 0 20 40 60 80 100 Percent Diagnosed Linked to Care Retained in Care Virally Suppressed EMA Women of Color Note: • Higher awareness • Disparity in rate of new HIV diagnoses (not shown)
  15. 15. Persons who inject drugs, 2016 91.6 87.3 50.1 54.9 99.8 58.6 49.7 47.6 0 20 40 60 80 100 Percent Diagnosed Linked to Care Retained in Care Virally Suppressed EMA PWID Note: • Lower rate of new diagnoses • Lower rate of linkage to care • Lower rate of viral suppression
  16. 16. Trends in Disparities Philadelphia
  17. 17. Racial/Ethnic Minority Youth (ages 13-24) 17 0 10 20 30 40 50 60 70 80 90 100 2012 2013 2014 2015 2016 Linkage Overall Linkage Youth Retention Overall Retention Youth Suppression Overall Suppression Youth
  18. 18. Transgender Persons who have sex with men (TSM) 0 10 20 30 40 50 60 70 80 90 100 2012 2013 2014 2015 2016 Linkage Overall Linkage TSM Retention Overall Retention TSM Suppression Overall Suppression TSM
  19. 19. MSM of color ≥25 years of age 0 10 20 30 40 50 60 70 80 90 100 2012 2013 2014 2015 2016 Linkage Overall Linkage MSM of Color Retention Overall Retention MSM of Color Suppression Overall Suppression MSM of Color
  20. 20. Heterosexual men of color 0 10 20 30 40 50 60 70 80 90 100 2012 2013 2014 2015 2016 Linkage Overall Linkage HET Men of Color Retention Overall Retention HET Men of Color Suppression Overall Suppression HET Men of Color
  21. 21. Women of color 0 10 20 30 40 50 60 70 80 90 100 2012 2013 2014 2015 2016 Linkage Overall Linkage Women of Color Retention Overall Retention Women of Color Suppression Overall Suppression Women of Color
  22. 22. Persons who inject drugs 0 10 20 30 40 50 60 70 80 90 100 2012 2013 2014 2015 2016 Linkage Overall Linkage PWID Retention Overall Retention PWID Suppression Overall Suppression PWID
  23. 23. Geographic Disparities
  24. 24. Differences by Geography • Lower rates of awareness in collar counties • Lower rates of retention in care in collar counties • Lower rates of viral suppression in collar counties 25
  25. 25. HIV Continuum Measures by Region, 2016 92.7 84.3 46.4 50.8 89.1 81.3 36.2 32.6 89.1 69.1 23.1 30.7 0 10 20 30 40 50 60 70 80 90 100 Percent Diagnosed Linked to Care Retained in Care Virally Suppressed Philadelphia PA counties NJ counties
  26. 26. Conclusions
  27. 27. Areas of action for decreasing disparities • PrEP access and adherence support • HIV Navigation Services • Targeted HIV Testing • Opt-out routinized HIV Testing in Health Care Settings/STD clinic/Jails • HIV screening in Emergency Departments • Linkage to care activities • Syringe service programs • Access to condoms • Ryan White MCM • CoRECT 28
  28. 28. Additional Areas of action for decreasing disparities • Stigma • Adherence • Culturally competent programs • Language barriers • Community mobilization • Leveraging the Ryan White Care system to improve health outcomes • Average/poor quality data on transgender persons • Changing opioid epidemic, and the need for rapid outbreak response planning 29
  29. 29. Next steps • Implementation of activities under CDC Prevention/Surveillance grant (18-1802) • Expand CoRECT (Data to care activities) • Restructuring of MCM in EMA • Further research on interventions to improve viral suppression once patients engaged in HIV care
  30. 30. Thank You! Kathleen A. Brady, MD Medical Director/Medical Epidemiologist AIDS Activities Coordinating Office Philadelphia Department of Public Health E-Mail: kathleen.a.brady@phila.gov Phone: (215)-685-4778

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