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Epidemiological Update 2017 (Positive Committee)

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Nicole Johns presented an excerpt from Kathleen Brady's annual epidemiological presentation at the January meeting of the Positive Committee.

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Epidemiological Update 2017 (Positive Committee)

  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. 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
  3. 3. 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.
  4. 4. 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
  5. 5. 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
  6. 6. 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
  7. 7. 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
  8. 8. 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
  9. 9. 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
  10. 10. 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
  11. 11. 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
  12. 12. 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
  13. 13. 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
  14. 14. Rates of Newly Diagnosed HIV/AIDS per 100,000 population, Philadelphia 2011-2015

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