Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Kathleen Brady - HIV in Philadelphia (Annual Epidemiological Presentation)

358 views

Published on

On April 27, 2016, Kathleen Brady of the Philadelphia AIDS Activities Coordinating Office (AACO) presented her annual review of the HIV Epidemic in Philadelphia and the surrounding areas.

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

Kathleen Brady - HIV in Philadelphia (Annual Epidemiological Presentation)

  1. 1. HIV in Philadelphia Kathleen A. Brady, MD Medical Director/Medical Epidemiologist AIDS Activities Coordinating Office Philadelphia Department of Public Health From Bench to Bus Stop January 26, 2016
  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. Prevalence-Based Continuum  Denominator:  National HIV Surveillance System  Persons aged ≥13 years with diagnosed or undiagnosed HIV infection in the United States  Estimates derived using back-calculation  Persons with HIV infection at the end of the specified year (2009, 2010, 2011, 2012)  Numerators:  National HIV Surveillance System  Persons with diagnosed HIV infection in the United States; calculated as a part of overall prevalence estimate for specified year  Medical Monitoring Project  Persons aged ≥18 years with diagnosed HIV infection in the United States and Puerto Rico  Received HIV medical care - Care visit during January to April of data collection year (2009, 2010, 2011, 2012)  Prescribed antiretroviral therapy - Documentation of antiretroviral prescription in the medical record  Viral Suppression – Most recent viral load test result in the preceding year was undetectable or <200 copies/mL
  5. 5. Persons Living with Diagnosed or Undiagnosed HIV Infection HIV Care Continuum Outcomes, 2012 — United States and Puerto Rico National HIV Surveillance System,: Estimated number of persons aged ≥13 years living with diagnosed or undiagnosed HIV infection (prevalence) in the United States at the end of 2012. The estimated number of persons with diagnosed HIV infection was calculated as part of the overall prevalence estimate. Medical Monitoring Project: Estimated number of persons aged ≥18 years who received HIV medical care during January to April of 2012, were prescribed ART, or whose most recent VL in the previous year was undetectable or <200 copies/mL—United States and Puerto Rico.
  6. 6. Diagnosis-Based Continuum  Denominator:  National HIV Surveillance System  Persons aged ≥18 years with diagnosed HIV infection in the United States and Puerto Rico  Persons with diagnosed HIV infection by the end of the year preceding the specified year (2008, 2009, 2010, 2011) and alive at the end of the specified year (2009, 2010, 2011, 2012)  Numerators:  Medical Monitoring Project  Persons aged ≥18 years with diagnosed HIV infection in the United States and Puerto Rico  Received HIV medical care - Care visit during January to April of data collection year  Prescribed antiretroviral therapy - Documentation of antiretroviral prescription in the medical record  Viral Suppression – Most recent viral load test result in preceding year was undetectable or <200 copies/mL
  7. 7. Persons Living with Diagnosed HIV Infection HIV Care Continuum Outcomes, 2012 United States and Puerto Rico National HIV Surveillance System: Estimated number of persons aged ≥18 years diagnosed with HIV infection by year-end 2011 and alive at year- end 2012—United States and Puerto Rico. Medical Monitoring Project: Estimated number of persons aged ≥18 years who received medical care January to April of 2012, were prescribed antiretroviral therapy, or whose most recent VL was undetectable or <200 copies/mL—United States and Puerto Rico.
  8. 8. 2010 2011 2012 2013 2014 Link 30 Days* 71 75 75 72 77 Link 90 Days 79 81 81 78 82 0 10 20 30 40 50 60 70 80 90 100 Percentage(%) Philadelphia HIV Linkage by Year *Significant increase in linkage within 30 days between 2010 and 2014 (p=0.02) Source: PDPH, AIDS Activities Coordinating Office, 2015
  9. 9. 2011 2012 2013 2014 HIV Diagnosed 100 100 100 100 Retention* 47 51 52 52 Suppression* 44 49 50 53 0 10 20 30 40 50 60 70 80 90 100 Percentage(%) Philadelphia Care Continuum Measures *Significant increase between 2011 and 2014 (p<0.0001) Source: PDPH, AIDS Activities Coordinating Office, 2015
  10. 10. US (2012 Data) Philadelphia (2014 Data Number 100 Diagnosed 80 Are linked to HIV care 54 Stay in HIV care 50 Get antiretroviral therapy 42 Have a very low amount of virus in their body Number 100 Diagnosed 82 Are linked to HIV care 52 Stay in HIV care N/A Get antiretroviral therapy 53 Have a very low amount of virus in their body For every 100 people living with HIV: Source: PDPH, AIDS Activities Coordinating Office, 2015
  11. 11. NEW HIV DIAGNOSES
  12. 12. Rates of Diagnoses of HIV Infection Among Adults and Adolescents, by Area of Residence, 2013 United States and 6 Dependent Areas N= 47,957 Total rate = 18.0
  13. 13. Newly Diagnosed HIV (Non-AIDS) for 2012-2014, Philadelphia EMA EMA Total N=2,120 EMA % Phila N=1,433 % PA N=391 % NJ N=224 % Race/Ethnicity White, non-Hispanic 409 19.3 13.0 38.9 23.6 Black, non-Hispanic 1,335 63.0 70.1 45.3 52.0 Hispanic 307 14.5 14.1 10.0 22.3 Asian/Pacific Islander 30 1.4 1.6 1.8 0.0 American Indian/Alaskan Native 9 0.4 0.6 0.3 0.0 Multi-Race 24 1.1 0.6 3.8 0.0 Unknown 6 0.3 0.0 0.0 2.0 Gender Male 1,641 76.2 78.3 79.0 70.9
  14. 14. Newly Diagnosed HIV (Non-AIDS) for 2012-2014, Philadelphia EMA EMA Total N=2,120 EMA % Phila N=1,433 % PA N=391 % NJ N=224 % Age <13 years 12 0.6 0.1 1.3 1.7 13 - 19 years 126 5.9 6.8 4.9 3.4 20-24 years 442 20.8 22.7 17.9 15.5 25-29 years 365 17.2 18.1 15.6 15.2 30-39 years 435 20.5 19.7 20.5 24.7 40-49 years 370 17.5 16.7 17.9 20.6 50+ years 370 17.5 15.9 22.0 18.9
  15. 15. Newly Diagnosed HIV (Non-AIDS) for 2012-2014, Philadelphia EMA EMA Total N=2,120 EMA % Phila N=1,433 % PA N=391 % NJ N=224 % Mode of Transmission Men who have sex with men (MSM) 1048 49.4 52.1 49.9 35.8 Injection drug users (IDU) 140 6.6 6.8 5.1 7.8 MSM/IDU 24 1.1 1.2 1.3 0.7 Heterosexuals 786 37.1 37.5 33.5 39.9 Other/hemophilia/blood transfusion 0 0.0 0.0 0.0 0.0 Perinatal exposures 15 0.7 0.3 1.3 1.7 Risk not reported or identified 107 5.0 2.1 9.0 14.2
  16. 16. Newly Diagnosed HIV Cases, Deaths, and Living HIV Cases by Year Philadelphia, 2008-2014 928 897 739 680 729 679 624 524 511 546 473 432 393 165* 18640 19237 19525 19157 19832 19564 19494 15000 15500 16000 16500 17000 17500 18000 18500 19000 19500 20000 0 200 400 600 800 1000 1200 1400 1600 1800 2000 2008 2009 2010 2011 2012 2013 2014 Newly Diagnosed Deaths Living HIV Cases *Data incomplete due to reporting delays Source: PDPH, AIDS Activities Coordinating Office, 2015
  17. 17. Newly Diagnosed HIV 2014 • 624 Newly Diagnosed cases • 78.8% male at birth • 67.6% black, 14.5% Hispanic, 14.4% white • 23.2% among 13-24 year olds 51.1% 5.4% 40.7% 0.4% 0.3% 1.9% Mode of Transmission MSM IDU HET MSM/IDU Pediatric NIR Source: PDPH, AIDS Activities Coordinating Office, 2015
  18. 18. 19 HIV/AIDS Cases by Date of Diagnosis 1086 1020 939 862 763 779 672 745 800 744 694 695 659 521 424 333 297 257 257 186 159 530 546 565 578 442 423 472 493 465 1266 0 200 400 600 800 1000 1200 1400 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 Year NumberofCases AIDS HIV
  19. 19. Newly Diagnosed HIV Disease by Sex at Birth (regardless of AIDS status) 0 100 200 300 400 500 600 2010 2011 2012 2013 2014 Year NumberofCases HIV Female HIV Male
  20. 20. Newly Diagnosed HIV Disease by Race/Ethnicity (regardless of HIV status) 105 97 73 90 479 501 503 422 87 110 80 91 0 100 200 300 400 500 600 2010 2011 2012 2013 2014 Year NumberofCases White AfrAm Hispanic
  21. 21. 22 Newly Diagnosed HIV Disease by Mode of Transmission (regardless of AIDS status) 281 297 51 69 35 34 274 11 12 319 352 254 324324 29 9 0 50 100 150 200 250 300 350 400 2010 2011 2012 2013 2014 Year NumberofCases MSM IDU HetSx NIR
  22. 22. Newly Diagnosed HIV Disease by Age at Diagnosis (regardless of HIV status) 39 32 219 265 251 211 138 126 111 127 133 120 136 32 43 134146149 152 159 112 0 50 100 150 200 250 300 2010 2011 2012 2013 2014 Year NumberofCases 13-19 20-29 30-39 40-49 50+
  23. 23. Newly Diagnosed HIV Cases, Deaths, and Living HIV Cases by Year Philadelphia, 2008-2014 928 897 739 680 729 679 624 524 511 546 473 432 393 165* 18640 19237 19525 19157 19832 19564 19494 15000 15500 16000 16500 17000 17500 18000 18500 19000 19500 20000 0 200 400 600 800 1000 1200 1400 1600 1800 2000 2008 2009 2010 2011 2012 2013 2014 Newly Diagnosed Deaths Living HIV Cases *Data incomplete due to reporting delays Source: PDPH, AIDS Activities Coordinating Office, 2015
  24. 24. Rates of Adults and Adolescents Living with Diagnosed HIV Infection, by Area of Residence, Year-end 2012 United States and 6 Dependent Areas N= 931,449 Total rate = 352.3
  25. 25. Proportion of Philadelphia Residents Diagnosed and Living with HIV by Race/Ethnicity and Sex, 2014 2.9% 2.2% 1.1% 1.1% 0.8% 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, 2015
  26. 26. PLWHA 2014 • 27,121 PLWHA (current EMA residents) • 71.7% male at birth • 57.9% black, 14.9% Hispanic, 23.2% white • 48.0% among 50+ year olds 35.6% 20.9% 35.4% 3.0% 1.5% 3.6% Mode of Transmission MSM IDU HET MSM/IDU Pediatric NIR Source: PDPH, AIDS Activities Coordinating Office, 2015
  27. 27. 2013 Local Estimate of HIV Incidence • Local estimate of 508 new HIV infections in 2013 in adults and adolescents (95% CI, 333- 683) Source: PDPH, AIDS Activities Coordinating Office, 2015
  28. 28. HIV Incidence Trends by Demographic Groups 0 200 400 600 800 1000 1200 2006 2007 2008 2009 2011 2012 2013 Total Age 13-24 Male Black MSM Source: PDPH, AIDS Activities Coordinating Office, 2015
  29. 29. Estimated Incidence Rates - 2013 Population Population in 2010 (13 +) ESTIMATED Incidence Estimate, 2013 Estimated Case Rate per 100,000 95% CI lower bound 95% CI upper bound MSM 29,737 324 1,089.6 632.2 1,550.3 IDU 37,378 18 48.2 0 136.4 HET 294,682* 166 56.3 25.5 86.9 *Includes persons >13 living in poverty Data Source: PDPH/AACO HIV Incidence Surveillance Program, 2015
  30. 30. Unaware Estimates by Select Demographic Groups, Philadelphia, 2013 Demographic Group % Unaware (95% CI) Sex Female 7.5% (0.9 %-14.1%) Male 11.5% (6.7%-15.4%) Race/Ethnicity Black 12.5% (8.4%-17.0%) Hispanic 9.6% (1.4%-17.5%) White/Other 4.7% (0.1%-11.1%) Mode of Transmission Heterosexual 13.5% (9.0%-19.1%) IDU (including MSM/IDU) 5.1% (2.9%-7.3%) MSM 13.2% (8.2%-19.2%) Total 10.4% (13.7% – 7.5%) Source: PDPH, AIDS Activities Coordinating Office, 2015
  31. 31. Non-Concurrent and Concurrent HIV/AIDS Among Incident HIV Diagnosis 2014 (EMA) Non-Concurrent Concurrent HIV/AIDS Total N Row % N Row % N Col % Total 739 72.9% 227 24.8% 917 100% Sex Male 579 81.4% 169 23.8% 711 77.5% Female 160 77.7% 58 28.2% 206 22.5% Race/Ethnicity Black 440 78.7% 140 25.0% 559 61.0% Hispanic 159 85.5% 46 24.7% 186 20.3% White 116 81.7% 33 23.2% 142 15.5% Other 24 80.0% 8 26.7% 30 3.3%
  32. 32. Non-Concurrent and Concurrent HIV/AIDS Among Incident HIV Diagnosis 2014 (EMA) Non-Concurrent Concurrent HIV/AIDS Total N Row % N Row % N Col % Age Group at HIV Diagnosis <13 0 0.0% 0 0.0% 0 0.0% 13-19 41 95.3% * 7.0% 43 4.7% 20-24 141 93.4% 11 7.3% 151 16.5% 25-29 130 90.3% 22 15.3% 144 15.7% 30-39 152 77.6% 54 27.6% 196 21.4% 40-49 127 73.0% 64 36.8% 174 19.0% 50+ 148 70.8% 73 34.9% 209 22.8%
  33. 33. Non-Concurrent and Concurrent HIV/AIDS Among Incident HIV Diagnosis 2014 (EMA) Non-Concurrent Concurrent HIV/AIDS Total N Row % N Row % N Col % Transmission Risk MSM 386 86.4% 81 18.1% 447 48.7% IDU 45 86.5% 10 19.2% 52 5.7% MSM/IDU 9 100.0% * 22.2% 9 1.0% Heterosexual 270 73.0% 119 32.2% 370 40.3% No identified risk 24 61.5% 15 38.5% 39 4.3% Pediatric 0 0.0% 0 0.0% 0 0.0% Geographic Area Philadelphia 480 76.9% 144 23.1% 624 68.1% PA Counties 110 69.2% 49 30.8% 159 17.3% NJ Counties 100 74.6% 34 25.4% 134 14.6%
  34. 34. SPECIAL POPULATIONS
  35. 35. HIV CARE CONTINUUM BY RESIDENCE IN GEOGRAPHIC HOTSPOTS Kathleen A. Brady, MD 37 100.0% 64.6% 33.0% 26.3% 100.0% 54.3% 24.0% 9.1% 0.0% 20.0% 40.0% 60.0% 80.0% 100.0% 120.0% Diagnosed Linked to Care Retained in Care Virally Suppressed Not a Hotspot Hotspot p < .05 p < .05 p < .05 N=1,704 Source: PDPH, AIDS Activities Coordinating Office, 2015
  36. 36. Percent Retained, Using ART and Virally Suppressed Source: PDPH, AIDS Activities Coordinating Office, 2015
  37. 37. Overall Transgender Linkage 90 Days 82 83 Retention 52 62 Suppression 53 62 0 10 20 30 40 50 60 70 80 90 100 Percentage(%) 2014 Care Continuum Measures: Transgender Source: PDPH, AIDS Activities Coordinating Office, 2015
  38. 38. Philadelphia HIV Care Continuum 2014 90% 47% 68% 48% 87% 44% 63% 47% 87% 44% 66% 48% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Diagnosed Engaged in Care Prescribed ART Virally Suppressed ALL PLWHA MSM of Color Black MSM Hispanic MSM Other MSM of Color White MSM Source: PDPH, AIDS Activities Coordinating Office, 2015
  39. 39. NHBS-IDU4
  40. 40. National HIV Behavioral Surveillance • Conducted 2004-Present • Establish and maintain a surveillance system among groups at high risk for HIV infection • 3 rounds completed to-date • Rounds consist of 3 cycles – MSM – IDU – HET • 6 city / 14 state health departments Source: PDPH, AIDS Activities Coordinating Office, 2015
  41. 41. NHBS IDU4 Cycle • Sample collection began July 2015 • Eligibility Requirements – Present a valid NHBS-IDU coupon – Have not previously participated in the current NHBS-IDU cycle – Live in the participating MSA (Philadelphia, Montgomery, Delaware, Chester, Bucks Counties) – 18 years old or older – Have injected drugs in the last 12 months • N=645 – Goal: 500 interviews Source: PDPH, AIDS Activities Coordinating Office, 2015
  42. 42. Screening Process with an NHBS Interviewer Eligible Interview $25: Risk Behavior Survey Offered to be Recruiter: Given Coupons to give to give to people they know to bring them into the study $10 per Recruit Optional: HIV Testing - INSTI $25 HCV Testing -ORAQUICK Ineligible Nothing Further Brief Overview of NHBS Process Source: PDPH, AIDS Activities Coordinating Office, 2015
  43. 43. Sample Characteristics • Gender – Male 74% – Female 25% – Transgender 1% • Race – White 66% – Black 11% – Hispanic 11% – Multiracial 12% – Asian <1% – American Indian/Alaskan Native <1% – Native Hawaiian/Other Pacific Islander <1%  Age  18-24 8%  25-29 16%  30-34 23%  35-39 19%  40+ 34%  Region  Kensington 42%  Northeast Phila 19%  North Phila 13%  Center City 7%  Outside Phila 5%  South Phila 5%  Other 9% Source: PDPH, AIDS Activities Coordinating Office, 2015
  44. 44. IDU3 IDU4 18-29 90 156 30+ 467 489 16% 24% 0 100 200 300 400 500 600 Particpants Youth Sample Comparision IDU3 to IDU4 Source: PDPH, AIDS Activities Coordinating Office, 2015
  45. 45. HIV Preliminary Results • IDU4 HIV Results – 32 Positive Participants (5%) • 19 Self-Reported as HIV positive • IDU3 HIV Results (2012) – 28 Positive Participants (5%) Source: PDPH, AIDS Activities Coordinating Office, 2015
  46. 46. HCV Results and Testing History HCV Results – 522 (81%) Reactive • 169 Newly Dxed HCV Infections – 109 (17%) Non-reactive – 2% Other • Coinfection Rates – 27 of the 32 HIV reactive individuals also reactive on the HCV test – 4% of total sample  553(86%) had previously been tested for HCV  28% Public Health/Community Health Center/Provider  19% Correctional Facility  15% Drug Treatment Program  15% Needle or Syringe Exchange Program  5% Mobile/Street Outreach  3% CTR site  3% Family Planning /OB  2% Don’t Know/Refused Source: PDPH, AIDS Activities Coordinating Office, 2015
  47. 47. Limitations • Do not perform the confirmatory HCV test – Unable to follow up to capture these results – Unable to calculate linkage rates on a person level • Survey sample may not be representative of overall IDU population in Philadelphia – Youth Population – Female Population – Hispanic Population Source: PDPH, AIDS Activities Coordinating Office, 2015
  48. 48. Questions

×