Consultant Matthew McClain presented these guidelines and suggestions for updates to the Prevention Planning Group (PPG), based on earlier suggestions from the body.
Dr. Kathleen Brady (AACO)'s annual epidemiological update. This presentation was given to the Philadelphia EMA Ryan White Planning Council on Thursday, February 20, 2014.
Reaching the goals of the National HIV/AIDS Strategy. This presentation was originally conducted at the Office of HIV Planning's Community Empowerment Workshop held at St. Luke's Church on October 16, 2012.
Nicole Johns of the Office of HIV Planning presented this updated version of the very popular "Where We Live Matters" to the Positive Committee on January 14, 2013.
Dr. Kathleen Brady's presentation on PrEP (pre-exposure prophylaxis) for HIV, as given to the Philadelphia HIV Prevention Planning Group (HPG) on March 25, 2015.
Dr. Kathleen Brady of Philadelphia's AIDS Activities Coordinating Office (AACO) gave this presentation at the January 9, 2013 Comprehensive Planning Committee meeting.
Kharfen: DC HIV Public-Private Partnershipshealthhiv
Michael Kharfen
Bureau Chief, Partnerships, Capacity Building, Community Outreach
DC Department of Health
HIV/AIDS, Hepatitis, STD and TB Administration
Dr. Kathleen Brady (AACO)'s annual epidemiological update. This presentation was given to the Philadelphia EMA Ryan White Planning Council on Thursday, February 20, 2014.
Kathleen Brady from the Philadelphia Department of Public Health presented her annual updated on the HIV Epidemic in Philadelphia at a February 2015 combined meeting of the Philadelphia Ryan White Part A Planning Council and the HIV Prevention Planning Group.
Dr. Kathleen Brady of Philadelphia's AIDS Activities Coordinating Office (AACO) gave this presentation at the January 9, 2013 Comprehensive Planning Committee meeting.
Consultant Matthew McClain presented these guidelines and suggestions for updates to the Prevention Planning Group (PPG), based on earlier suggestions from the body.
Dr. Kathleen Brady (AACO)'s annual epidemiological update. This presentation was given to the Philadelphia EMA Ryan White Planning Council on Thursday, February 20, 2014.
Reaching the goals of the National HIV/AIDS Strategy. This presentation was originally conducted at the Office of HIV Planning's Community Empowerment Workshop held at St. Luke's Church on October 16, 2012.
Nicole Johns of the Office of HIV Planning presented this updated version of the very popular "Where We Live Matters" to the Positive Committee on January 14, 2013.
Dr. Kathleen Brady's presentation on PrEP (pre-exposure prophylaxis) for HIV, as given to the Philadelphia HIV Prevention Planning Group (HPG) on March 25, 2015.
Dr. Kathleen Brady of Philadelphia's AIDS Activities Coordinating Office (AACO) gave this presentation at the January 9, 2013 Comprehensive Planning Committee meeting.
Kharfen: DC HIV Public-Private Partnershipshealthhiv
Michael Kharfen
Bureau Chief, Partnerships, Capacity Building, Community Outreach
DC Department of Health
HIV/AIDS, Hepatitis, STD and TB Administration
Dr. Kathleen Brady (AACO)'s annual epidemiological update. This presentation was given to the Philadelphia EMA Ryan White Planning Council on Thursday, February 20, 2014.
Kathleen Brady from the Philadelphia Department of Public Health presented her annual updated on the HIV Epidemic in Philadelphia at a February 2015 combined meeting of the Philadelphia Ryan White Part A Planning Council and the HIV Prevention Planning Group.
Dr. Kathleen Brady of Philadelphia's AIDS Activities Coordinating Office (AACO) gave this presentation at the January 9, 2013 Comprehensive Planning Committee meeting.
A presentation built by Clay Marsh, MD. executive director of the OSU Center for Personalized Medicine, designed to explain some of the scientific and social angles that are a part of personalized health care.
Similar to Dr. Kathleen Brady's 2013 Epidemiologic Update (20)
Behavioral Health Navigator Presentation by Emerson Evans 12-12-13Office of HIV Planning
Emerson Evans (AACO) presented on a SAMHSA-funded behavioral health navigator program on 12-12-13. This program in Philadelphia was discussed with the Philadelphia EMA Ryan White Part A Planning Council.
Evelyn Torres and Sebastian Branca's update on AACO's Client Services Unit (CSU), Housing Services Program (HSP), and Quality Improvement (QI) programs
Dr. Sarah Wood and Kimberley Desir's presentation to the RWPC's Positive Committee on Children's Hospital of Philadelphia's PrEP program, Project PrEPare, from April 2013.
AACO's Annual Client Services Unit, Housing, and Quality Management PresentationOffice of HIV Planning
Evelyn Torres and Sebastian Branca presented on Philadelphia's AIDS Activities Coordinating Office's Client Services Unit, Housing Services Program, and Quality Management program at the February 6, 2013 meeting of the Needs Assessment Committee of the Philadelphia EMA Ryan White Planning Council.
Planning in a time of uncertainty and change
This presentation was originally conducted at the Office of HIV Planning's Community Empowerment Workshop held at St. Luke's Church on October 16, 2012.
The effects on insurance coverage for people living with HIV/AIDS in the Philadelphia EMA (including Philadelphia, Montgomery, Delaware, Chester, and Bucks Counties in PA and Salem, Gloucester, Camden, and Burlington Counties in NJ)
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
6. National and Local Engagement in Care
Data
National and local HIV Surveillance System
Prevalence (total, diagnosed) – number of persons living with HIV
Linkage to care
Medical Monitoring Project (MMP)
Retention in care
Prescribed ART
Viral suppression
7. Methods
Prevalence
HIV diagnosis data
Data adjustments at the national level
Back-calculation methods to estimate unaware
Linkage to Care
Data reported through December 2011
Percentage of persons with >1 CD4 or viral load test result
within 3 months of HIV diagnosis
8. Medical Monitoring Project
MMP is a national probability sample of HIV-infected
persons receiving care in the US in order to:
describe HIV care and support services being received and the
quality of such services
describe the prevalence and occurrence of co-morbidities related to
HIV disease
determine prevalence of ongoing risk behaviors and access to and
use of prevention services among persons living with HIV
identify met and unmet needs for HIV care and prevention services
in order to inform community and care planning groups, health care
providers and other stakeholders
Philadelphia has participated in MMP since 2005. All
charts of sampled patients are abstracted for clinical
information and patients are offered a voluntary
interview.
9. MMP Population Size Estimates
States, facilities, and patients sampled with known
probabilities
Analysis weights include:
Design weights
Inverse of the probability of selection
Extend inference from sample to reference population
Non-response adjustment
Extend inference from respondents to sample
Sum of weights estimates number of HIV-infected
adults who received at least one medical visit
January-April 2009
10. MMP Definitions
Retention in care: Number of HIV-infected adults
who received at least one medical care visit between
January and April 2009
Prescription of antiretroviral therapy (ART):
Documentation in medical record abstraction of any
ART prescription in the past 12 months
Viral suppression: Documentation in medical
record abstraction of most
11.
12. Philadelphia Engagement in Care, 2009
25000 19188
20000 100% 15753
82% 11894
15000 62% 9944 8751
52% 46%
10000 5775
30%
5000
0
13. For every 100 people living with HIV:
US Philadelphia
Number Number
Are aware of their Are aware of their
82 82
infection infection
66 Are linked to HIV care 62 Are linked to HIV care
37 Stay in HIV care 52 Stay in HIV care
Get antiretroviral Get antiretroviral
33 46
therapy therapy
Have a very low amount Have a very low amount
25 30
of virus in their body of virus in their body
2009 Data
15. Philadelphia Engagement in Care, 2009
25000 19188
20000 100% 15753
82% 11894
15000 62% 9944 8751
52% 46%
10000 5775
30%
5000
0
16.
17.
18. HIV Prevalence in Philadelphia
(reported thru 6/30/2012)
19,157 PLWHA (aware) Rates (known) vary by
11,583 AIDS cases race
7,574 HIV cases 2.1% of blacks
4,205 estimated to be 1.5% of Latinos
living with HIV and 0.7% of whites
unaware Rates vary by sex
1.59% Philadelphia 1.9% of males
residents estimated to be 0.7% of females
HIV+
19. HIV Prevalence in Philadelphia EMA
(reported thru 6/30/2012)
25,968 PLWHA (aware) Rates (known) vary by
15,178 AIDS cases race
10,790 HIV cases 1.4% of blacks
5,700 estimated to be 0.9% of Latinos
living with HIV and 0.2% of whites
unaware Rates vary by sex
0.5% Philadelphia EMA 0.7% of males
residents estimated to be 0.3% of females
HIV+
21. HIV/AIDS Cases by Sex and Date of
Diagnosis
AIDS Female AIDS Male HIV Female HIV Male
1600
1400
Number of Cases
1200
1000
800
600
400
200
0
91
93
95
97
99
01
03
05
07
09
11
19
19
19
19
19
20
20
20
20
20
20
Year
21
22. HIV Cases by Race/Ethnicity and Date of
Diagnosis
White AfrAm Hispanic
700
575 594
600 534
498
Number of Cases
479
500
400
300
171
200 142 127
210 106 110
100 133 146 127
95
0
2006 2007 2008 2009 2010 2011
Year
22
23. HIV diagnoses by risk group, 2007-2011
600
500
400
300
200
100
0
2007 2008 2009 2010 2011
MSM IDU HET
24. Demographics of new positives, MSM
New HIV diagnoses among New HIV diagnoses among
MSM by race, 2007-2011 MSM by age, 2007-2011
70% 60%
60% 50%
50% 40%
40%
30%
30%
20% 20%
10% 10%
0% 0%
Black Latino White 13 - 24 25 - 44 45+
25. Demographics of new positives, MSM youth
New HIV diagnoses among New HIV diagnoses among
MSM youth, 2007-2011 MSM youth, 2007-2011
Race Age
7.6%
12.6%
9.3%
75.4% 92.0%
Black White Latino 13-17 18-24
26.
27.
28. Demographics of new positives, IDU
New HIV diagnoses among New HIV diagnoses among
IDU, 2007-2011 IDU, 2007-2011
Race Age
10.2%
16.0%
44.1% 36.2%
38.0% 53.1%
Black White Latino 13-24 25-44 45+
31. Demographics of new positives, Heterosexuals
New HIV diagnoses among New HIV diagnoses among
HET, 2007-2011 HET, 2007-2011
Race Age
8.8% 3.8%
15.0% 34.6%
50.6%
72.7%
Black White Latino 13-24 25-44 45+
36. Newly diagnosed HIV (Non-AIDS) for 2009-2011 for the Philadelphia EMA
EMA Philadelphia PA NJ
Total EMA N=1,606 N=378 N=237
N=2,221 % % % %
Race/Ethnicity
White, non-Hispanic 481 21.7 16.1 38.9 32.1
Black, non-Hispanic 1,313 59.1 64.1 46.8 45.1
Hispanic 372 16.7 17.8 10.0 20.3
Asian/PI 3 0.2 1.2 2.4 2.1
American Indian/Alaskan 4 0.2 0.0
Native 1.5 0.0
Multi-Race 18 0.8 0.6 1.9 0.4
Unknown 0 0.0 0.0 0.0 0.0
Gender
Male 1,634 73.6 73.6 74.6 71.7
Female 587 26.4 26.4 25.4 28.3
37. Newly diagnosed HIV (Non-AIDS) for 2009-2011 for the Philadelphia EMA
EMA Philadelphia PA NJ
Total EMA N=1,606 N=378 N=237
N=2,221 % % % %
Age
<13 years 13 0.6 .5 0.8 0.8
13 - 19 years 140 6.3 6.4 7.4 3.8
20 - 44 years 1,51 69.8 70.5 6.9 69.6
45+ years 517 23.3 22.5 24.9 25.7
Mode of Transmission
Men who have sex with men 840 37.8 39.5 29.9 38.8
Injection drug users 222 10.0 9.5 14.6 6.3
Men who have sex with men 50 2.3 2.2 2.9 1.3
and inject drugs
Heterosexuals 813 36.6 35.4 36.0 46.0
Other/Hemophilia/blood 0 0.0 0.0 0.0 0.0
transfusion
Perinatal Exposure 18 0.8 0.6 1.9 0.8
Risk not reported or identified 192 8.6 9.5 10.1 0.8
38. Newly diagnosed HIV (Non-AIDS) for 2009-2011 for the Philadelphia EMA
EMA Philadelphia PA NJ
Total EMA N=1,606 N=378 N=237
N=2,221 % % % %
Insurance
Medicaid 411 18.5 23.1 0.0 16.9
Private 414 18.6 21.9 0.0 26.6
No Coverage 167 7.5 7.7 0.0 18.1
Other Public Funding 305 13.7 18.4 0.0 3.8
Unknown 924 41.6 28.9 100.0 34.6
39. Summary
High HIV morbidity in Philadelphia, less so in the
EMA
Philadelphia epidemic predominantly affects
minority populations
MSM and Heterosexual transmission predominant
modes of transmission
Cases among MSM are increasing
Growing numbers of persons living with HIV and
AIDS
25% decline in newly diagnosed AIDS
39
45. Philadelphia Engagement in Care, 2009
25000 19188
20000 100% 15753
82% 11894
15000 62% 9944 8751
52% 46%
10000 5775
30%
5000
0
46. Linkage to Care 2009-2010
by Age, Race
85%
81%
80% 79%
76%
76%
75%
75% 74% 73%
72%
70%
68%
65%
60%
Total 13-24 25-34 35-44 45-54 55+ Black Hispanic White
47. Linkage to Care 2009-2010
by Sex, Mode
90%
81%
80% 75%
74% 73% 74%
72%
68% 69%
70%
60%
50%
43%
40%
30%
20%
10%
0%
Total Male Female MSM Male IDU Male HET Male Female IDU Female HET
MSM/IDU
49. Philadelphia Engagement in Care, 2009
25000 19188
20000 100% 15753
82% 11894
15000 62% 9944 8751
52% 46%
10000 5775
30%
5000
0
50. Definition: Met Need for Primary Care
Met Need for Primary Care defined as measurement
of at least one CD4 count and/or one Viral Load
and/or receipt of antiretroviral therapy during a
specified time period
51. Framework
Input
Population sizes of those with HIV and AIDS within the service
area
Care Patterns of those with HIV and AIDS
Calculated Result
Number of persons with HIV and AIDS with unmet need
52. Population Sizes
Population Sizes Value Data Source(s)
Row A. Number of persons living 11,569 Local eHARS data
with AIDS (PLWA), for (15,178) (EMA data)
the period of
12/31/2011
Row B. Number of persons living 7,523 Local eHARS data
with HIV (PLWH)/non- (10,090) (EMA data)
AIDS/aware, for the
period of 12/31/2011
Row C. Total number of 19,092 Local eHARS data
HIV+/aware for the (25,968) (EMA data)
period of 12/31/2011
53. Care Patterns Value Data Source(s)
Row D. Number of PLWA 9,948 Surveillance Data
who received the (13,053) (Lab Data),
specified HIV CAREWare
primary medical (EMA data)
care during the
12-month period
of 2011
Row E. Number of 5,132 Surveillance Data
PLWH/non-AIDS (7,370) (Lab Data)
who received the CAREWare
(EMA data)
specified HIV
primary medical
care during the
12-month period
of 2011
54. Row F. Total number of 15,080
HIV+/aware who (20,423)
received the
specified HIV
primary medical
care during the 12-
month period of
2011
55. Calculated Results Value Calculation
Row G. Number of PLWA who 1,621 =A–D
did not receive primary (2,125) (EMA data)
medical services during (14.0%)
the 12-month period of
2011
Row H. Number of PLWH/non- 2,391 =B–E
AIDS who did not receive (3,420) (EMA data)
primary medical services (31.8%)
during the 12-month
period of 2011
Row I. Total of HIV+/aware not 4,012 =G+H
receiving specified (5,545) (EMA data)
primary medical care (21.0%)
services (quantified
estimate of unmet need
56. Unmet need by demographic groups, 2011
40.0% 40.0%
35.0% 35.0% 33.4%
31.8%
33.6%
30.0% 27.4% 30.0% 28.1%
25.0% 25.0%
20.0% 20.0%
15.5% 15.2%
15.0% 15.0%
15.2% 10.6%
10.0% 13.4% 10.0%
5.0% 5.0%
0.0% 0.0%
HIV AIDS HIV AIDS
Black White Hispanic Male Female
57. Unmet need by insurance status, 2011
50.0% 46.4%
45.0% 43.1%
40.0%
35.0% 33.7%
28.3% 29.6%
30.0% 26.6%
25.0% 22.4%
20.0%
15.0% 13.5%12.6%
10.0% 7.5%
5.0%
0.0%
HIV AIDS
Medicaid Private Other public Unknown None
59. Philadelphia Engagement in Care, 2009
25000 19188
20000 100% 15753
82% 11894
15000 62% 9944 8751
52% 46%
10000 5775
30%
5000
0
60.
61. Engagement in Care by Sex, 2009
Male Female
12000 82% 6000
10000 5000 82%
8000 4000 67%
47% 54%
43%
6000 3000
35%
35%
4000 2000
2000 1000
0 0
62.
63. Engagement in Care by Race/Ethnicity, 2009
12000
82%
10000
8000
49%
6000 42%
31%
4000 82%
54%50%45% 82%68%
2000 60%
39%
0
Black White Hispanic
Diagnosed In Care On ART Suppressed
64.
65. Engagement in Care by Mode of
Transmission, 2009
6000
82%
82%
5000 4668
4000 64%
49%
46% 48% 51%
3000 39% 43%
32% 33%
2000
1000
0
MSM HET male HET female
Diagnosed In Care On ART Suppressed
66.
67. Engagement in Care by Age Group, 2009
6000
5000
4000
3000
2000
1000
0
18-24 25-34 35-44 45-54 55+
Diagnosed In Care On ART Suppressed
68. Engagement in Care Summary
On ART
Higher for males than females
Higher for men who have sex with men (MSM) than for
women who have sex with men (WSM)
Viral suppression
Higher for males than females
Higher for MSM than WSM
Higher for whites compared to blacks and Hispanics
Higher for those >50 compared to 18-29 year olds
All P values <0.05
69. Starting Antiretroviral Therapy in 2012: A Compendium of Interactive Cases
clinicaloptions.com/hiv
What Will It Take to Substantially Reduce
HIV Transmission in an Entire Population?
Undiagnosed HIV
•1,200,000 Not linked to care
Not retained in care
•Number of Individuals
•1,000,000 ART not required
ART not utilized
•800,000 Viremic on ART
Undetectable
•600,000 HIV-1 RNA
•400,000 •66%
•200,000 •34% •28%
•19% •22% •21%
•0
•Current •DX •Engage •Treat •VL < 50 •Dx,
90% 90% 90% in 90% Engage, Tx,
and VL < 50
in 90%
•Answer: Treatment AND Prevention
•Gardner EM, et al. Clin Infect Dis. 2011;52:793-800.
This paper was published in CID in March of 2011. The objective of this review was to describe and quantify the spectrum of engagement in HIV care.
Using data from the literature for each aspect of engagement in HIV care, Gardner estimated the spectrum of engagement in HIV care in the United States and the proportion of the HIV-infected population who have an HIV viral load <50 copies/mL.
They estimated that just 19% of the1.2 million persons infected with HIV in the United States had an undetectable viral load. These estimates are useful because they can be used to explore the potential impact of interventions to improve engagement in care on the proportion of HIV-infected individuals with an undetectable HIV viral load. Improvement in any single component in care will have minimal impact on the proportion of HIV-infected individuals in the US with an undetectable viral load. This occurs because achievement of an undetectable viral load is dependent on overcoming, sequential barriers, each of which has only a modest impact in overall engagement in care.
In the 46 states and 5 U.S. dependent areas with long-term confidential name-based HIV infection reporting, the estimated rate of diagnoses of HIV infection among adults and adolescents was 19.7 per 100,000 population in 2010. The rate for adults and adolescents diagnosed with HIV infection ranged from zero per 100,000 in American Samoa and the Northern Mariana Islands to 50.4 per 100,000 in the U.S. Virgin Islands.The following 46 states have had laws or regulations requiring confidential name-based HIV infection reporting since at least January 2007 (and reporting to CDC since at least June 2007): Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming. The 5 U.S. dependent areas include American Samoa, Guam, the Northern Mariana Islands, Puerto Rico and the U.S. Virgin Islands. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data are estimates. Estimated numbers resulted from statistical adjustment that accounted for reporting delays, but not for incomplete reporting.
Estimated rates (per 100,000 population) of adults and adolescents living with a diagnosis of HIV infection at the end of 2009 in the 46 states and 5 U.S. dependent areas with long-term confidential name-based HIV infection reporting are shown in this slide. Areas with the highest estimated rates of persons living with a diagnosis of HIV infection at the end of 2009 were New York (795.9), the U.S. Virgin Islands (632.7), Florida (594.8), Puerto Rico (555.7), New Jersey (497.1), Georgia (442.6) and Louisiana (440.4). The following 46 states have had laws or regulations requiring confidential name-based HIV infection reporting since at least January 2007 (and reporting to CDC since at least June 2007): Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming. The 5 U.S. dependent areas include American Samoa, Guam, the Northern Mariana Islands, Puerto Rico and the U.S. Virgin Islands. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data are estimates. Estimated numbers resulted from statistical adjustment that accounted for reporting delays, but not for incomplete reporting. Persons living with a diagnosis of HIV infection are classified as adult or adolescent based on age at end of 2009.