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Epidemiological Update 2017 (Positive Committee)
The document details the HIV care continuum and statistics in Philadelphia, highlighting the challenges in engaging individuals in HIV care and the rates of awareness among different demographic groups. It summarizes data on linkage to care, retention in medical care, and viral suppression from 2011 to 2015, indicating improvements over this period. Additionally, the document compares the prevalence of HIV in Philadelphia to national statistics, emphasizing the higher rates in Philadelphia and the demographic makeup of those affected.
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Epidemiological Update 2017 (Positive Committee)
- 1. HIV in Philadelphia KathleenA. 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. HIV Care Continuum Adaptedfrom 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. Diagnosed Infection amongPersons 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. Unaware Estimates bySelect 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. Linkage to HIVMedical 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. 2011 2012 20132014 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. Retention in HIVMedical 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. 2011 2012 20132014 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. 93% 91% 49% 52% 0% 20% 40% 60% 80% 100% HIV-DiagnosedLinked 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. US* Philadelphia** Number 87 Diagnosed 75Are 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. Comparison of HIVPrevalence 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. Proportion of PhiladelphiaEMA 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. Newly Diagnosed HIVPhiladelphia, 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. Rates of NewlyDiagnosed HIV/AIDS per 100,000 population, Philadelphia 2011-2015
Editor's Notes
- #4 This graph presents percentages of persons with diagnosed HIV infection among persons living with diagnosed and undiagnosed infection in the United States at the end of 2013 by age group. The percentage of persons with diagnosed HIV increased with age. Only 48.6% of persons aged 13 to 24 years had been diagnosed, while 98.2% of persons aged 65 years or older had been diagnosed. 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.
- #5 As part of HIV surveillance, we are also able to estimate the number of people who are HIV infected and unaware of their status. We have used back-calculation models developed by CDC and modified for local use to make these estimates. In 2013, we estimated that there were 1,900 people over the age of 13 who were living with HIV and unaware of their status. This represents 10.4% of all PLWH and is quite close to the National HIV/AIDS Strategy 2020 goal of 10%. Once again, we see significant disparities in our estimates by demographic and risk groups with 11.5% of males, 12.5% of blacks, 9.6% of Hispanics, 13.5% of heterosexuals and 13.2% of MSM being unaware of their status. We need to better understand barriers to routine HIV testing and implementation research on how best to implement routine HIV testing including populations that are not accessing health care. We will hear about a specific HIV testing intervention for Latino MSM in the Prevention session this morning.
- #6 This graph presents percentages of persons with HIV diagnosed during 2014 who were linked to care within 1 month of diagnosis by transmission category. Linkage to care within 1 month was highest among females with infection attributed to heterosexual contact (76.6%), followed by males with infection attributed to heterosexual contact (75.5%), males with infection attributed to injection drug use (75.3%), males with infection attributed to male-to-male sexual contact (74.1%), females with infection attributed to injection drug use (72.9%), and males with infection attributed to male-to-male sexual contact and injection drug use (70.0%). Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. Linkage was defined as having at least one CD4 or viral load test within 1 month of diagnosis. The estimates for linkage are based on data from 33 areas with complete reporting of CD4 and viral load test results to CDC as of December 2015. 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 This graph presents two of the indicators for HIV care outcomes – retention in care and viral suppression – by transmission category. Males with infection attributed to male-to-male sexual contact and injection drug use had the highest retention in medical care (60.1%), followed by males with infection attributed to male-to-male sexual contact (57.4%), females with infection attributed to heterosexual contact (57.1%), females with infection attributed to injection drug use (56.4%), males with infection attributed to heterosexual contact (53.3%), and males with infection attributed to injection drug use (49.4%). Males with infection attributed to male-to-male sexual contact had the highest viral suppression (57.9%), followed by males with infection attributed to male-to-male sexual contact and injection drug use (55.0%), females with infection attributed to heterosexual contact (53.4%), males with infection attributed to heterosexual contact (50.5%), females with infection attributed to injection drug use (49.9%), males with infection attributed to injection drug use (45.3%). The estimates for retention in care and viral suppression are based on data from 33 areas with complete reporting of CD4 and viral load test results to CDC as of December 2015. 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. Other includes hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified. MSM, male-to-male sexual contact; IDU, injection drug use
- #14 So who is being diagnosed with HIV in Philadelphia? In 2014, the most recent data available, 624 cases were diagnosed with HIV of which nearly 80% were male, 2/3rds black and nearly a quarter were between the ages of 13 and 24. In terms of mode of transmission, over half of the newly diagnosed cases in 2014 were secondary to male to male sexual transmission, and over 40% to heterosexual transmission. Historically, injection drug use has been a major contributor to HIV transmission in Philadelphia but only 5.4% of newly diagnosed cases occurred in persons who inject drugs. This is a major but often forgotten success story of the HIV epidemic in Philadelphia, a success that is attributable to the availability of clean needles largely through the needle exchange program.