Dr. Kathleen Brady of Philadelphia's AIDS Activities Coordinating Office (AACO) gave this presentation at the January 9, 2013 Comprehensive Planning Committee meeting.
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.
Kathleen Brady - HIV in Philadelphia (Annual Epidemiological Presentation)Office of HIV Planning
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.
Core practices that are moving from a pilot state to implementation at scale: Many of the
barriers facing HIV programs are common across countries. PEPFAR’s ECTs (described below in
Sections 2.3.2 and 2.3.3) identified common issues affecting countries at various levels of
epidemic control and then developed a compendium of evidence-based solutions, approaches
and case-studies that highlight successful means of addressing common barriers. Additional
evidence-based approaches and case-studies will be incorporated into this living compendium
over time. As highlighted in this PEPFAR Solutions Platform, these practices can be rapidly
adapted and scaled to move countries forward.
Key considerations for all PEPFAR programs include:
• Bringing Interventions to Scale with Fidelity: Getting to HIV epidemic control is dependent on
several factors; not the least of which is the ability to rapidly scale successful interventions with
fidelity and demonstrated impact. However, the logistics of cost- effective programmatic scale
have proven challenging, with several implementation barriers. Implementation science
defines scalability as the capacity to expand or extend an intervention to account for a growth
factor that aims to fill a gap or address unmet need in a defined population group/geographic
area.
• Data and Information Technology: The enabling environment for data and information
technology is rapidly maturing across countries, creating space, opportunity, and needed
political will to harness the Data Revolution for epidemic control. OUs should consider
innovative ways to use data and information technology to improve efficiency and
sustainability in achieving epidemic control, beyond immediate PEPFAR indicator data
collection needs. As highlighted in the Data Revolution Innovation Toolkit, available on the
PEPFAR SharePoint, OUs are encouraged to explore, adapt, and scale these and other data
driven approaches to move country epidemic control forward.
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.
Kathleen Brady - HIV in Philadelphia (Annual Epidemiological Presentation)Office of HIV Planning
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.
Core practices that are moving from a pilot state to implementation at scale: Many of the
barriers facing HIV programs are common across countries. PEPFAR’s ECTs (described below in
Sections 2.3.2 and 2.3.3) identified common issues affecting countries at various levels of
epidemic control and then developed a compendium of evidence-based solutions, approaches
and case-studies that highlight successful means of addressing common barriers. Additional
evidence-based approaches and case-studies will be incorporated into this living compendium
over time. As highlighted in this PEPFAR Solutions Platform, these practices can be rapidly
adapted and scaled to move countries forward.
Key considerations for all PEPFAR programs include:
• Bringing Interventions to Scale with Fidelity: Getting to HIV epidemic control is dependent on
several factors; not the least of which is the ability to rapidly scale successful interventions with
fidelity and demonstrated impact. However, the logistics of cost- effective programmatic scale
have proven challenging, with several implementation barriers. Implementation science
defines scalability as the capacity to expand or extend an intervention to account for a growth
factor that aims to fill a gap or address unmet need in a defined population group/geographic
area.
• Data and Information Technology: The enabling environment for data and information
technology is rapidly maturing across countries, creating space, opportunity, and needed
political will to harness the Data Revolution for epidemic control. OUs should consider
innovative ways to use data and information technology to improve efficiency and
sustainability in achieving epidemic control, beyond immediate PEPFAR indicator data
collection needs. As highlighted in the Data Revolution Innovation Toolkit, available on the
PEPFAR SharePoint, OUs are encouraged to explore, adapt, and scale these and other data
driven approaches to move country epidemic control forward.
Fast-track the end of AIDS in the EU - practical evidence-based interventions.
Presentation by: Jens Lundgren, CHIP
In a two-day meeting under the auspices of the Maltese Presidency of the Council of the European Union (30-31 January 2017), HIV experts from across the European Union discussed how to reverse this trend and how to prepare Europe to achieve the set target of ending AIDS by 2030.
Fast-track the end of AIDS in the EU - practical evidence-based interventions.
Presentation by: Julia del Amo, Instituto de Salud Carlos III, Madrid
In a two-day meeting under the auspices of the Maltese Presidency of the Council of the European Union (30-31 January 2017), HIV experts from across the European Union discussed how to reverse this trend and how to prepare Europe to achieve the set target of ending AIDS by 2030.
Laura Bamford, MD, MSCE
Associate Professor of Medicine
Medical Director, Owen Clinic
Division of Infectious Diseases and Global Public Health
Department of Medicine
University of California, San Diego
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.
Evelyn Torres and Sebastian Branca's update on AACO's Client Services Unit (CSU), Housing Services Program (HSP), and Quality Improvement (QI) programs
Mari Ross-Russell from the Office of HIV Planning shared a sampler of Delaware County Social Determinants maps at the December 2014 Philadelphia Ryan White Part A Planning Council meeting.
Fast-track the end of AIDS in the EU - practical evidence-based interventions.
Presentation by: Jens Lundgren, CHIP
In a two-day meeting under the auspices of the Maltese Presidency of the Council of the European Union (30-31 January 2017), HIV experts from across the European Union discussed how to reverse this trend and how to prepare Europe to achieve the set target of ending AIDS by 2030.
Fast-track the end of AIDS in the EU - practical evidence-based interventions.
Presentation by: Julia del Amo, Instituto de Salud Carlos III, Madrid
In a two-day meeting under the auspices of the Maltese Presidency of the Council of the European Union (30-31 January 2017), HIV experts from across the European Union discussed how to reverse this trend and how to prepare Europe to achieve the set target of ending AIDS by 2030.
Laura Bamford, MD, MSCE
Associate Professor of Medicine
Medical Director, Owen Clinic
Division of Infectious Diseases and Global Public Health
Department of Medicine
University of California, San Diego
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.
Evelyn Torres and Sebastian Branca's update on AACO's Client Services Unit (CSU), Housing Services Program (HSP), and Quality Improvement (QI) programs
Mari Ross-Russell from the Office of HIV Planning shared a sampler of Delaware County Social Determinants maps at the December 2014 Philadelphia Ryan White Part A Planning Council meeting.
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.
Dr. Anne Frankel from Temple University presented the results of the most recent Youth Risk Behavior Survey (YRBS) in Philadelphia at the March 2016 meeting of the Philadelphia HIV Prevention Planning Group.
The OHP's Nicole Johns reviewed the process of putting together the Integrated HIV Prevention and Care Plan at the August meeting of the Philadelphia Ryan White Part A Planning Council.
Philadelphia FIGHT's PrEP Retention and Adherence Coordinator Devon Clark presented on HIV Pre-exposure Prophylaxis (PrEP) at the September 2016 meeting of the Positive Committee.
Kathleen Brady of the PDPH presented the annual report on the HIV epidemic in Philadelphia at the February 2017 meeting of the Philadelphia Ryan White Part A Planning Council.
Fast-track the end of AIDS in the EU - practical evidence-based interventions.
Presentation by: Valerie Delpech, Public Health Engand
In a two-day meeting under the auspices of the Maltese Presidency of the Council of the European Union (30-31 January 2017), HIV experts from across the European Union discussed how to reverse this trend and how to prepare Europe to achieve the set target of ending AIDS by 2030.
Patient safety disparities presentation from 2015 CDC National Conference on ...Noel Eldridge
My portion of a panel presentation with 3 other speakers at conference session "CC6" on August 25, 2015. Will update when all conference slides are posted to public. Current web link as of September 19, 2015 is: http://www.cdc.gov/nchs/events/2015nchs/program_tuesday.htm#c6
Global Medical Cures™ | HIV TESTING IN USA
DISCLAIMER-
Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Overview of the 2018 Update to the Integrated Plan and PrEP Workgroup Draft R...Office of HIV Planning
Mari Ross-Russell (Office of HIV Planning) and Matthew McClain (Public Health Policy & Planning Consultant) presented these slides to the PrEP Workgroup of the Philadelphia EMA HIV Integrated Planning Council on January 16, 2019.
Dr. William R. Short presented this review of PrEP research from the Conference on Retroviruses and Opportunistic Infections to the PrEP Workgroup of the HIPC's Prevention Committee in April 2018.
Sebastian Branca of the AIDS Activities Coordinating Office provided this overview of AACO's quality management program to the HIV Integrated Planning Council on May 10, 2018. This presentation includes discussion of secret shoppers, quality improvement plans, and quality management initiatives.
C-YA! Philadelphia EMA's Plan to Connect our Co-infected Community to a Cure ...Office of HIV Planning
Alex Shirreffs of the Philadelphia Department of Public Health provided this overview of the Philadelphia area's plan to end HIV and Hepatitis C coinfections to the HIV Integrated Planning Council on May 10, 2018.
Ricardo Colon of the AIDS Activities Coordinating Office provided this overview of AACO's Client Services Unit to the HIV Integrated Planning Council on May 10, 2018. It includes information on the medical case management program and top needs identified at client intake.
This presentation was provided to the Philadelphia EMA HIV Integrated Planning Council by Briana Morgan of the Office of HIV Planning. It includes data related to population-level data, race/ethnicity, STIs, risk behaviors, HIV, and more.
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.
Increasing Treatment Access and Saving Lives in the Dual Opioid and Overdose ...Office of HIV Planning
Silvana Mazzella of Prevention Point Philadelphia gave this presentation on medication assisted treatment to the Philadelphia EMA HIV Integrated Planning Council on March 8, 2018.
Dr. Kathleen Brady of the AIDS Activities Coordinating Office discussed three cycles of the National HIV Behavioral Surveillance in Philadelphia, including cycles with men who have sex with men (MSM), high-risk heterosexuals, and injection drug users. This presentation took place at the Philadelphia EMA HIV Integrated Planning Council meeting on Thursday, January 11, 2018.
Caitlin Conyngham and Erika Aaron of the AIDS Activities Coordinating Office began the initial meeting of the PrEP Working Group with this presentation on November 15, 2017.
Antonio Boone of the Office of HIV Planning reviewed major points from the Mayor's Task Force to Combat the Opioid Epidemic in Philadelphia at the June 12, 2017 Positive Committee meeting.
Marcy Witherspoon, MSW, LSW of the Health Federation of Philadelphia discussed trauma-informed care with the Philadelphia EMA HIV Integrated Planning Council on November 9, 2018.
OHP's Antonio Boone gave this presentation on different prevention continuum examples at the July meeting of the Prevention Committee of the Philadelphia EMA HIV Integrated Planning Council.
Integrated HIV Surveillance and Prevention Programs for Health Departments - ...Office of HIV Planning
Caitlin Conyngham, Prevention Coordinator at the AIDS Activities Coordinating Office at the Philadelphia Department of Public Health, gave an overview of the new HIV prevention notice of funding opportunity to the HIPC's Prevention Committee on 07-26-2017.
Opioid Awareness - Report Review: The Mayor's Task Force to Combat the Opioid...Office of HIV Planning
The OHP's Antonio Boone presented at the June 2017 meeting of the Positive Committee on the recent report from the Mayor's Task Force to Combat the Opioid Epidemic in Philadelphia.
Planning Council Co-Chair and Prevention Committee member Jen Chapman presented on integrated planning and concurrence at the May 2017 meeting of the HIV Integrated Planning Council.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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
The HIV Engagement in Care Cascade by Dr. Kathleen Brady
1. K A T H L E E N A . B R A D Y , M D
M E D I C A L D I R E C T O R / M E D I C A L
E P I D E M I O L O G I S T
A I D S A C T I V I T I E S C O O R D I N A T I N G O F F I C E
J A N U A R Y 9 , 2 0 1 3
The HIV Engagement in Care
Cascade
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
19188
100% 15753
82% 11894
62% 9944
52%
8751
46% 5775
30%
0
5000
10000
15000
20000
25000
13. For every 100 people living with HIV:
US
Number
82
Are aware of their
infection
66 Are linked to HIV care
37 Stay in HIV care
33
Get antiretroviral
therapy
25
Have a very low amount
of virus in their body
Philadelphia
Number
82
Are aware of their
infection
62 Are linked to HIV care
52 Stay in HIV care
46
Get antiretroviral
therapy
30
Have a very low amount
of virus in their body
2009 Data
15. Philadelphia Engagement in Care, 2009
19188
100% 15753
82% 11894
62% 9944
52%
8751
46% 5775
30%
0
5000
10000
15000
20000
25000
16.
17.
18. HIV Prevalence in Philadelphia
(reported thru 6/30/2012)
19,157 PLWHA (aware)
11,583 AIDS cases
7,574 HIV cases
5,092 estimated to be
living with HIV and
unaware
1.59% Philadelphia
residents estimated to be
HIV+
Rates (known) vary by
race
2.1% of blacks
1.5% of Latinos
0.7% of whites
Rates vary by sex
1.9% of males
0.7% of females
20. 20
HIV/AIDS Cases by Sex and Date of
Diagnosis
0
200
400
600
800
1000
1200
1400
1600
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
Year
NumberofCases
AIDS Female AIDS Male HIV Female HIV Male
21. 21
HIV Cases by Race/Ethnicity and Date of
Diagnosis
171
142 127
106 110
575 594
534
479 498
133 146
210
127
95
0
100
200
300
400
500
600
700
2006 2007 2008 2009 2010 2011
Year
NumberofCases
White AfrAm Hispanic
22. HIV diagnoses by risk group, 2007-2011
0
100
200
300
400
500
600
2007 2008 2009 2010 2011
MSM IDU HET
23. Demographics of new positives, MSM
New HIV diagnoses among
MSM by race, 2007-2011
0%
10%
20%
30%
40%
50%
60%
70%
Black Latino White
New HIV diagnoses among
MSM by age, 2007-2011
0%
10%
20%
30%
40%
50%
60%
13 - 24 25 - 44 45+
24. New HIV diagnoses among
MSM youth, 2007-2011
New HIV diagnoses among
MSM youth, 2007-2011
75.4%
9.3%
12.6%
Race
Black White Latino
7.6%
92.0%
Age
13-17 18-24
Demographics of new positives, MSM youth
25.
26.
27. New HIV diagnoses among
IDU, 2007-2011
New HIV diagnoses among
IDU, 2007-2011
44.1%
38.0%
16.0%
Race
Black White Latino
10.2%
53.1%
36.2%
Age
13-24 25-44 45+
Demographics of new positives, IDU
30. New HIV diagnoses among
HET, 2007-2011
New HIV diagnoses among
HET, 2007-2011
72.7%
15.0%
8.8%
Race
Black White Latino
3.8%
50.6%
34.6%
Age
13-24 25-44 45+
Demographics of new positives, Heterosexuals
35. 35
Summary
High HIV morbidity in Philadelphia
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
37. Philadelphia Engagement in Care, 2009
19188
100% 15753
82% 11894
62% 9944
52%
8751
46% 5775
30%
0
5000
10000
15000
20000
25000
38. Incidence Surveillance
Collect and STARHS test the diagnostic blood
specimens from all newly diagnosed HIV infections
reported from public and private laboratories and
providers to HIV Surveillance Unit.
Collect the HIV testing information needed for the
statistical estimates of incidence.
Calculate population-based estimates of HIV
incidence.
Use these estimates to identify emerging sub-
epidemics, monitor trends, target prevention
resources and interventions to areas and
populations most heavily affected, and evaluate
programs.
39. Incidence vs. Prevalence
HIV Prevalence = the total number of HIV cases that exist at a
specific time within a specific population.
HIV Incidence = the number of individuals newly infected
with HIV within a given period of time (6 - 12
months).
20061981 2007
20061981 2007
41. Remnant HIV+
Serum
Supplemental Data
STARHS
Testing
using BED
Assay
Includes:
•Race, sex, mode of
transmission
•Testing history &
reasons for testing
(Calculating weights)
•Any exclusionary
info (AIDS diagnosis,
prior recent ART)
•Adjust for LFU, QNS
HIV Incidence Estimation
Requirements for HIV Incidence
Surveillance
42. CDC STARHS Test Results
(+) standard test and (+) STARHS test
= long-standing HIV infection
(+) standard test and (-) STARHS test =
recent HIV infection
43. National Incidence Data, 2010
Estimated 47,500 HIV infections in 2009 in adults
and adolescents (95% CI, 42,000 – 53,000)
Estimated incidence 18.8 infections per 100,000 population
44% among blacks, 21% Latinos
63% among MSM, 25% heterosexual
26% among 13-24 year olds
Early signs of an encouraging decrease in new HIV
infections among black women
21 percent decrease between 2008 and 2010
Continuing increase in new infections among young
gay and bisexual men
22 percent increase between 2008 and 2010
44. 2010 Local Estimate of
HIV Incidence
Local estimate of 577 new HIV infections in 2010 in
adults and adolescents (95% CI, 385-769)
2010 estimate is significantly lower than the
estimate from 2008 (926 infections) and 2009
(945 infections)
Case rate of 45.1 infections per 100,000 population
(2.4 times that of the national rate)
The estimated decline in incidence must be
interpreted with caution due to violations in the
estimation assumptions
45. HIV Incidence Trends by Demographic Groups
0
200
400
600
800
1000
2006 2007 2008 2009 2010
Total
Age 13-24
Male
Black
MSM
46. HIV Incidence Trends by Demographic Groups
0
200
400
600
800
1000
2006 2010
Total
Age 13-24
Male
Black
MSM
47. Estimated Incidence Rates - 2010
Population Population in
2010 (13 +)
ESTIMATED
Incidence
Estimate,
20010
Estimated
Case Rate
per
100,000
95% CI
lower
bound
95% CI
upper
bound
MSM 29,737 306 1,029.0 578.4 1,483.0
IDU 37,378 44 117.7 0.0 254.2
HET 294,682 226 76.7 30.1 60.1
*Includes persons >13 living in poverty
Data Source: PDPH/AACO HIV Incidence Surveillance Program
48. Incidence Summary
Includes people unaware of their status.
40% decrease between 2009 and 2010
P<0.05
Declines in all demographic groups
Incidence higher than baseline 2006 data for MSM
and youth 13-24
53. National HIV Behavioral Surveillance
Risk Behaviors
Assess prevalence of and trends in risk behaviors
Sexual risk behaviors
Drug-use risk behaviors
HIV Testing Behaviors
Assess prevalence of and trends in HIV testing behaviors (not
included until HET-1)
54. NHBS Objectives (cont.)
Prevention
Assess exposure to and use of prevention services
Assess impact of prevention services on behavior
Identify prevention service gaps and missed opportunities for
prevention
55. NHBS-MSM3
Interviews conducted at venues where at least 50%
of men identified as MSM
List of venues included in your attachments
566 MSM interviewed in Philadelphia
545 had sex with a man in the last 12 months
26.2% white, 57.6% black, 11.4% Latino
83.6% identified as gay, 14.6% bisexual, 1.9% as straight
56. NHBS-MSM Summary
We are not currently meeting the PHS guidelines for
HIV testing
76.8% of MSM ever tested
Less than half (46.9%) of MSM had tested in the last year
Lower prevalence of HIV in MSM seen in
Philadelphia
57. Philadelphia NHBS-MSM3, 2011
76.4% 76.2% 76.1%
78.5%
NHBS-MSM3
% of MSM who had an
HIV test in the last 12
months
ALL MSM Black MSM
LatinoMSM White MSM
Demograp
hic Group
MSM3
% HIV
Positive
Tested =
519
MSM3
% New
Positiv
es
Total 11.9% 29.0%
Race
Black 14.9% 31.8%
White 8.5% 16.7%
Latino 6.8% 50.0%
Age
18-24 8.2% 50.0%
25-44 10.6% 35.1%
45+ 19.8% 21.1%
58. NHBS-IDU2
539 IDU interviewed in Philadelphia
75.3% male, 24.7% female, 88.1% over 30
54.8% black, 42.8% white, 15% Latino
87.8% reported ever testing for HIV with 2.8% reporting
being HIV+
38.6% reported having an HIV test within the last year
16.0% reported having an HIV test within the last 6
months
57.7% ever tested for Hepatitis C
52.1% told they had Hepatitis (95.0% Hep C)
59. IDU2 Testing Data
Demographic
Group
IDU2
% HIV Positive
(Tested = 536)
IDU2
% New
Positives
Total 8.9% 68.1%
Gender
Male 7.7% 70.0%
Female 12.9% 64.7%
Race
Black 14.3% 65.7%
White 2.6% 80.0%
Latino 8.6% 71.4%
60. IDU2 Testing Data
Demographic
Group
IDU2
% HIV Positive
(Tested = 536)
IDU2
% New
Positives
Age Group
18-24 0.0% 0.0%
25-44 3.8% 66.7%
45+ 13.5% 60.5%
Geographic Area
Kensington 4.2% 66.6%
NW 12.5% 100.0%
North 8.6% 76.9%
West 23.4% 55.5%
61. What is a High-Risk Heterosexual?
Past definitions
Multiple sexual partners
Sexual partners’ risks
New definitions evaluated in NHBS-HET1
Geography (HIV is clustered in high-poverty
neighborhoods)
Social networks (Some social and sexual networks have
high HIV despite equal individual risks, greater inter-
network mixing)
62. HIV Prevalence
NHBS-HET1 2006-2007
HIV Test Result
Negative
Positive
Total
14,543
294
14,837
N
(98)
(2)
(100)
(%)
2% HIV prevalence is 10 to 20 times greater
than that among all heterosexuals in the U.S.
63. 10−19% 20−29% ≥ 40%
Proportion of Census Tract Residents Living Below the Poverty Level
0−9%
PercentHIV-positive
30−39%
HIV Prevalence, by Census Tract Poverty
NHBS-HET1 2006-2007
Chi-Square Trend, p< 0.0001
64. 10−19,999 20−49,999 ≥ 50,000
Annual Household Income (in Dollars)
0−9,999
PercentHIV-positive HIV Prevalence, by Income
NHBS-HET1 2006-2007
Chi-Square Trend, p< 0.0001
65. 10−19,999 20−49,999 ≥ 50,000
Annual Household Income (in Dollars)
0−9,999
PercentHIV-positive HIV Prevalence, by Income
NHBS-HET1 2006-2007
66. 10−19,999 20−49,999 ≥ 50,000
Annual Household Income (in Dollars)
0−9,999
PercentHIV-positive HIV Prevalence, by Income
NHBS-HET1 2006-2007
6X Greater
67. *Controlling for city, sex, race/ethnicity, age, education, employment,
income, homeless status, crack use, exchange sex, and STD diagnosis.
HIV Prevalence, Multivariable Model*
NHBS-HET1 2006-2007
Low socioeconomic status was
associated with higher HIV prevalence:
• Low income
• Limited education
• Unemployment
• Resident of city
• Sex with an opposite-gender partner in the past year
• English- or Spanish-speaking
68. HIV Surveillance & Census Data
37 States with HIV Reporting 2007
Persons(inthousands)
Heterosexuals Living with HIV
African-
American
Latino White
69. HIV Surveillance & Census Data
37 States with HIV Reporting 2007
Persons(inthousands)
Heterosexuals Living with HIV
African-
American
Latino White
Persons(inmillions)
Adult & Adolescent Population
African-
American
Latino White
70. Ratio of Heterosexuals Living
with HIV to the Population–
African-Americans:
> 20 times greater
Latinos:
6 times greater
71. HIV Prevalence, by Race/Ethnicity
NHBS-HET1 2006-2007
African-
American
Latino White
PercentHIV-positive
p= 0.14
72. HIV Prevalence, by Race/Ethnicity
NHBS-HET1 2006-2007
All Census Tracts
African-
American
Latino White
PercentHIV-positive
African-
American
Latino White
High Poverty Census Tracts
PercentHIV-positive
p= 0.14
p= 0.73
73. HIV Prevalence, by Race/Ethnicity
NHBS-HET1 2006-2007
All Census Tracts
African-
American
Latino White
PercentHIV-positive
African-
American
Latino White
High Poverty Census Tracts
PercentHIV-positive
p= 0.14
p= 0.73
74. HIV Prevalence, by Race/Ethnicity
NHBS-HET1 2006-2007
All Census Tracts
African-
American
Latino White
PercentHIV-positive
African-
American
Latino White
High Poverty Census Tracts
PercentHIV-positive
p= 0.14
p= 0.73
76. ● HIV prevalence was very high
● Low socioeconomic status was
associated with higher HIV prevalence
● Racial and ethnic disparities in HIV
prevalence were substantially less than
those in the general population
● Crack use and exchange sex were not
associated with higher HIV prevalence
Summary
77. NHBS-HET2 Methods
RDS method chosen for NHBS-HET2
Eligibility Criteria
Between the ages of 18-60
Male or female
Had vaginal or anal sex with a person of the opposite-sex in
the past 12 months
Lives in the EMA
Able to complete the interview in English or Spanish
78. NHBS-HET2 Data
617 HET screened in Philadelphia
552 HET interviewed
510 met the HET definition
42.5% male, 57.5% female
25.3% 18-24
84.3% black, 2.2% white, 12.4% Latino, 1.2% other
94.9% had never injected drugs, 5.1% past IDU
15.9% currently or previously homeless
79. NHBS-HET2 data
Education
34.5% less than high school education
54.5% high school education
10.0% with vocational/tech or some college
1.0% college graduate
Poverty
10.6% above poverty guideline
87.6% at or below poverty
80. HET2 Demographics
HIV Testing
76.3% reported ever testing for HIV with 2.8% reporting being
HIV+
20.3% reported having an HIV test within the last 6 months
28.4% reported having an HIV test within the last year
81. HET2 Testing Data
Tested # HIV Positive % New Positive
All Participants 4.4% (N=24) 79.2%
Low SES 4.5% (N=23)
Not Low SES 2.8% (N=1)
Male 5.9% (N=13)
Female 3.4% (N=10)
Black 5.1% (N=22)
Latino 1.6% (N=1)
White 0.0% (N=0)
82. HET2 Testing Data
Demographic
Group
HET2
% HIV Positive
(Tested = 552)
HET2
% New
Positives
All Participants 4.3% 79.2%
Gender
Male 5.4% 84.6%
Female 3.6% 72.7%
Race/Ethnicity
Black 5.0% 78.3%
Latino 1.4% 100.0%
White 0.0% 0.0%
83. HET2 Testing Data
Demographic
Group
HET2
% HIV Positive
(Tested = 552)
HET2
% New
Positives
Age
18-24 1.5% 50.0%
25-44 3.5% 75.0%
45+ 7.4% 85.7%
Low SES 3.4% 84.2%
Not Low SES 0.9% 60.0%
85. Philadelphia Engagement in Care, 2009
19188
100% 15753
82% 11894
62% 9944
52%
8751
46% 5775
30%
0
5000
10000
15000
20000
25000
86. Linkage to Care 2009-2010
by Age, Race
74%
68%
73%
79%
75%
76%
72%
76%
81%
60%
65%
70%
75%
80%
85%
Total 13-24 25-34 35-44 45-54 55+ Black Hispanic White
87. Linkage to Care 2009-2010
by Sex, Mode
74%
68%
73% 72%
74% 75%
43%
69%
81%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Total Male Female MSM Male IDU Male HET Male
MSM/IDU
Female IDU Female HET
89. Philadelphia Engagement in Care, 2009
19188
100% 15753
82% 11894
62% 9944
52%
8751
46% 5775
30%
0
5000
10000
15000
20000
25000
90. 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
91. 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
92. Population Sizes Value Data Source(s)
Row A. Number of persons living
with AIDS (PLWA), for
the period of
12/31/2011
11,569 Local HARS data
Row B. Number of persons living
with HIV (PLWH)/non-
AIDS/aware, for the
period of 12/31/2011
7,523 Local HARS data
Row C. Total number of
HIV+/aware for the
period of 12/31/2011
19,092 Local HARS data
Population Sizes
93. Care Patterns Value Data Source(s)
Row D. Number of PLWA
who received the
specified HIV
primary medical
care during the 12-
month period of
2011
9,948 Surveillance Data
(Lab Data)
CAREWare
Row E. Number of
PLWH/non-AIDS
who received the
specified HIV
primary medical
care during the 12-
month period of
2011
5,132 Surveillance Data
(Lab Data)
CAREWare
94. Row F. Total number of
HIV+/aware who
received the
specified HIV primary
medical care during
the 12-month period
of 2011
15,080
95. Calculated Results Value Calculation
Row G. Number of PLWA who
did not receive primary
medical services during
the 12-month period of
2011
1,621
(14.0%)
= A – D
Row H. Number of PLWH/non-
AIDS who did not receive
primary medical services
during the 12-month
period of 2011
2,391
(31.8%)
= B – E
Row I. Total of HIV+/aware not
receiving specified
primary medical care
services (quantified
estimate of unmet need
4,012
(21.0%)
= G + H
96. Unmet need by demographic groups, 2011
33.6%
13.4%
27.4%
15.5%
31.8%
15.2%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
HIV AIDS
Black White Hispanic
33.4%
15.2%
28.1%
10.6%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
HIV AIDS
Male Female
97. Unmet need by insurance status, 2011
28.3%
13.5%
22.4%
12.6%
33.7%
7.5%
46.4%
29.6%
43.1%
26.6%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
50.0%
HIV AIDS
Medicaid Private Other public Unknown None
99. Philadelphia Engagement in Care, 2009
19188
100% 15753
82% 11894
62% 9944
52%
8751
46% 5775
30%
0
5000
10000
15000
20000
25000
100.
101. Engagement in Care by Sex, 2009
0
2000
4000
6000
8000
10000
12000
Male
0
1000
2000
3000
4000
5000
6000
Female
102.
103. Engagement in Care by Race/Ethnicity, 2009
0
2000
4000
6000
8000
10000
12000
Diagnosed In Care On ART Suppressed
Black White Hispanic
104.
105. Engagement in Care by Mode of Transmission,
2009
0
1000
2000
3000
4000
5000
6000
Diagnosed In Care On ART Suppressed
MSM HET male HET female
106.
107. Engagement in Care by Age Group, 2009
0
1000
2000
3000
4000
5000
6000
Diagnosed In Care On ART Suppressed
18-24 25-34 35-44 45-54 55+
108. 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
109. clinicaloptions.com/hiv
Starting Antiretroviral Therapy in 2012: A Compendium of Interactive Cases
What Will It Take to Substantially Reduce
HIV Transmission in an Entire Population?
•Answer: Treatment AND Prevention
•Gardner EM, et al. Clin Infect Dis. 2011;52:793-800.
•200,000
•600,000
•0
•800,000
•1,000,000
•1,200,000
•400,000
•19% •22%
•34% •28% •21%
•66%
•NumberofIndividuals
•Current •DX
90%
•Engage
90%
•Treat
90%
•VL < 50
in 90%
•Dx,
Engage, Tx,
and VL < 50
in 90%
Undiagnosed HIV
Not linked to care
Not retained in care
ART not required
ART not utilized
Viremic on ART
Undetectable
HIV-1 RNA