Dr. Kathleen Brady of Philadelphia's AIDS Activities Coordinating Office (AACO) gave this presentation at the January 9, 2013 Comprehensive Planning Committee meeting.
The HIV Engagement in Care Cascade by Dr. Kathleen Brady
1. The HIV Engagement in Care
Cascade
KATHLEEN A. BRADY, MD
MEDICAL DIRECTOR/MEDICAL
EPIDEMIOLOGIST
AIDS ACTIVITIES COORDINATING OFFICE
JANUARY 9, 2013
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
5,092 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+
20. 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
20
21. 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
21
22. HIV diagnoses by risk group, 2007-2011
600
500
400
300
200
100
0
2007 2008 2009 2010 2011
MSM IDU HET
23. 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+
24. 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
25.
26.
27. 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+
28. Demographics of new positives, IDU
2007 - 2011
Sex
0
29.8%
Male
Female
70.1%
29.
30. 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+
31. Demographics of new positives, HET
2007 - 2011
Sex
0
Male
49.2%
Female
50.7%
32.
33.
34.
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
35
37. Philadelphia Engagement in Care, 2009
25000 19188
20000 100% 15753
82% 11894
15000 62% 9944 8751
52% 46%
10000 5775
30%
5000
0
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
1981 2006 2007
HIV Incidence = the number of individuals newly infected
with HIV within a given period of time (6 - 12
months).
1981 2006 2007
HIV Prevalence = the total number of HIV cases that exist at a
specific time within a specific population.
40. What is STARHS?
Serologic
Testing
Algorithm for
Recent
HIV
Seroconversion
41. Requirements for HIV Incidence
Surveillance
Remnant HIV+ Supplemental Data
Serum Includes:
•Race, sex, mode of
STARHS transmission
Testing •Testing history &
using BED reasons for testing
(Calculating weights)
Assay
•Any exclusionary
info (AIDS
diagnosis, prior
recent ART)
•Adjust for LFU, QNS
HIV Incidence Estimation
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
1000
800
Total
600 Age 13-24
400 Male
200 Black
MSM
0
2006 2007 2008 2009 2010
46. HIV Incidence Trends by Demographic Groups
1000
800 Total
600 Age 13-24
400 Male
200 Black
0 MSM
2006 2010
47. Estimated Incidence Rates - 2010
Population Population in Incidence Estimated 95% CI 95% CI
2010 (13 +) Estimate, Case Rate lower upper
ESTIMATED 20010 per bound bound
100,000
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
Demograp MSM3 MSM3
hic Group % HIV % New
% of MSM who had an Positive Positiv
HIV test in the last 12 Tested = es
519
months
78.5% Total 11.9% 29.0%
Race
76.4% 76.2% 76.1% Black 14.9% 31.8%
White 8.5% 16.7%
Latino 6.8% 50.0%
NHBS-MSM3 Age
ALL MSM Black MSM 18-24 8.2% 50.0%
Latino MSM White MSM 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 IDU2 IDU2
Group % HIV Positive % New
(Tested = 536) 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 IDU2 IDU2
Group % HIV Positive % New
(Tested = 536) 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 N (%)
Negative 14,543 (98)
Positive 294 (2)
Total 14,837 (100)
2% HIV prevalence is 10 to 20 times greater
than that among all heterosexuals in the U.S.
63. HIV Prevalence, by Census Tract Poverty
NHBS-HET1 2006-2007
Percent HIV-positive
Chi-Square Trend, p< 0.0001
0 − 9% 10 − 19% 20 − 29% 30 − 39% ≥ 40%
Proportion of Census Tract Residents Living Below the Poverty Level
64. HIV Prevalence, by Income
NHBS-HET1 2006-2007
Percent HIV-positive
Chi-Square Trend, p< 0.0001
0 − 9,999 10 − 19,999 20 − 49,999 ≥ 50,000
Annual Household Income (in Dollars)
65. HIV Prevalence, by Income
NHBS-HET1 2006-2007
Percent HIV-positive
0 − 9,999 10 − 19,999 20 − 49,999 ≥ 50,000
Annual Household Income (in Dollars)
66. HIV Prevalence, by Income
NHBS-HET1 2006-2007
Percent HIV-positive
6X Greater
0 − 9,999 10 − 19,999 20 − 49,999 ≥ 50,000
Annual Household Income (in Dollars)
67. 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
*Controlling for
city, sex, race/ethnicity, age, education, employment, income, homeless
status, crack use, exchange sex, and STD diagnosis.
68. HIV Surveillance & Census Data
37 States with HIV Reporting 2007
Heterosexuals Living with HIV
Persons (in thousands)
African- Latino White
American
69. HIV Surveillance & Census Data
37 States with HIV Reporting 2007
Heterosexuals Living with HIV Adult & Adolescent Population
Persons (in thousands)
Persons (in millions)
African- Latino White African- Latino White
American American
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
Percent HIV-positive
p= 0.14
African- Latino White
American
72. HIV Prevalence, by Race/Ethnicity
NHBS-HET1 2006-2007
All Census Tracts High Poverty Census Tracts
Percent HIV-positive
Percent HIV-positive
p= 0.73
p= 0.14
African- Latino White African- Latino White
American American
73. HIV Prevalence, by Race/Ethnicity
NHBS-HET1 2006-2007
All Census Tracts High Poverty Census Tracts
Percent HIV-positive
Percent HIV-positive
p= 0.73
p= 0.14
African- Latino White African- Latino White
American American
74. HIV Prevalence, by Race/Ethnicity
NHBS-HET1 2006-2007
All Census Tracts High Poverty Census Tracts
Percent HIV-positive
Percent HIV-positive
p= 0.73
p= 0.14
African- Latino White African- Latino White
American American
75. HIV Prevalence, by Risk Behavior
NHBS-HET1 2006-2007
Yes No
Percent HIV-positive
p< 0.0001 p< 0.0001 p< 0.0001
Crack Exchange STD
Use Sex Diagnosis
76. Summary
● 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
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 HET2 HET2
Group % HIV Positive % New
(Tested = 552) 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 HET2 HET2
Group % HIV Positive % New
(Tested = 552) 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
25000 19188
20000 100% 15753
82% 11894
15000 62% 9944 8751
52% 46%
10000 5775
30%
5000
0
86. 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
87. 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
89. Philadelphia Engagement in Care, 2009
25000 19188
20000 100% 15753
82% 11894
15000 62% 9944 8751
52% 46%
10000 5775
30%
5000
0
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
Population Sizes Value Data Source(s)
Row A. Number of persons living 11,569 Local HARS data
with AIDS (PLWA), for
the period of
12/31/2011
Row B. Number of persons living 7,523 Local HARS data
with HIV (PLWH)/non-
AIDS/aware, for the
period of 12/31/2011
Row C. Total number of 19,092 Local HARS data
HIV+/aware for the
period of 12/31/2011
93. Care Patterns Value Data Source(s)
Row D. Number of PLWA 9,948 Surveillance Data
who received the (Lab Data)
specified HIV CAREWare
primary medical
care during the 12-
month period of
2011
Row E. Number of 5,132 Surveillance Data
PLWH/non-AIDS (Lab Data)
who received the CAREWare
specified HIV
primary medical
care during the 12-
month period of
2011
94. Row F. Total number of 15,080
HIV+/aware who
received the
specified HIV primary
medical care during
the 12-month period
of 2011
95. Calculated Results Value Calculation
Row G. Number of PLWA who 1,621 =A–D
did not receive primary (14.0%)
medical services during
the 12-month period of
2011
Row H. Number of PLWH/non- 2,391 =B–E
AIDS who did not receive (31.8%)
primary medical services
during the 12-month
period of 2011
Row I. Total of HIV+/aware not 4,012 =G+H
receiving specified (21.0%)
primary medical care
services (quantified
estimate of unmet need
96. 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
97. 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
99. Philadelphia Engagement in Care, 2009
25000 19188
20000 100% 15753
82% 11894
15000 62% 9944 8751
52% 46%
10000 5775
30%
5000
0
100.
101. Engagement in Care by Sex, 2009
Male Female
12000 6000
10000 5000
8000 4000
6000 3000
4000 2000
2000 1000
0 0
102.
103. Engagement in Care by Race/Ethnicity, 2009
12000
10000
8000
6000
4000
2000
0
Diagnosed In Care On ART Suppressed
Black White Hispanic
104.
105. Engagement in Care by Mode of
Transmission, 2009
6000
5000
4000
3000
2000
1000
0
Diagnosed In Care On ART Suppressed
MSM HET male HET female
106.
107. Engagement in Care by Age Group, 2009
6000
5000
4000
3000
2000
1000
0
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. 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.
STARHS = serologic testing algorithm for recent HIV seroconversion
As with national data, the data indicates that Philadelphia has a generalized epidemic in the heterosexual community and nearly meets the definition of a concentrated epidemic (HIV prevalence rate is <1% in the general population, but >5% in at least one high-risk subpopulation)
As with national data, the data indicates that Philadelphia has a generalized epidemic in the heterosexual community and nearly meets the definition of a concentrated epidemic (HIV prevalence rate is <1% in the general population, but >5% in at least one high-risk subpopulation)
As with national data, the data indicates that Philadelphia has a generalized epidemic in the heterosexual community and nearly meets the definition of a concentrated epidemic (HIV prevalence rate is <1% in the general population, but >5% in at least one high-risk subpopulation)