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Marked increase in first-time HIV diagnoses in Ontario, 2002

Marked increase in first-time HIV diagnoses in Ontario, 2002. Acknowledgements. Public Health Laboratory staff, Ontario Ministry of Health and Long-Term Care Keyi Wu, programming Mark Fisher, systems consulting and custom download. Background.

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Marked increase in first-time HIV diagnoses in Ontario, 2002

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  1. Marked increase in first-timeHIV diagnoses in Ontario, 2002

  2. Acknowledgements • Public Health Laboratory staff, Ontario Ministry of Health and Long-Term Care • Keyi Wu, programming • Mark Fisher, systems consulting and custom download

  3. Background • In Ontario, HIV diagnostic testing is conducted at the HIV Laboratory and regional labs • Use HIV Laboratory data to monitor the HIV epidemics in Ontario • In late 2002, observed a marked increase in first-time diagnoses in the first three quarters

  4. Study objectives 1. To characterize the increase in first-time HIV diagnoses at the Ontario HIV Laboratory in 2002 2. To better understand to what extent this increase was due to increased HIV testing or HIV incidence

  5. Methods • Examined first-time HIV-positive and total HIV tests from 1985 to 2002 • First-time HIV positive: confirmed positive with no link to a previous positive result in database and no other evidence of previous HIV-positive test in Ontario • Based on the observed pattern, defined the period of increase as calendar year 2002 • Compared HIV test results for 2002 to those in 2001 by sex, age, exposure category, reason for testing, health region and seroconverter or not

  6. RESULTS First-time HIV positives and HIV tests by year, Ontario, 1985-2002 First-time HIV positives All HIV tests 2500 400000 350000 2000 300000 250000 1500 All HIV tests First-time HIV postive tests 200000 1000 150000 100000 500 50000 0 0 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Year of testing

  7. First-time HIV positives and HIV tests by quarter, Ontario, 1999-2002 First-time HIV positives All Tests 350 140000 300 120000 250 100000 Number of First-time Number of all HIV tests HIV positive tests 200 80000 150 60000 100 40000 50 20000 0 0 1999Q1 1999Q2 1999Q3 1999Q4 2000Q1 2000Q2 2000Q3 2000Q4 2001Q1 2001Q2 2001Q3 2001Q4 2002Q1 2002Q2 2002Q3 2002Q4 Year-Quarter

  8. First-time HIV diagnoses by sex Ontario, 2002 versus 2001 Year Female Male Unknown Total 2001 254 733 31 1,0182002 317 880 32 1,238 Relative rate (2002/2001) 1.28 1.20 1.03 1.22 Excess tests (2002-2001) 72 147 1 220

  9. First-time HIV diagnoses by health region Ontario, 2002 versus 2001 Year Northern Eastern Ottawa Central East Toronto South Central Other Other West West 2001 22 38 147 74 604 65 632002 24 30 164 70 809 53 84 Relative rate (2002/2001) 1.09 0.79 1.12 0.95 1.34 0.82 1.33 Excess tests (2002-2001) 2 2 17 -4 205 -12 21 Proportion of Excess 0.80% 6.90% 83.70% 8.60%

  10. First-time HIV diagnoses by exposure category by year, Ontario, 1985-2002 Unknown MSM IDU Endemic HR Hetero LR Hetero 1400 1200 1000 Number of first-time positives 800 600 400 200 0 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Year of testing

  11. First-time HIV diagnoses by exposure category , Ontario, 2002 versus 2001 Year MSM IDU Endemic HR hetero LR hetero Unknown 2001 221 35 36 24 99 5562002 317 37 45 26 107 660 Relative rate (2002/2001) 1.43 1.06 1.25 1.08 1.08 1.19 Excess tests (2002-2001) 96 2 9 2 8 104 Proportion of Excess 42.7% 0.9% 4.0% 0.9% 3.6% 46.2%

  12. First-time HIV diagnoses by reason for testing, Ontario, 2002 versus 2001 Year Donor of blood, tissue Diagnostic Follow-up Insurance Prenatal semenVisa (Known) Unknown 2001 380 31 2 11 2 6 8 5782002 447 40 2 8 0 119 12 610 Relative rate (2002/2001) 1.18 1.29 1.00 0.73 0.00 19.83 1.50 1.06 Excess tests (2002-2001) 67 9 0 -3 -2 1 13 4 32

  13. Is the the increase due to an increase in HIV testing?

  14. Summary of increase in major categories

  15. Proportion of seroconverters, linked and in progress, among first-time HIV diagnoses 2002 versus 2001 2001 2002 Relativerate Excess

  16. Summary of observations • Excess of 220 (+22%) first-time HIV diagnoses from 2001 to 2002 • Exposure category: MSM and persons from HIV-endemic regions (PHER) highest • Health region: Toronto and Central West highest • Reason for test, visa applicants highest • Reasons for testing and exposure categories were mutually exclusive, e.g., no MSM among visa applicants • Proportion of excess: MSM 43%, PHER 4%, visa 51%

  17. Conclusions • Increase among visa applicants entirely due to increase in HIV testing • Among MSM and PHER, increase in HIV diagnoses not due to increased HIV testing • Increases in these groups may be due to selective increased HIV testing in persons at high risk for HIV infection • Also, evidence of increased HIV incidence in MSM • Thus, both increased HIV testing and increased HIV incidence responsible for observed increase in HIV diagnoses • Relative importance not clear; requires further study

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