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HIV Care Continuum New Diagnoses, 2011 , DeKalb County, Georgia

HIV Care Continuum New Diagnoses, 2011 , DeKalb County, Georgia. Persons with HIV Engaged in S elected S tages of the Continuum of Care, United States. 82. 66. Percent. 37. 33. 25. Hall et al . XIX International AIDS Conference, 2012 ART, antiretroviral therapy.

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HIV Care Continuum New Diagnoses, 2011 , DeKalb County, Georgia

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  1. HIV Care Continuum New Diagnoses, 2011, DeKalb County, Georgia

  2. Persons with HIV Engaged in Selected Stages of the Continuum of Care, United States 82 66 Percent 37 33 25 Hall et al. XIX International AIDS Conference, 2012 ART, antiretroviral therapy

  3. Care Continuum Methodology, New HIV Diagnoses 2011, DeKalb County • Adults and adolescents are those aged >= 13 years • Diagnosed between 01/01/11 -12/31/11, • Alive at least 15 months after diagnosis • Residence at diagnosis DeKalb County, current residence in Georgia • Excludes 6 persons deceased within 15 months of diagnosis • Linked to care = CD4 or VL within 3 months of diagnosis , excluding day of diagnosis • Engaged in care >= 1 CD4 or VL 4-15 months after diagnosis • Retained in care >= 2 CD4 or VL at least 3 months apart 4-15 months after diagnosis • Estimated percentage prescribed ART derived from Medical Monitoring Project (MMP) Georgia sample • Viral suppression (VS) = VL<200 copies/ml in most recent viral load (VL) • All percentages are percent of total number of persons diagnosed with HIV

  4. HIV Care Continuum Methodology Months 4-15 after diagnosis Months 0-3 after diagnosis HIV Confirmatory Diagnosis Date CD4 or Viral Load CD4 or Viral Load CD4 or Viral Load Last viral load <200 copies/ml • This person is: • Linked YES • Engaged YES • Retained YES • Virally suppressed YES

  5. HIV Care Continuum Methodology Months 4-15 after diagnosis Months 0-3 after diagnosis HIV Confirmatory Diagnosis Date CD4 or Viral Load CD4 or Viral Load Last viral load undetectable • This person is • Linked YES • Engaged YES • Retained NO • Virally suppressed YES • “Engaged in care” is minimal engagement that indicates the person “touched” the medical system at least once during that 12 month period

  6. HIV Care Continuum Methodology Months 4-15 after diagnosis Months 0-3 after diagnosis HIV Confirmatory Diagnosis Date CD4 or Viral Load CD4 done but no viral load done • This person is • Linked NO • Engaged YES • Retained YES • Virally suppressed NO • If no viral load done, it is assumed to be not suppressed

  7. Adults and adolescents diagnosed with HIV infection, DeKalb County, 2011 Adults and adolescents >= age 13, diagnosed 01/01/11-12/31/11, DeKalb County = 525 Linked to care = CD4 or VL within 3 months of diagnosis Engaged in care >= 1 CD4 or VL 4-15 months after diagnosis Retained in care >= 2 CD4 or VL at least 3 months apart 4-15 months after diagnosis Prescribed ART derived from MMP sample Viral suppression (VS) = VL<200 copies/ml in most recent viral load = 220 Note: all percentages are percent of total number of persons diagnosed with HIV in category

  8. Adults and adolescents diagnosed with HIV infection, by race/ethnicity, DeKalb County 2011 Adults and adolescents >= age 13, diagnosed 01/01/11 - 12/31/11, DeKalb County= 525 Linked to care = CD4 or VL within 3 months of diagnosis Engaged in care >= 1 CD4 or VL 4-15 months after diagnosis Retained in care >= 2 CD4 or VL at least 3 months apart 4-15 months after diagnosis Viral suppression (VS) = VL<200 copies/ml in most recent viral load American Indian/Alaska Native, Asian, and Native Hawaiian/Other Pacific Islanders combined equal <2% of new diagnoses and are included in Other/Unknown

  9. Adults and adolescents diagnosed with HIV infection, by age, DeKalb County, 2011 N=43 N=128 N=99 N=95 N=160 Adults and adolescents >= age 13, diagnosed 01/01/11 - 12/31011, current address DeKalb County =525 Linked to care = CD4 or VL within 3 months of diagnosis Engaged in care >= 1 CD4 or VL 4-15 months after diagnosis Retained in care >= 2 CD4 or VL at least 3 months apart 4-15 months after diagnosis Viral suppression (VS) = VL<200 copies/ml in most recent viral load Note: all percentages are percent of total number of persons diagnosed with HIV in category

  10. Transmission category definitions • Multiple imputation was used to re-distribute transmission category where missing • MSM = Male to male sexual contact • IDU = Injection drug use • MSM/IDU = Male to male sexual contact and injection drug use • HET = Heterosexual contact with a person known to have, or to be at high risk for, HIV infection • Other = hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified

  11. Adult and adolescent males diagnosed with HIV infection, by transmission category*, DeKalb County, 2011 Adult and adolescent males >= age 13, diagnosed 01/01/11 - 12/31/11, DeKalb County = 423 Linked to care = CD4 or VL within 3 months of diagnosis Engaged in care >= 1 CD4 or VL 4-15 months after diagnosis Retained in care >= 2 CD4 or VL at least 3 months apart 4-15 months after diagnosis Viral suppression (VS) = VL<200 copies/ml in most recent viral load Multiple imputation was used to re-distribute transmission category where missing *MSM = Male to male sexual contact IDU = Injection drug use MSM/IDU = Male to male sexual contact and injection drug use HET = Heterosexual contact with a person known to have, or to be at high risk for, HIV infection Other = hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified

  12. Adults and adolescent females diagnosed with HIV infection, by transmission category*, DeKalb County, 2011 N=65 N=23 N=13 Adults and adolescent females >= age 13, diagnosed 01/01/11 - 12/31/11, DeKalb County = 101 Note: small N in all categories; use caution in interpretation Linked to care = CD4 or VL within 3 months of diagnosis Engaged in care >= 1 CD4 or VL 4-15 months after diagnosis Retained in care >= 2 CD4 or VL at least 3 months apart 4-15 months after diagnosis Viral suppression (VS) = VL<200 copies/ml in most recent viral load Multiple imputation was used to re-distribute transmission category where missing *IDU = Injection drug use HET = Heterosexual contact with a person known to have, or to be at high risk for, HIV infection Other = hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified

  13. Adult and adolescent Black MSM* diagnosed with HIV infection, by age (years), DeKalb County 2011 Adults and adolescent males >= age 13, diagnosed 01/01/11 -12/31/11, DeKalb County = 203 Linked to care = CD4 or VL within 3 months of diagnosis Engaged in care >= 1 CD4 or VL 4-15 months after diagnosis Retained in care >= 2 CD4 or VL at least 3 months apart 4-15 months after diagnosis Viral suppression (VS) = VL<200 copies/ml in most recent viral load Multiple imputation was used to redistribute transmission category when missing *MSM = men who have sex with men **N = number of persons in that category Note: all percentages are percent of total number of persons diagnosed with HIV in category

  14. Adult and adolescent Black MSM diagnosed with HIV infection, by age, DeKalb County, 2011 Adult and adolescent males >= age 13, diagnosed 01/01/11 - 12/31011, DeKalb County= 203 Linked to care = CD4 or VL within 3 months of diagnosis Engaged in care >= 1 CD4 or VL 4-15 months after diagnosis Retained in care >= 2 CD4 or VL at least 3 months apart 4-15 months after diagnosis Viral suppression (VS) = VL<200 copies/ml in most recent viral load Note: all percentages are percent of total number of persons diagnosed with HIV in category

  15. The HIV Care Continuum can help us… • Focus our efforts for linkage, retention and viral suppression. • Identify groups at increased risk for dropping out of each step in the continuum. • Monitor our progress in improvement of linkage, retention, and viral suppression. • Identify disparities not only in prevalence but in care • Evaluate efforts addressing specific populations with low viral suppression. • Monitor efforts in improving viral suppression in specific counties, census tracts, zip codes and some specific facilities • Encourage improvement in surveillance data completeness (race, sex, transmission category)

  16. Stage of HIV disease at diagnosis • Stage at diagnosis is defined by the first CD4 done within 3 months of diagnosis Stage 1 = CD4 >=500 Stage 2 = CD4 200-499 Stage 3 = CD4 <200 or OI • Stage at diagnosis is unknown if no CD4 done within 3 months of diagnosis

  17. Stage of disease by earliest CD4 count within 3 months of HIV diagnosis, adults and adolescents, DeKalb County, 2011 N=76 N=110 N=114 N=225 Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, DeKalb County = 525 CD4<200 = Stage 3 disease (AIDS) Stage unknown = no CD4 within 3 months of diagnosis

  18. Stage of disease by earliest CD4 count within 12 months of HIV diagnosis, adults and adolescents, DeKalb County 2011 N=92 N=135 N=130 N=168 Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, DeKalb County = 525 CD4<200 = Stage 3 disease (AIDS) Stage unknown = no CD4 within 12 months of diagnosis

  19. Number and proportion of adults and adolescents by stage at diagnosis by earliest CD4 count within 3 and 12 months after diagnosis, by race/ethnicity, DeKalb County, 2011 Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, DeKalb County = 525 CD4<200 = Stage 3 disease (AIDS) Stage Unknown = no CD4 within 3 or 12 months of diagnosis *American Indian/Alaska Native, Asian and Native Hawaiian/Pacific Islander groups together constitute <2% of adults diagnosed with HIV in Georgia, 2011 and are grouped with other/unknown race/ethnicity ** N = total number in this category

  20. Stage of disease by CD4 count within 12 months of HIV diagnosis, adults and adolescents, by race/ethnicity, DeKalb County 2011 N=300 N=46 N=31 N=148 Adults >= age 13, diagnosed 1/1/2011 - 12/31/2011, DeKalb County= 525 CD4<200 = Stage 3 disease (AIDS) Stage Unknown = no CD4 within 3 months of diagnosis *American Indian/Alaska Native, Asian and Native Hawaiian/Pacific Islander groups together constitute <2% of adults diagnosed with HIV in Georgia, 2010 and are grouped with Unknown race/ethnicity

  21. Number and proportion of adults and adolescents by stage at diagnosis using earliest CD4 count within 3 and 12 months after diagnosis, by sex, DeKalb County, 2011 Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, DeKalb County = 524 Excludes 1 case for which sex was not reported CD4<200 = Stage 3 disease (AIDS) Stage Unknown = no CD4 within 3 or 12 months of diagnosis *N = total number in this category Excludes 12 cases for which sex was not reported

  22. Stage of disease by CD4 count within 12 months of HIV diagnosis, adults and adolescents, by sex, DeKalb County, 2011 N=101 N=423 Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, DeKalb County = 524 Excludes 1 case for which sex was not reported CD4<200 = Stage 3 disease (AIDS) Stage Unknown = no CD4 within 3 months of diagnosis

  23. Number and proportion of adults and adolescents by stage at diagnosis by earliest CD4 count within 3 and 12 months after diagnosis, by transmission category*, DeKalb County, 2011 Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, DeKalb County = 525 CD4<200 = Stage 3 disease (AIDS) Stage Unknown = no CD4 within 3 or 12 months of diagnosis Multiple imputation was used to re-distribute transmission category where missing *MSM = Male to male sexual contact IDU = Injection drug use MSM/IDU = Male to male sexual contact and injection drug use HET = Heterosexual contact with a person known to have, or to be at high risk for, HIV infection Other = hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified **N = total number in this category

  24. Stage of disease by earliest CD4 count within 12 months of HIV diagnosis, adults and adolescents, by transmission category*, DeKalb County, 2011 N=22 N=277 N=10 Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, DeKalb County = 525 CD4<200 = Stage 3 disease (AIDS) Stage Unknown = no CD4 within 3 months of diagnosis Multiple imputation was used to re-distribute transmission category where missing *MSM = Male to male sexual contact IDU = Injection drug use MSM/IDU = Male to male sexual contact and injection drug use HET = Heterosexual contact with a person known to have, or to be at high risk for, HIV infection Other = hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified

  25. Limitations • Incomplete reporting • Missing data for race/ethnicity, sex, and address at diagnosis • Lack of transmission category information • Definition of heterosexual transmission (sexual contact with a known HIV infected partner or person with increased risk, i.e., MSM or IDU) • Missing laboratory reports • CD4 within 3 and 12 months of diagnosis yields high unknown stage in DeKalb County and in Georgia overall

  26. Uncertainties • Populations for which data are missing may be fundamentally different • How to obtain data for transgender category • How to improve completeness of reporting • Data on ART use • Understanding barriers to ART adherence • Prioritizing further research

  27. Viral suppression on most recent viral load, by stage of disease by earliest CD4 within 3 months of HIV diagnosis, adults and adolescents, DeKalb County, 2011 N=225 N=76 N=110 N=114 Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, DeKalb County = 525 CD4<200 = Stage 3 disease (AIDS) Stage unknown = no CD4 within 3 months of diagnosis

  28. For information on HIV prevention visit http://dph.georgia.gov/hiv-prevention-program For more information on HIV surveillance in Georgia, visit http://dph.georgia.gov/georgias-hivaids-epidemiology-surveillance-section

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