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Late HIV Diagnoses, Georgia, 2011-2012

Late HIV Diagnoses, Georgia, 2011-2012. Background. Late HIV diagnosis is defined as first CD4 within 12 months of diagnosis <200 cells/ml Late HIV diagnosis is associated with shorter lifespan compared to those with earlier diagnosis.

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Late HIV Diagnoses, Georgia, 2011-2012

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  1. Late HIV Diagnoses, Georgia, 2011-2012

  2. Background • Late HIV diagnosis is defined as first CD4 within 12 months of diagnosis <200 cells/ml • Late HIV diagnosis is associated with shorter lifespan compared to those with earlier diagnosis. • It is estimated that persons with late HIV diagnosis have been living 8-10 years with HIV, but have been undiagnosed and untreated. • Persons with late HIV diagnosis have twice the lifetime risk of transmitting HIV to others compared to those diagnosed early.1 • 1Farnham, P.G., et al, J Acquir Immune DeficSyndr, Vo. 64, No. 2, Oct 1,2013.

  3. Costs of Late Diagnosis • Lifetime direct medical costs and productivity losses for new HIV infections were estimated in 2002 as almost $1 million per person.2 • The costs are likely much higher today largely because of increased medical expenses. • The biggest cost, however, is in terms of new infections transmitted. • Each person with late HIV diagnosis has an average lifetime risk of transmitted HIV to 1.4 others.1 • Depending on risk behaviors, number of partners, concurrent STDs, lifetime transmission risk can be even higher. • Further, persons unaware of their HIV diagnosis have a higher annual rate of sexual transmission on HIV (9% vs. 0.4% per person per year).1 • 2 Hutchinson, A.B., et al. J Acquir Immune DeficSyndr, Vol 43, No. 4, December 1, 2006.

  4. Stage of disease by earliest CD4 count within 12 months of HIV diagnosis, adults and adolescents, Georgia, 2011 N=484 N=766 N=632 N=1003 Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, Georgia = 2885 CD4<200 = Stage 3 disease (AIDS) Stage unknown = no CD4 within 12 months of diagnosis

  5. Stage of disease by earliest CD4 count within 12 months of HIV diagnosis, adults and adolescents, by race/ethnicity, Georgia 2011 N=1616 N=271 N=144 N=854 Adults >= age 13, diagnosed 1/1/2011 - 12/31/2011, Georgia = 2885 CD4<200 = Stage 3 disease (AIDS) Stage Unknown = no CD4 within 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, 2010 and are grouped with Unknown race/ethnicity

  6. Stage of disease by earliest CD4 count within 12 months of HIV diagnosis, adult and adolescent males, by transmission category*, Georgia, 2011 N=36 N=68 N=1386 Adults and adolescent males >= age 13, diagnosed 1/1/2011 - 12/31/2011, Georgia = 2214 CD4<200 = Stage 3 disease (AIDS) Stage Unknown = no CD4 within 12 months of diagnosis Multiple imputation 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

  7. Resources For further information on late HIV diagnosis, the Care Continuum, surveillance reports, fact sheets and other slides sets visit: http://dph.georgia.gov/data-fact-sheet-summaries The remainder of this presentation will focus on the Care Continuum among people with late HIV diagnoses in Georgia in 2011

  8. 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

  9. Care Continuum Methodology, Late HIV Diagnoses 2011, Georgia • 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 and current address within Georgia • Excludes 52 persons deceased within 15 months of diagnosis • Late diagnosis = first CD4 within 12 months of diagnosis <200 • 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 • Viral suppression (VS) = VL<200 copies/ml in most recent viral load • All percentages are percent of total number of persons with late diagnosis of HIV in 2011

  10. HIV Care Continuum Methodology, Late Diagnosis, Georgia, 2011 Months 4-15 after diagnosis Months 0-3 after diagnosis Confirmatory Diagnosis Date CD4 or Viral Load CD4 or Viral Load CD4 or Viral Load First CD4 <200 cell/ml Last viral load <200 copies/ml • This person is: • Linked YES • Engaged YES • Retained YES • Virally suppressed YES

  11. Adults and adolescents with late HIV diagnosis*, 2011, Georgia N = 795 N = 2885 Adults and adolescents >= age 13,Georgia residence at diagnosis 01/01/11-12/31/11 *Late diagnosis = earliest CD4 within 12 months of diagnosis <200 cells/ml 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 = 1307 Note: all percentages are proportion of total number of persons diagnosed with HIV in category

  12. Adults and adolescents with late HIV diagnosis*, by sex, Georgia, 2011 N= 169 N= 594 Adults and adolescents >= age 13, Georgia residence at diagnosis 01/01/11-12/31/11 *Late diagnosis = earliest CD4 within 12 months of diagnosis <200 cells/ml Excludes 32 persons for whom sex was not reported 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

  13. Adults and adolescents with late HIV diagnosis*, by race/ethnicity, Georgia, 2011 Adults and adolescents >= age 13, Georgia residence at diagnosis 01/01/11-12/31/11 *Late diagnosis = earliest CD4 within 12 months of diagnosis <200 cells/ml 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

  14. Adult and adolescent males with late HIV diagnosis*, by race/ethnicity, Georgia, 2011 Adult and adolescent males >= age 13, Georgia residence at diagnosis 01/01/11-12/31/11 *Late diagnosis = earliest CD4 within 12 months of diagnosis <200 cells/ml 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

  15. Adult and adolescent females with late HIV diagnosis*, by race/ethnicity, Georgia, 2011 Adult and adolescent females >= age 13, Georgia residence at diagnosis 01/01/11-12/31/11 *Late diagnosis = earliest CD4 within 12 months of diagnosis <200 cells/ml 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

  16. Adults and adolescents with late HIV diagnosis*, by age, Georgia, 2011 N= 209 N= 83 N=192 N= 210 N= 101 Adults and adolescents >= age 13, Georgia residence at diagnosis 01/01/11-12/31/11 *Late diagnosis = earliest CD4 within 12 months of diagnosis <200 cells/ml 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 most recent viral load Note: all percentages are percent of total number of persons diagnosed with HIV in category

  17. 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

  18. Multiple Imputation • Multiple imputation (MI) methods are used to assign transmission categories to those persons whose diagnoses are reported without a risk factor • MI is a statistical approach in which missing transmission categories are replaced with plausible values • CDC uses MI for the national HIV dataset* • Georgia uses the same methodology as CDC *Harrison KM, Kajese T, Hall HI, Song R. Risk factor redistribution of the national HIV/AIDS surveillance data: an alternative approach. Public Health Rep 2008;123:618–27.

  19. Adult and adolescent males with late HIV diagnosis*, by transmission category**, Georgia, 2011 Adult and adolescent males >= age 13, Georgia residence at diagnosis 01/01/11-12/31/11 *Late diagnosis = earliest CD4 within 12 months of diagnosis <200 cells/ml 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

  20. Adults and adolescent females with late HIV diagnosis*, by transmission category**, Georgia, 2011 N= 139 N= 27 N= 30 Adult and adolescent females >= age 13, Georgia residence at diagnosis 01/01/11-12/31/11 *Late diagnosis = earliest CD4 within 12 months of diagnosis <200 cells/ml 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

  21. Adults and adolescents, total diagnosed and late diagnosis*, Georgia, 2011 Adult and adolescent males >= age 13, diagnosed by 09/30/2011, living 12/31/2012, Georgia * Late diagnosis = Stage 3 (AIDS)at or within 12 months of initial HIV diagnosis Multiple imputation is used to estimate number of persons in each transmission category. IDU = Injection drug use

  22. Conclusions • Late diagnosis is a predictor or viral suppression (VS) among persons diagnosed with HIV in 2011 in Georgia (VS 45% overall vs. 59% late diagnosis) • Among those with late diagnosis 2011, VS by race was lowest for Blacks (54%) than Hispanic/Latinos (71%) or Whites (69%) • Among those with late diagnosis 2011, VS by age was lowest for age 13-24 years (52%) and highest for age 45-54 years (65%)

  23. Limitations • Incomplete reporting • Missing data for race/ethnicity, sex, and complete address at diagnosis • Lack of transmission category information • Estimation using multiple imputation to redistribute risk when missing • Missing laboratory reports • Small N is some sub-groups limits meaningful analysis

  24. know your status. Get tested. http://locator.aids.gov/For More information visithttp://dph.georgia.gov/hiv-care-continuum

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