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HIV Care Continuum New Diagnoses, 2011, Atlanta Eligible Metropolitan Area (EMA)

HIV Care Continuum New Diagnoses, 2011, Atlanta Eligible Metropolitan Area (EMA). 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

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HIV Care Continuum New Diagnoses, 2011, Atlanta Eligible Metropolitan Area (EMA)

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  1. HIV Care Continuum New Diagnoses, 2011, Atlanta Eligible Metropolitan Area (EMA)

  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, Atlanta EMA* • 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 in Atlanta Eligible Metropolitan Area (EMA), current address in Georgia • Excludes 26 persons deceased within 15 months of diagnosis • Linked to care = CD4 or VL within 3 months of diagnosis , excluding CD4 or VL drawn on 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 MMP sample • Viral suppression (VS) = VL<200 copies/ml in most recent viral load • All percentages are percent of total number of persons diagnosed with HIV *EMA: Bartow, Paulding, Carroll, Coweta, Fayette, Spalding, Henry, Newton, Rockdale, Gwinnett, Walton, Barrow, Forsyth, Cherokee, Pickens, DeKalb, Fulton, Clayton, Cobb and Douglas counties.

  4. HIV Care Continuum Methodology 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 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 CD4 or Viral Load Last viral load <200 copies/ml • This person is: • Linked YES • Engaged YES • Retained YES • Virally suppressed YES

  6. 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

  7. 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

  8. Adults and adolescents diagnosed with HIV infection, Atlanta EMA, 2011 Adults and adolescents >= age 13, diagnosed 01/01/11 -12/31/11, Atlanta EMA = 1923 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 = 788 Note: all percentages are proportion of total number of persons diagnosed with HIV in category Excludes 26 cases deceased as of 03/31/13

  9. Adults and adolescents diagnosed with HIV infection, by race, Atlanta EMA 2011 Adults and adolescents >= age 13, diagnosed 01/01/11 - 12/31/11, Atlanta EMA = 1923 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

  10. Adult and adolescent males diagnosed with HIV infection, by race, Atlanta EMA 2011 Adult and adolescent males >= age 13, diagnosed 01/01/11 - 12/31/11, Atlanta EMA = 1539 Linked to care = CD4 or VL within 3 months of 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

  11. Adult and adolescent females diagnosed with HIV infection, by race, Atlanta EMA 2011 Adult and adolescent females >= age 13, diagnosed 01/01/11 - 12/31/11, Atlanta EMA = 372 Linked to care = CD4 or VL within 3 months of 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

  12. Adults and adolescents diagnosed with HIV infection, by age (years), Atlanta EMA 2011 Adults and adolescents >= age 13, diagnosed 01/01/11 -12/31/11, Atlanta EMA = 1923 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 Excludes 26 cases deceased as of 03/31/13

  13. Adults and adolescents diagnosed with HIV infection, by age, Atlanta EMA, 2011 N=420 N=155 N=442 N=345 N=561 Adults and adolescents >= age 13, diagnosed 01/01/11 - 12/31011, Atlanta EMA = 1923 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

  14. 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

  15. Adult and adolescent males diagnosed with HIV infection, by transmission category*, Atlanta EMA 2011 Adult and adolescent males >= age 13, diagnosed 01/01/11 -12/31/11, Atlanta EMA = 1539 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

  16. Adult and adolescent males diagnosed with HIV infection, by transmission category*, Atlanta EMA, 2011 Adult and adolescent males >= age 13, diagnosed 01/01/11 - 12/31/11, Atlanta EMA = 1539 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

  17. Adult and adolescent females diagnosed with HIV infection, by transmission category*, Atlanta EMA 2011 Adult and adolescent females >= age 13, diagnosed 01/01/11 -12/31/11, Atlanta EMA = 372 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

  18. Adults and adolescent females diagnosed with HIV infection, by transmission category*, Atlanta EMA, 2011 N=232 N=92 N=48 Adults and adolescent females >= age 13, diagnosed 01/01/11 - 12/31/11, Atlanta EMA = 372 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

  19. Adult and adolescent Black MSM* diagnosed with HIV infection, by age (years), Atlanta EMA 2011 Adults and adolescent males >= age 13, diagnosed 01/01/11 -12/31/11, Atlanta EMA = 725 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 = estimated number of persons in that category

  20. Adult and adolescent Black MSM diagnosed with HIV infection, by age, Atlanta EMA, 2011 Adult and adolescent males >= age 13, diagnosed 01/01/11 - 12/31011, Atlanta EMA = 725 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 proportion of total number of persons diagnosed with HIV in category

  21. 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)

  22. 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

  23. Stage of disease by earliest CD4 count within 3 months of HIV diagnosis, adults and adolescents, Atlanta EMA, 2011 N=426 N=364 N=292 N=841 Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1923 CD4<200 = Stage 3 disease (AIDS) Stage unknown = no CD4 within 3 months of diagnosis Excludes 26 cases deceased as of 03/31/13

  24. Stage of disease by earliest CD4 count within 12 months of HIV diagnosis, adults and adolescents, Atlanta EMA, 2011 N=416 N=664 N=332 N=511 Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1923 CD4<200 = Stage 3 disease (AIDS) Stage unknown = no CD4 within 12 months of diagnosis Excludes 26 cases deceased as of 03/31/13

  25. Number and proportion of adults and adolescents by stage at diagnosis by earliest CD4 count within 3 and 12 months after diagnosis, by age, Atlanta EMA, 2011 Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1923 CD4<200 = Stage 3 disease (AIDS) Stage Unknown = no CD4 within 3 or 12 months of diagnosis N = total number in this category Excludes 26 cases deceased as of 03/31/13

  26. Stage of disease by earliest CD4 count within 3 months of HIV diagnosis, adults and adolescents, by age (years), Atlanta EMA 2011 Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1923 CD4<200 = Stage 3 disease (AIDS) Stage Unknown = no CD4 within 3 months of diagnosis

  27. Stage of disease by earliest CD4 count within 12 months of HIV diagnosis, adults and adolescents, by age (years), Atlanta EMA, 2011 Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1923 CD4<200 = Stage 3 disease (AIDS) Stage Unknown = no CD4 within 12 months of diagnosis

  28. 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, Atlanta EMA, 2011 Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1923 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 <1% of adults diagnosed with HIV in Georgia, 2011 and are grouped with other/unknown race/ethnicity ** N = total number in this category Excludes 26 cases deceased as of 03/31/13

  29. Stage of disease by earliest CD4 count within 3 months of HIV diagnosis, adults and adolescents, by race/ethnicity, Atlanta EMA 2011 N=1067 N=160 N=101 N=595 Adults >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1923 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 <1% of adults diagnosed with HIV in Georgia, 2010 and are grouped with Unknown race/ethnicity

  30. Stage of disease by earliest CD4 count within 12 months of HIV diagnosis, adults and adolescents, by race/ethnicity, Atlanta EMA, 2011 Adults >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1923 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 <1% of adults diagnosed with HIV in Georgia, 2010 and are grouped with other/unknown race/ethnicity

  31. Number and proportion of adults and adolescents by stage at diagnosis by earliest CD4 count within 3 and 12 months after diagnosis, by sex, Atlanta EMA, 2011 Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA - 1911 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 Excludes 26 cases deceased as of 03/31/13

  32. Stage of disease by earliest CD4 count within 3 months of HIV diagnosis, adults and adolescents, by sex, Atlanta EMA, 2011 N=372 N=1539 Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1911 CD4<200 = Stage 3 disease (AIDS) Stage Unknown = no CD4 within 3 months of diagnosis Excludes 12 cases for which sex was not reported

  33. Stage of disease by earliest CD4 count within 12 months of HIV diagnosis, adults and adolescents, by sex, Atlanta EMA, 2011 Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1911 CD4<200 = Stage 3 disease (AIDS) Stage Unknown = no CD4 within 12 months of diagnosis Excludes 12 cases for which sex was not reported

  34. Number and proportion of adult and adolescent males by stage at diagnosis by earliest CD4 count within 3 and 12 months after diagnosis, by transmission category*, Atlanta EMA, 2011 Adult and adolescent males >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1539 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

  35. Stage of disease by earliest CD4 count within 3 months of HIV diagnosis, adult and adolescent males, by transmission category*, Atlanta EMA, 2011 N=42 N=961 N=25 Adult and adolescent males >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1539 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

  36. Stage of disease by earliest CD4 count within 12 months of HIV diagnosis, adult and adolescent males, by transmission category*, Atlanta EMA, 2011 Adult and adolescent males >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1539 CD4<200 = Stage 3 disease (AIDS) Stage Unknown = no CD4 within12 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

  37. Number and proportion of adult and adolescent females by stage at diagnosis by earliest CD4 count within 3 and 12 months after diagnosis, by transmission category*, Atlanta EMA, 2011 Adults and adolescent females >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA =372 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 *HET = Heterosexual contact with a person known to have, or to be at high risk for, HIV infection IDU = Injection drug use Other = hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified ** N = total number in this category

  38. Stage of disease by earliest CD4 count within 3 months of HIV diagnosis, adult and adolescent females, by transmission category*, Atlanta EMA, 2011 N=232 N=48 N=92 Adult and adolescent females >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 372 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 *HET = Heterosexual contact with a person known to have, or to be at high risk for, HIV infection IDU = Injection drug use Other = hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified

  39. Stage of disease by earliest CD4 count within 12 months of HIV diagnosis, adult and adolescent females, by transmission category*, Atlanta EMA, 2011 Adult and adolescent females >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 372 CD4<200 = Stage 3 disease (AIDS) Stage Unknown = no CD4 within 12 months of diagnosis Multiple imputation was used to re-distribute transmission category where missing *HET = Heterosexual contact with a person known to have, or to be at high risk for, HIV infection IDU = Injection drug use Other = hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified

  40. 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 • 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 Atlanta EMA

  41. 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

  42. Viral suppression on most recent viral load, by stage of disease by earliest CD4 within 12 months of HIV diagnosis, adults and adolescents, Atlanta EMA, 2011 N=332 N=511 N=664 N=416 Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1923 CD4<200 = Stage 3 disease (AIDS) Stage unknown = no CD4 within 3 months of diagnosis

  43. 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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