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Impact of Syndemics on People Living with HIV/AIDS in San Francisco

Priscilla Lee Chu, DrPH , MPH San Francisco Department of Public Health XIX International AIDS Conference July 23, 2012 Washington, DC. Impact of Syndemics on People Living with HIV/AIDS in San Francisco. Introduction: PCSI.

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Impact of Syndemics on People Living with HIV/AIDS in San Francisco

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  1. Priscilla Lee Chu, DrPH, MPH San Francisco Department of Public Health XIX International AIDS Conference July 23, 2012 Washington, DC Impact of Syndemics on People Living with HIV/AIDS in San Francisco

  2. Introduction: PCSI • Program Collaboration and Service Integration (PCSI) has prioritized the integrated monitoring of syndemicsamong four communicable disease registries: • HIV • Tuberculosis • Viral Hepatitis • STDs

  3. Introduction: Syndemics • Syndemics are the presence of two or more diseases interacting synergistically to exacerbate health outcomes within a population

  4. Introduction: Purpose • To assess the prevalence of co-occurring infections within the four registries and their impact on persons living with HIV/AIDS (PLWHA)

  5. Methods 1/2 • HIV/AIDS cases were matched against seven diseases from three other registries

  6. Methods 2/2 • Chi-square, t-test, and Kruskal-Wallis tests were used to assess differences between those with HIV only versus HIV plus at least one co-infection by: • Demographics • Health status • Neighborhood

  7. Results: Syndemics with HIV • HIV N=15,056 • N=2,050 (14%) with one or more infection in addition to HIV • Syndemic rate 13,616 per 100,000 HIV cases • Highest co-morbidities: HCV, HBV, Chlamydia, and latent TB

  8. Results: Characteristics of PLWHA with at least one other disease

  9. Results: Mean viral load by specific co-infection

  10. Results: Suppression rates by specific co-infection

  11. Results: Mean viral load by number of co-infections

  12. Results: Viral suppression rates by number of co-infections

  13. Results: PLWHA syndemics and poverty, San Francisco, 2009

  14. Conclusion 1/3 • Syndemics are associated with poorer HIV health outcomes among PLWHA • Significant “dose-response relationship” between the number of co-infections and mean VLs

  15. Conclusion 2/3 • In addition to numbers of co-infections, particular demographic subgroups, and certain geo-clusters were also associated with poorer health outcomes, underscoring the need to address multiple conditions in tandem in an integrated health system

  16. Conclusion 3/3

  17. Thanks & Acknowledgements Glenn-Milo Santos Annie Vu Israel Nieves-Rivera Grant Colfax Jennifer Grinsdale Sandra Huang Susan Philip Susan Scheer Tomas Aragon

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