Using HIV Surveillance to Achieve High Impact Prevention

1. Using HIV Surveillance to Achieve High Impact Prevention Irene Hall, PhD, FACE AIDS 2012 High-Impact Prevention: Reducing the HIV Epidemic in the United States July 22, 2012 National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of HIV/AIDS Prevention

2. The History of HIV Infection in the United States Prevalence, No. Diagnoses and deaths, No. Note. All displayed data have been statistically adjusted to account for reporting delays, but not for incomplete reporting. Death may be due to any cause. Year

3. People with HIV Sources of Reports Aggregate data reports Hospital Practitioners Private Practitioners Public Clinics Laboratories Prevention planning Resource allocation Outcome evaluation CDC Local Health Dept 74,353 HIV Report 2001 Region X HIV Case SurveillanceData for Prevention Linkage and re-engagement in care Individual data reports Partner services Case management Diagnosis facilities Care providers Active Case Finding

4. Indicators of Need and Outcome for Prevention Efforts • Incidence • Prevalence, including undiagnosed • Persons unaware of their infection disproportionately transmit HIV; identifying them for targeting testing is first step in prevention efforts • Linkage to care • Entering care early improves health outcomes • Retention in care • Ongoing care improves health outcomes and survival • Viral suppression • Viral suppression improves health outcomes and may prevent onward transmission

5. Estimated HIV incidence rates, by race/ethnicity – United States, 2009 Annual US incidence ~ 50,000 2009 US incidence rate = 19.0 (16.6-21.3) Prejean et al. Estimated HIV Incidence in the United States, 2006–2009. PLoS ONE 6(8): e17502. doi:10.1371/journal.pone.0017502.

6. Rates of Diagnoses of HIV Infection among Adults and Adolescents, 2010—46 States and 5 U.S. Dependent Areas

8. Estimated Number of Adults and Adolescents Living with HIV Infection (Diagnosed and Undiagnosed)* and Percent Undiagnosed† – United States, 1985 - 2008 *HIV prevalence was estimated based on national HIV surveillance data for adults and adolescents (aged ≥ 13 years at diagnosis) reported through June 2010 using extended back-calculation. †The number of undiagnosed HIV infections was derived by subtracting the estimated number of diagnosed living cases from the estimated overall HIV prevalence

9. Number of persons with HIV engaged in selected stages of the continuum of HIV care – United States 100% 28% 80% 62% 41% 36% CDC. Vital Signs: HIV Prevention Through Care and Treatment — United States. MMWR 2011;60:1618-1623

10. Data for Public Health Action Line Listing Patient A ---- --- --- --- --- Patient B --- --- --- --- --- Patient C --- --- --- --- --- …. Line Listing Patient A ---- --- --- --- --- Patient B --- --- --- --- --- Patient C --- --- --- --- --- …. Case Manager Diagnosis Facility Care Facility

11. Areas with Laws and Regulations for Reporting all CD4 and Viral Load Values, June 2012 VT NH MA RI CT NJ DE MD DC Laboratory reporting (laws and regulations) Not all values All values, specified All values, not specified PuertoRico VirginIslands, U.S.

12. Summary • HIV surveillance provides data for intervention planning and monitoring outcome indicators • Laboratory reporting of all CD4 and viral load test results allows use of surveillance data for public health action on provider and individual level • New emphasis on data use and sharing

13. For more information: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. www.cdc.gov/nchhstp/atlas • www.cdc.gov/hiv/topics/surveillance/index.htm National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of HIV/AIDS Prevention