Clusters of HIV in Texas Analise Monterosso, MPH Epidemiologist - - PowerPoint PPT Presentation

▶

Mar 27, 2024 404 likes •699 views

Rapidly Growing Molecular Clusters of HIV in Texas Analise Monterosso, MPH Epidemiologist Molecular HIV Surveillance Coordinator Outline HIV in Texas HIV Drug Resistance testing (genotyping) in Texas Molecular Clusters in Texas

SLIDE 1

Rapidly Growing Molecular Clusters of HIV in Texas

Analise Monterosso, MPH Epidemiologist Molecular HIV Surveillance Coordinator

SLIDE 2

Outline

HIV in Texas
HIV Drug Resistance testing (genotyping)

in Texas

Molecular Clusters in Texas
Cluster Case Study
Continuing Efforts

SLIDE 3

New HIV Diagnoses, Persons Living with HIV , and Deaths in Texas since 1980

15,000 30,000 45,000 60,000 75,000 90,000 1,000 2,000 3,000 4,000 5,000 6,000 1980 1984 1988 1992 1996 2000 2004 2008 2012 2016 People Living with HIV New Diagnoses/Deaths

New HIV Diagnoses Persons Living with HIV Deaths in Persons Living with HIV*

SLIDE 4

People Living With HIV by County, 2016

SLIDE 5

Hispanic Persons in Texas HIV Treatment Cascade, 2016

5 18,663 14,262 13,185 11,538 100% 76% 71% 62%

0% 20% 40% 60% 80% 100% 2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000 18,000

HIV+ Individuals Living at end of 2016 At Least One Visit/Lab Retained In Care Achieved Viral Suppression

SLIDE 6

HIV Incidence In Texas, 2010-2015

6 200 400 600 800 1000 1200 1400 1600 1800 2000 2010 2011 2012 2013 2014 2015 Black\ African American Hispanic\ Latino White

Estimated new HIV infections

SLIDE 7

HIV Genotype Testing in Texas

SLIDE 8

Genotyping Completeness by Texas Ending the Epidemic Priority Populations*, 2010-2016

63% 37%

Hispanic MSM

59% 41%

Black MSM

57% 43%

White MSM

56% 44%

Black Women

Genotyped Ever Not Genotyped

*Data on Trans-PLWH cannot be displayed at this time

SLIDE 9

*Counties with less than 30 diagnoses in timeframe have been suppressed for clarity

HIV Genotype Testing by County, 2010-2016*

*Counties with less than 30 diagnoses in the time period are suppressed for clarity

SLIDE 10

Genotype testing among those linked to care

In 2016:
Of Persons linked to HIV care within 3 months
f diagnosis- 55.7% received genotype

testing

Of Persons linked to HIV care within 6 months
f diagnosis- 55.5% received genotype

testing

In 2015:
Of Persons linked to HIV care within 3 months
f diagnosis- 53.4% received genotype

testing

Of Persons linked to HIV care within 6 months
f diagnosis- 53.1% received genotype

testing

SLIDE 11

Molecular clusters in Texas

SLIDE 12

Age distribution in Clusters Compared to new HIV diagnoses in 2016

51% 35% 7% 7%

Texas Clusters

15-24 25-34 35-44 45+ 23% 38% 18% 21%

Texas Diagnoses 2016

15-24 25-34 35-44 45+

SLIDE 13

Race distribution in Clusters Compared to new HIV diagnoses in 2016

62% 18% 16% 5%

Texas Clusters

Hispanic White Black Other 39% 36% 21% 4%

Texas Diagnoses 2016

Hispanic Black White Other

SLIDE 14

Transmission Risk distribution in Clusters Compared to new HIV diagnoses in 2016

80% 6% 2% 1% 11%

Texas Clusters

MSM MSM\PWID Heterosexual PWID NIR 72% 6% 2% 20%

Texas 2016 Diagnoses

MSM PWID MSM\PWID Heterosexual

SLIDE 15

Texas Cluster Case Study

SLIDE 16

Public Health Follow Up and Contact Tracing

SLIDE 17

Molecular Cluster Cases

17 Molecular Cluster Case Named Partner Relationship

SLIDE 18

Network diagram showing partner services links between molecular cluster members and

ther suspected

members of transmission cluster

SLIDE 19

Timing of exposure and infectiousness among molecular cluster members

SLIDE 20

Re-linkage to Care outcomes

11% 40% 17% 16% 4% 12% Located, Linked to Medical Care Located, Confirmed already in care Located, Refused Services Unable to Locate Open Case Deceased, Incarcerated, Moved

SLIDE 21

Major Findings from Cluster Investigation

Low availability of PrEP in the area
HIV diagnostic\testing algorithm was not

used correctly\completely

Acute HIV cases often missed without the

diagnostic algorithm completed

Clusters are not contained to one

geographic region or jurisdicition

SLIDE 22

Actions Taken to Address Community Factors

Released a Health Advisory
Sent to medical providers and stakeholders

statewide

Details the need to use diagnostic algorithm to

identify acute HIV cases

Recommends HIV genotype testing to identify

these clusters

Available on the Texas DSHS Website:

https://www.dshs.texas.gov/hivstd/

Increase in Prevention funding
More testing
Additional PrEP clinics

SLIDE 23

Continuing efforts

SLIDE 24

Prevention Opportunities

Speak with providers locally about the importance of

the CDC\APHL recommended diagnostic testing algorithm

Advocate for routine HIV testing in Emergency

Rooms\Urgent Care Centers

every patient who gets blood tests also gets an

HIV test

Offer PrEP
Work with local Health Department to link high-risk

persons to PrEP services - make sure the Health Department knows they can refer to your facility

Work with local Emergency rooms to advocate for

PrEP referral for high risk persons

SLIDE 25

Clusters Intervention and CDC funding

Cluster detection, intervention and use for high

impact prevention is a major goal for integrated funding for HIV Prevention and Surveillance

Texas and Houston received supplemental funding

to investigate and intervene on clusters identified using molecular methods that have Latino\Hispanic MSM

7 Field Health Advocate staff in Dallas (2), San

Antonio (1) and statewide(4)

3 PrEP navigators- Dallas, Houston and San

Antonio

1 Public Health Detailing staff dedicated to

clusters and drug resistance testing education

2 staff to help coordinate the functions around

the state

SLIDE 26

Thank you

Analise Monterosso Analise.Monterosso@dshs.texas. gov

SLIDE 27

HIV Treatment Cascade in Texas, 2016

27 86,669 66,680 60,993 51,329 100% 77% 70% 59%

0% 20% 40% 60% 80% 100% 10,000 20,000 30,000 40,000 50,000 60,000 70,000 80,000

HIV+ Individuals Living at end of 2016 At Least One Visit/Lab Retained In Care Achieved Viral Suppression

SLIDE 28

New HIV Diagnoses by County, 2016