[PPT] - Prevention Planning in Maryland Colin Flynn, Chief Center for HIV PowerPoint Presentation

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HIV Epidemiological Data for Prevention Planning in Maryland

Colin Flynn, Chief Center for HIV Surveillance & Epidemiology Infectious Disease & Environmental Health Admin. Maryland Department of Health & Mental Hygiene March 1, 2012

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 2

 To improve the health of Marylanders by reducing the

transmission of infectious diseases, helping impacted persons live longer, healthier lives, and protecting individuals and communities from environmental health hazards

 We work in partnership with local health departments,

providers, community based organizations, and public and private sector agencies to provide public health leadership in the prevention, control, monitoring, and treatment of infectious diseases and environmental health hazards.

IDEHA Mission

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 3

National HIV/AIDS Strategy

Goals:

 Reducing HIV incidence  Increasing access to care and

ptimizing health outcomes

 Reducing HIV-related health disparities  Achieving a more coordinated national

response

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 4

NHAS Goal 1 – Reducing Incidence

 By 2015, lower the annual number of

new HIV infections by 25%

– Reduce the HIV transmission rate by 30% – Increase from 79% to 90% the percentage

f people living with HIV who know their

status

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 5

NHAS Goal 2 – Increasing Access

 By 2015: – Increase the proportion of newly diagnosed

patients linked to clinical care within three months of their HIV diagnosis from 65 percent to 85 percent

– Increase the proportion of Ryan White

HIV/AIDS Program clients who are in continuous care (at least 2 visits for routine HIV medical care in 12 months at least 3 months apart) from 73 percent to 80 percent

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 6

NHAS Goal 3 – Reducing Disparities

 By 2015: – Increase the proportion of HIV diagnosed

gay and bisexual men with undetectable viral load by 20 percent.

– Increase the proportion of HIV diagnosed

Blacks with undetectable viral load by 20 percent.

– Increase the proportion of HIV diagnosed

Latinos with undetectable viral load by 20 percent.

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 7

Reducing HIV Transmission

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 8

HIV Transmission

Uninfected Exposure Infected

Bodily Fluids Sex Injections Perinatal Occupational

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 9

HIV Transmission

Uninfected Exposure Infected

Exposure = Transmission Probability X Frequency X Prevalence Probability per unprotected heterosexual coital act = 0.0001 to 0.0014

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 10

Transmission Example

 Baltimore City = 531,524 population age 13+  Transmission Probability = 0.0007 per coitus  Frequency = 50 acts with 50 random people  Prevalence = 3.0% estimated age 13+

531,524 X 0.0007 X 50 X 0.03 = 558 infections

Behavioral Interventions

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 11

HIV Transmission

Uninfected Exposure Infected

Exposure = Transmission Probability X Frequency X Prevalence More undetectable viral load Fewer infections X Viral Load

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 12

Enhanced Focus

 Identifying undiagnosed infected  Increasing linkage to care  Increasing retention in care  Decreasing viral load  Decreasing new infections

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 13

New Data Initiatives

 Providing new data on all these measures  Drilling down from populations to programs to

people

 Using surveillance data to promote public

health action

 New CDC Guidelines on security and

confidentiality

 New Prevention Category C funding

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 14

National Data

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 15

U.S. HIV/AIDS Prevalence

 At the end of 2009, an estimated 1.2

million Americans were infected with HIV

 It is also estimated that 20% of the

infected were undiagnosed

– CDC. HIV in the United States. Fact Sheet, Nov.

2011. Atlanta.

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 16

2009 Estimated AIDS Diagnoses, Ranked by Rates

STATE/TERRITORY Cases Rate per 100,000

1. District of Columbia

718 119.8

2. New York

4,799 24.6

3. Florida

4,392 23.7

4. Maryland

1,134 19.9

5. Louisiana

869 19.4

6. Puerto Rico

735 18.5

7. Delaware

159 18.0

8. New Jersey

1,475 16.9

9. South Carolina

713 15.6

10. Georgia

1,391 14.1 United States 34,993 11.2

CDC. HIV Surveillance Report, 2009. Vol. 21. Table 20.

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 17

2009 Estimated AIDS Diagnoses, Ranked by Rates

METROPOLITAN AREA Cases Rate per 100,000 1 Miami, FL 2,061 37.2

2. Baton Rouge, LA

241 30.6

3. Jacksonville, FL

387 29.1

4. New York, NY-NJ-PA

5,153 27.0

5. Washington, DC-VA-MD-WV

1,455 26.6

6. Columbia, SC

175 23.5

7. Memphis, TN-MS-AR

305 23.3

8. Orlando, FL

485 23.3

9. New Orleans-Metairie-Kenner, LA

274 23.0

10. Baltimore-Towson, MD

614 22.8

CDC. HIV Surveillance Report, 2009. Vol. 21. Table 24.

United States 34,981 11.2

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 18

2008 Estimated Adults Living with AIDS, Ranked by Rates

STATE/TERRITORY Cases Rate per 100,000

1. District of Columbia

9,475 1,865.1

2. New York

82,703 506.4

3. Maryland

17,063 363.3

4. Virgin Islands

321 356.4

5. Florida

50,833 327.8

6. Puerto Rico

10,453 319.4

7. New Jersey

19,076 264.8

8. Georgia

19,975 255.2

9. Delaware

1,841 252.8

10. Connecticut

6,999 238.6 United States 489,977 192.5

CDC. HIV Surveillance Report, 2009. Vol. 21. Table 22.

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 19

Epidemiological Description

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 20

Maryland HIV/AIDS Trends

500 1,000 1,500 2,000 2,500 3,000 Number of Events Year of Diagnosis or Death

Reported HIV Diagnoses Reported AIDS Diagnoses Reported AIDS Deaths

2001-2008 HIV high, due to reporting transition

Using data as reported through 12/31/2011

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 21

Maryland Living HIV Cases

5,000 10,000 15,000 20,000 25,000 30,000 35,000 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 Number of Cases

Year

Living HIV Cases without AIDS Living HIV Cases with AIDS

Using data as reported through 12/31/2011

+20% Undiagnosed?

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 22

Maryland Adult/Adolescent HIV/AIDS Statistics

Reported Diagnoses (during 2010) No. per 100,000 HIV 1,430 29.7 AIDS 909 18.9 Living Cases (on 12/31/10) No. per 100,000 1 in X HIV without AIDS 12,465 258.8 HIV with AIDS 17,177 356.6 Total HIV 29,642 615.5 162

Using data as reported through 12/31/2011

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 23

Maryland Living HIV Cases

Reported HIV cases with or without an AIDS diagnosis and not reported to have died as of 12/31/10 as reported by name through 12/31/11

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 24

Living Adult/Adolescent HIV Diagnoses on 12/31/10 (N=29,642)

 Engagement in Care: 46% had a CD4 test and

41% had a VL test in the last 12 months

 Immunosuppression: The median CD4 value for

those with a CD4 test was 451 cells/microliter

 Viral Suppression: 50% of those with a VL test

had undetectable VL levels

Using data as reported through 12/31/2011

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 25

Maryland Living Adult/Adolescent HIV Cases by Region, 12/31/10

Baltimore City 44% Suburban Washington 29% Suburban Baltimore 15% Corrections 5% Western 2% Eastern 3% Southern 2%

N = 29,642

Using data as reported through 12/31/2011

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 26

Population and Living HIV Cases by Sex at Birth

48.5 63.7 51.5 36.3

0% 20% 40% 60% 80% 100% Population Living HIV Cases

Female Male

Population on 7/1/09, Cases on 12/31/09 as reported through 12/31/10

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 27

Population and Living HIV Cases by Race/Ethnicity

56.8 15.8 7.2 3.6 29.0 78.4 5.2 0.5 1.8 1.7

0% 20% 40% 60% 80% 100% Population Living HIV Cases

Other NH-Asian NH-Black Hispanic NH-White

Population on 7/1/09, Cases on 12/31/09 as reported through 12/31/10

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 28

Population and Living HIV Cases by Age

26.6 1.8 13.6 8.4 13.1 17.1 15.4 36.3 13.8 27.2 17.5 9.2

0% 20% 40% 60% 80% 100% Population Living HIV Cases

60+ 50-59 40-49 30-39 20-29 <20

Population on 7/1/09, Cases on 12/31/09 as reported through 12/31/10

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 29

Maryland Reported HIV Diagnoses Reported HIV cases with or without

an AIDS diagnosis, diagnosed with HIV during 2010, as reported by name through 12/31/11

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 30

Maryland Reported Adult/Adolescent HIV Diagnoses by Region, 2010

Baltimore City 28% Suburban Washington 33% Suburban Baltimore 28% Corrections 4% Western 2% Eastern 3% Southern 2%

N = 1,430

Using data as reported through 12/31/2011

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 31

Reported Adult/Adolescent (age 13+ at HIV Diagnosis) HIV Cases with or without an AIDS diagnosis, per 100,000 population

50+ 25 – 49.9 15 – 24.9 10 – 14.9 0 – 9.9

Maryland Reported Adult/Adolescent HIV Diagnosis Rates by Jurisdiction, 2010

State Rate = 29.7 per 100,000 Using data as reported through 12/31/2011

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 32

2010 Reported Adult/Adolescent HIV Diagnoses (N=1,430)

 Linkage to Care: 68% had a CD4 or VL test

within 3 months of HIV diagnosis

 CD4 at Diagnosis: 72% had a CD4 test within 12

months of HIV diagnosis, and the median value was 327 cells/microliter

 Late HIV Diagnosis: 30% had an AIDS diagnosis

within 12 months of their HIV diagnosis

Using data as reported through 12/31/2011

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 33

Epidemiological Trends

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 34

Reported Adult/Adolescent HIV Diagnosis Trends by Region

20 40 60 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Percent Year of HIV Diagnosis Baltimore City Suburban Baltimore Suburban Washington Corrections Eastern Southern

Using data as reported through 12/31/2011

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 35

Reported Adult/Adolescent HIV Diagnosis Trends by Sex at Birth

20 40 60 80 100 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Percent Year of HIV Diagnosis Male Female

Using data as reported through 12/31/2011

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 36

Reported Adult/Adolescent HIV Diagnosis Trends by Race/Ethnicity

20 40 60 80 100 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Percent Year of HIV Diagnosis Hispanic NH-Asian NH-Black NH-White NH-Other

Using data as reported through 12/31/2011

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 37

Reported Adult/Adolescent HIV Diagnosis Trends by Age at Diagnosis

10 20 30 40 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Percent Year of HIV Diagnosis 13-19 20-29 30-39 40-49 50-59 60+

Using data as reported through 12/31/2011

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 38

Reported Adult/Adolescent HIV Diagnosis Trends by Exposure Category

10 20 30 40 50 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Percent Year of HIV Diagnosis MSM IDU MSM/IDU HetSex Other

Using data as reported through 12/31/2011

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 39

Maryland Reported HIV Diagnosis Trends MSM Exposure

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 40

Reported Adult/Adolescent HIV Diagnosis Trends by Race/Ethnicity – MSM Exposure

20 40 60 80 100 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Percent Year of HIV Diagnosis Hispanic NH-Asian NH-Black NH-White NH-Other

Using data as reported through 12/31/2011

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 41

Reported Adult/Adolescent HIV Diagnosis Trends by Age at Diagnosis – MSM Exposure

10 20 30 40 50 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Percent Year of HIV Diagnosis 13-19 20-29 30-39 40-49 50-59 60+

Using data as reported through 12/31/2011

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 42

Behavioral Surveillance MSM Overview

Wave 1 June 2004 – Apr 2005 Wave 2 Aug – Nov 2008 Data collection method Venue – based Venue – based Total MSM in past year * 645 448 HIV prevalence 37.7% 37.5% Prevalence unrecognized infection 58.4% 78.4%

*Complete survey and HIV test

Preliminary results for Wave 3 (2011) similar to Wave 2

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 43

2010 Reported Adult/Adolescent MSM HIV Diagnoses (N=208)

 Linkage to Care: 74% had a CD4 or VL test

within 3 months of HIV diagnosis

 CD4 at Diagnosis: 81% had a CD4 test within 12

months of HIV diagnosis, and the median value was 351 cells/microliter

 Late HIV Diagnosis: 31% had an AIDS diagnosis

within 12 months of their HIV diagnosis

Using data as reported through 12/31/2011

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 44

Maryland Reported HIV Diagnosis Trends Heterosexual Exposure

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 45

Reported Adult/Adolescent HIV Diagnosis Trends by Sex at Birth – Heterosexual Exposure

20 40 60 80 100 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Percent Year of HIV Diagnosis Male Female

Using data as reported through 12/31/2011

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 46

Reported Adult/Adolescent HIV Diagnosis Trends by Race/ Ethnicity – Heterosexual Exposure

20 40 60 80 100 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Percent Year of HIV Diagnosis Hispanic NH-Asian NH-Black NH-White NH-Other

Using data as reported through 12/31/2011

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 47

Reported Adult/Adolescent HIV Diagnosis Trends by Age at Diagnosis – Heterosexual Exposure

10 20 30 40 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Percent Year of HIV Diagnosis 13-19 20-29 30-39 40-49 50-59 60+

Using data as reported through 12/31/2011

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 48

Behavioral Surveillance HET Overview

Wave 1 July – Oct 2007 Wave 2 Sept – Dec 2010 Data collection method Venue – based Respondent Driven Total recruited * 332 338 HIV prevalence 3.9% 6.3% Prevalence unrecognized infection 83.3% 62.5%

*Complete survey and HIV test

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 49

2010 Reported Adult/Adolescent Heterosexual HIV Diagnoses (N=167)

 Linkage to Care: 82% had a CD4 or VL test

within 3 months of HIV diagnosis

 CD4 at Diagnosis: 86% had a CD4 test within 12

months of HIV diagnosis, and the median value was 338 cells/microliter

 Late HIV Diagnosis: 38% had an AIDS diagnosis

within 12 months of their HIV diagnosis

Using data as reported through 12/31/2011

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 50

Maryland Reported HIV Diagnosis Trends IDU Exposure

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 51

Reported Adult/Adolescent HIV Diagnosis Trends by Sex at Birth – IDU Exposure

20 40 60 80 100 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Percent Year of HIV Diagnosis Male Female

Using data as reported through 12/31/2011

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 52

Reported Adult/Adolescent HIV Diagnosis Trends by Race/ Ethnicity – IDU Exposure

20 40 60 80 100 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Percent Year of HIV Diagnosis Hispanic NH-Asian NH-Black NH-White NH-Other

Using data as reported through 12/31/2011

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 53

Reported Adult/Adolescent HIV Diagnosis Trends by Age at Diagnosis – IDU Exposure

10 20 30 40 50 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Percent Year of HIV Diagnosis 13-19 20-29 30-39 40-49 50-59 60+

Using data as reported through 12/31/2011

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 54

Behavioral Surveillance IDU Overview

Wave 1 Aug 2006 – Jan 2007 Wave 2 Sept – Dec 2009 Data collection method Respondent Driven Respondent Driven Total IDU in past year * 539 507 HIV prevalence 11.9% 16.2% Prevalence unrecognized infection 50% 48%

*Complete survey and HIV test

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 55

2010 Reported Adult/Adolescent IDU HIV Diagnoses (N=74)

 Linkage to Care: 81% had a CD4 or VL test

within 3 months of HIV diagnosis

 CD4 at Diagnosis: 88% had a CD4 test within 12

months of HIV diagnosis, and the median value was 288 cells/microliter

 Late HIV Diagnosis: 43% had an AIDS diagnosis

within 12 months of their HIV diagnosis

Using data as reported through 12/31/2011

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 56

Priority Population Recommendations

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 57

Maryland HIV Prevention Priorities

1) HIV Positive Persons

Living adult/adolescent HIV cases on 12/31/2010 (N=29,642) 81% non-Hispanic black 64% male 64% were 40-59 years old on 12/31/2010

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 58

Maryland HIV Prevention Priorities (continued)

2) Men who have Sex with Men

47% of 2010 reported adult/adolescent HIV diagnoses (N 680) 65% non-Hispanic black 51% were less than 30 years old at HIV diagnosis (includes MSM and MSM/IDU)

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 59

Maryland HIV Prevention Priorities (continued)

3) Heterosexuals

36% of 2010 reported adult/adolescent HIV diagnoses (N 510) 82% non-Hispanic black 68% female 58% were 30-49 years old at HIV diagnosis

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Maryland Infectious Disease and Environmental Health Administration March 1, 2012 60

Maryland HIV Prevention Priorities (continued)

4) Injection Drug Users

19% of 2010 reported HIV diagnoses (N 265) 77% non-Hispanic black 61% male 69% were 40-59 years old at HIV diagnosis (includes IDU and MSM/IDU)

5) Special Populations

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