San Francisco Department of Public Health

Slides:

Advertisements

Similar presentations

Impact of Age and Race on New HIV Infections among Men who have Sex with Men in Los Angeles County Shoshanna Nakelsky, MPH Division of HIV and.

Advertisements

Estimating the number of Kentuckians living with HIV disease with unmet needs for HIV-related primary care in calendar year 2010  Reducing new HIV infections.

Retention across the continuum of care in a cohort of HIV infected children in rural India G. Alvarez-Uria RDT Hospital, Department of Infectious Diseases,

HIV Care Continuum, Men Who Have Sex with Men Only (MSMO) and Men Who Have Sex with Men and Women (MSMW), Georgia, 2012.

Late HIV Diagnoses, Georgia,

Introduction DCDOH supports HIV test and treat activities - increased number of HIV tests performed, emphasis on earlier linkage to care. Limited data.

1 Is Managed Care Superior to Traditional Fee-For-Service among HIV-Infected Beneficiaries of Medicaid? David Zingmond, MD, PhD UCLA Division of General.

The Effect of Syphilis Co-infection on Clinical Outcomes in HIV-Infected Persons The Effect of Syphilis Co-infection on Clinical Outcomes in HIV-Infected.

Racial Disparities in Antiretroviral Therapy Use and Viral Suppression among Sexually Active HIV-infected Men who have Sex with Men— United States, Medical.

Wisconsin Department of Health Services HIV/AIDS Surveillance Annual Review New diagnoses, prevalent cases, and deaths through December 31, 2013 April.

Washington D.C., USA, JULY Rulin C. Hechter 1 MD,PhD Jean Q. Wang 1 PhD Margo A. Sidell 1 ScD William J. Towner 2 MD 1 Dept.

HIV Care Continuum, District 8- 2 Southwest (Albany), Georgia, 2012.

RESULTS Individual characteristics % (N) unless otherwise specified Gender Male 65% (255) Female 35% (136) Race/Ethnicity African American 35% (137) White-not.

Catherine Kober Margaret Johnson Martin Fisher Caroline Sabin On behalf of UK-CHIC BHIVA/BASHH Manchester 2010 Non-uptake of HAART among patients with.

Impact of Highly Active Antiretroviral Therapy on the Incidence of HIV- encephalopathy among perinatally- infected children and adolescents. Kunjal Patel,

Life expectancy of patients treated with ART in the UK: UK CHIC Study Margaret May University of Bristol, Department of Social Medicine, Bristol.

HIV Care Continuum, Georgia, United States, 2011 Presented to American Public Health Association, Annual Meeting Presented by Deepali Rane, MBBS, MPH,

How to Avoid a Flood: Practical Advice for Calculating the HIV Treatment Cascade Kathleen A. Brady, MD Medical Director/Medical Epidemiologist AIDS Activities.

Lipoatrophy and lipohypertrophy are independently associated with hypertension: the effect of lipoatrophy but not lipohypertrophy on hypertension is independent.

HIV Care Continuum New Diagnoses, 2011, Fulton County, Georgia.

HIV Care Continuum, District 10 Northeast (Athens), Georgia, 2012.

Monitoring Indicators of the National HIV/AIDS Strategy Using Data for Public Health Action Irene Hall, PhD, FACE HIV Incidence and Case Surveillance Branch.

HIV and STI Department, Health Protection Agency - Colindale HIV and AIDS Reporting System The United Kingdom provides excellent access and quality of.

HIV Care Continuum Persons Living With HIV, Georgia, 2012.

The case for HIV testing A presentation for the clinical team in your practice.

HIV and STI Department, Health Protection Agency - Colindale HIV and AIDS Reporting System The threshold for an ART secondary prevention effect on HIV.

The Continuum of HIV Care Florida, 2014 The Continuum of HIV Care Florida, 2014 Lorene Maddox, MPH Karalee Poschman, MPH Living data through 2014, as of.

Florida Department of Health HIV/AIDS Section Division of Disease Control and Health Protection Annual data trends as of 12/31/2014 Living (Prevalence)

Annual Epidemiological Spotlight on HIV in London: 2014 data Field Epidemiology Services PHE Publications gateway number

Florida Department of Health HIV/AIDS Section Division of Disease Control and Health Protection Annual data trends as of 12/31/2014 Living (Prevalence)

HIV Infection Among Those with an Injection Drug Use*-Associated Risk, Florida, 2014 Florida Department of Health HIV/AIDS Section Division of Disease.

Mean HIV viral load among resident cases and undiagnosed in Oregon Jeff Capizzi, Epidemiologist Sean Schafer, HIV/STD/TB Medical Epidemiologist Lea Bush,

To protect, promote and improve the health of all people in Florida through integrated state, county, and community efforts. Created: 12/04/14 Revision:

Epidemiology of HIV Among Men in Florida, Reported through 2014 Florida Department of Health HIV/AIDS Section Division of Disease Control and Health Protection.

HIV Care Continuum New Diagnoses, 2011, Georgia. Persons with HIV Engaged in Selected Stages of the Continuum of Care, United States Percent

Viral load distribution 2012 among persons living with HIV and persons newly diagnosed Georgia, 2011.

HIV and STI Department, Health Protection Agency - Colindale HIV and AIDS Reporting System Predictors for high viraemia among the treatment naïve population.

Estimating the population impact of homelessness on HIV viral suppression among people who use drugs Brandon DL Marshall, 1 Beth Elson, 1 Sabina Dobrer,

Summary of HIV Infection in Alaska, 1982–2015 Prepared by the State of Alaska Department of Health and Social Services, Division of Public Health, HIV/STD.

Ryan White Part A & Minority AIDS Initiative Service Utilization in the Indianapolis Transitional Grant Area: FY 2015 July 7, 2016 Tammie L. Nelson, MPH,

HIV Care Continuum Ryan White Program - Miami-Dade County

Ryan White Part A & Minority AIDS Initiative Service Utilization in the Indianapolis Transitional Grant Area: FY June 1, 2017 Tammie L. Nelson,

Illustrating the HIV Care Continuum in U.S. Cities

Earlier treatment and lower mortality in infants Initiating ART at

Illustrating the HIV Care Continuum in U.S. Cities

HIV treatment cascade analysis for people who inject drugs in Ukraine: identifying the correlates of HIV care outcomes Kostyantyn Dumchev1, Olga Varetska2,

HIV Epidemiological Profile for Chicago EMA

Conclusions & Implications

Simple assessments of adherence to antiretorviral therapy predict virologic failure in HIV+ patients in Lusaka, Zambia Ronald A. Cantrell, MPH University.

Illustrating the HIV Care Continuum in U.S. Cities

Better Retention Rates Observed in Patients on Lopinavir than Atazanavir in Uganda

Bronx Community Health Dashboard: HIV and AIDS Created: 5/4/2017 Last Updated: 10/23/2017 See last slide for more information about this.

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

MHEALTH to Improve Health: Effectiveness of a weekly text messaging intervention to improve ART adherence and HIV Viral Load: WelTel OAKTREE. M.C.M. Murray1,2,3,

Table 1: New HIV diagnoses, by UK country,

HIV surveillance in Northern Ireland 2014

Illustrating the HIV Care Continuum in U.S. Cities

Dorina Onoya1, Tembeka Sineke1, Alana Brennan1,2, Matt Fox1,2

HIV surveillance in Northern Ireland 2018

Poster WP41; Contact: David A. Katz,

North Carolina Medical Monitoring Project

M Javanbakht, S Guerry, LV Smith, P Kerndt

2017 HIV/AIDS Epidemiology profile Cleveland/cuyahoga county

T. Tzellos1,2; H. Yang3; F. Mu3; B. Calimlim4; J. Signorovitch3

Andreas D. Haas, PhD Postdoctoral fellow, ICAP at Columbia University

Receipt of medication-assisted treatment halves the risk of HIV-1 RNA viral load rebound for HIV-positive women who use illicit drugs Joëlla W. Adams,

Kyle T. Bernstein, Katherine Ahrens, Susan S. Philip, Jeffrey D

MSM Attending STD Clinics HIV Testing More Frequently: Implications for HIV Prevention and Surveillance D Helms1, H Weinstock1, K Mahle1, A Shahkolahi1,2,

Prevalence of recent alcohol and substance use in persons with HIV and associations with HIV care cascade outcomes in South Africa Adrienne E Shapiro,

Presentation transcript:

San Francisco Department of Public Health Trends in percent time spent viremic among persons newly diagnosed with HIV, San Francisco, CA, USA, 2008-2016 Alison Hughes, PhD, MPH Ling Hsu, MPH Susan Scheer, PhD, MPH San Francisco Department of Public Health San Francisco, CA, USA

Conflicts of Interest None to declare.

Background Virologic suppression benefits individuals and reduces transmission. Risk of sexual HIV transmission increases as HIV viral load increases. Persons newly diagnosed with HIV are at greater risk of co-morbidities and transmission until ART initiation and sustained viral suppression.

Number of new HIV diagnoses and viral suppression by year of diagnosis, San Francisco, 2008-2016. 85% 40%

Objectives Examine the amount of time spent viremic among persons newly diagnosed with HIV in San Francisco. Determine if any differences by: Year of HIV diagnosis Demographic factors Clinical factors

Methods Inclusion criteria: HIV diagnosis during 2008-2016 San Francisco resident at time of diagnosis Alive 12 months after HIV diagnosis ≥2 viral load tests within 12 months after HIV diagnosis

Method for estimating time spent >10000 copies/ml VL1 VL2 Example for hypothetical individual Orange shaded area shows the time spent above 10000 copies/ml VL4 124 days spent above 10000 copies/ml 34% of the 12 months after HIV diagnosis VL3 88 124 211 References: Gardner CROI 2014; Marks AIDS 2015; Buchacz CROI 2017

Multivariate regression Analysis Methods Multivariate regression Exposure: year of HIV diagnosis Outcome: days spent above each viral threshold in 12 months after diagnosis (offset parameter=number of days observed) Covariates: gender housing status transmission category CD4+ lymphocyte count race/ethnicity health insurance type age time from HIV diagnosis to ART initiation

Transmission category MSM 1862 (73%) 560 (72%) PWID 168 (7%) 41 (5%) Included n (%) Excluded Total 2556 (100%) 780 (100%) Gender Male 2292 (90%) 708 (91%) Female 183 (7%) 49 (6%) Trans female 81 (3%) 23 (3%) Transmission category MSM 1862 (73%) 560 (72%) PWID 168 (7%) 41 (5%) MSM-PWID 318 (12%) 104 (13%) Heterosexual 157 (6%) 39 (5%) Other/Unidentified 51 (2%) 36 (5%) Age at HIV diagnosis 16-24 years 253 (10%) 114 (15%) 25-29 years 400 (16%) 172 (22%) 30-39 years 798 (31%) 242 (31%) 40-49 years 715 (28%) 170 (22%) 50+ years 390 (15%) 82 (11%) Housing status at HIV diagnosis Homeless 220 (9%) 88 (11%) Insurance at HIV diagnosis Public 648 (25%) 162 (21%) Private 1065 (42%) 218 (28%) None 570 (22%) 256 (33%) Missing 273 (11%) 144 (19%) Time from HIV diagnosis to ART initiation 0-7 days 316 (12%) 57 (7%) 8-30 days 456 (18%) 25 (3%) 31-90 days 670 (26%) 36 (5%) 91-365 days 509 (20%) 65 (8%) No known ART 605 (24%) 597 (77%)

Mean percent time spent above each viral threshold among newly diagnosed persons, San Francisco, 2008-2016

Cochran-Armitage test for trend p<0.0001 for each threshold Percent time spent above each viral threshold during 12 months after HIV diagnosis by year of HIV diagnosis, San Francisco, 2008-2016. Cochran-Armitage test for trend p<0.0001 for each threshold

Multivariable factors associated with person time >200 copies/ml Characteristic Adjusted Rate Ratio (95% CI) Year of HIV diagnosis (numeric) 0.96 (0.95, 0.97) MSM-PWID (vs MSM) 1.15 (1.06, 1.24) Age 25-29 years (vs 50+ years) 1.1 (1, 1.2) Homeless (vs housed) 1.12 (1.02, 1.22) CD4 count 0-199 (vs 500+) 0.87 (0.81, 0.94) CD4 count 200-349 (vs 500+) 0.89 (0.83, 0.96) Time from HIV diagnosis to ART 31-90 days (vs 0-7 days) 1.21 (1.11, 1.32) 91-365 days (vs 0-7 days) 1.7 (1.54, 1.86) No known ART use within 1 year after HIV diagnosis (vs 0-7 days) 1.78 (1.62, 1.95) *No significant differences by gender, race/ethnicity or insurance type.

Limitations Date of diagnosis vs. HIV acquisition No viral load information before HIV diagnosis Misclassification of outcome Assumes linear relationship Less reliable if great amount of time between VL pairs Loss to follow-up Unmeasured confounding ART prescription vs. adherence Social factors not recorded in HIV registry

Discussion Lower CD4 count associated with decreased time spent viremic Results likely underestimate time spent viremic due to exclusion criteria Newly diagnosed persons with fewer than two viral loads were excluded (23%) Vulnerable populations, including younger ages and homeless individuals, were more likely to be excluded Adjusted RRs biased towards null

Conclusions Time spent above each viremic level decreased significantly among newly diagnosed persons from 2008 to 2016 and likely contributed to the decreased HIV incidence observed. PWID (including MSM-PWID) and younger age spent more person-time viremic. Homeless individuals spent more person-time >200 copies/ml.