Routine HIV Screening in Health Care Settings David Spach, MD Clinical Director Northwest AIDS Education and Training Center Professor of Medicine, Division.

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Presentation transcript:

Routine HIV Screening in Health Care Settings David Spach, MD Clinical Director Northwest AIDS Education and Training Center Professor of Medicine, Division of Infectious Diseases University of Washington Seattle This project was funded under cooperative agreement number U65/PS from the Centers for Disease Control and Prevention (CDC). HIV Epidemiology

HIV Incidence and Prevalence Definitions HIV Incidence HIV Prevalence Knowledge of HIV Infection Status HIV Testing Data HIV/AIDS Deaths

HIV Incidence and Prevalence Source: Hall HI, et al. JAMA. 2008;300: HIV Incidence. The number of people who become newly infected with HIV in a given period. HIV Prevalence. The number of people living with HIV in a population at a point in time.

HIV Incidence and Prevalence HIV Incidence. The number of people who become newly infected with HIV in a given period. HIV Prevalence. The number of people living with HIV in a population at a point in time. Source: Hall HI, et al. JAMA. 2008;300: HIV-Infected Persons

HIV Prevalence and Prevalence Rate HIV Prevalence. The number of people living with HIV in a population at a point in time. HIV Prevalence Rate. The percentage of people infected with HIV in a population. HIV-Infected Persons

HIV Epidemiology HIV Incidence and Prevalence Definitions HIV Incidence HIV Prevalence Knowledge of HIV Infection Status HIV Testing Data HIV/AIDS Deaths

Estimated New HIV Infections, Extended Back Calculation Model, 50 US States and DC, Source: Hall HI, et al. JAMA. 2008;300:520-9.

Estimated New HIV Infections, Extended Back Calculation Model, 50 US States and DC, Source: Hall HI, et al. JAMA. 2008;300: HIV Incidence Estimated 56,300 new HIV infections in US in 2006

Estimated Number of AIDS Cases in US, Source: Centers for Disease Control and Prevention

Reported AIDS Cases and Annual Rates (per 100,000 population), by Area of Residence, 2007 Source: CDC. HIV/AIDS Surveillance Report. 2009; Vol 19:1-63.

Estimated Rates of New HIV Infections in US, by Race/Ethnicity, 2006 Source: Hall HI, et al. JAMA. 2008;300:520-9.

Estimated Rates of New HIV Infections in US, by Race/Ethnicity, 2006 Source: Hall HI, et al. JAMA. 2008;300:520-9.

Estimated Rates of New HIV Infections in US, by Race/Ethnicity, 2006 Source: Hall HI, et al. JAMA. 2008;300:520-9.

Male-Male Sexual Contact (53%) Male-Male Sex & Injection Drug Use (4%) Estimated HIV Incidence in US, by Transmission Category, 2006 Source: Hall HI, et al. JAMA. 2008;300: High-Risk Heterosexual Contact (31%) Injection Drug Use (12%) Total = 56,300

Estimated HIV Incidence in US, by Race/Ethnicity, 2006 Source: Hall HI, et al. JAMA. 2008;300: Asian/Pacific Islander (2%) American Indian/Alaska Native (1%) Black (45%) White (35%) Hispanic (17%) Total = 56,300

Estimated HIV Incidence in US, by Sex, 2006 Source: Hall HI, et al. JAMA. 2008;300: Total = 56,300

HIV Epidemiology HIV Incidence and Prevalence Definitions HIV Incidence HIV Prevalence Knowledge of HIV Infection Status HIV Testing Data HIV/AIDS Deaths

Estimated HIV Prevalence in US, 2006 Source: CDC. MMWR. 2008;57: ,106,400 Persons Living with HIV in US

Estimated HIV Prevalence in US, 2006 Source: CDC. MMWR. 2008;57: ,106,400 Persons Living with HIV in US Prevalence Rate = 448/100,000 population

Estimated HIV Prevalence in US, 2006 Source: CDC. MMWR. 2008;57: ,106,400 Persons Living with HIV in US Prevalence Rate = 448/100,000 population 0.4% of Population Living with HIV

Estimated AIDS Prevalence, US, Source: Centers for Disease Control and Prevention

Estimated HIV Prevalence, US, Source: Campsmith M, et al. CROI 2009: Abstract 1036.

Estimated Percentage of Persons Living with HIV in US, by Sex, 2006 Source: CDC. MMWR. 2008;57: Female 25.2% Male 74.8%

Estimated Percentage of HIV-Infected in US, by Transmission Category, 2006 Source: CDC. MMWR. 2008;57: Other* (0.8%) Male-Male Sexual Contact (48.1) Injection-Drug Use (18.5%) High-Risk Heterosexual Contact (27.6%) Other* = hemophilia, blood transfusion, perinatal exposure, and risk factors not identified Male-Male Sex & Injection Drug Use (5.0%)

Estimated HIV Prevalence In US, by Transmission Category, 2006 Source: CDC. MMWR. 2008;57: Other MSM + IDU (0.8%) (5%) MSM (48.1%) IDU HRHC (18.5%) (27.6%) MSM = men who have sex with men IDU = Injection drug use HRHC = high risk heterosexual contact Transmission Category HIV Prevalence

Estimated HIV Prevalence In United States, by Age, 2006 Source: Campsmith M, et al. CROI Abstract Age Category

Estimated HIV Prevalence In US, by Race/Ethnicity, 2006 Source: CDC. MMWR. 2008;57: Asian/Pacific Islander (1.4%) American Indian/Alaska Native (0.4%) Black (46.1%) White (34.6) Hispanic (17.5%)

Estimated HIV Prevalence In US, by Race/Ethnicity, 2006 Source: CDC. MMWR. 2008;57: White, not Hispanic Black Hispanic Two or More Races Asian/Pacific Islander American Indian/Alaska Native U.S. PopulationHIV/AIDS Prevalence (%)

Estimated HIV Prevalence In US, by Race/Ethnicity, 2006 Source: CDC. MMWR. 2008;57: Black

National Health and Nutrition Examination Surveys Prevalence Rate of HIV Infection in US, Source: McQuillan GM, et al. J Acquir Immune Defic Syndr. 2010:53: US Household Population Aged N= 11,928 participants HIV tested

HIV Epidemiology HIV Incidence and Prevalence Definitions HIV Incidence HIV Prevalence Knowledge of HIV Infection Status HIV Testing Data HIV/AIDS Deaths

Knowledge of HIV Status, in US, at End of 2006 Source: CDC. MMWR. 2008;57: Unaware of HIV infection 21% Aware of HIV infection 79%

Knowledge of HIV Status, in US, at End of 2006 Source: CDC. MMWR. 2008;57: Unaware of HIV infection 21% Aware of HIV infection 79%

Estimated Undiagnosed HIV Infection, US Source: CDC. MMWR. 2008;57: Unaware of HIV infection 25% Aware of HIV infection 75% 2003 Unaware of HIV infection 21% Aware of HIV infection 79% 2006

Undiagnosed HIV Infection in US Percent Undiagnosed by Race/Ethnicity, at End of 2006 Source: Campsmith ML, et al. J Acquir Immune Defic Syndr. 2009; Oct 15 (Epub ahead of print).

Undiagnosed HIV Infection in US Percent Undiagnosed by Age, at End of 2006 Source: Campsmith ML, et al. J Acquir Immune Defic Syndr. 2009; Oct 15 (Epub ahead of print).

HIV Epidemiology HIV Incidence and Prevalence Definitions HIV Incidence HIV Prevalence Knowledge of HIV Infection Status HIV Testing Data HIV/AIDS Deaths

CDC HIV Testing Data HIV Testing Data CDC analysis of HIV testing data from the National Health Interview Survey Established baseline data prior to CDC 2006 HV screening recommendations CDC analysis of HIV testing data from the National Health Interview Survey Established baseline data prior to CDC 2006 HV screening recommendations Source: CDC. MMWR 2008;57(31):845-9.

CDC HIV Testing Data Source: CDC. MMWR 2008;57(31):845-9.

HIV Testing in Adults Aged 18-64, US Source: CDC. MMWR 2008;57(31):845-9.

HIV Testing in Adults Aged 18-64, US Testing levels flat

Source: CDC. MMWR 2008;57(31): HIV Testing in Adults Aged 18-64, US

Source: CDC. MMWR 2008;57(31): HIV Testing in Adults Aged 18-64, US

Setting for HIV Testing in Adults Aged 18-64, US, 2006 Non-Clinical 17% Clinical 83% Source: CDC. MMWR 2008;57(31):845-9.

HIV Testing in Adults Aged US, 1997-September 2008 Source: Centers for Disease Control and Prevention

HIV Testing in Adults Aged US, 1997-September 2008 Source: Centers for Disease Control and Prevention Testing levels increased

HIV Epidemiology HIV Incidence and Prevalence Definitions HIV Incidence HIV Prevalence Knowledge of HIV Infection Status HIV/AIDS Deaths

Deaths in Persons with AIDS, US, Source: Centers for Disease Control and Prevention

Age Adjusted Death Rates for HIV Disease, by Race and Sex*—US, Source: CDC. MMWR. 2008;57(30):830. Note: in 1987, a new category for HIV infection added to ICD-9; in 1999, ICD-10 took effect, resulting in additional deaths classified as HIV/AIDS category; therefore death rates for are not compatible with those computed after 1998.

Routine HIV Testing in Health Care Settings Summary Epidemiology Points Approximately 1.1 million living with HIV in US HIV and AIDS prevalence increasing in US African-Americans disproportionately affected 21% of HIV-infected unaware of HIV status MSM remains most common transmission category Death rate higher in blacks than whites

Acknowledgement This project was funded under cooperative agreement number U65/PS from the Centers for Disease Control and Prevention (CDC).