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Increase in New HIV Diagnosis from 14% to 32% in NYC
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Reported by Jules Levin
XVI Intl AIDS Conference, Toronto Aug 2006
.... Overall, 64% had initiated care within 3 months, 71% within 6, 76% within 12, and 78% within 15 months of diagnosis..(see 2nd report below)...
....there is a high prevalence (6.6%) and late diagnosis (31%) of HIV among Black men aged 40-54 in New York City..(see 3rd report below)...
"Increasing ascertainment of incident HIV infection reported to the NYC department of health and mental hygiene: maturation of a new HIV reporting system"
Bennani Y.1, Torian L.2
1NYC Department of Health and Mental Hygiene, HIV Surveillance and Epidemiology Program, New York, United States, 2NYC Department of Health and Mental Hygiene, HIV Epidemiology Program, New York, United States
Background: Accurate surveillance for HIV is essential for epidemiological monitoring, effective prevention planning and targeting of HIV prevention activities. Due to the long latent period of HIV infection (~9-10 years), new diagnoses reported to surveillance include persons infected long-term, and data represent both prevalent and incident infections. In this analysis, we used the serologic testing algorithm for recent HIV seroconversions (STARHS) to evaluate the proportion of incident infections reported to the NYC HIV surveillance system following the introduction of named HIV-reporting in June 2000.
Methods: 3464 Specimens from new HIV diagnoses reported to surveillance between June 1, 2000 and December 31, 2004 diagnosed at the NYC Public Health Laboratories (20.4% of all non-AIDS diagnoses in NYC) were re-tested using the Vironostika LS-EIA, which can distinguish recent (within 6 months) and long-standing HIV infections.
Results:
The proportion of new diagnoses classified as recent infections gradually and significantly increased from 14.6% (12.2%, 17.1%) at the onset of named HIV reporting to 32.3% (25.2%, 39.5%) in the second half of 2004.
Among MSM, the proportion of recent infections rose significantly from 21.4% (14.6%, 28.2%) to 43.1% (31.0%, 55.1%).
Though no significant change was observed among females (15.3% [11.6%, 19.0%] to 19.6% [8.7%, 30.5%]), the proportion of early infections among newly diagnosed males rose from 14.1% (10.8%, 17.1%) to 32.3% (25.3%, 39.5%). Other significant increases were observed among blacks, Hispanics, and persons age 25 and over.
Conclusions: These findings suggest that new diagnoses reported to the NYC HIV surveillance system increasingly represent recently infected persons. In addition to reflecting the absorption of prevalent diagnoses in early years of HIV surveillance, these trends may be evidence of successful efforts for case finding and increasing awareness of HIV status in NYC, leading to more timely diagnosis of HIV and improved ascertainment of incidence by the surveillance system.
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"Risk factors for failure to initiate primary care after diagnosis of HIV, New York city: impact of transmission risk and site of initial diagnosis on successful transition to care"
Torian L.1, Wiewel E.1, Hanna D.1, Sackoff J.1
1New York City Department of Health and Mental Hygiene, HIV Surveillance and Epidemiology Program, New York City, United States
Background: The full benefit of timely diagnosis of HIV is realized only if there is timely transition to primary care.
Methods: We measured time to first primary care visit in persons newly diagnosed with HIV (non-AIDS) and determined risk factors for delayed presentation or failure to present. The sample included all persons diagnosed by positive Western Blot in calendar year 2003, residing in New York City at the time of diagnosis, having a known provider, and surviving at least 15 months post diagnosis (N=1,855). Routinely reported laboratory tests that are standard components of an initial workup for HIV (viral load and CD4 count) were used to indicate first primary care visit.
Results:
Overall, 64% had initiated care within 3 months, 71% within 6, 76% within 12, and 78% within 15 months of diagnosis.
On multivariate analysis, predictors of delayed (>3 months) presentation included:
-- injecting drug use (IDU, ARR=2.2 [95% CI 1.6,3.1]),
-- initial diagnosis at public or community-based test site (ARR=1.8 [1.5,2.3]),
-- black race/ethnicity (ARR=1.5 [1.3,1.9]), and
-- non-US country of birth (ARR=1.3 [1.1,1.6]).
Site of original diagnosis was the most important predictor of complete failure to present (ARR=2.1 [1.6,2.7]), followed by IDU (ARR=1.8 [1.3,3.0], black race/ethnicity ARR=1.4 [1.1,1.7]) and non-US country of birth (ARR=1.3 [1.1,1.7]).
Conclusions: The majority (83%) of patients who initiate care do so within 3 months of diagnosis, suggesting that there is a window of opportunity during which the transition can most effectively be facilitated. IDU, blacks, and persons of non-US origin are at risk for delayed presentation; persons diagnosed at public and community-based testing sites are at risk for failure to present. New strategies are needed to facilitate linkage and to ensure timely presentation for care. Non-medical settings should develop more effective referral procedures so that patients transition successfully from diagnosis to care.
High prevalence and late diagnosis of HIV among Black men aged 40-54 in New York City
E W Wiewel, Y Bennani, C Ramaswamy, J E Sackoff, L V Torian
HIV Epidemiology Program, New York City Department of Health and Mental Hygiene, New York City, United States
New York City Department of Health and Mental Hygiene
Since New York City (NYC) began HIV reporting in June 2000, non-Hispanic Black men have comprised the largest group of people living with HIV or AIDS (PLWHA) and new HIV and AIDS diagnoses. Prevalence among Black men varies by age and geography, as do concurrent HIV/AIDS diagnoses, suggesting barriers to access to testing and care.
NY officials calculated prevalence of PLWHA as of December 31, 2001, by race/ethnicity, sex, and age, using census data and HIV surveillance data reported through September 30, 2003. NYC officials also examined geography, concurrent HIV/AIDS diagnoses, and foreign birth among Black men.
RESULTS:
Demographic data were available on 75,362 PLWHA (98.4%). Prevalence was 1 in 100 citywide, 1 in 43 for Black men of all ages, and 1 in 15 for Black men 40-54 years old, the highest prevalence of all demographic groups (11,039/166,818, 6.6% ; versus 2.3% of Black men of all ages).
Of 40-54-year-old Black male PLWHA diagnosed since June 2000 (n=1,523), nearly 1 in 3 had concurrent HIV/AIDS (31.4% of new HIV diagnoses). While Brooklyn accounted for the greatest number of PLWHA in Black men aged 40-54 in New York City (n=3,258), Manhattan had the highest prevalence, 1 in 8 (2,812/22,776, 12.3%; versus 1 in 21, 4.7% in Brooklyn).
One in 10 of NYC's 40-54-year-old Black male PLWHA was born outside the US: 70.4% in the Caribbean, 21.0% in Africa, and 8.6% in South America. Non-US-born Black men aged 40-54 who were diagnosed since June 2000 were significantly more likely than those born in the US to have concurrent HIV/AIDS (56.8% versus 30.0%; p<0.001).
The study authors conclude, the prevalence of HIV/AIDS is high in Black men aged 40-54, particularly in Manhattan, while Brooklyn has the greatest number of PLWHA. The high rate of concurrent AIDS diagnoses in 40-54-year-old Black male PLWHA, especially among those born outside the US, indicates that many were long-infected but not tested until symptomatic. Late diagnosis may delay entry to primary care and preventive counseling.
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