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CDC Prevention Conference: 9 Highlights - 50% Tested for HIV / Transmission Rate 0 if Undetectable / Florida: 73% in care
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www.natap.org
• Florida ranked second in the U.S. in new HIV diagnoses in 2016 and third in new AIDS cases. It is estimated that there are over 135,000 persons living with HIV (PLWH) in Florida. In 2016, approximately 84% (114,772) of Floridian’s living with HIV were diagnosed and aware of their infection. Among those diagnosed, 92% (105,895) have evidence of ever being in care, 73% were in care at least one time in 2016, 66% were retained in care, and 60% achieved viral suppression
• 45% of adults with diagnosed HIV in the US reported at least one disability. The most common disabilities were related to difficulties with mobility (24%), cognition (24%), independent living (13%), and vision (12%). Disabilities related to hearing (9%) and self-care (6%) were less common. Having at least one disability was significantly more common among females compared to males (54% vs. 42%)
CDC Prevention Conference/2019: US trends in HIV testing, linkage to care, and transmission - Mark Mascolini (03/22/19)
1 - A decade after the 2006 CDC recommendations [7], the CDC team noted, fewer than half of this nationally representative US sample self-reported ever getting tested for HIV, and only about 15% got tested in the past year. The researchers called for further work to determine how to encourage the general US population to get tested for HIV.
2 - Despite 2006 CDC advice that all 13- to 64-year-olds should get tested for HIV at least once [7], the US ever-tested rate still stands well below 50%, according to a 2011-2017 CDC analysis [2] (Table 2).. But proportions of people ever tested and tested in the past 12 months climbed significantly over the study period.
The proportion of people tested for HIV in the past 12 months inched up from 13.2% in 2011 to 14.8% in 2017, but that gain was statistically significant (P < 0.001). HIV testing in the past 12 months proved more likely in blacks (34.1%), 25- to 34-year-olds (22.3%), and females (15.6%) than in comparison groups. Utah had the lowest past-12-month testing rate (6.5%), while Washington, DC had the highest (40.7%).
3 - Numbers of CDC-funded HIV tests dipped from 3.4 million in 2012 to 3.1 million in 2017 to yield an EAPC of -1.8%
4 - People with an undetectable viral load thanks to antiretroviral therapy (ART) had a virtually nil HIV transmission rate in 2015, according to an updated model fashioned by the CDC [6]. In contrast, people unaware of their acute HIV infection had a 223-fold higher risk of HIV transmission.
5 - Between 2013-2016 we enrolled PLWH ≥18 years old detained in Cook County Jail, Chicago, Illinois to examine factors affecting post-release linkage and retention in HIV medical care. Participants were 79% male, 80% black and the median age was 42 years. Overall, 40% of released PLWH were virally suppressed at follow up. The proportion of persons who have been diagnosed with HIV and achieve viral suppression after release from Cook County Jail is close to the level for all PLWH in Illinois (44%). Abstract 5818
6 - In 2015, 1,202 persons received HIV infection diagnoses attributed to male-to-male sexual contact and injection drug use (MSM/IDU).
We used data from the National HIV Surveillance System for HIV diagnoses attributed to MSM/IDU in persons aged ≥13 years to determine stage at diagnosis of HIV infection and HIV care outcomes. In 2015, 19.8% of HIV infections diagnosed and attributed to MSM/IDU were classified as stage 3 (AIDS), with the highest percentage among Hispanics/Latinos (25.4%). Of the HIV diagnoses attributed to MSM/IDU, 76.6% and 86.1% were linked to care within 1 and 3 months, respectively. Of the HIV diagnoses attributed to MSM/IDU, 76.6% and 86.1% were linked to care within 1 and 3 months, respectively. In 2014, 76.7% received any care, 61.4% were retained in care and 58.9% achieved viral suppression. Blacks/African Americans (73.8%) and Hispanics/Latinos (74.0%) had the lowest percentages of any care and blacks/African Americans had the lowest percentages of retention in care (59.0%) and viral suppression (52.9%). The lowest viral suppression was among those aged 20-24 years (46.4%) and the lowest percentage of any care was among those aged 13-19 years (74.1%). Abstract 6044 - HIV care outcomes among men who have sex with men and also inject drugs, United States, 2015
7 - Disability among adults with diagnosed HIV in the United States, 2015
During 2015, 45% of adults with diagnosed HIV in the US reported at least one disability. The most common disabilities were related to difficulties with mobility (24%), cognition (24%), independent living (13%), and vision (12%). Disabilities related to hearing (9%) and self-care (6%) were less common. Having at least one disability was significantly more common among females compared to males (54% vs. 42%), persons with less than a high school education compared to those with more than a high school education (63% vs. 38%), persons who were homeless compared to those who were not (65% vs. 44%), and among persons who lived in poverty compared to those who did not (59% vs. 33%). In terms of differences in behavioral characteristics among persons with and without disabilities, persons with at least one disability were significantly more likely than those without disability to be current smokers (42% vs. 30%), have symptoms of depression (37% vs. 11%) or anxiety (39% vs. 13%) over the past 2 weeks, and have at least one unmet ancillary service need (67% vs. 47%). Viral suppression was not significantly associated with disability status. However, persons with at least one disability were significantly less likely to be 100% adherent to HIV medications (56% vs. 62%) compared with persons without disability. Conclusions/Implications: The prevalence of disabilities among adults with diagnosed HIV is much higher than in the general population. We found significant associations between disability status and challenging life circumstances, such as poverty and homelessness. Moreover, reduced medication adherence, poor mental health, and unmet need for services suggests adults with diagnosed HIV who are living with a disability may require enhanced support from clinicians and service providers.
8 - Integration of HIV data systems and electronic health records to improve health outcomes for PLWH along the care continuum: the evolution of Florida’s P4C Dashboard
Florida ranked second in the U.S. in new HIV diagnoses in 2016 and third in new AIDS cases. It is estimated that there are over 135,000 persons living with HIV (PLWH) in Florida. In 2016, approximately 84% (114,772) of Floridian’s living with HIV were diagnosed and aware of their infection. Among those diagnosed, 92% (105,895) have evidence of ever being in care, 73% were in care at least one time in 2016, 66% were retained in care, and 60% achieved viral suppression. Improving systems and processes for Data-to-Care (D2C) are needed to more efficiently identify, re-engage, and retain PLWH who are out of care. Six community health centers (CHCs) and the Florida Department of Health HIV/AIDS Section were funded by the Department of Health and Human Services Secretary’s Minority AIDS Initiative Fund, Partnerships for Care (P4C) demonstration project, to expand the provision of HIV prevention and care services within communities most impacted by HIV, especially racial/ethnic minorities, and to better serve PLWH along the HIV Care Continuum. The HIV/AIDS Section Data Integration, Prevention, and Surveillance Programs, as well as the STD and Viral Hepatitis Section, collaborated to develop a standardized system (i.e., P4C Dashboard) to track the progress of linkage and re-engagement activities, ensure proper documentation, and guide. case conferencing between Disease Intervention Specialists (DIS) and CHCs. In addition, a Data Warehouse was developed and is populated monthly from multiple HIV data systems (e.g., eHARS, CAREWare), allowing users the ability to search and view client data (e.g., demographics, labs, medications) across systems.
Results: The P4C Dashboard has evolved to include up-to-date monthly reports of all CHC clients who are: newly diagnosed and linked within 30 days; newly diagnosed and not linked within 30 days; and previously diagnosed (out of care for at least 6 months). Additional features of the dashboard include: task templates for DIS to document tasks and outcomes; notification alerts to assist DIS with working client lists; auto assignment of cases; and electronic lab reporting interface to auto match and update client records. This presentation will share a process development timeline of the P4C Dashboard and highlight potential scalability of the dashboard for use within Florida for D2C and HIV transmission cluster response.
Lessons Learned: The development and implementation of Florida’s P4C Dashboard has proven to be an effective tool in improving access to care for PLWH who are newly diagnosed, never been in care, or have fallen out of care. Task management and process monitoring of linkage and re-engagement activities help to ensure processes are followed and documented by field staff. Florida has been able to take lessons learned through the P4C project and apply them to Florida D2C activities. Abstract 5625 - Integration of HIV data systems and electronic health records to improve health outcomes for PLWH along the care continuum: the evolution of Florida’s P4C Dashboard
9 - Reducing HIV-related health disparities through HRSA’s Ryan White HIV/AIDS Program
Client-level data were used from the annual RWHAP Services Report submitted to HRSA from RWHAP Parts A-D recipients. VS was calculated among clients with ≥1 medical visit and ≥1 HIV viral load test reported during the measurement year (years 2010 through 2016). VS was defined as the most recent viral load test result in the calendar year <200 copies/mL. VS in 2010 was compared to 2016 for all clients, with focus on key populations such as youth, clients with housing instability, and black men who have sex with men (MSM). From 2010 through 2016, HIV VS among RWHAP clients has increased from 69.5% to 84.9%. During the same time, VS in youth aged 13-24 has increased nearly 25 percentage points, from 46.6% in 2010 to 71.1% in 2016. Similar gains were evident among clients with temporary or unstable housing, with increases of 15...2 percentage points and 17.2 percentage points respectively. Black men who have sex with men (MSM) also experienced increases in VS, with 61.5% achieving VS in 2010 compared to 79.7% in 2016. Abstract 5692 - Reducing HIV-related health disparities through HRSA’s Ryan White HIV/AIDS Program
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