Race/ethnicity of newly diagnosed HIV cases in Ontario,

Transcription

1 Race/ethnicity of newly diagnosed HIV cases in Ontario, Ashleigh Sullivan, Carol Swantee, Claudia Rank, Juan Liu, Robert W.H. Palmer, Mark Fisher, Keyi Wu, Robert S. Remis Public Health Ontario Public Health Agency of Canada OHTN Research Conference Monday, November 14-15, 2011 Toronto

2 Background HIV test requisitions often missing information on risk factors and previous test history LEP began in 1999 with the following objectives: Obtain more complete information on risk factors and test history among persons testing for HIV Estimate HIV incidence (STARHS assay)

3 Methods Questionnaires sent to all new HIV diagnoses and a 1:200 sample of negatives Sent to physician with HIV test report by mail or fax Follow-up with reminder phone calls as needed Questionnaires returned by fax or mail Data entered and managed in Access

4 Methods, continued Analyzed new HIV diagnoses by race/ethnicity, exposure category, health region, sex and time period Excluded persons with a previous positive HIV test result in Ontario Exposure category: based on risk factors and gender HIV-endemic: from country of birth

5 Methods: Race/ethnicity analysis Questionnaire updated in January 2009 to include race/ethnicity We wished to determine if: exposure category differed by race/ethnicity minorities over-represented in new HIV diagnoses race/ethnicity of new HIV diagnoses varied by region

6 Results January 1999 to June 2011: 12,785 HIV-positive questionnaires sent 65% returned January 2009 to June 2011: 2,662 HIV-positive questionnaires sent 61% returned Race/ethnicity: 90% complete Risk factors: 96% complete

7 HIV diagnoses by race/ethnicity, % 2.4% 3.3% 4.3% 7.1% 24.7% 54.6% White Black Latin American East/SE Asian South Asian Aboriginal Other

8 HIV diagnoses by race/ethnicity and year No White 53.6% 57.7% 49.8% Black 24.3% 22.6% 30.8% East/SE Asian 4.8% 4.1% 3.8% South Asian 4.4% 2.9% 2.5% Latin-American 7.8% 6.5% 7.2% Aboriginal 1.8% 3.4% 1.3% Other 3.2% 2.9% 4.6% Total 100% 100% 100%

9 HIV diagnoses by race/ethnicity and health region Northern Ottawa Eastern, other Toronto Central East, other Central West South west No White 5.6% 12.4% 2.9% 51.2% 7.7% 10.5% 9.6% Black 0.4% 16.0% 1.5% 57.6% 12.6% 6.7% 5.2% East/SE Asian 0.0% 12.0% 0.0% 68.0% 10.0% 8.0% 2.0% South Asian 0.0% 4.7% 0.0% 41.9% 41.9% 7.0% 4.7% Latin-American 0.0% 8.2% 0.0% 72.9% 5.9% 9.4% 3.5% First Nations 14.8% 11.1% 3.7% 33.3% 7.4% 11.1% 18.5% Other 0.0% 7.9% 5.3% 63.2% 13.2% 5.3% 5.3% Total 3.5% 12.4% 2.2% 54.7% 10.3% 9.2% 7.7%

10 HIV diagnoses by race/ethnicity and exposure category MSM IDU Endemic Hetero Other Total White 65.8% 12.6% 0.1% 14.0% 7.4% 100% Black 20.8% 0.9% 69.1% 8.3% 0.9% 100% East/SE Asian 51.7% 0.0% 6.9% 32.8% 8.6% 100% South Asian 52.4% 0.0% 4.8% 38.1% 4.8% 100% Latin-American 75.0% 1.0% 4.2% 16.7% 3.1% 100% Aboriginal 25.8% 32.3% 3.2% 38.7% 0.0% 100% Other 69.8% 7.0% 9.3% 9.3% 4.7% 100% Overall 54.4% 8.1% 18.6% 14.8% 5.0% 100%

11 HIV diagnoses by race/ethnicity and exposure category Examined by sex Males: Almost all Aboriginal non-msm HIV diagnoses were IDU Females: 87% acquired heterosexually (compared to <20% for males)

12 HIV diagnoses by race/ethnicity and exposure category MSM IDU Endemic Hetero Other Overall White 66.9% 84.0% 0.4% 51.3% 77.6% 54.1% Black 9.8% 2.8% 93.4% 14.0% 4.5% 25.1% East/SE Asian 4.3% 0.0% 1.7% 9.8% 7.5% 4.5% South Asian 3.2% 0.0% 0.8% 8.3% 3.0% 3.2% Latin-American 10.4% 0.9% 1.7% 8.3% 4.5% 7.4% Aboriginal 1.2% 9.4% 0.4% 6.2% 0.0% 2.4% Other 4.3% 2.8% 1.7% 2.1% 3.0% 3.3% Total 100% 100% 100% 100% 100% 100%

13 Race/ethnicity of new HIV diagnoses and Ontario population LEP # Population (000s) Rate /100,000 Relative Risk White 742 9, Ref Black Southeast Asian South Asian Latin-American Aboriginal Other

14 Race/ethnicity of new HIV diagnoses and Ontario population, females LEP # Population (000s) Rate /100,000 Relative Risk White 72 4, Ref Black Southeast Asian South Asian Latin-American Aboriginal Other

15 Limitations Selection bias in race/ethnicity HIV testing Return of questionnaires Completion of race/ethnicity

16 Conclusions LEP provides critical supplementary data to help monitor trends in HIV infection in Ontario HIV diagnoses over-represented among Black and Latin-American race/ethnicities Aboriginal females also over-represented Prevention programs need to be targeted and tailored to racial/ethnic communities

17 Acknowledgements Physicians who completed LEP questionnaires Lisa Santangelo, Kevin McCurley: data collection Ontario HIV Treatment Network, Public Health Agency of Canada: funding Laboratory Enhancement Program Public Health Agency of Canada: FSO Program Frank McGee, Coordinator, AIDS Bureau, Ontario Ministry of Health and Long-Term Care: support of the Ontario HIV Epidemiologic Monitoring Unit