Epidemiology is: The scien)fic study of disease distribu)on and the factors that cause diseases to spread in communi)es

Transcription

1 Speak Epidemiology

2 Epidemiology is: The scien)fic study of disease distribu)on and the factors that cause diseases to spread in communi)es

3 Effec3ve research advocates Analyze the facts Educate others Build partnership Lend their perspec3ves Raise cri3cal ques3ons Seek knowledge

4 Useful Tools Prevalence Incidence Rate Affected popula3ons Discussions Future Trends

5 HIV/AIDS Prevalence The number of people living with HIV/AIDS during a given year In 2006, an es+mated 1,106,400 individuals were living with HIV/ AIDS in the United States

6 HIV Incidence The annual number of people who become HIV infected in a given period of >me, typically a year. In 2006, an es+mated 56,300 individuals became HIV infected in the U.S.

7 Rate A rate measures a certain quan3ty or amount of one thing considered in rela3on to a unit of another thing. In public health, rates help describe the number of events per popula+on unit, typically expressed as health events or disease per 100,000 people.

8 Rate A rate consists of a numerator and a denominator. 525,600 / 56,300 = 9.33 Annual minutes (numerator) divided by annual infec3ons (denominator) equals a rate of 9 ½ minutes per infec>on

9 Rate Rates allow us to compare communi3es of different sizes. The numerator is the number of health events or disease and the denominator is the defined popula+on at risk (including those who experience the event/disease): numerator x 100,000 = popula+on rate denominator

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11 HIV Rate for MSM Based on meta analysis, CDC es3mates that: An es3mated 4% of U.S. males had same sex behavior in the past 5 yrs 7% of U.S. males have ever had MSM behavior MSM account for an es3mated 2% of the total U.S. popula3on

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14 HIV Rate for MSM CDC notes and disclaimers: These es3mates are preliminary! More complete analysis Refine meta analysis es3mates Re calculate rates; also do by race and age May conduct separate analysis for young MSM Iden3fy popula3on es3mates for IDU and HET

15 HIV Transmission Rate Transmission Rate: Represents the amount of transmission that occurs annually in rela3on to the popula3on infected with HIV. Technically, this is HIV incidence divided by prevalence in a given year.

16 HIV Transmission Rate (TR) CDC published in 2008 backcalcula3on es3mates for HIV incidence and prevalence between 1977 and The new es3mates allow retrospec3ve TR calcula3ons. Hall et al. JAMA. 2008; 300:

17 HIV Transmission Rate, United States, Source: Holtgrave et al. JAIDS 2009

18 HIV Transmission Rate, United States, Source: Holtgrave et al. JAIDS 2009

19 Affected Popula3ons What are the characteris3cs of people who become infected with HIV? How do we understand popula3on trends in the epidemic?

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24 HIV Infec3ons by Subpopula3on, 2006 (es3mates)

25 Discussions: Cri3cal Thinking Research advocates ask critical questions: Do the data give an accurate picture of the epidemic? Where/when/how was data collected? What methodologies were employed in data collection, analysis, and presentation? Who was involved? How might disease surveillance be improved?

26 Challenging No Iden>fied Risk Change HIV/AIDS Surveillance System Categories to More Accurately Reflect How Women Acquire HIV, Advocates Say End the seriously flawed CDC hierarchical classifica3on system that classifies most cases of HIV among women as no iden3fied risk Allow health departments to classify cases as presumed heterosexual when the male partner s HIV status and/or risk factors are unknown Collect acquisi3on category informa3on to reflect sexual networks and/or social networks of elevated HIV prevalence. New data might include: Prevalence of HIV where the person lives The area s post incarcera3on rates Drug/alcohol and homelessness partners for the area ms.founda3on.org/file%20library/nwac/nwacpolicypropcharlormfinalforweb.pdf

27 Data Leave Some Groups Behind Advocates Say Outreach and Surveillance Programs Undercount: Transgender popula3ons Asian/Pacific Islanders Undocumented people American Indians/Na3ve Hawaiians Rural popula3ons Without accurate surveillance, undercounted popula>ons may receive fewer dollars for HIV preven>on, care, and research ac>vi>es

28 It s not who you are, It s where you live Person Living with AIDS in 2005 By Region Region Rank Number North 2 126,867 Midwest 4 45,666 South 1 169,972 West 3 83,405

29 It s not who you are, It s where you live San Francisco Project maps concentra>on of HIV viral load across the city to determine where expanded services are needed

30 Future Trends To alter the course of the epidemic, We need to model where it is currently headed Advocates shared a model with the White House comparing stable growth in the epidemic against progress toward defined goals They call on the federal government to include a scien3fically rigorous model in the Na3onal HIV/AIDS Strategy The paper includes other important recommenda3ons na3onalaidsstrategy.org/2010/advocates recommend key components of an effec3ve strategy/

31 Projected Epidemic Based on A Constant 5% Transmission Rate Year Incidence Deaths Prevalence Minutes per Infec>on ,300 18,620 1,106, ,086 19,000 1,145, ,273 20,876 1,186, ,273 20,876 1,227, ,446 21,605 1,270, ,695 22,359 1,314, ,023 23,139 1,360, ,432 23,947 1,408, ,505 24,782 1,457, ,505 25,647 1,508, ,175 26,542 1,560,

32 Thank you! David Ernesto Munar Vice President AIDS Founda3on of Chicago aidschicago.org aidsconnect.net/dose