Epidemiologic Trends in HIV in Illinois. Prepared by Cheryl Ward for the 24 th Annual Illinois HIV/STD Conference

Transcription

1 Epidemiologic Trends in HIV in Illinois Prepared by Cheryl Ward for the 24 th Annual Illinois HIV/STD Conference October 28, 2015

2 Learning Objectives To describe epidemiologic trends in HIV/AIDS in Illinois Present findings from an analysis of selected national HIV prevention and care indicators 2

3 Limitations Data exclude cases that have tested positive anonymously. Data exclude positive cases that have not tested and are unaware of their status. An estimated 13% of people with HIV don t know they are living with the disease. State law prohibits the release of HIV/AIDS data when cell sizes contain fewer than 5 cases. 3

4 Other Considerations HIV/AIDS Surveillance data are provisional and subject to change due to: Reporting delays Loss of cases to other states/jurisdictions Ascertainment of missing data (e.g., race and risk) Exercise caution when using statewide data extrapolations to make local program and policy decisions as they may not adequately describe local populations. 4

5 Other Considerations (cont.) HIV Disease refers to all cases of HIV regardless of the stage of disease (i.e., HIV infection Stage 1, 2, 3 [AIDS], or unknown). Unless otherwise noted, all data were extracted from the IL HIV/AIDS Reporting System (ehars). When referencing data in reports, publications, etc., use the following citation: Illinois Department of Public Health, HIV/AIDS Surveillance Unit, August

6 HIV INCIDENCE, LATE DIAGNOSIS, PREVALENCE AND MORTALITY

7 State Ranking of HIV Diagnoses Among Adults and Adolescents, 2012 Estimated Numbers of HIV Diagnoses California 5,801 (12.1%) 2. Florida 5,082 (10.6%) 3. Texas 4,675 (9.8% 4. New York 4,161 (8.7%) 5. Georgia 4,031 (8.4%) 6. Illinois 2,165 (4.5%) 7. Maryland 1,801 (3.8%) 8. Louisiana 1,236 (2.6%) 9. South Carolina 761 (1.5%) 10. Mississippi 493 (3.1%) Estimated Rates per 100,000 of HIV Diagnoses* Georgia Maryland Louisiana Florida New York New Jersey Texas Illinois Mississippi Delaware 19.4 *Rate rankings exclude the District of Columbia and U.S. territories. Source:

8 State Ranking of HIV Diagnoses Among Adults and Adolescents, 2013 Estimated Numbers of HIV Diagnoses Florida 5,364 (11.4%) 2. California 5,315 (11.3%) 3. Texas 4,836 (10.3%) 4. New York 3,800 (8.1%) 5. Georgia 3,011 (6.4%) 6. New Jersey 2,169 (4.6%) 7. Maryland 2,168 (4.6%) 8. Illinois 2,077 (4.4%) 9. North Carolina 1,566 (3.3%) 10. Pennsylvania 1,419 (3.0%) Estimated Rates per 100,000 of HIV Diagnoses* Maryland Georgia Louisiana Florida New Jersey New York Texas Mississippi Nevada Illinois 19.4 *Rate rankings exclude the District of Columbia and U.S. territories. Source:

9 Rates of Diagnoses of HIV Infection among Adults and Adolescents, 2013 United States and 6 Dependent Areas N = 47,958 Total Rate = 18.0 Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been statistically adjusted to account for reporting delays, but not for incomplete reporting.

10 HIV Diagnoses by Jurisdiction 2,500 HIV Disease Diagnoses 2,000 1,500 1, IL-Excluding Chicago Chicago Total IL Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of August 2015.

11 HIV Diagnoses in Illinois by Sex 2,500 HIV Disease Diagnoses 2,000 1,500 1, Males Females Total IL Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of August 2015.

12 HIV Diagnoses Among Males HIV Disease Diagnoses 1,800 1,600 1,400 1,200 1, IL-Excluding Chicago Chicago Total IL Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of August 2015.

13 HIV Diagnoses Among Females HIV Disease Diagnoses IL-Excluding Chicago Chicago Total IL Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of August 2015.

14 HIV Diagnoses in Illinois by Race/Ethnicity HIV Disease Diagnoses 1,200 1, Black White Hispanic Other Excludes cases with missing race/ethnicity. Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of August 2015.

15 HIV Diagnoses in Illinois Outside of Chicago by Race/Ethnicity HIV Disease Diagnoses Black White Hispanic Other Excludes cases with missing race/ethnicity. Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of August 2015.

16 HIV Diagnoses in Chicago by Race/Ethnicity HIV Disease Diagnoses Black White Hispanic Other Excludes cases with missing race/ethnicity. Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of August 2015.

17 Rate of Diagnoses of HIV Infection by Race/Ethnicity, 2014 Race/Ethnicity No. Rate NH-Black NH-White Hispanic Other 32 5 In 2014, the rate of new HIV infection in African Americans in Illinois Excluding Chicago was over 3 times that of Hispanics and nearly 11 times that of whites, based on population size. Race/Ethnicity No. Rate NH-Black NH-White Hispanic Other In 2014, the rate of new HIV infection in African Americans in Chicago was over 2 times that of Hispanics, whites and other racial/ethnic categories based on population size. Excludes cases with missing race/ethnicity. Rate is per 100,000 population. Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of August 2015.

18 HIV Diagnoses by Sex, Race and IL Excluding Chicago Black (N=1,547) Geography, White (N=1,065) Hispanic (N=591) 26% 74% 16% 84% 14% 86% Males Females Chicago Black (N=2,745) 24% 76% White (N=1,003) 3% 97% Hispanic (N=1,066) 8% 92% Males Females Excludes cases with missing race/ethnicity. Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of August

19 HIV Diagnoses by Sex, Race and IL Excluding Chicago Males (N=2,704) 19% 6% 33% Geography, % 5% 12% 25% Females (N=695) 57% Black White Hispanic Other Chicago 23% Males (N=4,298) 23% 6% 48% 4% 6% Females (N=845) 11% 79% Black White Hispanic Other Excludes cases with missing race/ethnicity. Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of August

20 Diagnoses and Rate of HIV Infection by Illinois Excluding Chicago Sex and Race/Ethnicity, 2014 Males (N=543) Females (N=124) Race/Ethnicity No. Rate No. Rate NH-Black NH-White Hispanic Other The estimated rate of new HIV infections for African American men in Illinois Excluding Chicago was more than nine times that of white men and three times that of Hispanic men. The estimated rate of new HIV infections for African American women was 15 times that of white women. Chicago Males (N=832) Females (N=142) Race/Ethnicity No. Rate No. Rate NH-Black NH-White Hispanic Other The estimated rate of new HIV infections for African American men in Chicago was nearly double that of white and Hispanic men. The estimated rate of new HIV infections for African American women was more than 12 times that of white women. Excludes cases with missing race/ethnicity. Rate is per 100,000 population. Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of August

21 HIV Diagnoses in Illinois by Age at Diagnosis HIV Disease Diagnoses Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of August 2015.

22 HIV Diagnoses in Illinois by Jurisdiction and Age at Diagnosis HIV Disease Diagnoses Illinois Excluding Chicago HIV Disease Diagnoses Chicago Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of August 2015.

23 HIV Diagnoses Among Males in Illinois by Transmission Category HIV Disease Diagnoses 1,200 1, MSM IDU MSM+IDU HET Other Excludes cases with missing risk. Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of August 2015.

24 HIV Diagnoses Among Females in Illinois by Transmission Category 250 HIV Disease Diagnoses IDU HET Other Excludes cases with missing risk. Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of August 2015.

25 Diagnostic Status of New HIV Cases in Illinois by Year of Diagnosis 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% HIV (non-aids) AIDS (Late Diagnoses) 36% 23% Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of August 2015.

26 HIV Late Diagnoses, Illinois, Who were our late testers from ? 31% of cases overall tested late 32% of males and 30% of females 37% of Hispanics, 31% of blacks and 30% of whites 45% of persons over the age of 50, 40% of year-olds, 33% of year-olds and 21% of year-olds and 16% of yearolds 36% of IDU, 29% of MSM, 40% of MSM+IDU and 38% of heterosexuals Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of August 2015.

27 Illinois HIV Prevalence and Mortality HIV Prevalence 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5, HIV Prevalence Mortality 2,000 1,800 1,600 1,400 1,200 1, Mortality (Deaths) Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of August 2015.

28 Illinois HIV Prevalence, 2014 Of the nearly 37,900 PLW HIV disease in Illinois 80% are male 47% are black 29% are white 17% are Hispanic = Represents 1,000 people Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of August 2015.

29 Illinois HIV Prevalence, 2014 Of the nearly 37,900 PLW HIV disease in Illinois 29% are years-old 27% are years-old 8% are between the ages of % are under the age of 25 = Represents 1,000 people Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of August 2015.

30 Illinois HIV Prevalence, 2014 Of the nearly 25,000 males living with HIV disease in Illinois 75% are MSM 10% are MSM+IDU 7% are Heterosexual = Represents 1,000 males Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of August 2015.

31 Illinois HIV Prevalence, 2014 Of the nearly 6,000 females living with HIV disease in Illinois 70% have infections attributed to heterosexual contact 26% are IDU = Represents 250 females Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of August 2015.

32 Trends in HIV Prevalence in Illinois Over the past decade, the number of PLWHD has increased, while the annual number of new infections has remained relatively stable. The proportion of PLWHD attributed to injection drug use has declined from 18% in 2005 to 11% in 2014, but injecting drugs remains a significant risk. The number of PLWHD increased 44% since 2005; the number of and year-olds LWHD increased by 88% and 84% in that same period.

33 ANALYSIS OF SELECTED NATIONAL HIV PREVENTION AND CARE INDICATORS

34 2014 Unmet Need Analysis Unmet Need Estimates, 2004 and Unmet Need Estimate Sources Reporting Data Sources Reporting Data Sources Reporting Data Sources Reporting Data Sources Reporting Data Sources Reporting Data Sources Reportin g Data Sources Reporting Data Sources Reporting Data PLWA 32.8% 36.4% 35.4% 47.6% 42.8% 46.7% 45.5% 55.3% 65.2% PLWH 38.1% 44.4% 43.7% 57.0% 52.2% 53.3% 51.2% 43.1% 55.3% PLWA+PLWH 35.3% 40.0% 39.1% 51.9% 47.0% 49.7% 48.0% 49.0% 55.3% Note: Analysis includes cases diagnosed through December 31, 2013 and living as of December 31, Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of October

35 2014 Unmet Need Analysis Statewide, 2014 % of Total Cases with Unmet Need Diagnostic Status HIV (non-aids) 38.1% Sex at Birth AIDS 32.8% Male 35.4% Female 35.0% Statewide, 2014 % of Total Cases with Unmet Need Race/ Ethnicity NH-Black 35.6% NH-White 35.8% Hispanic 36.0% NH-Asian 37.3% NH-American 55.1% Indian/Alaskan Native NH-Native 42.3% Hawaiian/PI NH-Multi-Race 16.6% Statewide, 2014 Current Age % of Total Cases with Unmet Need % % % % % % % 65 and older 45.4% Note: Analysis includes cases diagnosed through December 31, 2013 and living as of December 31, Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of October

36 2014 Unmet Need Analysis Statewide, 2014 % of Total Cases with Unmet Need Statewide, 2014 % of Total Cases with Unmet Need Transmission Category Region MSM 31.8% IDU 44.1% MSM+IDU 32.3% Heterosexual 32.5% Blood Transfusion 29.9% Perinatal 33.4% Other 36.9% No Risk Reported 68.9% Winnebago 34.8% Peoria 37.7% Sangamon 36.1% St. Clair 36.2% Jackson 40.9% Champaign 39.1% Collar 34.2% Suburban Cook 33.3% Chicago 35.4% Note: Analysis includes cases diagnosed through December 31, 2013 and living as of December 31, Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of October

37 Illinois HIV Care Continuum, ,334 individuals had >=1VL test in 2013 (51%). Among them, 82% were virally suppressed

38 Medical Monitoring Project (MMP) Supplemental surveillance project conducted by the Illinois Department of Public Health (IDPH), in collaboration with CDC and the Department of Health and Human Services Health Resources and Services Administration (HRSA). Survey data collected provide local and national estimates for the population in care for HIV. Patient interview and medical record abstraction gather information on: Behaviors Clinical Outcomes Type and quality of care received Met and unmet needs for HIV care and prevention service 38

39 Medical Monitoring Project (MMP) Select Demographic Characteristics of Participating MMP Respondents Gender and Sexual Orientation No. Weighted % Race/Ethnicity No. Weighted % Age at Time of Interview No. Weighted % Gender White, NH 66 29% % Male % Female 67 29% Sexual Orientation Homosexual % Heterosexual 59 21% Bisexual 66 28% Other/Unclassified 5 2% Black, NH % Hispanic 38 13% Other 6 3% % % % => % *Data collected from respondents were or weighted to represent the population of HIV+ individuals in care for their HIV infection. Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of December 2014.

40 Medical Monitoring Project (MMP) ART and HIV Detection Status of Participating MMP Respondents Antiretroviral Status (On ART?) High Viral Load Status No. Weighted % Yes % No 17 10% HIV viral load undetectable % HIV viral load detectable 36 16% Unknown 8 4% MMP estimate of viral suppression is consistent with statewide estimates of Engagement in HIV Care. IL Gardner Cascade: 82% of people in care (evidenced by a CD4 or VL) are virally suppressed. *Data collected from respondents were or weighted to represent the population of HIV+ individuals in care for their HIV infection. Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of December 2014.

41 Medical Monitoring Project (MMP) ART Status of Participating MMP Respondents by Select Demographic Characteristics Gender On ART No. Weighted % Yes % Male No 15 7% Yes 65 85% Female No 2 15% Age Group On ART No. Weighted % Yes 10 44% No 2 56% Yes 29 93% No 2 7% Yes 56 95% No 3 5% =>55 Yes 88 91% No 9 9% Yes 56 99% No 1 1% *Data collected from respondents were or weighted to represent the population of HIV+ individuals in care for their HIV infection. Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of December 2014.

42 Medical Monitoring Project (MMP) ART Status of Participating MMP Respondents by Race/Ethnicity and Sexual Orientation Race/Ethnicity White, NH Black, NH Hispanic Other On ART No. Weighted % Yes 63 96% No 3 4% Yes % No 10 13% Yes 35 94% No 3 6% Yes 5 78% No 1 22% Sexual Orientation Homosexual Heterosexual Bisexual Other/Unclassified On ART No. Weighted % Yes % No 11 8% Yes 56 96% No 3 4% Yes 64 84% No 2 16% Yes 4 78% No 1 22% *Data collected from respondents were or weighted to represent the population of HIV+ individuals in care for their HIV infection. Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of December 2014.

43 Medical Monitoring Project (MMP) Viral Load Suppression of Participating MMP Respondents by ART Status ART Status (On ART) Yes No Viral Load Status No. Weighted % Viral load suppression % Viral load un-suppressed 30 11% Unknown 8 4% Viral load suppression 11 34% Viral load un-suppressed 6 66% Unknown 0 0% *Data collected from respondents were or weighted to represent the population of HIV+ individuals in care for their HIV infection. Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of December 2014.

44 Medical Monitoring Project (MMP) Viral Load Suppression Status of Participating MMP Respondents by Gender Gender Viral Load Status No. Weighted % Viral load suppression % Male Viral load un-suppressed 22 12% Unknown 5 3% Female Viral load suppression 50 68% Viral load un-suppressed 14 28% Unknown 3 4% *Data collected from respondents were or weighted to represent the population of HIV+ individuals in care for their HIV infection. Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of December 2014.

45 Medical Monitoring Project (MMP) HIV Viral Load Suppression of Participating MMP Respondents by Age Age Group Viral Load Status No. Weighted % Viral load suppression 7 32% Viral load un-suppressed 5 68% Unknown 0 0% Viral load suppression 24 78% Viral load un-suppressed 7 20% Unknown 0 0% Viral load suppression 50 83% Viral load un-suppressed 7 12% Unknown 2 5% Viral load suppression 83 86% Viral load un-suppressed 13 12% Unknown 1 2% =>55 Viral load suppression 48 85% Viral load un-suppressed 4 6% Unknown 5 9% *Data collected from respondents were or weighted to represent the population of HIV+ individuals in care for their HIV infection. Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of December 2014.

46 Medical Monitoring Project (MMP) Viral Load Suppression of Participating MMP Respondents by Race/Ethnicity Race/Ethnicity Viral Load Status No. Weighted % White, NH Viral load suppression 61 91% Viral load un-suppressed 4 6% Unknown 1 2% Black, NH Viral load suppression % Viral load un-suppressed 27 23% Unknown 5 3% Hispanic Viral load suppression 32 83% Viral load un-suppressed 4 9% Unknown 2 8% Other Viral load suppression 5 78% Viral load un-suppressed 1 22% Unknown 0 0% *Data collected from respondents were or weighted to represent the population of HIV+ individuals in care for their HIV infection. Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of December 2014.

47 Medical Monitoring Project (MMP) Viral Load Suppression of Participating MMP Respondents by Sexual Orientation Sexual Orientation Viral Load Status No. Weighted % Viral load suppression % Homosexual Viral load un-suppressed 14 11% Unknown 1 1% Heterosexual Viral load suppression 48 80% Viral load un-suppressed 7 12% Unknown 4 8% Bisexual Viral load suppression 49 67% Viral load un-suppressed 14 28% Unknown 3 5% Other/Unclassified Viral load suppression 4 86% Viral load un-suppressed 1 14% Unknown 0 0% *Data collected from respondents were or weighted to represent the population of HIV+ individuals in care for their HIV infection. Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of December 2014.

48 So what now?? What do we do with all of this data?? Identify emerging trends in HIV disease More accurately target services and programs Identify cases eligible for linkage to care and partner services Evaluate prevention and care service delivery

49 Acknowledgments Content Contributors Lily Cheng Fangchao Ma Annie McGowan Zhi Wang HIV Surveillance Program Staff Christine Hoffman Marti Merritt Luke Giacomini Jill Gooding Krista Helm Kapil Jadhav Mijiza Jefferson Kandice Moore Lori Smith

50 Questions?? For questions regarding the information contained in this document or for more information, contact: Cheryl Ward, MS HIV Surveillance Program Administrator Office: Additional data including the Monthly HIV/STD Surveillance Update can be found on the new IDPH website found here:

51 Sociodemographic Characteristics of the General Population* Chicago (R9) % Regions 1-8 % Total Population 2,695, % 10,135, % Sex Male 1,308, % 4,984, % Female 1,387, % 5,150, % Age , % 2,797, % , % 1,290, % , % 1,281, % , % 1,460, % , % 1, % , % 1,878, % *Source: U.S. Census,

52 Sociodemographic Characteristics of the General Population* Chicago (R9) % Regions 1-8 % Total Population 2,695, % 10,135, % Race/Ethnicity Black 872, % 960, % White 854, % 7,313, % Hispanic 778, % 1,248, % Other 189, % 612, % *Source: U.S. Census,

53 HIV Disease Diagnoses in Illinois Outside of Chicago by Age at Diagnosis HIV Disease Diagnoses Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of August 2015.

54 HIV Disease Diagnoses in Chicago by Age at Diagnosis HIV Disease Diagnoses Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of August 2015.

55 HIV Diagnoses Among Males in Illinois Outside of Chicago by Transmission Category HIV Disease Diagnoses MSM IDU MSM+IDU HET Other Excludes cases with missing risk. Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of August 2015.

56 HIV Diagnoses Among Males in Chicago by Transmission Category HIV Disease Diagnoses MSM IDU MSM+IDU HET Other Excludes cases with missing risk. Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of August 2015.

57 HIV Diagnoses Among Females in Illinois Outside of Chicago by Transmission Category HIV Disease Diagnoses IDU HET Other Excludes cases with missing risk. Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of August 2015.

58 HIV Diagnoses Among Females in Chicago by Transmission Category HIV Disease Diagnoses IDU HET Other Excludes cases with missing risk. Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit. Data as of August 2015.