Rapidly Growing Molecular Clusters of HIV in Texas. Analise Monterosso, MPH Epidemiologist Molecular HIV Surveillance Coordinator

Transcription

1 Rapidly Growing Molecular Clusters of HIV in Texas Analise Monterosso, MPH Epidemiologist Molecular HIV Surveillance Coordinator

2 Outline HIV in Texas HIV Drug Resistance testing (genotyping) in Texas Molecular Clusters in Texas Cluster Case Study Continuing Efforts 2

3 New Diagnoses/Deaths People Living with HIV New HIV Diagnoses, Persons Living with HIV, and Deaths in Texas since ,000 5,000 New HIV Diagnoses 90,000 75,000 4,000 3,000 Persons Living with HIV 60,000 45,000 2,000 30,000 1,000 0 Deaths in Persons Living with HIV* ,

4 People Living With HIV by County,

5 Hispanic Persons in Texas HIV Treatment Cascade, , % 100% 16,000 14,000 76% 71% 80% 12,000 62% 60% 10,000 18,663 8,000 6,000 14,262 13,185 11,538 40% 4,000 20% 2,000 0 HIV+ Individuals Living at end of 2016 At Least One Visit/Lab Retained In Care Achieved Viral Suppression 0% 5

6 HIV Incidence In Texas, Estimated new HIV infections Black\ African American Hispanic\ Latino White 6

7 HIV Genotype Testing in Texas 7

8 Genotyping Completeness by Texas Ending the Epidemic Priority Populations*, Hispanic MSM White MSM 37% 43% 63% 57% Genotyped Ever Not Genotyped Black MSM Black Women 41% 59% 44% 56% *Data on Trans-PLWH cannot be displayed at this time

9 HIV Genotype Testing by County, * *Counties with less than 30 diagnoses in timeframe have been suppressed for clarity *Counties with less than 30 diagnoses in the time period are suppressed for clarity

10 Genotype testing among those linked to care In 2016: Of Persons linked to HIV care within 3 months of diagnosis- 55.7% received genotype testing Of Persons linked to HIV care within 6 months of diagnosis- 55.5% received genotype testing In 2015: Of Persons linked to HIV care within 3 months of diagnosis- 53.4% received genotype testing Of Persons linked to HIV care within 6 months of diagnosis- 53.1% received genotype testing

11 Molecular clusters in Texas 11

12 Age distribution in Clusters Compared to new HIV diagnoses in 2016 Texas Clusters Texas Diagnoses % 7% 21% 23% 35% 51% 18% 38%

13 Race distribution in Clusters Compared to new HIV diagnoses in 2016 Texas Clusters 5% Texas Diagnoses % 16% 21% 39% 18% 62% 36% Hispanic White Hispanic Black Black Other White Other

14 Transmission Risk distribution in Clusters Compared to new HIV diagnoses in 2016 Texas Clusters 1% 2% 11% 6% 80% 2% 6% Texas 2016 Diagnoses 20% 72% MSM Heterosexual NIR MSM\PWID PWID MSM MSM\PWID PWID Heterosexual

15 Texas Cluster Case Study 15

16 Public Health Follow Up and Contact Tracing 16

17 Molecular Cluster Cases Molecular Cluster Case Named Partner Relationship 17

18 Network diagram showing partner services links between molecular cluster members and other suspected members of transmission cluster 18

19 Timing of exposure and infectiousness among molecular cluster members

20 Re-linkage to Care outcomes 4% 12% 11% 16% 40% 17% Located, Linked to Medical Care Located, Refused Services Open Case Located, Confirmed already in care Unable to Locate Deceased, Incarcerated, Moved 20

21 Major Findings from Cluster Investigation Low availability of PrEP in the area HIV diagnostic\testing algorithm was not used correctly\completely Acute HIV cases often missed without the diagnostic algorithm completed Clusters are not contained to one geographic region or jurisdicition 21

22 Actions Taken to Address Community Factors Released a Health Advisory Sent to medical providers and stakeholders statewide Details the need to use diagnostic algorithm to identify acute HIV cases Recommends HIV genotype testing to identify these clusters Available on the Texas DSHS Website: Increase in Prevention funding More testing Additional PrEP clinics

23 Continuing efforts 23

24 Prevention Opportunities Speak with providers locally about the importance of the CDC\APHL recommended diagnostic testing algorithm Advocate for routine HIV testing in Emergency Rooms\Urgent Care Centers every patient who gets blood tests also gets an HIV test Offer PrEP Work with local Health Department to link high-risk persons to PrEP services - make sure the Health Department knows they can refer to your facility Work with local Emergency rooms to advocate for PrEP referral for high risk persons

25 Clusters Intervention and CDC funding Cluster detection, intervention and use for high impact prevention is a major goal for integrated funding for HIV Prevention and Surveillance Texas and Houston received supplemental funding to investigate and intervene on clusters identified using molecular methods that have Latino\Hispanic MSM 7 Field Health Advocate staff in Dallas (2), San Antonio (1) and statewide(4) 3 PrEP navigators- Dallas, Houston and San Antonio 1 Public Health Detailing staff dedicated to clusters and drug resistance testing education 2 staff to help coordinate the functions around the state

26 Thank you Analise Monterosso gov 26

27 HIV Treatment Cascade in Texas, % 100% 80,000 70,000 77% 80% 60,000 70% 50,000 59% 60% 40,000 86,669 30,000 66,680 60,993 51,329 40% 20,000 20% 10,000 0 HIV+ Individuals Living at end of 2016 At Least One Visit/Lab Retained In Care Achieved Viral Suppression 0% 27

28 New HIV Diagnoses by County,