Bronx Community Health Dashboard: HIV and AIDS

Transcription

1 Bronx Community Health Dashboard: HIV and AIDS Created: 5/4/17 Last Updated: 3//19 See last slide for more information about this project. 1

2 Overview of HIV/AIDS in the Bronx Disparities exist in early HIV/AIDS detection, but are declining Bronx residents are being diagnosed with HIV at a lower rate and are living with HIV longer Bronx residents with lower incomes and less education are more likely to have had an HIV/AIDS test Bronx residents have the highest likelihood of ever having an HIV/AIDS screening compared to other boroughs Newly diagnosed Bronx residents equally likely to initiate care, but somewhat less likely to have viral suppression, 17 AIDS diagnoses are highest in the Bronx amongst non-hispanic black residents and males 2

3 Fewer people are being newly diagnosed with HIV and AIDS in the Bronx Rate of HIV and AIDS diagnoses per, HIV Diagnosis AIDS Diagnosis HIV 65% decrease AIDS 81% decrease HIV Diagnosis: positive Western blot test in adults and positive PCR (polymerase chain reaction) test in infants <18 months AIDS Diagnosis: HIV-infected and either 1+ AIDS-defining opportunistic illness or a lab test indicating suppressed CD4+ cell counts (< cells/µl) 3 Data source: New York City HIV/AIDS Annual Surveillance Statistics, 1-17.

4 The percent of Bronx residents living with HIV/AIDS has been steadily increasing over the last 15 years 2.5 Bronx NYC Excluding Bronx Percent of population living with HIV/AIDS Data source: New York City HIV/AIDS Annual Surveillance Statistics, 1-17.

5 New HIV and AIDS diagnoses rates are falling 1 Bronx NYC Excluding Bronx Bronx NYC Excluding Bronx 99.7 Rate of HIV diagnoses per, fold decrease in new HIV diagnoses 31.8 Rate of AIDS diagnoses per, fold decrease in new AIDS diagnoses Data source: New York City HIV/AIDS Annual Surveillance Statistics, 1-17.

6 The rate of new HIV/AIDS cases is falling but the rate of people living with HIV/AIDS is increasing People Living with HIV/AIDS HIV Diagnosis AIDS Diagnosis 1 Note different axis scales Percent of People Living with HIV and AIDS Rate of HIV and AIDS diagnoses per, Data source: New York City HIV/AIDS Annual Surveillance Statistics, 1-17.

7 7 HIV Testing

8 Bronx adult residents are more likely to have ever had an HIV/AIDS test compared to other boroughs Age-adjusted percent reporting ever getting HIV/AIDS test Bronx only Data source: Community Health Survey, 17. Age results not age-adjusted.

9 Residents with lower incomes and less education more likely to have ever had an HIV/AIDS test Age-adjusted percent reporting ever getting HIV/AIDS test Hispanic Non- Hispanic black Non- Hispanic white* Highest poverty High poverty Medium poverty Low poverty Lowest poverty* <HS High school Some college College 9 Data source: Community Health Survey, 17.

10 Since 4, the Bronx has had the highest percentage of people ever getting an HIV/AIDS test Age-adjusted percent reporting ever getting HIV/AIDS test Bronx Brooklyn Manhattan Queens Staten Island Data source: Community Health Survey, Comparable data not collected in 6.

11 11 HIV Diagnoses in the Bronx

12 HIV diagnosis rates have decreased in all groups, but disparities remain 1 Hispanic Non-Hispanic Black Non-Hispanic White Asian HIV diagnosis rate per, Non-Hispanic black population s HIV diagnosis rate has fallen over 3 fold since 1 but remains highest of all race/ethnicities in the Bronx Data source: New York City HIV/AIDS Annual Surveillance Statistics, data for the Asian population is unstable. For 16 and 17, denominators are from the American Community Survey. For all other years, denominators are DOHMH population estimates.

13 Males in the Bronx have higher rates of HIV diagnoses Male Female HIV diagnosis rate per, HIV diagnosis rate per, Data source: New York City HIV/AIDS Annual Surveillance Statistics, For 16 and 17, denominators are from American Community Survey. For all other years, denominators are DOHMH population estimates.

14 4 of 1 community districts with highest rates of new HIV diagnoses are in the Bronx HIV Diagnosis Rate Per, Bronx 35.7 NYC 24. Highest: Central Harlem and Brownsville 1 Mott Haven & Melrose 2 Hunts Point & Longwood 3 Morrisania & Crotona 4 Highbridge & Concourse 5 Fordham & University Heights 6 Belmont & East Tremont 7 Kingsbridge Heights & Bedford 8 Riverdale & Fieldston 9 Parkchester & Soundview 21 Throgs Neck & Co-op City 211 Morris Park & Bronxdale 212 Williamsbridge & Baychester HIV Diagnosis Rate per, Data source: NYC Community Health Profiles, 18.

15 In the Bronx, HIV diagnoses are highest for men who have sex with men MSM IDU MSM-IDU Heterosexual Transgender Perinatal Unknown Male HIV Diagnosis % MSM IDU Number of male HIV diagnoses % 2% 1% 64% MSM-IDU Heterosexual Transgender Perinatal Unknown *numbers from 17 data Abbreviations MSM=men who have sex with men IDU=people who inject drugs MSM-IDU=men who have sex with men and inject drugs 15 Data source: New York City HIV/AIDS Annual Surveillance Statistics, 1-17.

16 HIV diagnoses are highest for females with heterosexual contact in the Bronx 582 IDU Heterosexual Transgender Perinatal Unknown Female HIV Diagnosis 3% 5 9% Number of female HIV diagnoses % 81% IDU Heterosexual Transgender Perinatal Unknown *numbers from 17 data Data source: New York City HIV/AIDS Annual Surveillance Statistics, 1-17.

17 AIDS Diagnoses in the Bronx AIDS diagnosis is defined as: 1) Those diagnosed concurrent with HIV 2) Those who transitioned from HIV to AIDS 17

18 AIDS diagnoses rates are highest among the non-hispanic black population in the Bronx AIDS diagnosis rate per, Hispanic Non-Hispanic Black Non-Hispanic White Asian AIDS Diagnosis: HIV-infected and either 1 AIDS-defining opportunistic illness or a lab test indicating suppressed CD4+ cell counts (< cells/µl) Data source: New York City HIV/AIDS Annual Surveillance Statistics, data for Asian population is unstable. For 16 and 17, denominators are from American Community Survey. For all other years, denominators are DOHMH population estimates.

19 Males in the Bronx have higher rates of AIDS diagnoses Male Female AIDS diagnosis rate per, AIDS diagnosis rate per, Data source: New York City HIV/AIDS Annual Surveillance Statistics, AIDS diagnosis rates pre-6 are unavailable. For 16 and 17, denominators are from American Community Survey. For all other years, denominators are DOHMH population estimates.

20 In the Bronx, AIDS diagnoses are highest for men who have sex with men MSM IDU MSM-IDU Heterosexual Transgender Perinatal Unknown AIDS Diagnosis MSM Number of male AIDS diagnoses % 31% 11% 6% 1% % IDU MSM-IDU Heterosexual Transgender Perinatal Unknown *numbers from 17 data Abbreviations MSM=men who have sex with men IDU=people who inject drugs MSM-IDU=men who have sex with men and inject drugs Data source: New York City HIV/AIDS Annual Surveillance Statistics, MSM-IDU category was not created until 9; Transgender category was not created until 11.

21 In the Bronx, AIDS diagnoses are highest for females with heterosexual contact 573 IDU Heterosexual Transgender Perinatal Unknown AIDS Diagnosis Number of female AIDS diagnoses % 6% 17% 11% 64% IDU Heterosexual Transgender Perinatal Unknown *numbers from 17 data Data source: New York City HIV/AIDS Annual Surveillance Statistics, MSM-IDU category was not created until 9; Transgender category was not created until 11.

22 22 HIV/AIDS Related Care in the Bronx

23 Timely initiation of care among those newly diagnosed with HIV slightly increased in the Bronx between 13 and 17 Bronx NYC Timely initiation of care, percent Timely initiation of care is defined as first CD4 or VL drawn within 3 days of HIV diagnosis Data source: HIV/AIDS in the Bronx, New York City, 17. As reported to the New York City Department of Health and Mental Hygiene by March 31, 18.

24 Among Bronx residents newly diagnosed with HIV in 17, Hispanic residents were most likely to have timely initiation of care Percent of newly diagnosed Bronx residents with timely initiation of care Timely initiation of care is defined as first CD4 or VL drawn within 3 days of HIV diagnosis Black (n=222) Latino/Hispanic (n=219) White (n=18) 24 Data source: HIV/AIDS in the Bronx, New York City, 17. As reported to the New York City Department of Health and Mental Hygiene by March 31, 18.

25 Among Bronx residents newly diagnosed with HIV in 17, MSM-IDU were most likely to have timely initiation of care Percent of newly diagnosed Bronx residents with timely initiation of care MSM IDU MSM-IDU Heterosexual TG-SC Timely initiation of care is defined as first CD4 or VL drawn within 3 days of HIV diagnosis. Abbreviations MSM=men who have sex with men IDU=people who inject drugs MSM-IDU=men who have sex with men and inject drugs TG-SC=transgender sexual contact 25 Data source: HIV/AIDS in the Bronx, New York City, 17. As reported to the New York City Department of Health and Mental Hygiene by March 31, 18.

26 Newly diagnosed Bronx residents are equally likely to initiate care, but somewhat less likely to have viral suppression, 17 Timely Initiation of Care Among Newly Diagnosed, 17 Viral Suppression* within 6 Months of HIV Diagnosis, 17 Viral Suppression* Among PLWHA, Percent BX BK M Q SI BX BK M Q SI BX BK M Q SI Timely initiation: First CD4 or viral load drawn within 3 days of diagnosis *Viral suppression: Viral load copies/ml; PLWHA: People Living with HIV/AIDS 26 Data source: HIV/AIDS in the Bronx, New York City, 17. As reported to the New York City Department of Health and Mental Hygiene by March 31, 18.

27 HIV/AIDS related care by risk category for all of New York City, 17 Timely Initiation of Care Among Newly Diagnosed, 17 Viral Suppression* within 6 Months of HIV Diagnosis, 17 Viral Suppression* Among PLWHA, 17 Percent Timely initiation: First CD4 or viral load drawn within 3 days of diagnosis *Viral suppression: Viral load copies/ml; PLWHA: People Living with HIV/AIDS 27 Data source: HIV/AIDS in the Bronx, New York City, 17. As reported to the New York City Department of Health and Mental Hygiene by March 31, 18.

28 Among Bronx residents newly diagnosed with HIV, 41% achieved viral suppression within 3 months and 61% within 6 months 7 Bronx NYC Percent of newly diagnosed achieving viral suppression in the Bronx Viral suppression is defined as viral load copies/ml 1 3 Months 6 Months 28 Data source: HIV/AIDS in the Bronx, New York City, 17. As reported to the New York City Department of Health and Mental Hygiene by March 31, 18.

29 Among people newly diagnosed with HIV in the Bronx, MSM were most likely to achieve viral suppression within 6 months Percent of newly diagnosed achieving viral suppression within 6 months of diagnosis in the Bronx Viral suppression is defined as viral load copies/ml Abbreviations MSM=men who have sex with men IDU=people who inject drugs MSM-IDU=men who have sex with men and inject drugs TG-SC=transgender sexual contact MSM IDU MSM-IDU Heterosexual Contact TG-SC 29 Data source: NYC HIV Surveillance Registry, 16. Data not available for 17.

30 Among diagnosed PLWHA in the Bronx, non-hispanic black residents had the lowest viral suppression proportion Percent of newly diagnosed achieving viral suppression in the Bronx Viral suppression is defined as viral load copies/ml Black Latino/Hispanic White Asian/Pacific Islander Native American Other 3 Data source: HIV/AIDS in the Bronx, New York City, 17. PLWHA = People Living with HIV/AIDS. As reported to the New York City Department of Health and Mental Hygiene by March 31, 18.

31 Among diagnosed PLWHA in NYC, people with perinatal transmission risk had the lowest viral suppression proportion Viral Suppression among diagnosed PLWHA by transmission risk in the Bronx, Viral suppression is defined as viral load copies/ml Abbreviations MSM=men who have sex with men IDU=people who inject drugs MSM-IDU=men who have sex with men and inject drugs TG-SC=transgender sexual contact MSM IDU MSM-IDU Heterosexual Contact TG-SC Perinatal Other/Unknown 31 Data source: HIV/AIDS in the Bronx, New York City, 17. PLWHA = People Living with HIV/AIDS. As reported to the New York City Department of Health and Mental Hygiene by March 31, 18.

32 Of approximately 25,3 PLWHA in the Bronx in 17, 69% had a suppressed viral load 9 86 Viral suppression is defined as viral load copies/ml % of PLWHA who are Retained in Care (defined as 1 viral load/cd4 measurement) Prescribed anti-retroviral therapy Virally Suppressed 32 Data source: HIV/AIDS in the Bronx, New York City, 17. PLWHA = People Living with HIV/AIDS. As reported to the New York City Department of Health and Mental Hygiene by March 31, 18.

33 33 HIV/AIDS Mortality in the Bronx

34 HIV mortality rates have fallen over 4-fold since Bronx -- : 3 rd leading cause of death 17: 12 th leading cause of death Age-adjusted HIV/AIDS mortality rate per, Bronx Rest of NYC Bronx 83% decrease NYC Excluding Bronx 81% decrease Age-adjusted HIV/AIDS mortality rate per, Bronx DC Miami-Dade County Baltimore City These areas chosen for comparison due to similar demographics and high HIV/AIDS burden Data source: Underlying Cause of Death, -17.

35 Males and year olds have highest rates of HIV mortality in the Bronx 7 Female Male Age-adjusted HIV mortality rate per, HIV/AIDS mortality rate per, Data Suppressed Data source: Underlying Cause of Death, -17. Age-specific rates are not age-adjusted year data unstable after unstable after 16.

36 HIV/AIDS mortality rates are highest for the non-hispanic black population in the Bronx Age-adjusted HIV/AIDS mortality rate per, Hispanic Non-Hispanic Black Non-Hispanic White 12.5 Data Suppressed Data source: Underlying Cause of Death, -17. Data on non-hispanic white respondents statistically unstable 8-17.

37 There are dramatic disparities in all-cause mortality among people living HIV/AIDS in the Bronx Note: Different analysis approach from previous slides. 35 Males, including transgender men Female, including transgender women 3.7 Estimated deaths among people with HIV/AIDS per 1, PLWHA Abbreviations MSM=men who have sex with men IDU=people who inject drugs MSM-IDU=men who have sex with men and inject drugs MSM IDU MSM-IDU Heterosexual IDU Heterosexual 37 Data source: Calculated from NYC HIV/AIDS Annual Surveillance Statistics, All-cause mortality can include any cause of death, not necessarily HIV/AIDS.

38 About the Community Health Dashboard Project The goal of the project is to provide Bronx-specific data on risk factors and health outcomes with an emphasis on presenting data on trends, socio-demographic differences (e.g., by age, sex, race/ethnicity, etc.) and sub-county/neighborhood level data Data will be periodically updated as new data becomes available. Produced by Montefiore s Office of Community & Population Health using publicly-available data sources For more information please contact us at OCPHDept@montefiore.org 38