Ending the Epidemic and Older Adults:Case Counts and Care Data

December 9, 2015

Daniel Gordon, PhD

Bureau of HIV/AIDS Epidemiology

AIDS Institute

NYSDOH

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Today’s Presentation

• Newly Diagnosed Cases

• Persons Living with Diagnosed HIV Infection (PLWDHI)

• Population Projection (2032)

• Measures of Linkage and Retention

• Observations

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New diagnoses

4

6,070

3,512

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

An

nu

al N

ewly

Dia

gno

sed

Cas

es

Year of Diagnosis

Newly Diagnosed HIV CasesNew York State, 2002-2013*

*Data as of April 2015

42% drop in new HIV diagnoses 2002-2013

5

0

500

1,000

1,500

2,000

2002 2004 2006 2008 2010 2012

Nu

mb

er

of

Cas

es

30-39

40-49

25-29

20-24

50-59

60+

13-19

12 & under

Newly Diagnosed HIV Casesby Age at Diagnosis and Year of Diagnosis

New York State, 2002-2013*

*Data as of April 2015

32% drop in new HIV diagnoses age 50+ 2002-2013.

Age 50+ has accounted for15-18% of new diagnoses over

the last decade.

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Age Distribution of Newly Diagnosed HIV* CasesNew York State, 2013**

0

200

400

600

800

1000

1200

<13 13-19 20-29 30-39 40-49 50-59 60+

Nu

mb

er

of

Cas

es

Age at Diagnosis

Male

Female

3,512 Total; 2,007 Male, 537 Female

*Regardless of subsequent or concurrent AIDS diagnosis**Data as of September 2015

Among new cases age 50+, about a third are women

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Newly Diagnosed HIV Cases,by Age and Race/Ethnicity,

New York State, 2013

0%

10%

20%

30%

40%

<50 50-59 60+Age at Diagnosis

White

Black

Hispanic

All Others*

N=2,818 N=391 N=201

*Includes Asians, Pacific Islanders, Native Americans, Alaskan Natives and Multi-Race

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Percent Concurrent HIV/AIDS Diagnoses by Age GroupNew York State, 2013

0%

10%

20%

30%

40%

50%

<50 50-59 60+

As

Pe

rce

nt

of

All

HIV

Dia

gno

ses

Concurrent HIV & AIDS Dx Other Late (AIDS within 12 mos.)

A large proportion of persons diagnosed at later ages have long-standing infections

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Persons Living with Diagnosed HIV Infection

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Persons Living with Diagnosed HIV Infection Residing in NYS†, December 2013*by Age

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

0-12 13-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-65 65-69 70+

Age (years) in 2013

Male

Female

N=113,049Average age=47.3 yrs

† Based on most recent address, regardless of where diagnosed. Excludes persons with AIDS with no evidence of care for ≥5 years and persons with diagnosed HIV (non-AIDS) with no evidence of care for ≥8 years.

46% of PLWDHI are age 50+

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PLWDHI by Age Group and Race/Ethnicity,New York State, 2013

0%

10%

20%

30%

40%

<50 50-59 60+

White

Black

Hispanic

All Others*

N=60,647 N35,428 N=16,974

*Includes Asians, Pacific Islanders, Native Americans, Alaskan Natives and Multi-Race

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HIV Incidence EstimatesNYS, 2013

NYSDOH uses a method developed by the Centers for Disease Control, NYSDOH estimated that in 2013 there were about 2,800 new HIV infections in New York State.

Persons age 45 and over account for 22% of estimated new infections in 2013

Agegroup

Estimated Incidence, 2013*

13-14 643

25-34 937

35-44 589

45-54 388

55+ 239

Total 2,796

* Estimate of 12/2014 based on data as of 10/2014

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Projection – PLWDH age 50+

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Population Projections

A population simulation model developed by the AIDS Institute Bureau of HIV/AIDS Epidemiology projected thatif recent HIV diagnosis and death rates are maintained, then between 2013 and 2032:

The number of PLWDHI age > 50 will rise by about 47%

age > 65 will rise by 360%

PLWDHI > 50 will rise from 47% to 59% of total PLWDHI

65+ will rise from 7% to 28% of total PLWDHI

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Measures of Care

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0%

20%

40%

60%

80%

<50 50-59 60+

Measures of HIV Care by Age GroupNew York State, 2013*

0%

20%

40%

60%

80%

<50 50-59 60+ <50 50-59 60+

Entry to Care within 3 Months of Diagnosis

Continuity of Care (≥2 tests in 2013, ≥3 months apart)

Viral Suppression at Last Test in the Year

*Data as of February, 2015

National HIV/AIDS Strategy (2015) TargetsNational HIV/AIDS Strategy (2010) Target

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Summary &Discussion

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Observations/Discussion (1)

•Persons age 50+ accounted for 18% of the 3,500 new diagnoses in NYS in 2013, and a roughly similar proportion of the estimated 2,800 new infections.

•Prevention services must be directed to older persons as well as younger ones•The high proportion (1/3) of concurrent HIV/AIDS diagnoses indicate missed opportunities for diagnosis and need for outreach

• Currently, nearly half the 113,000 persons living with diagnosed HIV infection in New York State are age 50+

•Over the coming 20 years this group will increase substantially both in number and as proportion of total PLWDHI

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Observations/Discussion (2)

•Entry to care after diagnosis is similar across age groups•The 2010 NHAS goal (85% within 3 months) is almost met, butthe 2015 NHAS goal (85% within 1 month) has not yet been met

• Continuity of care and viral suppression among those age 50+ are higher than among younger ages, but the 2015 NHAS goals have not yet been met.

•HIV in persons age 50+ presents a distinct challenge in terms of• prevention,•diagnosis outreach and• coordination of HIV-specific care with the normal increasing care needs of older persons in general

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Contact Information:

Bureau of HIV/AIDS EpidemiologyAIDS Institute

New York State Department of HealthPhone (518) 474-4284

Email bhae@health.ny.gov