Impact of Syndemics on People Living with HIV/AIDS in San Francisco

Priscilla Lee Chu, DrPH, MPHSan Francisco Department of Public HealthXIX International AIDS ConferenceJuly 23, 2012Washington, DC

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Introduction: PCSI

Program Collaboration and Service Integration (PCSI) has prioritized the integrated monitoring of syndemics among four communicable disease registries: HIV Tuberculosis Viral Hepatitis STDs

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Introduction: Syndemics

Syndemics are the presence of two or more diseases interacting synergistically to exacerbate health outcomes within a population

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Introduction: Purpose

To assess the prevalence of co-occurring infections within the four registries and their impact on persons living with HIV/AIDS (PLWHA)

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Methods 1/2

HIV/AIDS cases were matched against seven diseases from three other registries

HIV

STDSyphilis

Gonorrhea Chlamydia

Viral HepatitisChronic Hepatitis B

Hepatitis C

TBActive TBLatent TB

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Methods 2/2

Chi-square, t-test, and Kruskal-Wallis tests were used to assess differences between those with HIV only versus HIV plus at least one co-infection by: Demographics Health status Neighborhood

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Results: Syndemics with HIV

HIV14%

Syphilis 1%

Gonorrhea 2%

Chlamydia 2%

HCV 4%HBV 4%

LTBI 2%

Active TB 1%

HIV N=15,056 N=2,050 (14%) with

one or more infection in addition to HIV

Syndemic rate 13,616 per 100,000 HIV cases

Highest co-morbidities: HCV, HBV, Chlamydia, and latent TB

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Results: Characteristics of PLWHA with at least one other disease

Injection Drug Users

Very High Viral Loads (>100K)

Virologically Unsuppressed

Homeless

African American

Women

Transgender

Age 20-29

0tan28a566028 0tan9a56609 0tan19a566019 0tan29a566029

0tan26a566026

0tan25a566025

0tan22a566022

0tan22a566022

0tan20a566020

0tan17a566017

0tan17a566017

0tan15a566015

Percent of HIV syndemic (all p<0.01)

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Results: Mean viral load by specific co-infection

0tan28a566028

0tan6a57156

0tan14a576914

0tan22a582422

0tan29a587929

13823

0tan26a573726

0tan14a586514

0tan15a587115

0tan20a567720

0tan15a569315

0tan19a570719

0tan24a569924

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Results: Suppression rates by specific co-infection

0%

20%

40%

60%

80%

100%

82%64% 67% 61%

78%65%

74% 69%

18%36% 33% 39%

22%35%

26% 31%

Percent Unsup-pressedPercent Suppressed

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Results: Mean viral load by number of co-infections

0tan28a566028

0tan6a57156

0tan14a576914

0tan22a582422

0tan30a569830

0tan20a570320

0tan2a58302 0tan28a582028

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Results: Viral suppression rates by number of co-infections

0%

20%

40%

60%

80%

100%

82%71% 65%

39%

18%29% 35%

61%

Percent Unsup-pressedPercent Suppressed

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Results: PLWHA syndemics and poverty, San Francisco, 2009

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Conclusion 1/3

Syndemics are associated with poorer HIV health outcomes among PLWHA Significant “dose-response

relationship” between the number of co-infections and mean VLs

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Conclusion 2/3

In addition to numbers of co-infections, particular demographic subgroups, and certain geo-clusters were also associated with poorer health outcomes, underscoring the need to address multiple conditions in tandem in an integrated health system

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Conclusion 3/3

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Thanks & AcknowledgementsGlenn-Milo SantosAnnie VuIsrael Nieves-RiveraGrant ColfaxJennifer GrinsdaleSandra HuangSusan PhilipSusan ScheerTomas Aragon