Download pdf - D.M Rane, MBBS, MPH; J.M Kelly, MD; D Hughes, BS; A. Pennisi

HIV/AIDS Unmet Needs, Georgia, 2011D.M Rane, MBBS, MPH; J.M Kelly, MD; D Hughes, BS; A. Pennisi, MA, MPH; C.L Drenzek, DVM, MSGeorgia Department of Public Health (GDPH), Division of Health Protection, Epidemiology Program, HIV/AIDS Epidemiology Section

Results• ThetotalnumberofpersonslivingwithHIVinfectioninthe

AtlantaEMA(28,683)wasalmosttwicethatofthoselivingintheGeorgianon-EMA(16,844)

• EstimatesofunmetprimarycareneedsofpersonslivingwithHIVinfectionwere20,627(45%)forGeorgiastatewide,12,285(43%)fortheAtlantaEMAand8,342(50%)forGeorgia,non-EMA[Figure1]

• ProportionsofunmetneedswerehighestintheGeorgianon-EMAamongPLWH(non-AIDS)(54%)andPLWA(46%)comparedtoAtlantaEMA(43%forbothPLWHnon-AIDSandPLWA)

• MaleslivingwithHIVinfectionintheAtlantaEMA(9,805;44%),Georgianon-EMA(5,772;51%)andGeorgiastatewide(15,577;46%)hadhigherunmetneedsthanfemalesintheAtlantaEMA(2,475;40%),Georgianon-EMA(2,562;46%)andGeorgiastatewide(5,037,43%)[Figure4]

• Amongadultsandadolescents(13yearsofageandgreater),higherunmetneedswereseenamongthose45to59yearsofageintheAtlantaEMA,Georgianon-EMAandGeorgiastatewide[Figure5].However,byproportionhigherunmetneedswereseeninamongthose60yearsandgreaterinGeorgiaanditsregions

• Hispanic/Latinoshadthelowestnumberofpersonsbuthighestproportionwithunmetneedscomparedtoallotherracial/ethnicgroupsintheAtlantaEMA(720,48%)andGeorgianon-EMA(374,56%)[Figures6,7]

Conclusions• Quantifiedestimatesofunmetprimarymedicalcareneeds

amongpersonslivingwithHIVinfectionintheAtlantaEMAassistsRyanWhiteprogramAgranteestomonitorandensurethatpersonslivingwithHIVinfectionintheAtlantaEMAhaveaccesstoprimarymedicalcare.

• EstimatesofunmetprimarymedicalcareneedsinGeorgiastatewideandinGeorgianon-EMAguidestakeholdersindecision-makingtoimproveprimarycareaccessforallHIVpositiveGeorgians

• Itisimportanttoconsiderbothnumbersofpersonsandproportionsofpopulationstomeasureunmetneedssowecanidentifydisparitiesinprovisionofcare

• OngoingeffortstoestimateunmetneedsforGeorgiastatewide,theAtlantaEMAandGeorgianon-EMAinthefuturewillallowcomparativeandtrendanalysisofunmetneeds

Limitations• TheburdenofHIVinfectioninGeorgiamaybeunderestimated

duetolimitationsinreporting• EvidenceofoneviralloadorCD4laboratorytestmaynotbe

indicativeofcomprehensiveprimarymedicalcareforpersonslivingwithHIVinfection

• UtilityofunmetneedestimatesbytransmissioncategoryislimitedbythelargenumberofindividualswithunspecifiedtransmissioncategoryintheGeorgiasurveillancedata

• AdditionalstudiesareneededtoidentifybarrierstoaccesstocareandunmetneedsthatmaydifferfortheAtlantaEMAandnon-EMApopulations

References1.CentersforDiseaseControlandPrevention.HIVSurveillanceReport,2011;vol.23.http://www.cdc.gov/hiv/topics/surveillance/resources/reports/.PublishedFebruary2013.AccessedApril2013.

2.ApracticalguidetomeasuringunmetneedforHIVrelatedprimarymedicalcare:Usingtheunmetneedframework;InstituteofHealthPolicyStudies,UniversityofCalifornia,SanFrancisco,May2003

ResultsFigure 1:EstimatesofunmetprimarymedicalcareneedsamongpersonslivingwithHIVinfection*inGeorgia,AtlantaEMAandGeorgianon-EMA,January01toDecember31,2011

Pickens

CherokeeBartow Forsyth

CobbPauldingGwinnett

Barrow

Carroll

Douglas FultonDeKalb

Rockdale

Newton

Coweta

Fayette Henry

Clayton

Spalding

Numberwithunmetneeds:Georgia:20,627AtlantaEMA§:12,285Georgianon-EMA:8,342

*PersonslivingwithHIVinfectionincludePLWH(non-AIDS)andPLWA§AtlantaEMAconsistsofBarrow,Bartow,Carroll,Cherokee,Clayton,Cobb,Coweta,DeKalb,Douglas,Fayette,Forsyth,Fulton,Gwinnett,Henry,Newton,Paulding,Pickens,Rockdale,SpaldingandWaltoncounties

Figure 2:EstimatesofunmetprimarycareneedsamongpersonslivingwithHIV(non-AIDS),Georgiaanditsregions,January01toDecember31,2011

Figure 3:EstimatesofunmetprimarycareneedsamongpersonslivingwithAIDS,Georgiaanditsregions,January01toDecember31,2011

19,818

12,058

7,760

10,506

6,915

3,591

9,312

5,4134,169

0

5,000

10,000

15,000

20,000

25,000

Georgia Atlanta EMA Georgia non-EMA

Number of cases

Total Population In Care Out-of-Care

Figure 2: Estimates of unmet primary care needs among persons living with HIV(non-AIDS), Georgia and its regions, January 01 to December 31, 2011

25,709

16,625

9,084

14,394

9,483

4,911

11,315

7,1424,173

0

5,000

10,000

15,000

20,000

25,000

30,000


Number of cases

Total Population In Care Out-of-Care

Figure 3: Estimates of unmet primary care needs among persons living with AIDS , Georgia and its regions, January 01 to December 31, 2011

TotalpopulationreferstoPLWH(non-AIDS)[Figure2]orPLWA[Figure3]asofDecember31,2011IncarereferstoPLWH(non-AIDS)[Figure2]orPLWA[Figure3]asofDecember31,2011withanevidenceofviralloadand/orCD4countbetweenJanuary01toDecember31,2011Out-of-Care=TotalPopulation–InCare

Figure 4:EstimatesofunmetprimarycareneedsamongpersonslivingwithHIVinfectionbysex,Georgiaanditsregions,January01toDecember31,2011

Figure 5:EstimatesofunmetprimarycareneedsamongpersonslivingwithHIVinfectionbyage(13yearsandgreater),Georgiaanditsregions,January01toDecember31,2011

15,577

9,805

5,7725,037

2,475 2,562

0

5,000

10,000

15,000

20,000


Number of cases

Male Female

14,108

8,447

5,6614,494

2,5801,914

1,094 720 374931 538 3930

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000


Number of cases

Black, NH* White,NH* Hispanic/Latino Other

Figure 6:EstimatesofunmetprimarycareneedsamongpersonslivingwithHIVinfectionbyrace/ethnicity,Georgiaanditsregions,January01toDecember31,2011

Figure 7:ProportionofunmetprimarycareneedsamongpersonslivingwithHIVinfectionbyrace/ethnicity,Georgiaanditsregions,January01toDecember31,2011

2,4611,439 1,022

7,098

4,154

2,944

8,873

5,407

3,466

2,0751,240 835

0

2,000

4,000

6,000

8,000

10,000


Number of cases

13-29 30-44 45-59 60+

*NH(non-Hispanic)§OtherIncludesAsian,Hawaiian/PacificIslander,Multiracial,AmericanIndian,AlaskanNativeandUnknown

Background• Georgiarankssixthhighestinthenationfortotalnumberof

adultsandadolescentslivingwithdiagnosedHIVinfectionin20101

• AsofDecember31,2011theGeorgiaDepartmentofPublicHealthreports45,527peoplelivingwithHIV/AIDS;44%withHIV(notAIDS)and56%withAIDS

• Sixty-threepercentoftheseliveintheAtlantaEligibleMetropolitanArea(EMA)

• GDPHestimatestheunmetprimarymedicalcareservicesofpersonslivingwithHIVinfectioninGeorgiaasrequiredbytheRyanWhiteTreatmentandModernizationAct

• Theanalysisidentifiesthenumber,behavior,anddemographicsofpersonslivingwithHIVinfectionandnotreceivingHIVrelatedmedicalservices

• TheestimatesinformcommunityplanninggroupsandotherstakeholderstorespondtotheprimarymedicalcareneedsofemergingunderservedHIV/AIDSpopulationsandreducedisparitiesinaccesstocare

Methods• TheEnhancedHIV/AIDSReportingSystem(eHARS)isa

web-basedsurveillancesystemthatgathersclinicalandbehavioralHIVinfectiondataviadocumentssuchascasereports,electronicandpaper-basedlaboratoryreports,andbirthanddeathcertificates

• Caseswithcompleteinformationonlastnamesoundex,stateidentificationnumber,dateofbirth,race/ethnicity,birthsex,HIV/AIDSdiagnosisinformationandvitalstatusaretermedeligibleandarereportedtotheCentersforDiseaseControlandPrevention(CDC)

• UnmetneedsforGeorgia,AtlantaEMAandGeorgianon-EMAwereestimatedbyanalyzingCDCeligibleHIVinfectiondatareportedintheGeorgiaeHARSbasedonaframeworkdevelopedbytheUniversityofCalifornia,SanFrancisco2usingSASprogramming

• AllpersonslivingwithHIVinfectionreportedintheGeorgiaeHARSwereassumedtobeawareoftheirstatus

• Forthepurposeofthisanalysis,populationsizesweredeterminedforpersonslivingwithAIDS(PLWA)andpersonslivingwithHIV/non-AIDS(PLWHnon-AIDS)asofDecember31,2011forGeorgiastatewide,theAtlantaEMA,andGeorgianon-EMA

• Primarymedicalcare‘metneeds’wereestimatedforPLWAandPLWH(non-AIDS)forGeorgiaasawhole,theAtlantaEMAandGeorgianon-EMAasevidencedbyviralloadtestingand/orCD4countfora12monthperiodfromJanuary01toDecember31,2011

• UnmetneedsforHIVinfectionprimarymedicalcareweredefinedasnoevidenceofeitherofthetwomeasuresdescribedaboveduringthespecified12-monthtimeframe

• PersonslivingwithHIVinfectionwhoarenotidentifiedtobe‘incare’wereassumedtobe‘outofcare’

AcknowledgementsAnalysisofunmetprimarycareneedsofHIVpositivepeopleofGeorgiawouldnothavebeenpossiblewithoutthehardworkandcontributionsoftheCoreSurveillanceUnit,HIVEpidemiologySection,GPDHinthecollectionandintegrationofpopulationbasedHIV/AIDSdata.WewouldliketothankMargueriteCamp,RaimiEwetola,ThelmaFannin,RodriquesLambert,SheilaMaxwell,MildredMcGainey,LatoyaMoss,AkilahSpratlingandEinaWalker.

§

§

47 454947 45

5250 48

56

2621

40

0

20

40

60

80


Proportion of cases

Black, NH* White, NH* Hispanic/Latino Other

Proportion ofcases