Evaluating the National HIV/AIDS Strategy with Surveillance Data

H. Irene Hall, PhD, FACE

Chief, HIV Incidence and Case Surveillance Branch

2011 National HIV Prevention Conference

August 15, 2011

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Division of HIV/AIDS Prevention

Outline

Outcome measures of the National HIV/AIDS

Strategy

Surveillance data collection

Preliminary data

Conclusion

National HIV/AIDS Strategy

Reducing New HIV Infections

Increasing Access to Care and Improving Health

Outcomes for People Living with HIV

Reducing HIV-Related Health Disparities

Reducing New HIV Infections

Lower the annual number of new infections by 25

percent

Reduce the HIV transmission rate, which is a

measure of annual transmissions in relation to the

number of people living with HIV, by 30 percent

Increase from 79 percent to 90 percent the

percentage of people living with HIV who know

their serostatus

Increasing Access to Care and Improving Health

Increase the proportion of newly diagnosed patients

linked to clinical care within three months of their

HIV diagnosis from 65 percent to 85 percent

Increase the proportion of Ryan White HIV/AIDS

Program clients who are in continuous care (at least

2 visits for routine HIV medical care in 12 months at

least 3 months apart) from 73 percent to 80 percent

A benchmark for surveillance?

Reducing HIV-Related Health Disparities

Increase the proportion of HIV diagnosed gay and

bisexual men with undetectable viral load by 20

percent

Increase the proportion of HIV diagnosed Blacks

with undetectable viral load by 20 percent

Increase the proportion of HIV diagnosed Latinos

with undetectable viral load by 20 percent

HIV Surveillance

HIV diagnosis (1st positive confidential test) 1st CD4 Count

1st Viral Load Test

1st Drug Resistance test

1st CD4 Count <200 (IMM-AIDS)

AIDS-OI

Death

Measures of HIV morbidity and mortality

HIV Infection

Entry to care Retention in care and viral suppression

HIV Case Surveillance Information Flow

Sources of Reports

Hospital Practitioners

Private Practitioners

Public Clinics

Laboratories

7,738

State Health Dept CDC

74,353

Dissemination

Local Bulletins

CDC Semiannual Report

HIV Web Sites

Public Information Data Set

Surveillance Slide Set

Active

Case Finding

Local Health Dept

HIV

Report

2001 Region X

People with HIV

National HIV Surveillance

Data Year

2008: confidential, name-

based HIV reporting in all

states

2011: all states included in

estimates of HIV diagnoses

Phil

National HIV Incidence Surveillance

TX

AZ

CA

SF

LA

Cty

FL

AL MS

LA

SC

NC

VA

NYS

IN

MI

CO

WA CHI

HOU

MA

CT

NJ

NYC

DC

DE

MA RI CT

NJ

MD

DC

NH

VT

Virgin Islands, U.S.

Puerto Rico

Areas with Laws and Regulations for

Reporting all CD4 and Viral Load Values

Laboratory reporting (laws and regulations)

Not all values

All values, specified

All values, not

specified

National HIV/AIDS Strategy Implementation Plan

VA, CMS, HRSA, CDC, SAMHSA and NIH will jointly consider and issue

a report of strategies to encourage providers to collect and report

standardized viral load and CD4 data from infected individuals within

populations at greatest risk for HIV infection.

CDC will identify which States and localities collect CD4 and viral load data

HRSA and CDC will convene a consultation with clinical providers and

community-based organizations to develop recommendations for

gathering and reporting necessary data to calculate community viral load

CDC, in consultation with States, will provide technical assistance to

localities, particularly those with a heavy disease burden, to collect

necessary data to calculate community viral load

National HIV/AIDS Strategy Implementation Plan

CDC will release a report on suggestions for border states to help

improve HIV surveillance and prevention interventions among

migrant communities

CDC will provide State health departments with greater

concentrations of AAPI or AI/AN populations with recommendations

on effective HIV surveillance activities for these small populations

HHS OS will coordinate among HHS agencies to mine existing

databases to explore associations between HIV infection and social

determinants of health

PRELIMINARY DATA

HIV Incidence 2006-2009,

United States

0

10,000

20,000

30,000

40,000

50,000

60,000

2006 2007 2008 2009

48,600

(42,400-54,700)

56,000

(49,100-69,200) 47,800

(41,800-53,800)

48,100

(42,200-54,000)

Prejean (2011) Estimated HIV Incidence in the United States, 2006–2009. PLoS ONE 6(8): e17502.

doi:10.1371/journal.pone.0017502

Estimated AIDS Diagnoses, Deaths, Persons Living with an AIDS

Diagnosis and Persons Living with HIV Infection (Diagnosed and

Undiagnosed) Among Adults and Adolescents – United States,

1981 - 2008

0

100

200

300

400

500

600

700

800

900

1,000

1,100

1,200

0

10

20

30

40

50

60

70

80

19

81

19

82

19

83

19

84

19

85

19

86

19

87

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

Pre

vale

nce

(tho

usan

ds)

No

. o

f D

iag

no

ses a

nd

Death

s

(th

ou

san

ds)

Year

AIDS Diagnoses

Deaths

Living with an AIDS Diagnosis

Living with HIV infection

MMWR 2011;60:689-693.

Annual Transmission Rates per 100 Persons Living with HIV, 1977–2006

Holtgrave . Updated Annual HIV Transmission Rates in the United States, 1978-2006. JAIDS 2009;50(2):236-38.

Estimated Number of Adults and Adolescents Living with HIV

Infection (Diagnosed and Undiagnosed) and Percent Undiagnosed

– United States, 1985 - 2008

0.0

20.0

40.0

60.0

80.0

100.0

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000 1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

Percen

t Nu

mb

er

Year

No. living with undiagnosed HIV infection

No. living with diagnosed HIV infection

Percent undiagnosed

Linkage to Care and Continuous Care

Data from 13 areas with mandatory laboratory

reporting of HIV-related tests and reporting to

national HIV surveillance

82% of persons diagnosed in 2009 linked to care within 3

months -- NHAS 85 percent Poster No. 083M. Mahle et al. Using HIV Surveillance-based Indicators to Monitor the National HIV/AIDS

Strategy, 13 U.S. Jurisdictions

Persons living with HIV in 2009 in continuous care – NHAS 80% Track B Session B04 . Hall et al. Retention in Care of HIV-Infected Adults and Adolescents in 13 U.S.

Areas

Reducing HIV-Related Health Disparities

Data from 13 areas with mandatory laboratory reporting of HIV-

related tests and reporting to national HIV surveillance

Persons living with HIV in 2009

Viral suppression (≤400 copies/mL) among those in care, vs.

NHAS undetectable viral load

77% among MSM

65% among blacks/African Americans

74% among Hispanics/Latinos

• vs. 81% among whites

NHAS – increase by 20 percent

Poster No. 083M. Mahle et al. Using HIV Surveillance-based Indicators to Monitor the National HIV/AIDS

Strategy, 13 U.S. Jurisdictions

Conclusion

Of 9 outcome measures in the National HIV/AIDS

Strategy, 8 can be measured with surveillance data

However, there is a need to

Support and strengthen HIV … surveillance activities: There

is a need to support existing surveillance methods to

identify populations at greatest risk that need to be targeted

for HIV prevention services.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position o f

the Centers for Disease Control and Prevention.

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Division of HIV/AIDS Prevention

Thank you