HIV Care Continuum New Diagnoses, 2011,

Atlanta Eligible Metropolitan Area (EMA)

Diagnosed

Linke

d to ca

re

Retained in

care

Prescribed ART

Viral S

uppression

0102030405060708090

100

Persons with HIV Engaged in Selected Stages of the Continuum of Care, United States

Perc

ent

82

66

37 3325

Hall et al. XIX International AIDS Conference, 2012ART, antiretroviral therapy

Care Continuum Methodology, New HIV Diagnoses, 2011, Atlanta EMA* • Adults and adolescents are those aged >= 13 years• Diagnosed between 01/01/11 -12/31/11• Alive at least 15 months after diagnosis• Residence at diagnosis in Atlanta Eligible Metropolitan Area (EMA),

current address in Georgia• Excludes 26 persons deceased within 15 months of diagnosis• Linked to care = CD4 or VL within 3 months of diagnosis , excluding

CD4 or VL drawn on day of diagnosis• Engaged in care >= 1 CD4 or VL 4-15 months after diagnosis• Retained in care >= 2 CD4 or VL at least 3 months apart 4-15 months

after diagnosis• Estimated percentage prescribed ART derived from MMP sample • Viral suppression (VS) = VL<200 copies/ml in most recent viral load• All percentages are percent of total number of persons diagnosed

with HIV

*EMA: Bartow, Paulding, Carroll, Coweta, Fayette, Spalding, Henry, Newton, Rockdale, Gwinnett, Walton, Barrow, Forsyth, Cherokee, Pickens, DeKalb, Fulton, Clayton, Cobb and Douglas counties.

HIV Care Continuum Methodology

Confirmatory Diagnosis

Date

Months 0-3 after diagnosis

Months 4-15 after diagnosis

CD4 or Viral Load

CD4 or Viral Load

CD4 or Viral Load

This person is:• Linked YES• Engaged YES • Retained YES• Virally suppressed YES

Last viral load <200 copies/ml

HIV Care Continuum Methodology

HIV Confirmatory

Diagnosis Date

Months 0-3 after diagnosis

Months 4-15 after diagnosis

CD4 or Viral Load

CD4 or Viral Load

CD4 or Viral Load

This person is:• Linked YES• Engaged YES • Retained YES• Virally suppressed YES

Last viral load <200 copies/ml

HIV Care Continuum Methodology

HIV Confirmatory

Diagnosis Date

Months 0-3 after diagnosis

Months 4-15 after diagnosis

CD4 or Viral Load

This person is• Linked YES• Engaged YES• Retained NO• Virally suppressed YES

• “Engaged in care” is minimal engagement that indicates the person “touched” the medical system at least once during that 12 month period

Last viral load undetectableCD4 or Viral Load

HIV Care Continuum Methodology

HIV Confirmatory

Diagnosis Date

Months 0-3 after diagnosis

Months 4-15 after diagnosis

CD4 or Viral Load

This person is• Linked NO• Engaged YES• Retained YES• Virally suppressed NO

• If no viral load done, it is assumed to be not suppressed

CD4 done but no viral load done

Adults and adolescents diagnosed with HIV infection, Atlanta EMA, 2011

Diagnosed only0

102030405060708090

100 100

60 66

47 46DiagnosedLinked to careEngaged in careRetained in careViral suppression

Perc

ent

Adults and adolescents >= age 13, diagnosed 01/01/11 -12/31/11, Atlanta EMA = 1923Linked to care = CD4 or VL within 3 months of diagnosis Engaged in care >= 1 CD4 or VL 4-15 months after diagnosisRetained in care >= 2 CD4 or VL at least 3 months apart 4-15 months after diagnosisViral suppression (VS) = VL<200 copies/ml in most recent viral load = 788Note: all percentages are proportion of total number of persons diagnosed with HIV in categoryExcludes 26 cases deceased as of 03/31/13

Adults and adolescents diagnosed with HIV infection, by race, Atlanta EMA 2011

Black Hispanic/Latino White Other/unknown0

102030405060708090

100

5870 68

626471 73 68

44

58 5647

38

56 57 55

Diagnosed Linked to care Engaged in careRetained in care Viral suppression

Perc

ent

N=1,067 N=101 N=160 N=595

Adults and adolescents >= age 13, diagnosed 01/01/11 - 12/31/11, Atlanta EMA = 1923Linked to care = CD4 or VL within 3 months of diagnosis Engaged in care >= 1 CD4 or VL 4-15 months after diagnosisRetained in care >= 2 CD4 or VL at least 3 months apart 4-15 months after diagnosisViral suppression (VS) = VL<200 copies/ml in most recent viral load American Indian/Alaska Native, Asian, and Native Hawaiian/Other Pacific Islanders combined equal <2% of new diagnoses and are included in Other/Unknown

Adult and adolescent males diagnosed with HIV infection, by race, Atlanta EMA 2011

Black Hispanic/Latino White Other/unknown0

102030405060708090

100

54

71 67 626374 72 71

42

60 5751

34

56 57 58

Diagnosed Linked to care Engaged in careRetained in care Viral suppression

Perc

ent

N=828 N=80 N=138 N=493

Adult and adolescent males >= age 13, diagnosed 01/01/11 - 12/31/11, Atlanta EMA = 1539 Linked to care = CD4 or VL within 3 months of diagnosis Retained in care >= 2 CD4 or VL at least 3 months apart 4-15 months after diagnosisViral suppression (VS) = VL<200 copies/ml in most recent viral load American Indian/Alaska Native, Asian, and Native Hawaiian/Other Pacific Islanders combined equal <2% of new diagnoses and are included in Other/Unknown

Adult and adolescent females diagnosed with HIV infection, by race, Atlanta EMA

2011

Black Hispanic/Latino White Other/unknown0

102030405060708090

100

69 67 6856

7062

73

5552 52 50

31

5057 55

43

Diagnosed Linked to care Engaged in careRetained in care Viral suppression

Perc

ent

N=231 N=21 N=22 N=98

Adult and adolescent females >= age 13, diagnosed 01/01/11 - 12/31/11, Atlanta EMA = 372Linked to care = CD4 or VL within 3 months of diagnosis Retained in care >= 2 CD4 or VL at least 3 months apart 4-15 months after diagnosisViral suppression (VS) = VL<200 copies/ml in most recent viral load American Indian/Alaska Native, Asian, and Native Hawaiian/Other Pacific Islanders combined equal <2% of new diagnoses and are included in Other/Unknown

Adults and adolescents diagnosed with HIV infection, by age (years),

Atlanta EMA 2011Age at

diagnosis (years)

N LinkedN (%)

Engaged N (%)

Retained N (%)

Viral suppressio

nN (%)

13-24 420 211 50% 255 61% 155 37% 138 33%25-34 561 326 58% 367 65% 264 47% 239 43%

35-44 442 290 66% 307 69% 218 49% 233 53%45-54 345 232 67% 245 71% 190 55% 188 54%55+ 155 101 65% 103 66% 77 50% 83 54%

Adults and adolescents >= age 13, diagnosed 01/01/11 -12/31/11, Atlanta EMA = 1923Linked to care = CD4 or VL within 3 months of diagnosis Engaged in care >= 1 CD4 or VL 4-15 months after diagnosisRetained in care >= 2 CD4 or VL at least 3 months apart 4-15 months after diagnosisViral suppression (VS) = VL<200 copies/ml in most recent viral load Note: all percentages are percent of total number of persons diagnosed with HIV in categoryExcludes 26 cases deceased as of 03/31/13

Adults and adolescents diagnosed with HIV infection, by

age, Atlanta EMA, 2011

13-24 25-34 35-44 45-54 55+0

20406080

100

5058

66 67 6561 65 69 71 66

3747 49 55 50

3343

53 54 54

Diagnosed Linked to care Engaged in careRetained in care Viral suppression

Perc

ent

Adults and adolescents >= age 13, diagnosed 01/01/11 - 12/31011, Atlanta EMA = 1923Linked to care = CD4 or VL within 3 months of diagnosis Engaged in care >= 1 CD4 or VL 4-15 months after diagnosisRetained in care >= 2 CD4 or VL at least 3 months apart 4-15 months after diagnosisViral suppression (VS) = VL<200 copies/ml in most recent viral load Note: all percentages are percent of total number of persons diagnosed with HIV in category

N=420 N=561 N=442 N=345 N=155

Transmission category definitions

• Multiple imputation was used to re-distribute transmission category where missing

• MSM = Male to male sexual contact• IDU = Injection drug use• MSM/IDU = Male to male sexual contact and injection drug

use• HET = Heterosexual contact with a person known to have, or

to be at high risk for, HIV infection• Other = hemophilia, blood transfusion, perinatal exposure,

and risk factor not reported or not identified

Adult and adolescent males diagnosed with HIV infection, by transmission category*,

Atlanta EMA 2011Transmission

categoryN Linked

N (%)Engaged N (%)

Retained N (%)

Viral suppressio

nN (%)

MSM 961 544 57% 626 65% 435 45% 376 39%IDU 42 28 67% 27 64% 22 52% 18 43%MSM/IDU 25 16 64% 17 68% 11 44% 11 44%HET 58 40 69% 38 66% 28 48% 24 41%Other 453 281 62% 319 70% 233 51% 267 59%

Adult and adolescent males >= age 13, diagnosed 01/01/11 -12/31/11, Atlanta EMA = 1539Linked to care = CD4 or VL within 3 months of diagnosis Engaged in care >= 1 CD4 or VL 4-15 months after diagnosisRetained in care >= 2 CD4 or VL at least 3 months apart 4-15 months after diagnosisViral suppression (VS) = VL<200 copies/ml in most recent viral load Multiple imputation was used to re-distribute transmission category where missing*MSM = Male to male sexual contact IDU = Injection drug useMSM/IDU = Male to male sexual contact and injection drug useHET = Heterosexual contact with a person known to have, or to be at high risk for, HIV infectionOther = hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified

Adult and adolescent males diagnosed with HIV infection, by transmission category*, Atlanta

EMA, 2011

MSM IDU MSM/IDU HET Other0

20406080

100

5767 64 69

6265 64 68 6370

4552

44 47 5139 43 44 40

59

Diagnosed Linked to care Engaged in careRetained in care Viral suppression

Perc

ent

N=961 N=25N=42 N=58 N=453

Adult and adolescent males >= age 13, diagnosed 01/01/11 - 12/31/11, Atlanta EMA = 1539Linked to care = CD4 or VL within 3 months of diagnosis Engaged in care >= 1 CD4 or VL 4-15 months after diagnosisRetained in care >= 2 CD4 or VL at least 3 months apart 4-15 months after diagnosisViral suppression (VS) = VL<200 copies/ml in most recent viral load Multiple imputation was used to re-distribute transmission category where missing*MSM = Male to male sexual contact IDU = Injection drug useMSM/IDU = Male to male sexual contact and injection drug useHET = Heterosexual contact with a person known to have, or to be at high risk for, HIV infectionOther = hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified

Adult and adolescent females diagnosed with HIV infection, by transmission category*,

Atlanta EMA 2011

Transmission category

N LinkedN (%)

Engaged N (%)

Retained N (%)

Viral suppressio

nN (%)

IDU 48 35 73% 35 73% 26 54% 27 56%HET 232 159 69% 162 69% 122 53% 119 52%Other 92 50 54% 47 51% 24 26% 36 39%

Adult and adolescent females >= age 13, diagnosed 01/01/11 -12/31/11, Atlanta EMA = 372Linked to care = CD4 or VL within 3 months of diagnosis Engaged in care >= 1 CD4 or VL 4-15 months after diagnosisRetained in care >= 2 CD4 or VL at least 3 months apart 4-15 months after diagnosisViral suppression (VS) = VL<200 copies/ml in most recent viral load Multiple imputation was used to re-distribute transmission category where missing*IDU = Injection drug useHET = Heterosexual contact with a person known to have, or to be at high risk for, HIV infectionOther = hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified

Adults and adolescent females diagnosed with HIV infection, by transmission category*,

Atlanta EMA, 2011

IDU HET Other0

102030405060708090

100

73 69

54

73 69

5154 53

26

56 52

39

Diagnosed Linked to care Engaged in care Retained in care Viral suppression

Perc

ent

Adults and adolescent females >= age 13, diagnosed 01/01/11 - 12/31/11, Atlanta EMA = 372Linked to care = CD4 or VL within 3 months of diagnosis Engaged in care >= 1 CD4 or VL 4-15 months after diagnosisRetained in care >= 2 CD4 or VL at least 3 months apart 4-15 months after diagnosisViral suppression (VS) = VL<200 copies/ml in most recent viral load Multiple imputation was used to re-distribute transmission category where missing*IDU = Injection drug useHET = Heterosexual contact with a person known to have, or to be at high risk for, HIV infectionOther = hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified

N=48 N=232 N=92

Adult and adolescent Black MSM* diagnosed with HIV infection, by age

(years), Atlanta EMA 2011Age at

diagnosis (years)

N** LinkedN (%)

Engaged N (%)

Retained N (%)

Viral suppressio

nN (%)

13-24 254 113 44% 152 60% 87 34% 64 25%25-34 262 139 53% 164 63% 115 44% 92 35%35-44 110 70 64% 76 69% 52 47% 45 41%45-54 72 49 68% 50 69% 41 57% 35 49%55+ 27 15 56% 13 48% 9 33% 8 30%

Adults and adolescent males >= age 13, diagnosed 01/01/11 -12/31/11, Atlanta EMA = 725Linked to care = CD4 or VL within 3 months of diagnosis Engaged in care >= 1 CD4 or VL 4-15 months after diagnosisRetained in care >= 2 CD4 or VL at least 3 months apart 4-15 months after diagnosisViral suppression (VS) = VL<200 copies/ml in most recent viral load Multiple imputation was used to redistribute transmission category when missing*MSM = men who have sex with men**N = estimated number of persons in that category

Adult and adolescent Black MSM diagnosed with HIV infection, by age,

Atlanta EMA, 2011

13-24 25-34 35-44 45-54 55+0

20

40

60

80

100

4453

64 685660 63

69 69

4834

44 4757

3325

3541

49

30

Diagnosed Linked to care Engaged in careRetained in care Viral suppression

Perc

ent

N= 255 N= 267 N= 112 N= 74 N= 27

Adult and adolescent males >= age 13, diagnosed 01/01/11 - 12/31011, Atlanta EMA = 725Linked to care = CD4 or VL within 3 months of diagnosis Engaged in care >= 1 CD4 or VL 4-15 months after diagnosisRetained in care >= 2 CD4 or VL at least 3 months apart 4-15 months after diagnosisViral suppression (VS) = VL<200 copies/ml in most recent viral load Note: all percentages are proportion of total number of persons diagnosed with HIV in category

The HIV Care Continuum can help us…

• Focus our efforts for linkage, retention and viral suppression.• Identify groups at increased risk for dropping out of each

step in the continuum.• Monitor our progress in improvement of linkage, retention,

and viral suppression.• Identify disparities not only in prevalence but in care• Evaluate efforts addressing specific populations with low

viral suppression.• Monitor efforts in improving viral suppression in specific

counties, census tracts, zip codes and some specific facilities• Encourage improvement in surveillance data completeness

(race, sex, transmission category)

Stage of HIV disease at diagnosis

• Stage at diagnosis is defined by the first CD4 done within 3 months of diagnosis

Stage 1 = CD4 >=500Stage 2 = CD4 200-499Stage 3 = CD4 <200 or OI

• Stage at diagnosis is unknown if no CD4 done within 3 months of diagnosis

Stage of disease by earliest CD4 count within 3 months of HIV diagnosis, adults and

adolescents, Atlanta EMA, 2011

Stage 1 CD4

>=500

Stage 2 CD4 200-

499

Stage 3 CD4 <200

Stage unknown

0

0.1

0.2

0.3

0.4

0.5

15%22% 19%

43%

Perc

ent

Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1923CD4<200 = Stage 3 disease (AIDS)Stage unknown = no CD4 within 3 months of diagnosisExcludes 26 cases deceased as of 03/31/13

N=292 N=426 N=364 N=841

Stage of disease by earliest CD4 count within 12 months of HIV diagnosis, adults

and adolescents, Atlanta EMA, 2011

Stage 1 CD4

>=500

Stage 2 CD4 200-

499

Stage 3 CD4 <200

Stage unknown

0

0.1

0.2

0.3

0.4

0.5

17%

27%22%

35%

Perc

ent

Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1923CD4<200 = Stage 3 disease (AIDS)Stage unknown = no CD4 within 12 months of diagnosisExcludes 26 cases deceased as of 03/31/13

N=332 N=511 N=416 N=664

Number and proportion of adults and adolescents by stage at diagnosis by earliest

CD4 count within 3 and 12 months after diagnosis, by age, Atlanta EMA, 2011

Age at diagnos

is (years)

N*Stage 1

CD4>500Stage 2

CD4 200-499Stage 3

CD4 <200Stage

Unknown CD4 Missing

3 mos.N (%)

12 mos.

N (%)

3 mos.N (%)

12 mos.

N (%)

3 mos.N (%)

12 mos.

N (%)

3 mos.N (%)

12 mos.N (%)

13-24 420 54 (13)

72 (17)

95 (23) 122 (29)

36 (9) 47 (11)

235 (56)

179 (43)

25-34 561 81 (14)

92 (16)

112 (20)

137 (24)

99 (18)

117 (21)

269 (48)

215 (38)

35-44 442 59 (13)

64 (14)

110 (25)

128 (29)

97 (22)

110 (25)

176 (40)

140 (32)

45-54 345 63 (18)

67 (19)

76 (22) 87 (25)

94 (27)

104 (30)

112 (32)

87 (25)

55+ 155 35 (23)

37 (24)

33 (21) 37 (24)

38 (25)

38 (25)

49 (32) 43 (28)Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1923CD4<200 = Stage 3 disease (AIDS)Stage Unknown = no CD4 within 3 or 12 months of diagnosisN = total number in this categoryExcludes 26 cases deceased as of 03/31/13

Stage of disease by earliest CD4 count within 3 months of HIV diagnosis, adults and

adolescents, by age (years), Atlanta EMA 2011

13-24 25-34 35-44 45-54 55+0

102030405060

13 14 13 18 2323 20 25 22 219

18 2229 25

5648

4032 32

Stage 1 CD4>=500Stage 2 CD4 200-499

Age at diagnosis (years)

Perc

ent

N= 420 N= 442N= 561 N= 345 N= 155

Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1923CD4<200 = Stage 3 disease (AIDS) Stage Unknown = no CD4 within 3 months of diagnosis

Stage of disease by earliest CD4 count within 12 months of HIV diagnosis, adults and

adolescents, by age (years), Atlanta EMA, 2011

13-24 25-34 35-44 45-54 55+0

102030405060

17 16 1419

2429

2429 25 24

1121 25

3025

4338

3225 28

Stage 1 CD4>=500 Stage 2 CD4 200-499Stage 3 CD4 <200 Stage Unknown

Age at diagnosis (years)

Perc

ent

N= 420 N= 561 N= 442 N= 345 N= 155

Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1923CD4<200 = Stage 3 disease (AIDS)Stage Unknown = no CD4 within 12 months of diagnosis

Number and proportion of adults and adolescents by stage at diagnosis by

earliest CD4 count within 3 and 12 months after diagnosis, by race/ethnicity, Atlanta

EMA, 2011Race/

Ethnicity

N**Stage 1

CD4>500Stage 2

CD4 200-499Stage 3

CD4 <200Stage

Unknown CD4 Missing

3 mos.N (%)

12 mos.

N (%)

3 mos.N (%)

12 mos.

N (%)

3 mos.N (%)

12 mos.N (%)

3 mos.N (%)

12 mos.

N (%)

Black, 1067

132 (12)

160 (15)

223 (21)

283 (27)

233 (22)

274 (26)

479 (45)

350 (33)

Hispanic/ Latino

101 12 (12) 13 (13) 26 (26) 30 (30) 32 (32) 33 (33) 31 (31) 25 (25)

White 160 31 (19) 33 (21) 39 (24) 49 (31) 36 (23) 40 (25) 54 (34) 38 (24)

Other*/ Unknown

595 117 (20)

126 (21)

138 (23)

149 (25)

63 (11) 69 (12) 277 (47)

251 (42)

Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1923CD4<200 = Stage 3 disease (AIDS)Stage Unknown = no CD4 within 3 or 12 months of diagnosis*American Indian/Alaska Native, Asian and Native Hawaiian/Pacific Islander groups together constitute <1% of adults diagnosed with HIV in Georgia, 2011 and are grouped with other/unknown race/ethnicity** N = total number in this categoryExcludes 26 cases deceased as of 03/31/13

Stage of disease by earliest CD4 count within 3 months of HIV diagnosis, adults and

adolescents, by race/ethnicity, Atlanta EMA 2011

Black Hispanic/Latino White Other*/Unknown

0

10

20

30

40

50

12 1219 2021

26 24 2322

3223

11

45

31 34

47

Stage 1 CD4 >500 Stage 2 CD4 200-499Stage 3 CD4 <200 Stage Unknown

Perc

ent

Adults >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1923CD4<200 = Stage 3 disease (AIDS)Stage Unknown = no CD4 within 3 months of diagnosis*American Indian/Alaska Native, Asian and Native Hawaiian/Pacific Islander groups together constitute <1% of adults diagnosed with HIV in Georgia, 2010 and are grouped with Unknown race/ethnicity

N=1067 N=101 N=160 N=595

Stage of disease by earliest CD4 count within 12 months of HIV diagnosis, adults and

adolescents, by race/ethnicity, Atlanta EMA, 2011

Black Hispanic/Latino White Other*/Unknown

0102030405060

15 1321 21

27 30 312526

3325

12

3325 24

42

Stage 1 CD4 >500 Stage 2 CD4 200-499Stage 3 CD4 <200 Stage Unknown

Perc

ent

N=1067 N=101 N=1610 N=595

Adults >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1923CD4<200 = Stage 3 disease (AIDS)Stage Unknown = no CD4 within 12 months of diagnosis*American Indian/Alaska Native, Asian and Native Hawaiian/Pacific Islander groups together constitute <1% of adults diagnosed with HIV in Georgia, 2010 and are grouped with other/unknown race/ethnicity

Number and proportion of adults and adolescents by stage at diagnosis by earliest

CD4 count within 3 and 12 months after diagnosis, by sex, Atlanta EMA, 2011

Sex N*Stage 1

CD4>500Stage 2

CD4 200-499Stage 3

CD4 <200Stage

Unknown CD4 Missing

3 mos.N (%)

12 mos.

N (%)

3 mos.N (%)

12 mos.N (%)

3 mos.N (%)

12 mos.

N (%)

3 mos.N (%)

12 mos.

N (%)Male 1539 241 (16) 275

(18)320 (21)

394 (25)

272 (18)

317 (21)

696 (45) 553 (36)

Female

372 50 (13) 56 (15) 95 (26) 116 (31)

88 (24) 95 (26) 139 (37) 105 (28)

Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA - 1911CD4<200 = Stage 3 disease (AIDS)Stage Unknown = no CD4 within 3 or 12 months of diagnosis*N = total number in this categoryExcludes 12 cases for which sex was not reportedExcludes 26 cases deceased as of 03/31/13

Stage of disease by earliest CD4 count within 3 months of HIV diagnosis, adults and adolescents, by sex, Atlanta EMA,

2011

Male Female0

102030405060

16 1321

2618

24

4537

Stage 1 CD4 >500 Stage 2 CD4 200-499Stage 3 CD4 <200 Stage Unknown

Perc

ent

Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1911CD4<200 = Stage 3 disease (AIDS)Stage Unknown = no CD4 within 3 months of diagnosisExcludes 12 cases for which sex was not reported

N=1539 N=372

Stage of disease by earliest CD4 count within 12 months of HIV diagnosis, adults

and adolescents, by sex, Atlanta EMA, 2011

Male Female0

102030405060

18 1525

3121

2636

28

Stage 1 CD4 >500 Stage 2 CD4 200-499Stage 3 CD4 <200 Stage Unknown

Perc

ent

1539 N=372

Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1911CD4<200 = Stage 3 disease (AIDS)Stage Unknown = no CD4 within 12 months of diagnosisExcludes 12 cases for which sex was not reported

Number and proportion of adult and adolescent males by stage at diagnosis by earliest CD4 count within 3 and 12

months after diagnosis, by transmission category*, Atlanta EMA, 2011

Trans-mission categor

y

N**Stage 1

CD4>500Stage 2

CD4 200-499

Stage 3CD4 <200

Stage Unknown

CD4 Missing3 mos.N (%)

12 mos.N (%)

3 mos.N (%)

12 mos.

N (%)

3 mos.N (%)

12 mos.

N (%)

3 mos.N (%)

12 mos.

N (%)

MSM 961 127 (13)

153 (16) 206 (21)

259 (27)

184 (19)

223 (23)

444 (46)

327 (34)

IDU 42 5 (12) 5 (12) 6 (14) 8 (19) 19 (45)

20 (48) 12 (29) 9 (21)

MSM/IDU 25 4 (16) 5 (20) 5 (20) 5 (20) 6 (24) 6 (24) 11 (44) 9 (36)

HET 58 7 (12) 8 (14) 10 (17)

11 (19)

24 (41)

25 (43) 18 (31) 14 (24)

Other 453 98 (22)

105 (23) 103 (23)

111 (25)

40 (9) 43 (9) 212 (47)

194 (43)

Adult and adolescent males >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1539CD4<200 = Stage 3 disease (AIDS) Stage Unknown = no CD4 within 3 or 12 months of diagnosisMultiple imputation was used to re-distribute transmission category where missing*MSM = Male to male sexual contact IDU = Injection drug useMSM/IDU = Male to male sexual contact and injection drug useHET = Heterosexual contact with a person known to have, or to be at high risk for, HIV infectionOther = hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified**N = total number in this category

Stage of disease by earliest CD4 count within 3 months of HIV diagnosis, adult and adolescent males, by transmission category*, Atlanta EMA,

2011

MSM IDU MSM/IDU HET Other 0

10

20

30

40

50

13 1216

12

222114

20 1723

19

45

20

41

9

46

29

44

31

47

CD4 >500 CD4 200-499 CD4 <200 Stage Unknown

Perc

ent

N=58 N=453

Adult and adolescent males >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1539CD4<200 = Stage 3 disease (AIDS) Stage Unknown = no CD4 within 3 months of diagnosisMultiple imputation was used to re-distribute transmission category where missing*MSM = Male to male sexual contact IDU = Injection drug useMSM/IDU = Male to male sexual contact and injection drug useHET = Heterosexual contact with a person known to have, or to be at high risk for, HIV infectionOther = hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified

N=961 N=42 N=25

Stage of disease by earliest CD4 count within 12 months of HIV diagnosis, adult and adolescent males, by transmission category*, Atlanta EMA,

2011

MSM IDU MSM/IDU HET Other 0102030405060

16 1220

142327

19 20 192523

48

24

43

9

34

21

36

24

43

CD4 >500 CD4 200-499 CD4 <200 Stage Unknown

Perc

ent

N=961 N=42 N=25 N=58 N=453

Adult and adolescent males >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1539CD4<200 = Stage 3 disease (AIDS) Stage Unknown = no CD4 within12 months of diagnosisMultiple imputation was used to re-distribute transmission category where missing*MSM = Male to male sexual contact IDU = Injection drug useMSM/IDU = Male to male sexual contact and injection drug useHET = Heterosexual contact with a person known to have, or to be at high risk for, HIV infectionOther = hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified

Number and proportion of adult and adolescent females by stage at diagnosis by earliest CD4 count within 3 and 12 months after diagnosis, by transmission category*, Atlanta EMA, 2011

Trans-mission categor

y

N**Stage 1

CD4>500Stage 2

CD4 200-499Stage 3

CD4 <200Stage

UnknownCD4 Missing

3 mos.N (%)

12 mos.

N (%)

3 mos.N (%)

12 mos.

N (%)

3 mos.N (%)

12 mos.N (%)

3 mos.N (%)

12 mos.

N (%)

HET 232 29 (13) 34 (15) 60 (26) 77 (33) 63 (27) 70 (30) 80 (34) 52 (22)

IDU 48 6 (13) 8 (17) 12 (25) 15 (31) 15 (31) 15 (31) 15 (31) 11 (23)

Other 92 15 (16) 15 (16) 23 (25) 25 (27) 10 (11) 10 (11) 44 (48) 42 (46)Adults and adolescent females >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA =372 CD4<200 = Stage 3 disease (AIDS) Stage Unknown = no CD4 within 3 or 12 months of diagnosisMultiple imputation was used to re-distribute transmission category where missing*HET = Heterosexual contact with a person known to have, or to be at high risk for, HIV infectionIDU = Injection drug useOther = hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified** N = total number in this category

Stage of disease by earliest CD4 count within 3 months of HIV diagnosis, adult and adolescent

females, by transmission category*, Atlanta EMA, 2011

HET IDU Other0

102030405060

13 13 1626 25 2527 31

11

34 31

48

CD4 >=500 CD4 200-499 CD4 <200 Stage Unknown

Perc

ent

Adult and adolescent females >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 372CD4<200 = Stage 3 disease (AIDS) Stage Unknown = no CD4 within 3 months of diagnosisMultiple imputation was used to re-distribute transmission category where missing*HET = Heterosexual contact with a person known to have, or to be at high risk for, HIV infectionIDU = Injection drug useOther = hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified

N=232 N=48 N=92

Stage of disease by earliest CD4 count within 12 months of HIV diagnosis, adult and adolescent females,

by transmission category*, Atlanta EMA, 2011

HET IDU Other0

10

20

30

40

50

15 17 16

33 312730 31

11

22 23

46

CD4 >=500 CD4 200-499 CD4 <200 Stage Unknown

Perc

ent

N=232 N=48 N=92

Adult and adolescent females >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 372CD4<200 = Stage 3 disease (AIDS) Stage Unknown = no CD4 within 12 months of diagnosisMultiple imputation was used to re-distribute transmission category where missing*HET = Heterosexual contact with a person known to have, or to be at high risk for, HIV infectionIDU = Injection drug useOther = hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified

Limitations• Incomplete reporting • Missing data for race/ethnicity, sex, and complete

address at diagnosis• Lack of transmission category information• Estimation using multiple imputation to

redistribute risk when missing• Definition of heterosexual transmission (sexual

contact with a known HIV infected partner or person with increased risk, i.e., MSM or IDU)

• Missing laboratory reports• CD4 within 3 and 12 months of diagnosis yields

high unknown stage in Atlanta EMA

Uncertainties• Populations for which data are missing

may be fundamentally different• How to obtain data for transgender

category• How to improve completeness of reporting• Data on ART use• Understanding barriers to ART adherence• Prioritizing further research

Viral suppression on most recent viral load, by stage of disease by earliest CD4 within 12

months of HIV diagnosis, adults and adolescents, Atlanta EMA, 2011

Stage 1 CD4

>=500

Stage 2 CD4 200-

499

Stage 3 CD4 <200

Stage unknown

00.10.20.30.40.50.60.7

50% 54%63%

26%

Perc

ent

Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, Atlanta EMA = 1923CD4<200 = Stage 3 disease (AIDS)Stage unknown = no CD4 within 3 months of diagnosis

N=332 N=511 N=416 N=664

For information on HIV prevention visithttp://dph.georgia.gov/hiv-prevention-program

For more information on HIV surveillance in Georgia, visithttp://dph.georgia.gov/georgias-hivaids-epidemiology-surveillance-section