Using HIV Surveillance to Achieve High Impact Prevention

Irene Hall, PhD, FACEAIDS 2012

High-Impact Prevention: Reducing the HIV Epidemicin the United States

July 22, 2012

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

Division of HIV/AIDS Prevention

19811983

19851987

19891991

19931995

19971999

20012003

20052007

20090

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000Persons living with HIV infection (46 states)Persons living with AIDSAIDS Diagnoses Deaths of persons with AIDS Diagnoses of HIV infection (46 states)

The History of HIV Infection in the United States

Note. All displayed data have been statistically adjusted to account for reporting delays, but not for incomplete reporting. Death may be due to any cause.

Year

Dia

gnose

s and d

eath

s, N

o.

Pre

vale

nce

, N

o.

HIV Case SurveillanceData for Prevention

Sources of Reports

Hospital PractitionersPrivate PractitionersPublic ClinicsLaboratories

CDC

74,353

Aggregate data reportsPrevention planningResource allocationOutcome evaluation

Active Case Finding

Local Health Dept HIV Report

2001Region X

People with HIV

Partner servicesCase managementDiagnosis facilitiesCare providers

Individual data reports

Linkage and re-engagement in care

Indicators of Need and Outcome for Prevention Efforts

Incidence Prevalence, including undiagnosed

Persons unaware of their infection disproportionately transmit HIV; identifying them for targeting testing is first step in prevention efforts

Linkage to care Entering care early improves health outcomes

Retention in care Ongoing care improves health outcomes and survival

Viral suppression Viral suppression improves health outcomes and may

prevent onward transmission

Estimated HIV incidence rates, by race/ethnicity – United States, 2009

Black/African American

Native Hawaiian/Other Pacific Islander

Hispanic/Latino

Multiple races

American Indian/Alaska Native

White

Asian

0 10 20 30 40 50 60 70 80

69.9

43.7

26.4

17.9

14

9.1

8.3

Rate, per 100,000

Prejean et al. Estimated HIV Incidence in the United States, 2006–2009. PLoS ONE 6(8): e17502. doi:10.1371/journal.pone.0017502.

Annual US incidence ~ 50,0002009 US incidence rate = 19.0

(16.6-21.3)

Rates of Diagnoses of HIV Infection among Adults and Adolescents, 2010—46 States and 5 U.S.

Dependent Areas

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

20080

200,000

400,000

600,000

800,000

1,000,000

1,200,000

0

20

40

60

80

100No. living with undi-agnosed HIV infectionNo. living with diagnosed HIV infectionPercent undiagnosed

Year

Num

ber P

erce

nt

Estimated Number of Adults and Adolescents Living with HIV Infection (Diagnosed and Undiagnosed)* and Percent Undiagnosed† – United States, 1985 - 2008

*HIV prevalence was estimated based on national HIV surveillance data for adults and adolescents (aged ≥ 13 years at diagnosis) reported through June 2010 using extended back-calculation. †The number of undiagnosed HIV infections was derived by subtracting the estimated number of diagnosed living cases from the estimated overall HIV prevalence

Number of persons with HIV engaged in selected stages of the continuum of HIV

care – United States

CDC. Vital Signs: HIV Prevention Through Care and Treatment — United States. MMWR 2011;60:1618-1623

100% 80% 62% 41% 36% 28%

Data for Public Health Action

0%

30%

60%

90%

Yes No

Line ListingPatient A ---- --- --- --- --- Patient B --- --- --- --- ---Patient C --- --- --- --- ---…. Line Listing

Patient A ---- --- --- --- --- Patient B --- --- --- --- ---Patient C --- --- --- --- ---….

Case Manager

Diagnosis Facility

Care Facility

DE

MARICTNJ

MDDC

NH

VT

Virgin Islands, U.S.

Puerto Rico

Areas with Laws and Regulations for Reporting all CD4 and Viral Load Values,

June 2012

Not all values

All values, specified

Laboratory reporting(laws and regulations)

All values, not specified

Summary

HIV surveillance provides data for intervention planning and monitoring outcome indicators

Laboratory reporting of all CD4 and viral load test results allows use of surveillance data for public health action on provider and individual level

New emphasis on data use and sharing

For more information:

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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

Division of HIV/AIDS Prevention

www.cdc.gov/nchhstp/atlas

www.cdc.gov/hiv/topics/surveillance/index.htm