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 PreventionDivision 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
Diag
nose
s and
dea
ths,
No.
Prev
alen
ce, N
o.
HIV Case SurveillanceData for Prevention
Sources of ReportsHospital 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 AmericanNative Hawaiian/Other Pacific Islander
Hispanic/LatinoMultiple races
American Indian/Alaska NativeWhiteAsian
0 10 20 30 40 50 60 70 8069.9
43.726.4
17.914
9.18.3
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
2008
0
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 Percent
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 valuesAll 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 PreventionDivision of HIV/AIDS Prevention
www.cdc.gov/nchhstp/atlas
www.cdc.gov/hiv/topics/surveillance/index.htm
