HIV/STD Epidemiology: Beyond the Charts and Graphs Bree Weaver, MD

Disclosures: No Relevant Relationships HIV/STD Epidemiology: Beyond the Charts and Graphs Bree Weaver, MD

Learning Objectives • Discuss epidemiological trends of HIV and STDs in Indiana. • Appraise Indiana’s success achieving the National STD Prevention Strategic Plan • Describe Indiana’s progress toward fulfilling the goals of the President’s National HIV/AIDS Strategy.

Epidemiology • Study of disease distribution in populations. • Descriptive - surveys a population to see what segments affected, follows changes, and helps identify associations with risk factors. • Epidemiologic data is used to find those at high risk, identify causes and take preventive measures, and plan new health services. Reference: Paraphrased from the Concise Encyclopedia - Merriam Webster http://www.merriam-webster.com/browse/concise/a.htm

Division of STD Prevention Strategic Plan2008-2013October 1, 2008 Division of STD Prevention National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention Coordinating Center for Infectious Diseases Center for Disease Control and Prevention

Seven Strategic Goals • Prevent STI-related infertility • Prevent STI-related adverse outcomes of pregnancy • Prevent STI-related cancers • Prevent STI-related HIV transmission • Strengthen STD prevention capacity and infrastructure • Reduce STD health disparities across and within communities and populations • Address the effects of the social and economic determinants and the costs of specific STDs and associated sequelae among specific populations

Reference: Indiana State Department of Health, Division of HIV/STD/Viral Hepatitis, Report from STD Program Manager – Andrea Radford, MPH on April 10, 2014

Chlamydia Screening Indiana, 17 health plans reporting in 2008, N = 75,278 sexually active females Reference: National Committee for Quality Assurance (NCQA), Healthcare Effectiveness Data and Information Set (HEDIS) http://www.ncqa.org/HEDISQualityMeasurement/HEDISMeasures/HEDIS2013.aspx accessed on April 10, 2014 http://www.cdc.gov/std/chlamydia/female-enrollees-00-08.htm

Success/Challenge:Expedited Partner Therapy (EPT) EPT helps to prevent STI-related infertility by treating partners without a medical evaluation. Success – Indiana law allows for EPT Challenge – Implementation of EPT has been slow Guidance from Indiana State Department of Health http://www.in.gov/isdh/files/EPT_Guidance_Document.pdf EPT Brochure from Indiana State Department of Health http://www.state.in.us/isdh/files/13-EPT_Brochure_webonlyFINAL(1).pdf

Gonococcal Isolate Surveillance Project (GISP) Marion County Public Health Department participated in GISP for the first time in 2013 • 315 isolates were collected (2/1/13 – 12/31/13). Susceptibilities were performed on 300 of these isolates Take Home Points: • ~30% - fully susceptible with the lowest MICs to all antibiotics tested • ~20% - elevated MICs to one or more antibiotics but remained susceptible • 11% - high level ciprofloxacin resistance • ~4% - MIC to Azithromycin of 1.0 µg/ml Reference: Marion County Public Health Department. Report from Dr. Janet Arno, Medical Director, Bell Flower Clinic – April 2014

Reference: Marion County Public Health Department, Bell Flower STD Clinic, accessed on April 15, 2014

Success: Innovative Testing Strategies Reaching populations highly impacted by health disparities by: • Offering screening in non-traditional settings • Bars (nights and weekends) • Bath Houses • Commercial Sex Worker Project • Providing education as part of screening sessions.

Success: Collaboration Stamp Out Syphilis (SOS) coalition was reconvened to help address STD health disparities across and within communities and populations by: • Creating an MSM subcommittee to address unique needs of population. • Monthly meetings and collaborative projects aimed at increased education and testing, and decreased duplication of services.

Estimated Vaccination Coverage, Adolescents Aged 13-17 Years National Immunization Survey-Teen, Indiana 2012 Reference: National Center for Immunization and Respiratory Diseases, 2012 NIS- Teen Vaccination Coverage Table Data, Centers for Disease Control and Prevention, www.cdc.gov, accessed 4/15/2014

Success/Challenge: HPV Vaccination Rates UNITED STATES INDIANA Reference: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6234a1.htm - Morbidity and Mortality Weekly Report (MMWR) August 30, 2013 / 62(34);685-693

Moving Forward Strengthen STD prevention capacity and infrastructure: • Improve prevention impact • Provide training • Leverage partnerships Address the effects of the social and economic determinants and the costs of specific STDs and associated sequelae among specific populations • Characterize effects of social and economic determinants and costs of specific STDs and sequelae among populations • Develop capacity to address determinants

National HIV/AIDS Strategy for the United States (NHAS)2010-2015 The White House Office of National AIDS Policy AIDSpolicy@who.eop.gov www.whitehouse.gov/onap

Vision for the NHAS “The United States will become a place where new HIV infections are rare and when they do occur, every person, regardless of age, gender, race/ethnicity, sexual orientation, gender identity or socio-economic circumstance, will have unfettered access to high quality, life-extending care, free from stigma and discrimination.”

We achieve this by: • Reducing new HIV infections • Increasing access to care and improving health outcomes for people living with HIV • Reducing HIV-related health disparities • Achieving a more coordinated national response to the HIV epidemic in the united states

Reference: Indiana State Department of Health, Spotlight on HIV/STD/Viral Hepatitis, Indiana Semi-Annual Report, 2008-2013

Reference: Indiana State Department of Health, Spotlight on HIV/STD/Viral Hepatitis, Indiana Semi-Annual Report

Indiana Newly Reported HIV/AIDS Cases by Age at Diagnosis January 1, 2013 – December 31, 2013 Reference: Indiana State Department of Health, Spotlight on HIV/STD/Viral Hepatitis, Indiana Semi-Annual Report, 2013

Indiana Newly Reported HIV/AIDS Cases by Race/Ethnicity and Gender January 1, 2013 – December 31, 2013 Reference: Indiana State Department of Health, Spotlight on HIV/STD/Viral Hepatitis, Indiana Semi-Annual Report, 2013

The Continuum of HIV Care, Indiana 2012 • Indiana • United States • Of those aware of their HIV status, 67% are retained in care • Of those on ART, 67% have a suppressed viral load Indiana State Department of Health, HIV/STD/Viral Hepatitis

Success: Expanded HIV Testing Initiative (EHTI) • Indiana State Department of Health program funded by Centers for Disease Control and Prevention (CDC) • Sites selected using viral load mapping • Sites Funded: • The Michael & Susan Smith Emergency Department at Eskenazi Health • Blackburn Community Health Center • Methodist Hospital in Gary (Emergency Room)

Success: Innovative Testing and Outreach Marion County Public Health Department’s Ryan White Program has expanded routine HIV testing in the Transitional Grant Area. Newest Example: • Shalom Health Center (FQHC) • Integrated model of HIV testing

Success: L2C at Damien Center Linkage to Care Program • “Of our 60 clients, 21 of them have been in the program long enough to have at least 2 visits for routine HIV medical care in 12 months at least 3 months apart. “ • “For these 21 Linkage Clients, 71% of them have seen over a 99% decrease in their Viral Load since enrollment. “ • “All of our Linkage Clients are currently stably housed.” Reference : Response from The Damien Center, Abbe Shapiro, MSW, Linkage to Care Program Manager, April 1, 2014.

Challenges • Indiana averages approximately 500 new infections each year, so by 2015, Indiana should only average 375 new infections. • Indiana is slightly below the national average when it comes to continuous care. • National average is 73% of persons, Indiana’s percentage is presently at 67%; • According to care surveys conducted in Indiana, supportive care and transportation issues were that of the most important factors to impact continuing care. Source: THE NATIONAL HIV/AIDS STRATEGY FOR THE UNITED STATES, Power Point presentation provided by the Indiana State Department of Health, Division of HIV/STD/Viral Hepatitis – Cena Bain, Program Director from March 1, 2014.

Moving Forward • Intensify HIV prevention efforts in communities where HIV is most heavily concentrated. • Expand targeted efforts to prevent HIV infection using a combination of effective, evidence-based approaches. • Educate the public and care providers about HIV and how to prevent it. • Immediately link those who test HIV positive to quality care. • Support people living with HIV who have challenges meeting their basic needs, such as housing. • Continue to develop and support community-level approaches to reduce HIV infection in high risk communities • Reduce stigma and discrimination against people living with HIV. • Develop improved mechanisms to monitor, evaluate, and report on progress of our work. Reference : National HIV/AIDS Strategy, Federal Implementation Plan, July 2010. http://www.whitehouse.gov/files/documents/nhas-implementation.pdf

Enjoy the Conference!

HIV/STD Epidemiology: Beyond the Charts and Graphs Bree Weaver, MD