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Late HIV Diagnoses, Georgia, 2011-2012. Background. Late HIV diagnosis is defined as first CD4 within 12 months of diagnosis <200 cells/ml Late HIV diagnosis is associated with shorter lifespan compared to those with earlier diagnosis.

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background
Background
  • Late HIV diagnosis is defined as first CD4 within 12 months of diagnosis <200 cells/ml
  • Late HIV diagnosis is associated with shorter lifespan compared to those with earlier diagnosis.
  • It is estimated that persons with late HIV diagnosis have been living 8-10 years with HIV, but have been undiagnosed and untreated.
  • Persons with late HIV diagnosis have twice the lifetime risk of transmitting HIV to others compared to those diagnosed early.1
  • 1Farnham, P.G., et al, J Acquir Immune DeficSyndr, Vo. 64, No. 2, Oct 1,2013.
costs of late diagnosis
Costs of Late Diagnosis
  • Lifetime direct medical costs and productivity losses for new HIV infections were estimated in 2002 as almost $1 million per person.2
  • The costs are likely much higher today largely because of increased medical expenses.
  • The biggest cost, however, is in terms of new infections transmitted.
  • Each person with late HIV diagnosis has an average lifetime risk of transmitted HIV to 1.4 others.1
  • Depending on risk behaviors, number of partners, concurrent STDs, lifetime transmission risk can be even higher.
  • Further, persons unaware of their HIV diagnosis have a higher annual rate of sexual transmission on HIV (9% vs. 0.4% per person per year).1
  • 2 Hutchinson, A.B., et al. J Acquir Immune DeficSyndr, Vol 43, No. 4, December 1, 2006.
slide4
Stage of disease by earliest CD4 count within 12 months of HIV diagnosis, adults and adolescents, Georgia, 2011

N=484

N=766

N=632

N=1003

Adults and adolescents >= age 13, diagnosed 1/1/2011 - 12/31/2011, Georgia = 2885

CD4<200 = Stage 3 disease (AIDS)

Stage unknown = no CD4 within 12 months of diagnosis

slide5
Stage of disease by earliest CD4 count within 12 months of HIV diagnosis, adults and adolescents, by race/ethnicity, Georgia 2011

N=1616

N=271

N=144

N=854

Adults >= age 13, diagnosed 1/1/2011 - 12/31/2011, Georgia = 2885

CD4<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 <2% of adults diagnosed with HIV in Georgia, 2010 and are grouped with Unknown race/ethnicity

slide6

Stage of disease by earliest CD4 count within 12 months of HIV diagnosis, adult and adolescent males, by transmission category*, Georgia, 2011

N=36

N=68

N=1386

Adults and adolescent males >= age 13, diagnosed 1/1/2011 - 12/31/2011, Georgia = 2214

CD4<200 = Stage 3 disease (AIDS) Stage Unknown = no CD4 within 12 months of diagnosis

Multiple imputation 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

resources
Resources

For further information on late HIV diagnosis, the Care Continuum, surveillance reports, fact sheets and other slides sets visit:

http://dph.georgia.gov/data-fact-sheet-summaries

The remainder of this presentation will focus on the Care Continuum among people with late HIV diagnoses in Georgia in 2011

persons with hiv engaged in s elected s tages of the continuum of care united states
Persons with HIV Engaged in Selected Stages of the Continuum of Care, United States

82

66

Percent

37

33

25

Hall et al. XIX International AIDS Conference, 2012

ART, antiretroviral therapy

care continuum methodology late hiv diagnoses 2011 georgia
Care Continuum Methodology, Late HIV Diagnoses 2011, Georgia
  • 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 and current address within Georgia
  • Excludes 52 persons deceased within 15 months of diagnosis
  • Late diagnosis = first CD4 within 12 months of diagnosis <200
  • Linked to care = CD4 or VL within 3 months of diagnosis, excluding 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
  • Viral suppression (VS) = VL<200 copies/ml in most recent viral load
  • All percentages are percent of total number of persons with late diagnosis of HIV in 2011
hiv care continuum methodology late diagnosis georgia 2011
HIV Care Continuum Methodology, Late Diagnosis, Georgia, 2011

Months 4-15 after diagnosis

Months 0-3 after diagnosis

Confirmatory Diagnosis Date

CD4 or Viral Load

CD4 or Viral Load

CD4 or Viral Load

First CD4 <200 cell/ml

Last viral load <200 copies/ml

  • This person is:
  • Linked YES
  • Engaged YES
  • Retained YES
  • Virally suppressed YES
adults and adolescents with late hiv diagnosis 2011 georgia
Adults and adolescents with late HIV diagnosis*, 2011, Georgia

N = 795

N = 2885

Adults and adolescents >= age 13,Georgia residence at diagnosis 01/01/11-12/31/11

*Late diagnosis = earliest CD4 within 12 months of diagnosis <200 cells/ml

Linked to care = CD4 or VL within 3 months 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

Viral suppression (VS) = VL<200 copies/ml in most recent viral load = 1307

Note: all percentages are proportion of total number of persons diagnosed with HIV in category

a dults and adolescents with late hiv diagnosis by sex georgia 2011
Adults and adolescents with late HIV diagnosis*, by sex, Georgia, 2011

N= 169

N= 594

Adults and adolescents >= age 13, Georgia residence at diagnosis 01/01/11-12/31/11

*Late diagnosis = earliest CD4 within 12 months of diagnosis <200 cells/ml

Excludes 32 persons for whom sex was not reported

Linked to care = CD4 or VL within 3 months 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

Viral suppression (VS) = VL<200 copies/ml in most recent viral load

adults and adolescents with late hiv diagnosis by race ethnicity georgia 2011
Adults and adolescents with late HIV diagnosis*, by race/ethnicity, Georgia, 2011

Adults and adolescents >= age 13, Georgia residence at diagnosis 01/01/11-12/31/11

*Late diagnosis = earliest CD4 within 12 months of diagnosis <200 cells/ml

Linked to care = CD4 or VL within 3 months 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

Viral 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 with late hiv diagnosis by race ethnicity georgia 2011
Adult and adolescent males with late HIV diagnosis*, by race/ethnicity, Georgia, 2011

Adult and adolescent males >= age 13, Georgia residence at diagnosis 01/01/11-12/31/11

*Late diagnosis = earliest CD4 within 12 months of diagnosis <200 cells/ml

Linked to care = CD4 or VL within 3 months 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

Viral 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 with late hiv diagnosis by race ethnicity georgia 2011
Adult and adolescent females with late HIV diagnosis*, by race/ethnicity, Georgia, 2011

Adult and adolescent females >= age 13, Georgia residence at diagnosis 01/01/11-12/31/11

*Late diagnosis = earliest CD4 within 12 months of diagnosis <200 cells/ml

Linked to care = CD4 or VL within 3 months 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

Viral 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

a dults and adolescents with late hiv diagnosis by age georgia 2011
Adults and adolescents with late HIV diagnosis*, by age, Georgia, 2011

N= 209

N= 83

N=192

N= 210

N= 101

Adults and adolescents >= age 13, Georgia residence at diagnosis 01/01/11-12/31/11

*Late diagnosis = earliest CD4 within 12 months of diagnosis <200 cells/ml

Linked to care = CD4 or VL within 3 months 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

Viral suppression (VS) = VL<200 copies/ml most recent viral load

Note: all percentages are percent of total number of persons diagnosed with HIV in category

transmission category definitions
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
multiple imputation
Multiple Imputation
  • Multiple imputation (MI) methods are used to assign transmission categories to those persons whose diagnoses are reported without a risk factor
  • MI is a statistical approach in which missing transmission categories are replaced with plausible values
  • CDC uses MI for the national HIV dataset*
  • Georgia uses the same methodology as CDC

*Harrison KM, Kajese T, Hall HI, Song R. Risk factor redistribution of the national HIV/AIDS surveillance data: an alternative approach. Public Health Rep 2008;123:618–27.

adult and adolescent males with late hiv diagnosis by transmission category georgia 2011
Adult and adolescent males with late HIV diagnosis*, by transmission category**, Georgia, 2011

Adult and adolescent males >= age 13, Georgia residence at diagnosis 01/01/11-12/31/11

*Late diagnosis = earliest CD4 within 12 months of diagnosis <200 cells/ml

Linked to care = CD4 or VL within 3 months 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

Viral 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 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

a dults and adolescent females with late hiv diagnosis by transmission category georgia 2011
Adults and adolescent females with late HIV diagnosis*, by transmission category**, Georgia, 2011

N= 139

N= 27

N= 30

Adult and adolescent females >= age 13, Georgia residence at diagnosis 01/01/11-12/31/11

*Late diagnosis = earliest CD4 within 12 months of diagnosis <200 cells/ml

Linked to care = CD4 or VL within 3 months 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

Viral 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 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

adults and adolescents total diagnosed and l ate diagnosis georgia 2011
Adults and adolescents, total diagnosed and late diagnosis*, Georgia, 2011

Adult and adolescent males >= age 13, diagnosed by 09/30/2011, living 12/31/2012, Georgia

* Late diagnosis = Stage 3 (AIDS)at or within 12 months of initial HIV diagnosis

Multiple imputation is used to estimate number of persons in each transmission category.

IDU = Injection drug use

conclusions
Conclusions
  • Late diagnosis is a predictor or viral suppression (VS) among persons diagnosed with HIV in 2011 in Georgia (VS 45% overall vs. 59% late diagnosis)
  • Among those with late diagnosis 2011, VS by race was lowest for Blacks (54%) than Hispanic/Latinos (71%) or Whites (69%)
  • Among those with late diagnosis 2011, VS by age was lowest for age 13-24 years (52%) and highest for age 45-54 years (65%)
limitations
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
  • Missing laboratory reports
  • Small N is some sub-groups limits meaningful analysis
slide24
know your status. Get tested. http://locator.aids.gov/For More information visithttp://dph.georgia.gov/hiv-care-continuum