HIV Care Continuum Report by Health District, … by...This HIV Care Continuum Report by Health...
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HIV Care Continuum Report by Health District, Georgia, 2014 HIV/AIDS Epidemiology Section Epidemiology Program Division of Health Protection Georgia Department of Public Health July 2016
Transcript of HIV Care Continuum Report by Health District, … by...This HIV Care Continuum Report by Health...
HIVCareContinuumReportbyHealthDistrict,Georgia,2014HIV/AIDSEpidemiologySectionEpidemiology ProgramDivisionofHealthProtectionGeorgiaDepartmentofPublicHealthJuly2016
ThisHIVCareContinuumReportbyHealthDistrict,Georgia,2014ispublishedbytheGeorgiaDepartmentofPublicHealth(DPH),HIV/AIDSEpidemiologySection(HAES),2PeachtreeStreet,AtlantaGeorgia30303.
DataarepresentedfromknowndiagnosesandlaboratoryreportsenteredintotheGeorgiaEnhancedHIV/AIDSReportSystem(eHARS).Alldataareprovisional.
TheHIVCareContinuumReportbyHealthDistrict,Georgia,2014isnotcopyrightedandmaybeusedandreproducedwithoutpermission.Citationofthesourceis,however,appreciated.
Suggestedcitation:GeorgiaDepartmentofPublicHealth,HIV/AIDSEpidemiologySectionHIVCareContinuumReportbyHealthDistrict,Georgia,2014https://dph.georgia.gov/data---fact---sheet---summaries,PublishedJuly2016[Accessed:date]
AcknowledgementsPublicationofthisreportwasmadepossiblewiththecontributionsoftheGeorgiaDPHHAESCoreHIVsurveillancestaff,HIVCaseReportFormssubmittedbyGeorgiahealthcarefacilitystaff,HIVinfection-relatedlaboratorytestresultstransmittedbylaboratoryfacilitiesinGeorgia,datamatcheswithotherpublichealthprograms,andtheongoingeffortsofmultipleindividualsfrompublicandprivatesectororganizationsdedicatedtoimprovingsurveillance,prevention,testing,andcareofpersonslivingwithHIVinfection.
GeorgiaHIVCoreSurveillanceTeamcontributors:LaurenBarrineau-Vejjavija,VictoriaDavis,ThelmaFannin,JaneKelly,RodriquesLambert,MildredMcGainey,LatoyaMoss,RamaNamballa,DorisPearson,A.EugenePennisi,AkilahSpratling,LakeciaVanerson,andAndrenitaWest.
ThisreportwaspreparedbythefollowingstaffoftheGeorgiaDepartmentofPublicHealth:BrianHuylebroeck,JaneKelly,RodriquesLambert,A.EugenePennisi,PascaleWortley,andCherieDrenzek.
TableofContentsSuggestedcitation:......................................................................................................................................2Acknowledgements......................................................................................................................................2
Background...................................................................................................................................................4
Commentary.................................................................................................................................................5
Figure1HIVprevalencebycurrentdistrictofresidence,Georgia,2014...........................................6
Figure2HIVnewdiagnosesbycurrentdistrictofresidence,Georgia,2014....................................7
Methodology................................................................................................................................................8GeorgiaCareContinuumMethodology,PersonsLivingWithHIV(PLWH),byHealthDistrict,2012...........8TransmissionCategoryDefinitions..............................................................................................................8MultipleImputation.....................................................................................................................................9TechnicalNotes..........................................................................................................................................10Limitations.................................................................................................................................................11
Section1:CareContinuumamongpersonslivingwithdiagnosedHIV,byHealthDistrict,Georgia,2014.............................................................................................................................................12
Figure3AdultsandadolescentslivingwithdiagnosedHIV,Georgia,2014....................................12HIVCareContinuumamongpersonslivingwithHIV,byhealthdistrict,Georgia,2014............................13
Section2:ViralsuppressionamongpersonslivingwithdiagnosedHIV,byHealthDistrict,Georgia,2014.............................................................................................................................................14
Figure4ViralSuppressionamongadultsandadolescentsretainedincare,byrace/ethnicity,Georgia,2014.............................................................................................................................................15
ViralsuppressionanalysisamongpersonsretainedinHIVcare,byHealthDistrict,Georgia,2014..........15
References..................................................................................................................................................17
AppendixAHIVSurveillanceandReportingLawinGeorgia..............................................................18
BackgroundInJanuary2013,theCentersforDiseaseControlandPrevention(CDC)releasedHIVSurveillanceSupplementalReportVolume18,Number2MonitoringSelectedNationalHIVPreventionandCareObjectivesbyUsingHIVSurveillanceData–UnitedStatesand6U.S.DependentAreas---2010.1ThereportprovideddatabyselectedjurisdictiononstageofdiseaseatdiagnosisofHIVinfectionin2010,andontheHIVCareContinuum(previouslycalledtheHIVCareCascade),i.e.,linkagetoandretentioninHIVcareandviralsuppression.ThesemetricscanbeusedtomonitorprogresstowardtheachievementofobjectivesoutlinedintheNationalHIV/AIDSStrategyfortheUnitedStates(NHAS),releasedbytheWhiteHouseinJuly2010.2Whilethereisnoconsensusor“goldstandard”formeasuresoflinkageandretentionincare,severalmeasuresforretentionhavebeenreportedtocorrelate3.Selectionofappropriatemeasuresmusttakeintoconsiderationavailabilityandaccuracyofdatacollectionsystems,aswellaspotentialusesofthemetrics.
InJuly2015,theWhiteHousereleasedthenewNationalHIV/AIDSStrategy(NHAS)2020goals,includingachangetothemetricfor“linkedtocare.”Whereaspreviouslythemetricforlinkagewaswithin90daysofdiagnosis,thenewNHAS2020goalsincludeIndicator#4:“IncreasethepercentageofnewlydiagnosedpersonslinkedtoHIVmedicalcarewithinonemonthoftheirHIVdiagnosistoatleast85percent.”4Inkeepingwiththisnewmetric,wereporthereonlinkagetocareinGeorgiawithin30daysofdiagnosis,achangefrompreviousreportsusing90days.
SinceJanuary1,2004,GeorgiahasadualreportingsystemthatlegallyrequiresHIV/AIDSreportingbybothhealthcareprovidersandlaboratories(O.C.G.A.§31---12---2(b)).Allhealthcareprovidersdiagnosingand/orprovidingcaretoapatientwithHIVhavetheobligationtoreportthemusingtheHIV/AIDSCaseReportForm.Casereportformsaremandatedtobecompletedwithinseven(7)daysofdiagnosingapatientwithHIVand/orAIDSorwithinseven(7)daysofassumingcareofanHIVpositivepatientwhoisnewtotheprovider,regardlessofwhetherthepatienthaspreviouslyreceivedcareelsewhere.AlllaboratoriescertifiedandlicensedbytheStateofGeorgiaarerequiredtoreportlaboratorytestresultsindicativeofHIVinfection,suchaspositiveWesternBlotresults,alldetectableandundetectableviralloads,andallCD4countstotheGeorgiaDepartmentofPublicHealth(GDPH)HIV/AIDSEpidemiologySection(HAES)5.
RecentimprovementsintheGeorgiaelectroniclaboratoryreporting(ELR)systemhavefacilitateduseoflaboratory-basedmeasuresforlinkageandretentionincare.Althoughothermeasuressuchasmissedappointments,healthcarevisitconsistency,andgapsincaremaybeassessedatindividualhealthcarefacilities,itisdifficulttoaccuratelygatherthesemeasuresonastatewidebasisinGeorgia.Forthesereasons,measuresinthisreportandpreviousGeorgiaCareContinuumreportsrelyonlaboratorydata-drivendefinitions.Inaddition,multiplemeasures,suchaslinkedtocarewithin30daysofdiagnosis,anyHIVcare(atleastoneCD4orviralloadin12months)aswellastheHealthResourcesandServicesAdministration(HRSA)
medicalvisitperformancemeasure(atleasttwoCD4orviralloadmeasuresasleastthreemonthsapartwithina12monthperiod)6canbeusefultovariousstakeholdersinmonitoringimpactofefforttoimproveoutreach,testing,andcare.
Commentary
ThisreportexpandsupontheCareContinuumReport,Georgia,2014byprovidingCareContinuuminformationatthehealthdistrictleveldefinedbythecurrentaddressesofpersonslivingwithHIVinGeorgia.
TheGeorgiaDepartmentofPublicHealth(DPH)funds,andcollaborateswith,18separatePublicHealthDistrictsthroughoutthestate.EachiscomprisedofoneormoreofGeorgia's159countiesandcountyhealthdepartments.Figure1showsthenumberofpersonslivingwithHIV(prevalence)andFigure2thenumberofnewdiagnosesbyHealthDistrictforGeorgia.
Figure1HIVprevalencebycurrentdistrictofresidence,Georgia,2014
Figure2HIVnewdiagnosesbycurrentdistrictofresidence,Georgia,2014
MethodologyGeorgiaCareContinuumMethodology,PersonsLivingWithHIV(PLWH),byHealthDistrict,2012
• Personsincludedareadultsandadolescentsage13andolder,diagnosedby12/31/13,livingasof12/31/14withcurrentaddressinoneof18HealthDistrictsinGeorgia
• “Linkedtocare”within30daysismeasuredonlyforthenewdiagnosesmadein2014.ThislinkagemeasureisdifferentfrompreviousCareContinuumreportsforGeorgia,andshouldnotbecomparedtopreviousyearsfortrendanalysis.Intheslidesandfigures,linkageisshowninadifferentcolorfromtherestofthecontinuumtoemphasizethedifferentdenominator.
• “AnyHIVcare”isdefinedashavinghadatleast1CD4orviralload(VL)measurementin2014
• “Retainedincare”isdefinedashavinghadatleast2CD4orVLatleast3monthsapartin2014
• “Viralsuppression”(VS)isdefinedasaVL<200copies/mlorundetectableinthemostrecentVLin2014.Personswithnoviralloadtestsareassumedtobeoutofcareandnotvirallysuppressed.
• Eachbarinthecontinuumisindependentofthoseprecedingit;allpercentagesareofthetotalnumberofpersonsdiagnosedwithHIVinacategory
CurrentResidence
• PersonsarecategorizedashavingacurrentaddressinaparticularHealthDistrictbasedonthemostrecentaddressavailableinthesurveillancesystem.Thisaddressisreferredtoastheir“current”address,thoughitmaybeseveralyearsold,andmaynotrepresentthetruecurrentaddressiftheymovedandhavenothavealabresultreportedcontaininganupdatedaddress.
• Additionally,personsmayreceivecareinanareadifferentfromwheretheyreside,forexample,apersonlivinginanon-eligiblemetropolitanarea(EMA)countymayreceivecareintheAtlantaEMA.
TransmissionCategoryDefinitionsTransmissioncategoryisdeterminedfromriskbehaviornotedoncasereportformsorobtainedthroughmatchwithotherdatabases(suchasCAREWarefromtheRyanWhiteProgram,ornon-HIVsourcessuchastheGeorgiaDPHtuberculosisandSTDsurveillancedatabases).The
transmissioncategoryassignmentsarehierarchicalasperCDCmethodologyanddefinedasfollows:
• MSMisdefinedasmale-to-malesexualcontact
• IDUisdefinedasinjectiondruguse
• TheMSM/IDUtransmissioncategoryincludesthosepersonswhoreportedbothmalesexualcontactandinjectiondruguse
• HETisdefinedasheterosexualcontactwithapersonknowntohave,ortobeathighriskfor,HIVinfection
• Otherincludesthetransmissioncategoriesofhemophilia,bloodtransfusion,andperinatal
exposure.
MultipleImputationMissingdataisanongoingprobleminroutinelycollecteddataorlarge-scaleepidemiologicstudies.BecauseasubstantialproportionofpersonswithdiagnosedHIVinfectionarereportedtotheGeorgiaDepartmentofPublicHealthwithoutanidentifiedriskfactor,multipleimputationmethodsareusedtoassigntransmissioncategoriestothosepersonswhosediagnosesarereportedwithoutariskfactor.
Multipleimputations(MI)isastatisticalapproachinwhichmissingtransmissioncategoriesforeachpersonarereplacedwithplausiblevaluesthatrepresenttheuncertaintyregardingtheactual,butmissing,values.ThisisthesamestatisticalstrategythattheCDCusestoassigntransmissioncategoriestothosereportedwithoutariskfactorinthenationaldataset.8
WhetherthesetransmissioncategoryadjustmentsusingMIintroduceanysystematicbiasinoverestimationorunderestimationofpercentagesofHIVinfectionattributedtospecificcategoriesisunknown.Insteadofestimatingtheriskfactordistributionprobabilitiesforcaseswithmissingriskfactorsbyasimpleredistributionapproach,MIdrawsarandomsampleofthemissingvaluesfromitsdistribution.
Then,insteadoffillinginasinglevalueforeachmissingvalue,MIreplaceseachmissingvaluewithasetofplausiblevaluesthatreservethestatisticaldistributionoftheimputedvariableandtherelationshipwithothervariablesintheimputationmodel.Themultiply-imputeddatasetsarethenanalyzedbyusingstandardproceduresforcompletedata.Resultsfromtheseanalysesarethencombinedtogetthefinalestimates.
MIisconsideredasoundapproachforlargedatasets.InananalysiscomparingtheCareContinuumfortheGeorgiaHIVprevalentpopulationin2012,stratifiedbytransmissioncategory,estimatedwithandwithoutuseofMI,littledifferencewasfound,similartothe
experiencewiththenationaldataset.8Specificexamplescanbefoundintheslideset“MultipleImputation,Georgia2012”foundontheGeorgiaDPHwebsite(https://dph.georgia.gov/data-fact-sheet-summaries).
SummaryofMethodologyChanges
ChangesfromtheGeorgia2012CareContinuumbyHealthDistrictReportinclude:
• LinkagetocareismeasuredbyCD4orVLwithin30daysofdiagnosisincludingthedayofdiagnosisforpersonsdiagnosedin2014only.TheGeorgia2012reportmeasured“linked”aswithin90daysofdiagnosisandexcludedlaboratoryvaluesdrawnonthedayofdiagnosis.
• Theterm“anyHIVcare”isusedforthosehavinghadatleastoneCD4orVLin2014.Inpreviousreportsthismeasurewasreferredtoas“engagedincare”.
TechnicalNotesThisreportincludesdatareportedtoGeorgiaDPHHAESfromJanuary1,2004(whenname-basedHIVreportingbeganinGeorgia)throughMay2016.
Alldatareportedhereareprovisionalandshouldbeinterpretedwithcaution.NotallHIVinfectedpersonsinGeorgiahavebeentestedorsomemayhavebeentestedatapointtooearlyininfectiontobedetectedbythetestused.AlthoughHIVreportingismandatedforhealthcareprovidersandlaboratoryfacilities,notallprovidersandlaboratoriesmaycomply,resultinginmissingdata.LaboratorytestsperformedinotherjurisdictionsmaynotbereportedtoGDPHandthereforewouldnotbeincludedintheseanalyses.
DefinitionsandhierarchyforassignmentoftransmissioncategoryfollowsthedefinitionsusedbyCDC.7,8Databytransmissioncategorywerestatisticallyadjustedusingthemultipleimputationmethodtoaccountformissingriskfactorinformation.Estimatesareroundedtothenearestwholenumber.DatareferringtodiagnosesofHIVinfectionandpersonslivingwithHIVinfectionincludeallpersonswithHIVinfectionregardlessofstageofdisease(Stage1,2,3[AIDS]orunknown)atthetimeofdiagnosis.
TablesdisplayingCareContinuumdataforbyHealthDistrictstratifiedbysex,age,race/ethnicity,andtransmissioncategoryareavailableontheGeorgiaDPHwebsiteat
https://dph.georgia.gov/hiv-care-continuum.
VeryfewindividualsarereportedinthetransgendercategoryinGeorgia.Effortsareunderwaytoimprovedatacollectionongender.Thisreportusesreportedbirthgender,notcurrentgenderidentity.
Lessthan0.5%oftheprevalentpopulationlivingwithHIVinGeorgiaisAmericanIndian/AlaskaNative,AsianorNativeHawaiian/OtherPacificIslander.Becauseofsmallcellsizeswhenstratifiedbythe18HealthDistricts,distributionbyrace/ethnicityisonlyreportedforBlacks,Hispanic/Latinos,andWhitesinthisreport.
LimitationsLimitationstothisreportinclude:
• Incompletereportingoncasereportformsofrace,sex,completeaddressatdiagnosisandriskbehavior(whichisusedindefiningtransmissioncategory)limitstratificationandcomparisonamonggroups.
• BecauseCDCdoesnotacceptreportingofcasesmissingrace/ethnicityorsextothenationaldatabase,suchcasesarenotincludedintheRoutineInterstateDuplicationReport(RIDR)process.Thuscurrentaddressinformationmaynotbeupdateduponrelocationtoanotherstate.RetentionincareandVSmaybeunderestimatedforcasesmissingrace/ethnicityorsex.
• Thehighproportionofmissingriskbehaviorinformationoncasereportformslimitscomparisonsamonggroups.
• TheCDCdefinitionofheterosexualtransmissionlimitsthiscategorytothosewithsexualcontactwithaknownHIV-infectedpartnerorthosewithknownincreasedrisk(e.g.,MSMorIDU).Forexample,womenwhohavehadheterosexualcontactwithamannotknowntobeHIV-infected,bisexualorIDUwillbeclassifiedashavingnoidentifiedrisk.
• Populationsforwhichdataaremissingmaybefundamentallydifferentfromothergroupsforwhichrace,sexandtransmissioncategoryareknown.
• CD4orviralloadisusedasaproxymeasureforlinkage,engagementandretentionincare.IflaboratorytestsareobtainedpriortoanHIVcareappointmentwhichisnotkept,retentionincaremaybeoverestimated;conversely,apersonmaybeseenforHIVcarewithoutlaboratorydatamarkingthevisit,resultinginanunderestimationofretentionincare.
• Thenumberofindividualsinsomegroupsissmallandcautionshouldbeusedininterpretation.
Despitetheselimitations,bymaintainingmethodologicalconsistencyacrossreportingtimeperiods,GeorgiaDPHusestheHIVCareContinuumtoidentifydisparitiesandmonitorimprovementsinHIVlinkage,retentionincare,andultimately,viralsuppression.
Section1:CareContinuumamongpersonslivingwithdiagnosedHIV,byHealthDistrict,Georgia,2014
Figure3(below)showstheHIVCareContinuumforpersonslivingwithHIV(PLWH)statewideinGeorgiaasof12/31/2012.
Figure3AdultsandadolescentslivingwithdiagnosedHIV,Georgia,2014
Whilelinkagetocarewithin30daysofdiagnosisforpersonsdiagnosedin2014washighat75%,receiptofanyHIVcareandretentionincareforallpersonslivingwithHIVinGeorgiawassubstantiallylowerat61%and48%,respectively.Forty-fivepercentofGeorgianslivingwithdiagnosedHIVwerevirallysuppressed(VL<200orundetectable).
Theoverallpatternofhigherlinkagetocarewithin30daysofdiagnosisfornewlydiagnosedpersons,comparedwithalowerpercentofpersonslivingwithdiagnosedHIVwithanyHIVcare,retentionincare,andVSwasseeninallHealthDistricts,buttheproportionsanddisparitiesvariedbyHealthDistrict.
75%
61%
48% 45%
0%
20%
40%
60%
80%
100%
Percen
t
Linkedtocarewithin30days Anycare Retainedincare VirallySuppressed(VS)
N=49922N=2631
Tables1-4display,byHealthDistrict,thetotalpopulation,numberandpercentofPLWH,percentlinkedtocarewithin30daysamongthosediagnosedin2013,receiptofanyHIVcarein2014,retainedincarein2014,andvirallysuppressed(VL<200)onlastVLdrawnin2014,stratifiedbysex,race,age,andtransmissioncategory.ThoseindividualswithnoVLmeasurementin2014areassumedtobenotvirallysuppressed.
ThefollowingtablesdisplayingtheHIVCareContinuumbyHealthDistrictcanbefoundathttp://dph.georgia.gov/data---fact---sheet---summaries
Table1.HIVCareContinuumbyHealthDistrict,Georgia,2014,bysexTable2.HIVCareContinuumbyHealthDistrict,Georgia,2014,byrace/ethnicity
Table3.HIVCareContinuumbyhealthdistrict,Georgia,2014,bytransmissioncategory
Table4.HIVCareContinuumbyhealthdistrict,Georgia,2014,byage(inyears)
Highlights
HIVCareContinuumamongpersonslivingwithHIV,byhealthdistrict,Georgia,2014
• Note:missinglaboratoryreportshavelikelyresultedinanunderestimateofcarecontinuummeasuresforHealthDistrict6(Augusta).Thesemeasurementsarethereforeexcludedinthisreport.Similarly,unusuallylowproportionsofVSamongthoseretainedincareforDistrict9-2(Waycross)shouldbeviewedwithcautionastheymayreflectadeficitinviralloadreporting.
• Therewaslittleoveralldifferencebysexinthecarecontinuum,thoughproportionsvarybyhealthdistrict.Amongmen,anyHIVcarerangedfrom58-69%,retentionincarefrom45-57%,andVS38-58%byHealthDistrict.Forwomen,anycarerangedfrom58-70%,retentionfrom45-56%,andVSfrom37-55%.
• AlowerpercentageofBlackswerevirallysuppressedcomparedtoWhitesin15/18HealthDistricts(HD).Themagnitudeofthedifferencewas10ormorepercentagepointsinthreeHD(2Gainesville,5-1Dublin,7Columbus).VSwashigherforBlacksthanWhitesinHD9-1Savannah(48%vs.45%)and9-2Waycross(40%vs.35%),andequalinHD8-1Valdosta(45%).
• VSamongHispanic/LatinoswaslowerthanWhitesinallHD,equaltoBlacksin3HD(2Gainesville,3-3Clayton,3-5DeKalb),andlowerthanBlacksin7HD(1-1Rome,5-1Dublin,7Columbus,8-1Valdosta,8-2Albany,9-1Savannah,10Athens).
• Bytransmissioncategory,VSvariedwidelyfrom33-63%.VSwaslowestamongIDUorMSM/IDUfor11/18andlowestamongHETfor3/18HD.Inonly1HDwasVSlowestamongMSM.Cautionshouldbeusedininterpretation,especiallywhenstratificationresultsinsmallnumbers.
• RetentionincareandVSweresubstantiallyloweramongpersons20-24comparedwithpersons13-19formostHealthDistricts,perhapsreflectingtransitiontodifferenthealthcareprovidersaswellasdifferentfamilyandsocietalroles.FultonHDwastheexceptionwith49%and50%retentionincare,respectively,fortheseagegroups;VSwas36%amongpersons20-24comparedwith52%amongthose13-19inFultonHD.
• VSbyagerangedfrom20%(age20-24,HD8-2Albany)to75%(age55+,HD1-1Rome)withlowestVSamongthoseaged20-24yearsandgenerallyincreasingVSwithincreasingage.
Section2:ViralsuppressionamongpersonslivingwithdiagnosedHIV,byHealthDistrict,Georgia,2014AlowpercentvirallysuppressedmayreflectdifferencesinreceiptofanyHIVcare,retentionincare,treatmentwithandadherencetoART,ormissingdata.Whennoviralloadfor2014wasreportedtotheGeorgiaDepartmentofPublicHealth,theindividualwasassumedtobenotvirallysuppressed.Itishelpfultoexaminetheproportionvirallysuppressedamongpersonsretainedincare.Forthestateoverall,therewasasmalldifferenceinviralsuppressionamongthoseretainedincarebysex(males82%,females78%).Therewere,however,greaterdifferencesbyrace(Figure4).Thisanalysisofpersonsretainedincaredemonstratesthatdisparitiesinviralsuppressionarenotalwayssimplyafunctionofaccesstoandretentionincare.
Figure4ViralSuppressionamongadultsandadolescentsretainedincare,byrace/ethnicity,Georgia,2014.
ViralsuppressionanalysisamongpersonsretainedinHIVcare,byHealthDistrict,Georgia,2014
• Amongthoseretainedincare,disparityinviralsuppressionbyracewasconsistentacrossHD.BlackshadlowerpercentVSamongretainedincarethanWhitesforallHD,equaltoHispanic/LatinosisoneHD(9-2Waycross)andlowerthanHispanic/LatinosinallotherHDexceptthree(1-1Rome,3-5DeKalb,5-1Dublin).
• VSamongthoseretainedincarewasconsistentlyloweramongpersons20-24comparedwiththose13-19,withsubstantialdifferencesinsomeHD.ThereasonfortheparticularlylowVSamongretainedinFultonCounty20-24yearolds(64%)hasnotbeendeterminedandcontrastswiththepatternobservedinadjacentDeKalbCounty,whereVSamong20-24yearoldsretainedincarewas79%.Thiscouldbeanartifactoflaboratoryreporting.
• Beginningwithages20-24years,VSamongthoseretainedincaregenerallyincreased
77%
84%88%
94%
0%
20%
40%
60%
80%
100%
Black Hispanic/La5no White Unknown
Percen
t
N=15703 N=1377 N=4953 N=587
withincreasingage.VSamongthoseretainedincarewashighestamongpersons55yearsandolder(81-95%)inallHDexceptWaycross(58%)wherealmosthalfofthoseage60+whowereretainedincarehadnoviralloadmeasurementin2014.Itisnotknownifthisrepresentsareportingartifact,unreporteddeaths,orreceivingcareinanotherstate(WaycrossHDbordersFlorida).
• ApproximatelyhalfofpersonslivingwithHIVinGeorgiainmostdemographiccategoriesexaminedhadnoviralloadreportedin2014,andareconsiderednotsuppressedinthisanalysis.MissingviralloadmeasurementsmayleadtoanunderestimateofVSandVSamongthoseretainedincare.
LackofviralsuppressionmayreflectARTnotbeingprescribed,lackofARTadherence,orinappropriatemedicationchoice.AnadditionalconsiderationisthatalthoughindividualsareincludedinthisanalysisbecauseofdocumentedCD4andVLvalues,theselaboratorytestsmayhavebeendrawnduringanon-HIV-relatedhospitalization,ordrawnpriortoanHIVclinicappointmentthatwasneverkept.Conversely,relianceonlaboratoryreportsmaycontributetoanunderestimationofretentionincarebecausevisitscouldoccurwithoutlabsbeingordered,andbecauselabreportingmaybeincomplete.LaboratorytestinghaslimitationsasaproxyformeasuringHIVcare.
References
1. CentersforDiseaseControlandPrevention.MonitoringselectednationalHIVpreventionandcareobjectivesbyusingHIVsurveillancedata–UnitedStatesand6U.S.dependentareas–2010.HIVSurveillanceSupplementalReport2013;18(No.2,partB).http//www.cdc.gov/hiv/topics/surveillance/resources/reports/#supplemental.PublishedJanuary2013.AccessedMarch31,2013
2. NationalHIV/AIDSStrategyfortheUnitedStates.http://www.whitehouse.gov/administration/eop/onap/nhas/.PublishedJuly2010.AccessedMarch31,2013.
3. Yehia,BalighR.,Fleishman,JohnA.,Metlay,JoshuaP.,etal.ComparingdifferentmeasuresofretentioninoutpatientHIVcare.AIDS2012,26:1131-1139.
4. NationalHIV/AIDSStrategyfortheUnitedStates,Updatedto2020.https://www.aids.gov/federal-resources/national-hiv-aids-strategy/nhas-update.pdfAccessedJune6,2016.
5. O.C.G.A.§31-12-2.http://www.ecphd.com/Resources/353.pdf,AccessedMarch31,2013
6. HealthResourcesandServiceAdministration,HIV/AIDSBureau,HABHIVcoreclinicalperformancemeasuresforadult/adolescentclients:group1.http://hab.hrsa.gov/deliverhivaidscare/files/habgrp1pms08.pdfAccessedMarch31,2013.
7. CentersforDiseaseControlandPrevention.HIVSurveillanceReport,2011;vol.23.
http://www.cdc.gov/hiv/topics/surveillance/resources/reports/.AccessedMay4,2013.
8. CDC.Terms,definitionsandcalculationsusedinCDCHIVsurveillancepublications.Atlanta,GA:USDepartmentofHealthandHumanServices,CDC;2012.Availableathttp://www.cdc.gov/hiv/topics/surveillance/resources/factsheets/pdf/surveillance_terms_definitions.pdfAccessedMarch31,2013.
9. HarrisonKM,KajeseT,HallHI,SongR.RiskfactorredistributionofthenationalHIV/AIDSsurveillancedata:analternativeapproach.PublicHealthRep2008;123:618–27.
10. RubinDB.Multipleimputationfornonresponseinsurveys.NewYork:JohnWiley&Sons;1987.
AppendixAHIVSurveillanceandReportingLawinGeorgiaCompleteandtimelyreportingofHIVinfectioncasesbyiscriticalformonitoringtheepidemicinGeorgiaandensuringfederalfundingforpublicsectorHIVprevention,careandtreatmentservicessincefundingallocationisdirectlylinkedtothenumberofcases.
• GeorgiaDepartmentofPublicHealth(DPH),HIV/AIDSEpidemiologySection(HAES)isresponsibleformonitoringtheHIVepidemicinthestatebyusingtheenhancedHIV/AIDSReportingsystemtocollect,manage,analyzeandreportsurveillancedatatoCentersforDiseaseControlandPrevention
• GeorgiabegancollectingAIDScasereportsintheearly1980s.HIV(notAIDS)reporting
wasmandatedinGeorgiaonDecember31,2003
• Georgialaw(OCGA§31-22-9.2)requireshealthcareproviderstosubmitaconfidentialcasereportforpatientsdiagnosedwithHIVinfectionwithinsevendaysofdiagnosistotheGeorgiaDPHHAEP.
• Casereportformsaremandatedtobecompletedwithinseven(7)daysofdiagnosinga
patientwithHIVand/orAIDSorwithinseven(7)daysofassumingcareofanHIVpositivepatientwhoisnewtotheprovider,regardlessofwhetherthepatienthaspreviouslyreceivedcareelsewhere.
• AlllaboratoriescertifiedandlicensedbytheStateofGeorgiaarerequiredtoreportlaboratorytestresultsindicativeofHIVinfection,suchaspositiveWesternBlotresults,alldetectableandundetectableviralloads,allCD4counts,andallviralnucleotidesequenceresultstotheGeorgiaDPHHAEP.
ToaccesstheAdultandPediatricCaseReportFormsvisit:http://dph.georgia.gov/reporting-forms-data-requests
NEW:HIVElectronicCaseReportingthroughSENDSSAnelectronicAdultCaseReportForm(eACRF)canbetransmittedtoGeorgia'sDepartmentofPublicHealththroughthesecurediseasereportingsystemcalledSENDSS(StateElectronicNotifiableDiseaseSurveillanceSystem).Auserloginandpasswordmustbeassigned.Tobegintheprocess,pleasecontactLaurenBarrineau-Vejjajiva,ELRLabLiaison,atLauren.Barrineau-Vejjajiva@dph.ga.govor404-463-3753.TocreateaSENDSSauthorizeduseraccount,orforassistancewithanexistingaccount,pleasecontactAngelaAlexander,[email protected].
