TB, STDs, HIV, HEPATITIS C and SUBSTANCE ABUSE: A Local Perspective Paula Kriner, MPH Imperial...

TB, STDs, HIV, HEPATITIS C and SUBSTANCE ABUSE: A Local Perspective

Paula Kriner, MPHImperial County Public Health Department

Management of TB, STDs, HIV, Substance Abuse and Hepatitis C on the Border: Focus on Testing

June 20-21, 2014

Management of TB, STDs, HIV, Hepatitis C and Substance Abuse on the Border

Management of TB, STDs, HIV, Hepatitis C and Substance Abuse on the Border

I do not have any financial arrangements or affiliations with commercial sponsors which have direct interest in the subject matter:

Objectives

Describe epidemiological trends for HIV/AIDS, sexually transmitted diseases, tuberculosis, hepatitis C, and substance abuse in Imperial County

Discuss challenges to identifying, testing, and treating diseases

Management of TB, STDs, HIV, Substance Abuse and Hepatitis C on the Border: Focus

on Testing

Demographics

Estimated 2014 population: 180,672

Predominantly Latino (>80%) Younger population than

California Higher rates of poverty than

stateManagement of TB, STDs, HIV, Substance

Abuse and Hepatitis C on the Border: Focus on Testing

TUBERCULOSIS

Tuberculosis

In California, tuberculosis (TB) rates have declined since 1992

In Imperial County, TB case rates have fluctuated and are now on rise

IC has highest TB rates in California– 15.2 cases per 100,000 population

in IC compared to 6.1 cases/100,000 statewide


on Testing

Tuberculosis


on Testing

2004 2005 2006 2007 2008 2009 2010 2011 2012 20130

5

10

15

20

25

Tuberculosis Rates, Imperial County and California, 2004-2013

Imperial County California

Rate

per

10

0,0

00

Tuberculosis

Nearly all cases are Latino Many are foreign-born Diabetes and HIV/AIDS are

increasingly common co-morbidities in persons infected with TB


on Testing

TB Challenges

Homelessness and drug use are risk factors

Binational cases: cross-border travel and contacts

Latent TB Infection (LTBI) cases not adequately followed by local health-care providers

Management of TB, STDs, HIV, Hepatitis C and Substance Abuse:

Focus on Testing

Sexually Transmitted Diseases (STDs)

STD Highlights

Chlamydia is the most common STD reported

IC Public Health participated in statewide enhanced gonorrhea surveillance project

County has improved local surveillance for all STDs


on Testing

Chlamydia


on Testing

20012002

20032004

20052006

20072008

20092010

20112012

20130

100200300400500600700

Chlamydia Rates by Year of Diag-nosis, Imperial County, 2001-2013

FemaleMale

Ra

te p

er

10

0,0

00

Chlamydia


on Testing

10-14 15-19 20-24 25-29 30-34 35-44 45+0

500

1000

1500

2000

2500

3000

Chlamydia Rates by Age Group Imperial County, 2012

FemaleMale

Age Group

Rate

per

10

0,0

00

Gonorrhea


on Testing

20012002

20032004

20052006

20072008

20092010

20112012

20130

10

20

30

40

50

60

Gonorrhea Rates by Year of Diag-nosis, Imperial County, 2001-2013

FE-MALE

Rate

per

10

0,0

00

Gonorrhea

Management of TB, STDs, HIV, Hepatitis C and Substance Abuse on the Border: Focus on

Testing

10-14 15-19 20-24 25-29 30-34 35-44 45+0

1020304050607080

Gonorrhea Rates by Age Group, Imperial County, 2012

Female

Male

Age Group

Rate

per

100,0

00

Syphilis


on Testing

20012002

20032004

20052006

20072008

20092010

20112012

201302468

101214

Primary and Secondary Syphilis Rates, Imperial County, 2001-2013

FEMALE MALE

Rate

per

10

0,0

00

STD Challenges

Diagnosis and treatment of partners– Limited use of Expedited Partner

Therapy– Out-of-jurisdiction including Mexico– Other factors (drug use, co-

morbidities) Limited services for counseling

and testingManagement of TB, STDs, HIV, Hepatitis C and Substance Abuse:

Focus on Testing

HIV / AIDS

HIV/AIDS

AIDS: 266 cases since 1983–106 (40%) deaths reported

HIV: 87 cases reported by name since April 2006.–Three (3%) deceased


on Testing

AIDS

Nearly all cases (90%) are male Most (76%) are Latino More than half (55%) identified

risk as men who have sex with men (MSM)

12% reported risk as injection drug use (IDU)

7% reported risk as MSM/IDUManagement of TB, STDs, HIV, Substance

Abuse and Hepatitis C on the Border: Focus on Testing

HIV

Most cases are Latino (76%) and male (80%)

Most are MSM (57%) IDUs (14%)


on Testing

HIV/AIDS Cases

Management of TB, STDs, HIV, Hepatitis C and Substance Focus on

Testing

Befo

re ..

.19

9019

9119

9219

9319

9419

9519

9619

9719

9819

9920

0020

0120

0220

0320

0420

0520

0620

0720

0820

0920

1020

1120

1220

13

0

5

10

15

20

25

30

HIV and AIDS Cases by Year of Diagnosis,

Imperial County HIV

AIDS

Nu

mb

er

of

Ca

se

s

HIV/AIDS Challenges

Stigma Many cases test out of jurisdiction

--often in Mexico -- and don’t seek care until very sick

Limited counseling and testing services available

Management of TB, STDs, HIV, Hepatitis C and Substance Abuse :

Focus on Testing

HEPATITIS C

Hepatitis C

In 2011, one acute case and 178 newly reported non-acute HCV cases were identified countywide

Many of the reported cases are incarcerated

Management of TB, STDs, HIV, Substance Abuse and Hepatitis C: Focus on Testing

Hepatitis C

Management of TB, STDs, HIV, Hepatitis C and Substance Abuse on the Border: Focus on

Testing

18-24 25-34 35-44 45-54 55-64 65+0

100

200

300

400

500

Chronic Hepatitis C ∙ Rate of New Cases by Age Group, Imperial County,

2011 Female Male

Age Group

Rate

per

10

0,0

00

Hepatitis C ∙ Challenges Injection drug users Small percentage share needles

for vitamins and medicines Many older people are not aware

that they may have been exposed

Management of TB, STDs, HIV, Hepatitis C and Substance Abuse: Focus on

Testing

SUBSTANCE ABUSE

Substance Abuse

Admission rates to treatment facilities in Imperial County have increased since 2000

In 2000, IC reported 417 admissions per 100,000 compared to 790 admissions per 100,000 in 2008

IC’s alcohol and drug admission rate was higher than the state overall each year since 2000


on Testing

Substance Abuse

Marijuana use accounted for 29% of all treatment admissions in 2008

Heroin = 27% Methamphetamine = 24% Alcohol = 19% Crack/cocaine = 1% Highest rate in 25 to 34 year olds

Management of TB, STDs, HIV, Hepatitis C and Substance Abuse on the Border: Focus

on Testing

Substance Abuse

Death rates due to alcohol and drug use increased slightly between 2000 and 2007

Death rate due to alcohol use increased nominally

Death rate due to drug use increased from 7.65 per 100,000 to 10.29 per 100,000

Management of TB, STDs, HIV, Hepatitis C and Substance Abuse:

Focus on Testing

Substance Abuse Challenges

Substance abuse is a risk factor for sexually transmitted diseases

Lack of local treatment facilities Homelessness and other risk

factors makes it difficult to follow up and ensure completion of treatment

Management of TB, STDs, HIV, Hepatitis C and Substance Abuse :

Focus on Testing

Summary

Imperial County has highest rate of TB in California

High number of chronic hepatitis C reported annually

Increasing rates of HIV and other STDs due in part to increased testing, improved surveillance and provider reporting


on Testing

Questions?

Paula Kriner, MPHImperial County Public Health Dept.

(760) [email protected]


on Testing

TB, STDs, HIV, HEPATITIS C and SUBSTANCE ABUSE: A Local Perspective Paula Kriner, MPH Imperial...

Documents

Transcript of TB, STDs, HIV, HEPATITIS C and SUBSTANCE ABUSE: A Local Perspective Paula Kriner, MPH Imperial...