Impact of Syndemics on People Living with HIV/AIDS in San Francisco
Priscilla Lee Chu, DrPH, MPHSan Francisco Department of Public HealthXIX International AIDS ConferenceJuly 23, 2012Washington, DC
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Introduction: PCSIProgram Collaboration and Service
Integration (PCSI) has prioritized the integrated monitoring of syndemics among four communicable disease registries: HIV Tuberculosis Viral Hepatitis STDs
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Introduction: Syndemics
Syndemics are the presence of two or more diseases interacting synergistically to exacerbate health outcomes within a population
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Introduction: Purpose
To assess the prevalence of co-occurring infections within the four registries and their impact on persons living with HIV/AIDS (PLWHA)
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Methods 1/2
HIV/AIDS cases were matched against seven diseases from three other registries
HIV
STDSyphilis
Gonorrhea Chlamydia
Viral HepatitisChronic Hepatitis B
Hepatitis C
TBActive TBLatent TB
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Methods 2/2
Chi-square, t-test, and Kruskal-Wallis tests were used to assess differences between those with HIV only versus HIV plus at least one co-infection by: Demographics Health status Neighborhood
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Results: Syndemics with HIV
HIV14%
Syphilis 1%
Gonorrhea 2%
Chlamydia 2%
HCV 4%HBV 4%
LTBI 2%
Active TB 1%
HIV N=15,056 N=2,050 (14%) with
one or more infection in addition to HIV
Syndemic rate 13,616 per 100,000 HIV cases
Highest co-morbidities: HCV, HBV, Chlamydia, and latent TB
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Results: Characteristics of PLWHA with at least one other disease
Injection Drug Users
Very High Viral Loads (>100K)
Virologically Unsuppressed
Homeless
African American
Women
Transgender
Age 20-29
0tan28a566028 0tan9a56609 0tan19a566019 0tan29a5660290tan26a5660
260tan25a5660
250tan22a5660
220tan22a5660
220tan20a5660
200tan17a5660
170tan17a5660
170tan15a5660
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Percent of HIV syndemic (all p<0.01)
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Results: Mean viral load by specific co-infection
0tan28a566028
0tan6a57156
0tan14a576914
0tan22a582422
0tan29a587929
13823
0tan26a573726
0tan14a586514
0tan15a587115
0tan20a567720
0tan15a569315
0tan19a5707190tan24a5699
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Results: Suppression rates by specific co-infection
0%
20%
40%
60%
80%
100%
82%64% 67% 61%
78%65% 74% 69%
18%36% 33% 39%
22%35% 26% 31%
Percent Unsup-pressedPercent Suppressed
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Results: Mean viral load by number of co-infections
0tan28a566028
0tan6a57156
0tan14a576914
0tan22a582422
0tan30a569830
0tan20a570320
0tan2a58302 0tan28a582028
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Results: Viral suppression rates by number of co-infections
0%
20%
40%
60%
80%
100%
82%71% 65%
39%
18%29% 35%
61%
Percent Unsup-pressedPercent Suppressed
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Results: PLWHA syndemics and poverty, San Francisco, 2009
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Conclusion 1/3
Syndemics are associated with poorer HIV health outcomes among PLWHA Significant “dose-response
relationship” between the number of co-infections and mean VLs
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Conclusion 2/3
In addition to numbers of co-infections, particular demographic subgroups, and certain geo-clusters were also associated with poorer health outcomes, underscoring the need to address multiple conditions in tandem in an integrated health system
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Conclusion 3/3
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Thanks & AcknowledgementsGlenn-Milo SantosAnnie VuIsrael Nieves-RiveraGrant ColfaxJennifer GrinsdaleSandra HuangSusan PhilipSusan ScheerTomas Aragon
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