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
Management of TB, STDs, HIV, Substance Abuse and Hepatitis C on the Border: Focus
on Testing
Tuberculosis
Management of TB, STDs, HIV, Substance Abuse and Hepatitis C on the Border: Focus
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
Management of TB, STDs, HIV, Substance Abuse and Hepatitis C on the Border: Focus
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
Management of TB, STDs, HIV, Substance Abuse and Hepatitis C on the Border: Focus
on Testing
Chlamydia
Management of TB, STDs, HIV, Substance Abuse and Hepatitis C on the Border: Focus
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
Management of TB, STDs, HIV, Substance Abuse and Hepatitis C on the Border: Focus
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
Management of TB, STDs, HIV, Substance Abuse and Hepatitis C on the Border: Focus
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
Management of TB, STDs, HIV, Substance Abuse and Hepatitis C on the Border: Focus
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
Management of TB, STDs, HIV, Substance Abuse and Hepatitis C on the Border: Focus
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%)
Management of TB, STDs, HIV, Substance Abuse and Hepatitis C on the Border: Focus
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
Management of TB, STDs, HIV, Substance Abuse and Hepatitis C on the Border: Focus
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
Management of TB, STDs, HIV, Substance Abuse and Hepatitis C on the Border: Focus
on Testing
Questions?
Paula Kriner, MPHImperial County Public Health Dept.
(760) [email protected]
Management of TB, STDs, HIV, Substance Abuse and Hepatitis C on the Border: Focus
on Testing
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