2006 indiana hiv incidence
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2006 Indiana HIV Incidence. Richard T. Passey Indiana State Department of Health Office of Clinical Data and Research HIV Incidence Surveillance. Need for HIV Incidence Surveillance. Gives cutting edge picture of epidemic Targets at risk populations for prevention and testing - PowerPoint PPT PresentationTRANSCRIPT
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2006 Indiana HIV Incidence
Richard T. PasseyIndiana State Department of HealthOffice of Clinical Data and Research
HIV Incidence Surveillance
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Need for HIV Incidence Surveillance
Gives cutting edge picture of epidemic
Targets at risk populations for prevention and testing
Planners redistribute resources
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New Infection of HIV Is Difficult to Pinpoint in Time
• How do we pinpoint when someone becomes infected?
– Asymptomatic window period
– Individual’s testing pattern is essential
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Incidence Defined
The number of NEW INFECTIONS in a given time period; usually one year
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HIV Incidence Defined
• Not just new HIV diagnoses
• Incidence is NEW HIV INFECTIONS– Excludes those with HIV infections longer
than one year– May be higher or lower than new HIV
diagnoses– Accounts for HIV not yet tested: about 25%– Not changed by increased or decreased
testing rates
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2006 National HIV Incidence Calculation
• First Method: Point Estimate for 2006 (Reference JAMA Article)
– Laboratory Test (STARHS/BED)• Can classify infection as less than 156 days• Not for individual; for population surveillance
– Testing and Treatment History
– Core HIV Surveillance Data
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2006 U.S. HIV Incidence Estimation
Point Estimate 56,30022.8/100,000 rate40% Higher than
Previous Estimate 40,00016.2/100,000
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2006 U.S. HIV Incidence by Gender
73% Male34.3/100,000 rate
27% Female11.9/100,000 rate
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2006 U.S. HIV Incidence by Transmission
53% Men that have Sex with Men (MSM)
12% Injection Drug User (IDU)
4% MSM/IDU
31% Heterosexual
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2006 National HIV Incidence Age
13-29 34% 26.8/100,000
30-39 31% 42.6/100,000
40-49 24% 30.7/100,000
50-99 10% 6.5/100,000
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National HIV Incidence by Race/Ethnicity
• 35% White• Rate 11.5/100,000
• 17% Hispanic• Rate 29.3/100,000• Almost three times the rate of white individuals
• 45% Black Individuals• Rate of 83.7/100,00 for Black• Seven times the rate of white individuals
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Artist’s Depiction of HIV Virus Particle
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2006 National HIV Incidence Calculation
• Second Method Confirmatory for STARHS
– Statistical Back Calculation Approach
• Looked at HIV incidence since 1970’s
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HIV Incidence by Back Calculation for U.S.
• Incidence first noticed in 1977
• Peaked mid 80’s at 130,000
• Low point early 1990’s at 49,000
• Second peak late 90’s at 58,000
• Since 2000 stayed at roughly 55,000
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One Area of Success
Overall HIV incidence among IDU has decreased 80% in the U.S.
From 35,000 in 1990 to 6,600 in 2006
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Conclusions for National HIV Incidence
Racial Disparities are Greater than Expected
Incidence Rate is 40% Higher than Expected and has been for Years
Young, Black, MSM at Most Risk
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Prevention, and Testing Plan
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Indiana 2006 HIV Incidence
New Statewide Calculation is Cutting Edge
– STARHS Lab Test
– Core HIV Surveillance
– Testing and Treatment History
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Indiana 2006 HIV Incidence(New Infections)
• Local Estimate is 639
• CDC Estimate is 700
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Indiana HIV Diagnosis Compared to Incidence (Infected) for 2006
• 519 Diagnosed with HIV/AIDS • 10.0 per 100,000
• 323 Diagnosed with HIV not AIDS• 6.2 per 100,000
• 639 Incidence for HIV not AIDS • 12.3 per 100,000 (double)
• 700 Incidence for HIV not AIDS • 13.5 per 100,000
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Indiana 2006 HIV Incidence Stratified by Gender
• Women 6.9/100,000 HIV incidence rate• 29% (187) new HIV infections (incidence)
• Men 17.5/100,000 HIV incidence rate• 71% (452) new HIV infections
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Indiana 2006 HIV Incidence Stratified by Race
• White 60% of 2006 incidence
• Rate is 8.2/100,000
• Other (Minorities) 40% of incidence
• Rate is 45.8/100,000
• 5.6 times higher rate for other than white
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Indiana 2006 HIV Incidence Stratified by Age
13-29 41% 17.3/100,000
30-39 35% 26.3/100,000
40+ 25% 5.6/100,000
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Indiana 2006 HIV Incidence Stratified by Transmission
• MSM 55% of incidence in 2006
• Other 45%
• Could not be further separated
• Includes IDU, Heterosexual, and No Reported Risk
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Conclusions on Indiana Statewide HIV Incidence
HIV Incidence Rate Double that of HIV Diagnosis Rate
Racial Disparities are Alarming
Young Minority MSM at Greatest Risk
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2006 Indiana HIV Incidence Estimation ‡
HIV Incidence Estimate* Std. Dev.** HIV/AIDS Diagnosis***
STRATA Count % Rate/100,000 Count Count
Sex
Male 452 70.7 17.5 104 414
Female 187 29.3 6.9 63 105
Race/Ethnicity
White 380 59.5 8.2 77 280
Other 259 40.5 45.8 74 239
Diagnosis Age
13-29 261 40.8 17.3 51 176
30-39 220 34.5 26.3 55 155
40+ 158 24.7 5.6 68 188
Transmission
MSM 352 55.1 N/A 67 271
Other (IDU,HET,NRR) 287 44.9 N/A 90.7 248
Total ± 639 100.0 12.3 126 519
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‡Source: Indiana State Department of Health, Office of Clinical Data and Research, January 1, 2006 to December 31, 2006; Reported through August 1, 2008
*Incidence Estimate-Estimated Number of New HIV Infections. Estimations will vary according to STRATA.
**Std. Dev-Standard Deviation of Incidence Estimate 'Count'
***HIV/AIDS Diagnosis-Newly Reported HIV/AIDS Cases to ISDH though August 31, 2008 and diagnosed January 1, 2006 – December 31, 2006
±Total-Non-Stratified (includes all variables) HIV Incidence Estimation. Each set of STRATA separately equals the number represented in the 'Total' with the exception of 'Std. Dev.'.
Other categories-Represent All Race/Ethnicity's other than Whites and All Transmissions other than MSM. Categories represented in 'Other' were too small separately to accurately estimate Incidence when stratifying.
NRR-No Reported Risk
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• Bibliography • Estimation of HIV Incidence in the United
States, Irene Hall et. al., JAMA, August 6, 2008, vol. 300, No. 5
• Estimating HIV Incidence in the United States from HIV/AIDS Surveillance Data and Biomarker HIV Test Results, John Karon et al., Statistics in Medicine 2008
• Morbidity and Mortality Weekly Report, Prejean, J et. al., (www.cdc.gov/mmwr) Sept.12, 2008 vol. 57,no. 36 pp. 485-489.
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Images of HIV Virus Particles:
• Russell Knightly Media
• Custom Medical Stock Photo (CMSP)
• AIDS Pathology
• Department of Microbiology University Otago, New Zealand
• Taken from www.virology.net/BIG_Virology/BVretro.html
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• Cartoons– www.un.org/events/aids/2006/exhibit.asp
United Nations World AIDS Day HIV/AIDS Cartoon Exhibition Dec. 1, 2006
– www.dance4life.com/en_4life/en_cartoons Made by the World Health Organization, UN AIDS and the Office of the High Commissioner for Human Rights