Annual Epidemiological Presentation, 2017 - Kathleen Brady, PDPH

HIV in Philadelphia
Kathleen A. Brady, MD
Medical Director/Medical Epidemiologist
AIDS Activities Coordinating Office
Philadelphia Department of Public Health
Office of HIV Planning Epi Update
February 9, 2017

HIV Care Continuum
Adapted from
Eldred et al AIDS Patient Care STDs 2007;21(Suppl1):S1-S2
Cheever LW Clin Infect Dis 2007;44:1500-2
Not in HIV Care Engaged in HIV Care
Unaware of
HIV infection
Aware of
HIV infection
(not in care)
Receiving some
medical care but
not HIV care
Entered HIV
care but lost to
follow-up
Cyclical or
intermittent user
of HIV care
Fully engaged
in HIV care

CDC HIV Continuum Measures
 Aligns with NHAS 2020 indicator definitions
 Represents the best available data for measuring progress
 Uses National HIV Surveillance System (NHSS) data which meet the NHAS
indicator data source criteria
– Timely and routine
– Can stratify by demographic characteristics
– Prioritized data sources that are available at the state level to allow
states ability to monitor progress toward Strategy goals in their
jurisdictions
 Uses different denominators for each measure

Calculation of Indicators
 Prevalence of diagnosed HIV – United States
– Numerator: Persons aged ≥13 years living with diagnosed HIV
infection year-end 2013
– Denominator: Persons aged ≥13 years living with diagnosed or
undiagnosed HIV infection year-end 2013 (derived using back-
calculation)
 The following indicators only use data from areas with complete
reporting of CD4 and viral load test results to CDC (32 states and the
District of Columbia):
– Linkage to care (within 1 month)
– Retention in care
– Viral suppression

Diagnosed Infection among Persons Aged ≥13 Years Living with Diagnosed or
Undiagnosed HIV Infection, by Sex, 2013—United States
Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. Estimates were derived by using back-
calculation on HIV data for persons aged ≥13 years at diagnosis in the 50 states and the District of Columbia.

Diagnosed Infection among Persons Aged ≥13 Years Living with Diagnosed or
Undiagnosed HIV Infection, by Age, 2013—United States
Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. Estimates were derived by using back-
calculation on HIV data for persons aged ≥13 years at diagnosis in the 50 states and the District of Columbia.

Unaware Estimates by Select Demographic
Groups, Philadelphia, 2014
Demographic Group % Unaware (95% CI)
Sex
Female 4.7% (0.0 %-9.8%)
Male 7.7% (3.8%-11.2%)
Race/Ethnicity
Black 8.5% (4.3%-12.4%)
Hispanic 4.4% (0%-11.4%)
White/Other 5.2% (0.1%-12.2%)
Mode of Transmission
Heterosexual 9.5% (9.0%-19.1%)
IDU (including MSM/IDU) 0.0% (0.0%-2.2%)
MSM 9.2% (4.0%-15.0%)
Total 7.0% (4.0% – 10.4%)
Source: PDPH, AIDS Activities Coordinating Office, 2016

EMA Concurrent HIV/AIDS
29.7% 29.1%
26.1% 24.9% 23.5%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
2011 2012 2013 2014 2015
Philly PA Counties NJ Counties EMA

Concurrent HIV/AIDS, 2014 - 2015
Year
2014 2015
Non-concurrent Concurrent HIV/AIDS Non-concurrent Concurrent HIV/AIDS
N Col % N Col % N Col % N Col %
Total 444 78.0% 125 22.0% 433 80.5% 105 19.5%
Sex
Female 89 74.2% 31 25.8% 95 80.5% 23 19.5%
Male 35 79.1% 94 20.9% 338 80.5% 82 19.5%
Race/
Ethnicity
Black 294 76.2% 92 23.8% 312 80.0% 78 20.0%
Hispanic 63 88.7% 8 11.3% 66 86.8% 10 13.2%
White 70 80.5% 17 19.5% 46 82.1% 10 17.9%
Asian 10 76.9% * 23.1% * 45.5% 6 54.5%
Multi-race * 50.0% * 50.0% * 50.0% * 50.0%
Other/Unk * 75.0% * 25.0% * 100.0% 0 0.0%

Concurrent HIV/AIDS, 2014 - 2015Year
2014 2015
Non-concurrent Concurrent HIV/AIDS Non-concurrent Concurrent HIV/AIDS
N Col % N Col % N Col % N Col %
Age at HIV Dx
0-12 * 100.0% 0 0.0% * 100.0% 0 0.0%
13-19 31 93.9% * 6.1% 33 97.1% * 2.9%
20-24 101 91.8% 9 8.2% 96 95.0% * 5.0%
25-29 77 88.5% 10 11.5% 81 88.0% 11 12.0%
30-39 89 74.2% 31 25.8% 101 78.3% 28 21.7%
40-49 62 63.9% 35 36.1% 57 64.8% 31 35.2%
50+ 83 68.6% 38 31.4% 63 68.5% 29 31.5%
Transmission
Risk
MSM 247 84.9% 44 15.1% 253 83.2% 51 16.8%
IDU 33 82.5% 7 17.5% 27 90.0% * 10.0%
Heterosexual 153 68.0% 72 32.0% 142 75.1% 47 24.9%
MSM/IDU 6 100.0% 0 0.0% * 50.0% * 50.0%
Pediatric * 100.0% 0 0.0% * 100.0% 0 0.0%
No Risk
Reported
* 66.7% * 33.3% 8 72.7% * 27.3%

 Linkage to care
– Numerator: Persons aged ≥13 years who were diagnosed during 2014
and who had ≥1 viral load (VL) or CD4 test within 1 month of HIV
diagnosis
– Denominator: Persons aged ≥13 years who were diagnosed during 2014
(32 states and the District of Columbia)

Linkage to HIV Medical Care within 1 Month after HIV Diagnosis during 2014,
among Persons Aged ≥13 Years, by Sex—32 States and the District of Columbia
Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. Linkage to HIV medical care was defined as
having a CD4 or VL test ≤1 month after HIV diagnosis.

Linkage to HIV Medical Care within 1 Month after HIV Diagnosis during 2014,
among Persons Aged ≥13 Years, by Transmission Category—32 States and the
District of Columbia
Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. Linkage to HIV medical care was defined as
having a CD4 or VL test ≤1 month after HIV diagnosis. Heterosexual contact is with a person known to have, or be at high risk for, HIV infection.
MSM, male-to-male sexual contact; IDU, injection drug use

2011 2012 2013 2014 2015
Linkage 30 Days 75 75 72 77 81
Linkage 90 Days 81 81 78 82 91
0
20
40
60
80
100
Percentage(%) Care Continuum Measures
Source: Philadelphia Department of Public Health, AIDS Activities Coordinating Office
Philadelphia Linkage to Care Indicators, 2011-2015

 Retention in care
– Numerator: Persons aged ≥13 years with ≥2 tests (CD4 or VL) at least ≥3
months apart in 2013
– Denominator: Persons aged ≥13 years who were diagnosed by year-end
2012 and alive at year-end 2013 (32 states and the District of Columbia)
 Viral suppression
– Numerator: Persons aged ≥13 years with <200 copies/mL on their most
recent VL test in 2013
– Denominator: Persons aged ≥13 years who were diagnosed by year-end
2012 and alive at year-end 2013 (32 states and the District of Columbia)

Retention in HIV Medical Care and Viral Suppression among Persons Aged ≥13
Years Living with Diagnosed HIV Infection, by Sex, 2013—32 States and the
District of Columbia
Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. Retained in medical care was defined as ≥2
tests (CD4 or VL) ≥3 months apart in 2013. Viral suppression was defined as <200 copies/mL on the most recent VL test in 2013.

Retention in HIV Medical Care and Viral Suppression among Persons Aged ≥13
Years Living with Diagnosed HIV Infection, by Transmission Category, 2013—32
States and the District of Columbia
Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. Retained in medical care was defined as ≥2
tests (CD4 or VL) ≥3 months apart in 2013. Viral suppression was defined as <200 copies/mL on the most recent VL test in 2013. Heterosexual
contact is with a person known to have, or be at high risk for, HIV infection. MSM, male-to-male sexual contact; IDU, injection drug use

2011 2012 2013 2014 2015
Retention* 47 51 52 52 53
Suppression* 44 49 50 53 56
0
20
40
60
80
100
Percentage(%) Care Continuum Measures
*Significant increase between 2011 and 2015 (p<0.0001)
Philadelphia Diagnosis-Based HIV Care Continuum, 2011-2015

87%
75%
49% 48%
0%
20%
40%
60%
80%
100%
HIV-Diagnosed Linked to Care
(2015 New Cases)
In HIV Care
during 2015
Suppressed VL
(<200copies/mL)
US Prevalence-Based HIV Care Continuum, 2013

93% 91%
49% 52%
0%
20%
40%
60%
80%
100%
HIV-Diagnosed Linked to Care
(2015 New Cases)
In HIV Care
during 2015
Suppressed VL
(<200copies/mL)
19,280 488/538
10,173 10,758
Philadelphia Prevalence-Based HIV Care
Continuum, 2015

US* Philadelphia**
Number
87 Diagnosed
75 Are linked to HIV care
49 Stay in HIV care
48
Have a very low amount
of virus in their body
Number
93 Diagnosed
91 Are linked to HIV care
49 Stay in HIV care
52
Have a very low amount
of virus in their body
For every 100 people living with HIV:
*2013 Data **2015 Data

Newly Diagnosed HIV Cases, Deaths, and Living HIV Cases by Year
Philadelphia, 2008-2015
928 897
739 694 737
634 569 538523 513 550 473 434 497
349 312
18640
19237
19525
19157
19832
19564 19494 19280
15000
16000
17000
18000
19000
20000
0
500
1000
1500
2000
2008 2009 2010 2011 2012 2013 2014 2015
Newly Diagnosed Deaths Living HIV Cases

Rates of Adults and Adolescents Living with Diagnosed HIV Infection, by Area of
Residence, Year-end 2014 — United States and 6 Dependent Areas
N = 970,319 Total Rate: 360.0
Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. Data are based on address of residence as of
December 31, 2014 (i.e., most recent known address).

Persons Living with HIV/AIDS by Census Tract,
Philadelphia, 2015

Comparison of HIV Prevalence in the
US and Philadelphia
Philadelphia EMA
• 26,807 PLWH as of 12/2015
– 482.6/100,000 population
– 1,263.4/100,000 in Philadelphia
• 57.9% black, 15.0% Latino, 22.8% white
• 70.9% male
• 48.8% current age >50 and 24.6% 40-49
• MSM – 35.5%, IDU – 21.3%,
Heterosexual – 34.8%
• Majority of cases among blacks,
regardless of risk
United States
• 955,081 as of 12/2014
– Rate 299.5/100,000 population
• 42.4% black, 20.8% Latino, 31.4%
white
• 75.6% male
• 44.9% current age >50 and 27.6%
40-49
• MSM – 53.3%, IDU – 13.7%,
Heterosexual – 25.8%
• Highest rates of HIV in the
Northeast US
Sources: PDPH, AIDS Activities Coordinating Office, 2016
https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2015-vol-27.pdf

Proportion of Philadelphia Residents Diagnosed and Living with HIV by
Race/Ethnicity and Sex, 2015
2.9%
2.3%
1.1% 1.1% 0.9%
0.2%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
Black Males Hispanic
Males
Black
Females
White Males Hispanic
Females
White
Females
Overall Prevalence 1.3%
Epidemic Level 1.0%

Proportion of Philadelphia EMA Residents Diagnosed
and Living with HIV by Race/Ethnicity and Sex, 2015
2.9%
2.3%
1.1% 1.1% 0.9%
0.2%
1.0%
0.6% 0.5% 0.1% 0.4%
0.0%
1.0% 0.8% 0.5% 0.2% 0.4%
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
3.5%
Black Males Hispanic
Males
Black
Females
White Males Hispanic
Females
White
Females
Philly PA counties NJ Counties

HIV/AIDS Prevalence per 100,000 Population by Race
and Transmission Group, 2015

Rates of Diagnoses of HIV Infection among Adults and Adolescents, by Area of
Residence, 2015 — United States and 6 Dependent Areas
N = 39,920 Total Rate: 14.7
Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. Data for the year 2015 are preliminary and based on 6
months reporting delay.

Persons Diagnosed with HIV (regardless of AIDS status)
by Census Tract, Philadelphia, 2015

Newly Diagnosed HIV United States,
2014
• 44,073 estimated cases
• 80.7% male at birth
• 43.7% black, 24.3%
Hispanic, 26.9% white
• 22.0% among 13-24
year olds
66.5%
6.1%
24.1%
2.7%0.4%0.2%
MSM IDU HET
MSM/IDU Pediatric NIR
Source: http://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-
surveillance-report-us.pdf

Newly Diagnosed HIV Philadelphia,
2015
• 538 Newly Diagnosed
cases
• 78.0% male at birth
• 72.4% black, 14.1%
Hispanic, 10.4% white
• 25.0% among 13-24
year olds
56.5%
5.5%
35.1%
0.4%0.5% 2.0%
MSM IDU HET
MSM/IDU Pediatric NIR

Newly Diagnosed HIV Disease by Age at Diagnosis
(regardless of HIV status)
41 33
222
269
232
197 193
129
111
97 88
127 133
113 121
92
34
33
44
129
120147151
154
164
114
0
50
100
150
200
250
300
2010 2011 2012 2013 2014 2015
Year
NumberofCases
13-19 20-29 30-39 40-49 50+

Newly Diagnosed HIV Disease by Race/Ethnicity
(regardless of HIV status)
105 93
68
87
56
486
508
474
386 390
91
114
69 71 76
0
100
200
300
400
500
600
2010 2011 2012 2013 2014 2015
Year
NumberofCases
White AfrAm Hispanic

Newly Diagnosed HIV Disease by Sex at
Birth (regardless of AIDS status)
0
100
200
300
400
500
600
2010 2011 2012 2013 2014 2015
Year
NumberofCases
HIV Female HIV Male

41
Newly Diagnosed HIV Disease by Mode of
Transmission (regardless of AIDS status)
286
300
70
83
40 40 30
250
8 6 11
304
291
322
189
225
313313
30
9
0
50
100
150
200
250
300
350
2010 2011 2012 2013 2014 2015
Year
NumberofCases
MSM IDU HetSx NIR

Rates of Newly Diagnosed HIV/AIDS per 100,000
population, Philadelphia 2011-2015

Newly Diagnosed HIV (Non-AIDS) for
2015, Philadelphia EMA
EMA
Total
N=596
EMA
%
Phila
N=433
%
PA
N=85
%
NJ
N=78
%
Race/Ethnicity
White, non-Hispanic 98 16.4 10.6 42.4 20.5
Black, non-Hispanic 399 66.9 72.1 48.2 59.0
Hispanic 87 14.6 15.2 8.2 17.9
Asian/Pacific Islander 7 1.2 1.4 1.2 0.0
American Indian/Alaskan
Native
<6 0.2 0.2 0.0 0.0
Multi-Race <6 0.3 0.5 0.0 0.0
Gender
Male 449 70.2 75.5 72.9 76.9

EMA
Total
N=596
EMA
%
Phila
N=433
%
PA
N=85
%
NJ
N=78
%
Age
<13 years <6 0.3 0.8 0.0 0.0
13 - 19 years 38 6.4 7.6 2.4 3.8
20-24 years 128 21.5 22.2 16.5 23.1
25-29 years 121 20.3 18.7 18.8 30.8
30-39 years 127 21.3 23.3 15.3 16.7
40-49 years 79 13.3 13.2 17.6 9.0
50+ years 101 16.9 14.5 29.4 16.7

EMA
Total
N=596
EMA
%
Phila
N=433
%
PA
N=85
%
NJ
N=78
%
Men who have sex with men
(MSM)
326 54.7 58.4 44.7 4.9
Injection drug users (IDU) 39 6.5 6.2 5.9 9.0
MSM/IDU <6 0.3 0.2 1.2 0.0
Heterosexuals 207 34.7 32.8 41.2 38.5
Other/hemophilia/blood
transfusion
0 0.0 0.0 0.0 0.0
Perinatal exposures <6 0.7 0.5 0.0 0.0
Risk not reported or identified 20 5.0 1.8 7.1 7.7

2014 Local Estimate of
HIV Incidence
• Local estimate of 299 new HIV infections in
2014 in adults and adolescents (95% CI, 205-
393)
• Significant reduction since 2012
– 618 estimated HIV infections (95% CI, 419-817)

HIV Incidence Trends by Demographic
Groups
0
200
400
600
800
1000
1200
2006 2007 2008 2009 2011 2012 2013 2014
Total Age 13-24 Male Black MSM

Estimated Incidence Rates - 2014
Population Population in 2010
(13 +)
ESTIMATED
Incidence
Estimate,
2014
Estimated
Case Rate per
100,000
95% CI
lower
bound
95% CI
upper
bound
MSM 233,550 196 584.2 363.6 801.8
IDU 26,400 33 125.0 22.7 223.5
HET 269,231* 70 26.0 12.3 39.7
*Includes persons >13 living in poverty
Data Source: PDPH/AACO HIV Incidence Surveillance Program, 2016

Annual Retention, Annual Viral Suppression, and Durable
Viral Suppression by Ryan White Care, 2010-2014
52.8
63.3
46
19.2
27.8
20.4
0
20
40
60
80
100
Annual Retention
in Care*
Annual Viral
Suppression*
Durable Viral
Suppression*
Percent(%)
Ryan White
Non-Ryan White
*p<0.0001
Source: Philadelphia Department of Public Health, 2016

Philadelphia HIV Care Continuum 2015
0%
20%
40%
60%
80%
100%
Diagnosed Linked In Care Retained in
Care
Prescribed
ART
Virally
Suppressed
ALL PLWHA MSM of Color AA Men
Youth 13-24 AA Women Transgender

Philadelphia HIV Care Continuum 2015
0%
20%
40%
60%
80%
100%
ALL PLWHA MSM of
Color
AA Men Youth 13-24 AA Women Transgender
Diagnosed Linked In Care
Retained in Care Prescribed ART Virally Suppressed

Annual Epidemiological Presentation, 2017 - Kathleen Brady, PDPH

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